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2020 OPEN ENROLLMENT GUIDEArkansas Public School Employees (PSE)
InsideOpen Enrollment. 3Enrolling Online. 5Health Insurance 101. 6Health Plans. 7Securian.12HSA.13Links to kEBD@dfa.arkansas.govEBD OfficePhone Number1-877-815-1017 x1501-682-96561-800-482-8416501-378-2364Health e 1New Directions Behavioral Health (EAP)www.ndbh.com1-877-300-9103ARBenefits Summary Plan Descriptionwww.ARBenefits.orgEBD OfficeThe EBD office is openMonday - Friday8 a.m. - 4:30 p.m. CSTCheck out ARBenefits on Facebook at www.Facebook.com/ARBenefits.Our Facebook page is a public page; please do not post or send any personal health information.2020 ARBenefits Open Enrollment Guide (PSE)2
2020 Open EnrollmentOpen Enrollment is the time of year employees can enroll, or make changes to their health planwithout the need of a qualifying event.2020 Plan Year Open EnrollmentHealth Insurance/ConnectYourCare HSA: October 1-31, 2019Open Enrollment gives employees the opportunity to make the following changes for the 2020 plan year: Enroll in coverage for you and your dependents Add/Drop dependents from your current policy Change plan levels between Premium, Classic and Basic Cancel your coverage Change from pre-tax to post-tax deduction or vice versa. Non-Medicare retirees can change their plan level (Premium, Classic or Basic)Note: Any open enrollment changes received prior to the start of open enrollment, or after the deadline,will not be processed.If you do not wish to make any changes to your health insurance coverage, you do not need to submitan enrollment form during open enrollment. Your current coverage will continue as is for 2020.Retiring in 2020?Remember, you must be actively covered on the ARBenefits plan the last day of your employment to beeligible for ARBenefits retiree coverage.THE OPEN ENROLLMENT PERIOD: Members can make changes to enrollment elections throughout theentire open enrollment period. However, the statement “Submission to EBD is final” will remain at thebottom of the enrollment form.PARTIAL PROCESSING: EBD will process enrollment forms submitted by employees that are incomplete.For instance, if an employee is requesting to cover a spouse or dependent child, but did not providethe required documentation; EBD will notify the employee of the missing information and request itto be provided within ten (10) days of receipt of notice. If the employee fails to provide the necessarydocuments to fully process their enrollment form, EBD will complete the enrollment process for theEMPLOYEE ONLY.2020 ARBenefits Open Enrollment Guide (PSE)3
EligibilityPer the ARBenefits Summary Plan Description, public school employees that can answer yes to thequestions below are eligible to enroll in coverage.Are you: A full-time employee in a position that requires on average at least thirty (30) hours per week ofactual performance of duty during the annual school year? A full-time bus driver who is employed by a public school district to drive regular routes during theannual school year? A driver can be considered a “full-time school bus driver” if one of the followingis true:1)the bus driver contracts with the school district to operate a school bus for aminimum of 720 hours during the school year, or2)the bus driver’s primary source of income is obtained by operating a school buswithin the school district, or3)the bus driver is under contract with the public-school district to operate a school busand is designated by the superintendent as a “full-time school bus driver”. Thesuperintendent’s designation must be provided in writing by the superintendent tothe Director of EBD.Eligible Dependents Your current legal spouse (includes same-sex spouses). Former spouses with court orders requiringcoverage are NOT ELIGIBLE to join the plan. Spouses eligible for coverage through his/her employerare not eligible for coverage. Dependent children (natural, step-child, legal guardian and legally adopted child) less than age 26.Required Documentation for Adding DependentsDuring Open EnrollmentAdding a spouse Adding dependents Dropping a