|
Services Provided through Arkansas Employee Benefits Division
The Annual Benefits Guide
includes information on the new 2010 plan, what changes can be made, how to enroll, who to call with
questions, benefit coverage, rates, retirement information and frequently asked questions.
The Annual Benefits Guide contains important information about pre-certification, appeals and case management. Please read to avoid denials for services not pre-certified.
Health Advantage
Arkansas State and Public School Employee Benefits Division (EBD) and Health Advantage partnered
in 2005 to offer the ARHealth plan to retirees with Medicare. All Medicare and non-Medicare
Arkansas State and Public School Retirees are enrolled automatically in the ARHealth Plan upon
retirement.
Health Advantage, a subsidiary company of Arkansas Blue Cross and Blue Shield, has offered health
insurance products to Arkansas State Employees and their dependents for more than 10 years. We
understand the importance of having local access to customer service for you and your family. If
you need to walk in and speak with someone, we are there to help you, with local offices in
Texarkana, Little Rock, Hot Springs, Jonesboro, Fort Smith, Pine Bluff and Fayetteville. These
local offices provide services to all the counties within their region.
If Medicare is not your primary coverage, the 2010 ARHealth plan features are as follows:
- You will be automatically enrolled in this plan upon retirement.
- You do not have to select a primary care physician (PCP).
- You will have many preventive services (65 KB PDF) covered at 100 percent.
- Your copayment will be $25 for PCP visits and $35 for specialist visits.
- Your in-network coinsurance will be 20 percent on many services.
- You can use any in-state provider in the Health Advantage network without a referral.
- If you elect to use an out-of-network provider within the state of Arkansas, your out-of-network coinsurance will be 40 percent and the
out-of-network deductible amount will be $1000 per individual and $2,000 per family, with a maximum out-of-pocket
expense of $5,000 per individual and $10,000 per family.
- If you wish to obtain services from an out-of-state provider, you can use any provider in the BlueCard® PPO network.
- Your prescription drug benefits and mental health benefits will remain the same.
- One vision screening will be covered every 24 months with a $35 copayment.
- One hearing screening will be covered every 36 months with a $35 copayment.
If Medicare is your primary coverage, the 2010 ARHealth plan features remain as follows:
- If Medicare is your primary coverage, you will be enrolled in this plan upon retirement.
- If you become Medicare eligible during the year, your coverage will be supplemental to traditional Medicare A and B benefits. Send the Employee Benefits Division a copy of your Medicare card as soon as you receive it.
- Your ARHealth plan will coordinate with any qualified Medicare plan (Medicare A, Medicare B and Medicare C — also called Medicare Advantage plans).
- You do not have to select a primary care physician (PCP).
- You can see any physician — anywhere in the United States.
- If you are a state retiree, the premium for the ARHealth plan covers your prescription drugs, unlike other Medicare supplemental policies. Under federal guidelines, since state retirees have a qualified prescription plan, they cannot select a Medicare D drug plan, or a part C plan that has prescription coverage.
- If you are a public school retiree, your ARHealth premium has been substantially reduced to enable you to purchase a Medicare Part D Prescription Drug Plan of your choice.
- Your mental health benefits are covered by Medicare and ARHealth.
- You will have coverage for one vision exam every 24 months with a $35 copay, even if Medicare does not cover it.
- You will have coverage for one hearing exam every 36 months with a $35 copay, even if Medicare does not cover it.
- Your ARHealth plan now covers hearing aids. The benefit is $1400 per ear every three years. You may use any provider.
Refer to your Health Insurance Enrollment Guide for specific benefits and rates,
or call Health Advantage Customer Service at 1-800-482-8416 or Employee Benefits Customer Service at 1-877-815-8017 or 501-682-9656.
BlueCard®
As an ARHealth member through Health Advantage, you have more freedom to choose the doctors and
hospitals that best suit you and your family. Your coverage gives you a world of choices through
the BlueCard® Program.
|