spouseand/or dependentsEnrollment FormSpousal AffidavitCopy of MarriageLicenseEnrollment FormEnrollment FormBirth Certificate, BirthAnnouncement fora newborn (up to sixmonths of age) or courtapproved adoptionpapersIf Stepchild: MarriageLicense to the stepchild’s parent and BirthCertificateIf Legal Guardian: Courtapproved guardianshippapers2020 ARBenefits Open Enrollment Guide (PSE)Non-Eligible Dependents Former spouse after the finaldate of the divorce A common-law spouse A parent, grandparent orstep-parent of eligible employee Grandchildren, niece, nephew orfoster child (unless legallyadopted) Dependent children over theage of 26.4
Online EnrollmentDuring open enrollment, and for newly hired employees, the easiest way to elect plan coverage is throughthe ARBenefits Member Portal. Enrolling through the ARBenefits Member Portal gives members instantconfirmation that their elections have been received by EBD. Employees who have e-mail addresses on filewith EBD will receive alerts through the portal to their e-mail address with the progress of their submittedchanges.The online enrollment feature is available during open enrollment, and during a new employee's initial 60day enrollment period. Non-Medicare retirees can also use the online enrollment function to change theirplan level during open enrollment.Employees can elect changes during open enrollment by either going online to their account atwww.ARBenefits.org, or by submitting paper forms requesting their elections.Be sure to attach any necessary supporting documentation to your online application, or you can fax/maildocumentation to EBD.Submit paper forms by fax: 501-683-0983*Keep a copy of your fax confirmation pageMail forms to:Employee Benefits DivisionP.O. Box 15610Little Rock, AR 72231-5610Check out the step-by-stepguide to online enrollment atwww.ARBenefits.org2020 ARBenefits Open Enrollment Guide (PSE)5
101Health InsurancePremiumThe amount the member pays for coverage whetherthey utilize medical services or not.DeductibleBelow are terms that can aid you in understandingthe ARBenefits plan and the details of your coverage policy.A more extensive list of terms and definitions canbe accessed in the Glossary section of the ARBenefits Summary Plan Document (SPD).Plan-Year12-month period for benefits coverage. TheARBenefits plan starts a new plan year everyJanuary 1 that runs through December 31 of thatyear.The amount the member(s) must pay before theplan starts to contribute for medically necessarycovered services. All ARBenefits plans include adeductible.Amounts contributed to deductible and out-ofpocket maximums reset with the start of a new planyear.CopaysThird Party Administrator (TPA)Fixed amount a member pays for medical servicessuch as a doctor's office visit, a prescription or ERvisit. Copays do not count towards a member'sdeductible, but do count towards the out-of-pocketmaximum.Health Advantage serves as the TPA for allARBenefits plans. Health Advantage processesclaims for ARBenefits, and ARBenefits follows thecoverage policies of Health Advantage.Voluntary ProductsAny type of optional benefit included in anAfter the satisfaction of the deductible, coinsurance employer's benefit options. These products include:life insurance, dental, vision, cancer insurance,is cost sharing between the Plan and member forcovered services. The Plan will pay 80% coinsurance short/long term disability, etc. Each of theseproducts have a provider who is separate from thefor in-network covered services while the memberhealth plan.pays 20%. Out-of-network coinsurance rates vary.CoinsuranceOut-of-Pocket MaximumThe maximum amount a member must pay towardscovered medical services for the plan year. Oncereached, the plan will pay 100% for coveredservices for the remainder of that plan year.Deductible, coinsurance and copays count towardsthe out-of-pocket maximum. However, out-ofnetwork services and prescription copays do notcount towards the medical out-of-pocket maximum.Qualifying EventsA qualifying event, or qualifying life event, createsa special enrollment period for employees thatundergo major life changes such as, birth, death,marriage, and/or loss/gain of other group coverage.This special enrollment period gives activeemployees sixty (60) days, and retirees thirty (30)days, to submit their enrollment changes along withproof of the qualifying event to EBD.Open EnrollmentAnnual period that allows employees to makechanges to their coverage without the need of aqualifying event. Changes elected during openenrollment go into effect the following January 1st.2020 ARBenefits Open Enrollment Guide (PSE)6
ARBenefits Health PlansPublic school employees, non-Medicare retirees and members with COBRA have three different planslevels to choose from with ARBenefits. The medical plans are self insured with Health Advantage serving asthe third-party administrator. MedImpact serves as the plan's administrator for pharmacy benefits.All three plan levels offer: Coverage for medical care, including doctor's visits, hospital stays, prescription drugs, rehabilitationservices and more. Access to see specialists without a referral. Some services may require pre-certification through HealthAdvantage. In-network providers in the state of Arkansas as well as access to providers nationwide through BlueCross Blue Shield's provider network. Eligible preventive care covered 100% by the Plan, even if the deductible has not been met. Plan benefit of 160 towards the purchase of a breast pump and supplies. Plan benefit of 1,400 per ear every three years towards the cost of hearing aids. 24x7 Nurse Line members can call if they are not feeling well and are not sure if they need to go to theemergency room. The nurse line also offers information on a variety of health topics. An option to designate a primary care physician to help guide your care. 24-hour care for medical emergencies in- or out-of-network. Access to Health Advantage's My Blueprint portal where you can access past claims, find in-networkproviders, cost estimates, see how much you have contributed towards your deductible and more. Access to Health Advantage's Blue 365 deals program where members can access discounts on healthand wellness products such as, apparel, gym memberships, personal care and more. VisitwwwBlue365deals.com.2020 ARBenefits Open Enrollment Guide (PSE)7
Health PlansPremiumActive Employee, COBRA and Non-Medicare Retiree Highest plan premiums Lowest deductible, out-of-pocket and prescription drug costsPlan Information Copays and coinsurance for covered services* Copays do not count toward annual plandeductible, but do apply to out-of-pocketmaximum amount. Has separate medical and pharmacy out-ofpocket maximums Includes reference priced drug coverage2020 Employee Monthly PremiumsActive EmployeeWith WellnessWithout WellnessEmployee Only 183.46 258.46Employee Spouse 831.20 906.20Employee & Children 470.54 545.54Family 833.44 908.44*The above rates are based upon your school districtpaying the 2020 minimum district contribution of 161.87. If your district contributes over minimum, theywill provide you with your district specific rates.Non-Medicare Retiree Monthly PremiumsRetireeRetiree OnlyRetiree & Non-Medicare Spouse 750 2,000Family 1,500 4,00080%60%Individual 3,250N/AFamily 6,500N/APCP Office Visit 25N/ASpecialist Visit 50N/AUrgent Care 100N/AEmergency Room 250Paid by Plan aftersatisfaction ofdeductibleOut-of-Pocket MaxOffice Visit CopaysPrescription Drug CopaysTier I - Generic 15Tier II - Preferred 40Tier III - Non-Preferred 80Tier IV - Specialty 100Rx Out of Pocket Max 3,350 Ind. / 6,700 Family 1,457.18 1,192.60 2,008.642020 ARBenefits Open Enrollment Guide (PSE)IndividualDeductible 641.14Retiree & Non-Medicare Spouse & ChildrenRetiree & Medicare Primary Spouse & ChildrenOut-of-networkPremiumRetiree & ChildrenRetiree & Medicare Primary SpouseIn-network 795.12 1,346.588
Health PlansActive Employee, COBRA and Non-Medicare RetireeClassic Mid-level plan premiums Qualified High Deductible Health Plan (HDHP)Plan Highlights 20% coinsurance for covered services afterIn-networkOut-of-network 1,750 3,000DeductibleIndividualdeductible is met.FamilyPaidby Plan after Employee is eligible to establish a Health SavingssatisfactionofAccount (HSA). 2,800 / 2,850 6,00080%60%Individual 6,450N/AFamily 9,675N/APCP Office pecialist rgent ergency ductibleOut-of-Pocket Max2020 Monthly PremiumsWith WellnessWithout WellnessEmployee OnlyActive Employee 46.02 121.02Employee Spouse 354.62 429.62Employee & Children 158.42 233.42Family 358.32 433.32*The above rates are based upon your school districtpaying the 2020 minimum district contribution of 161.87. If your district contributes over minimum, theywill provide you with your district specific rates.Non-Medicare Retiree Monthly RatesOffice VisitsPrescription DrugsTier I - GenericDeductible/CoinsuranceTier II - PreferredDeductible/CoinsuranceTier III - Non-Preferred Deductible/CoinsuranceTier IV - SpecialtyRetireePremiumRetiree Only 273.30Retiree & Non-Medicare Spouse 565.78Retiree & Children 469.82Retiree & Non-Medicare Spouse & Children 746.202020 ARBenefits Open Enrollment Guide (PSE)Deductible/CoinsuranceThe Classic plan does not include coverage for reference pricedrugs except when approved through physician's appeal toEBRx.9
Health PlansBasicActive Employee, COBRA and Non-Medicare Retiree Lowest plan premiums, but highest out-of-pocket costs Qualified High Deductible Health Plan (HDHP)Plan Information No out-of-network coverage, except for medicalemergencies 20% coinsurance after satisfaction of deductible Employee is eligible to establish a Health SavingsAccount (HSA)In-Network Benefits OnlyDeductibleIndividual 4,000Family 8,000Paid by Plan aftersatisfaction ofdeductible80%Out-of-Pocket Max2020 Monthly PremiumsIndividual 6,450Family 12,900Office VisitsActive EmployeeWith WellnessWithout WellnessPCP Office VisitDeductible/CoinsuranceEmployee Only 11.26 88.26Employee Spouse 272.78 347.78Specialist VisitDeductible/CoinsuranceEmployee & Children 121.86 196.86Urgent CareDeductible/CoinsuranceFamily 275.62 350.62Emergency RoomDeductible/Coinsurance*The above rates are based upon your school districtpaying the 2020 minimum district contribution of 161.87. If your district contributes over minimum, theywill provide you with your district specific rates.Non-Medicare Retiree Monthly RatesRetireePremiumRetiree Only 148.50Retiree & Non-Medicare Spouse 269.72Retiree & Children 238.52Retiree & Non-Medicare Spouse & Children 335.722020 ARBenefits Open Enrollment Guide (PSE)Prescription DrugsTier I - GenericDeductible/CoinsuranceTier II - PreferredDeductible/CoinsuranceTier III - Non-Preferred Deductible/CoinsuranceTier IV - SpecialtyDeductible/CoinsuranceThe Basic plan does not include coverage forreference price drugs except when approved throughphysicians appeal to EBRX.10
Below is a snapshot of benefits covered by the ARBenefits plan for each of our 2020 PublicSchool Employee (PSE) plan levels. A full schedule of benefits for each plan level is availableat www.ARBenefits.org.Questions? Contact EBD Member Services at 1-877-815-1017 x1, or orkOut-of-NetworkIn-NetworkIndividual Deductible 750 2,000Family Deductible 1,500 4,000 2,800/ 2,850Individual Medical Out-Of Pocket Max 3,250N/A 6,450Family Medical Out-Of Pocket Max 6,500N/A 9,675Covered ServicesPhysician’s Office VisitSpecialist’s Office VisitOut-of-NetworkIn-Network 3,000 4,000 6,000 8,000N/A 6,450N/A 12,900 1,750You PayBASICYou PayYou PayIn NetworkOut of NetworkIn NetworkOut of NetworkIn-Network 25 copay40% after deductible20% after deductible40% after deductible20% after deductible 50 copay40% after deductible20% after deductible40% after deductible20% after deductibleOther Physician Services20% after deductible40% after deductible20% after deductible40% after deductible20% after deductibleAdvanced Imaging (Radiology)20% after deductible40% after deductible20% after deductible40% after deductible20% after deductible 250 copay0%20% after deductible40% after deductible20% after deductibleIn-patient Hospital Services20% after deductible40% after deductible20% after deductible40% after deductible20% after deductibleOutpatient Hospital Services20% after deductible40% after deductible20% after deductible40% after deductible20% after deductibleDiagnostic Services20% after deductible40% after deductible20% after deductible40% after deductible20% after deductibleUrgent Care CenterEmergency Room Visit & Observation 100 copay0%20% after deductible40% after deductible20% after deductiblePhysical Exams/Preventative Care0%40% after deductible0%40% after deductible0%Immunizations0%0%0%0%0%Well Baby/ Child Care visits0%40% after deductible0%40% after deductible0%Vision Screening 50 copay 50 copay 50 copay 50 copay 50 copayHearing Screening 50 copay 50 copay 50 copay 50 copay 50 copayInsulin Pump20% after deductible40% after deductible20% after deductible40% after deductible20% after deductibleGlucometers20% after deductible40% after deductible20% after deductible40% after deductible20% after deductible* Members must meet their plan’s deductible amount before coinsurance begins for covered services.* The family deductible is the deductible amount for any tier above Employee Only coverage (Employee Spouse, Employee Children, Family).* Copays do not count towards the satisfaction of your deductible amount.* The out-of-pocket maximum includes the deductible, copays and coinsurance amounts you have paid towards covered in-network services.* Employees on the Premium plan can have the 250 ER copay waived if they are referred to the ER by the 24/7 Nurse Hotline (1-866-458-0408). The 24/7 Nurse Hotline is not intended for useduring a medical emergency.* The plan will pay 100 percent for individuals on family coverage when they reach the individual out-of-pocket maximum amount.PREMIUMCLASSICBASICTier 1 - Generic 15 copay20% after deductible20% after deductibleTier 2 - Preferred 40 copay20% after deductible20% after deductibleTier 3 - Non-Preferred 80 copay20% after deductible20% after deductiblePrescription DrugsTier 4 - Specialty 100 copay20% after deductible20% after deductiblePlan pays certain amount per unit; the member isresponsible for the remaining cost.Not coveredNot coveredIndividual RX Out of Pocket Max 3,350N/AN/AFamily RX Out of Pocket Max 6,700N/AN/AReference Priced Drugs* Employees on the Classic or Basic plans must meet their plan medical deductible amounts prior to starting 20% coinsurance for covered drugs.2020 ARBenefits Open Enrollment Guide (PSE)11
Life InsuranceThe Employee Benefits Division (EBD) is excited to announce a new partnership with Colonial Life! As of1/1/2020, Colonial Life will join the ARBenefits family as the State's new life insurance provider. ColonialLife is eager to serve state and public school employees and retirees across Arkansas.Have life insurance through Securian?Current and new policies in force with Securian Financial (Minnesota Life) by 12/31/19 will automaticallyport over to our new partner, Colonial Life.An open enrollment period will be offered to employees. More information concerning how employees canelect life insurance changes for 2020 will be announced soon. Stay tuned!Sincerely,ARBenefits!erYaeH!eYarHe2020 ARBenefits Open Enrollment Guide (PSE)12
Health Savings Account (HSA)The State uses ConnectYourCare as its HSA/FSA administrator. However, school districts can choose any HSA/FSAadministrator for their employees. Your district will inform you concerning your HSA/FSA options.A Health Savings Account(HSA) allows you tocontribute pre-tax funds touse towards eligible medicalexpenses not covered byinsurance.Health Savings Account(HSA)EligibilityMust be enrolled inan ARBenefits HighDeductible Health Plan(Classic or Basic).Annual contributionlimitsLimits for 2020:Individual: 3,550Family: 7,100Persons aged 55 andolder may contributean additional 1,000annually above thoselimits.To be eligible to contribute toan HSA, you must be enrolledin a High Deductible HealthPlan (HDHP). This means youare required to be coveredon the ARBenefits Classic orChanging contributionBasic plan. Employees on the amountPremium plan are not eligibleto contribute to an HSA.You must have funds alreadycontributed to your accountto be able to use them.However, there is no limiton the amount of funds youcan roll over year-to-year withyour HSA.You also own your HSA,account even if you leaveemployment with your schooldistrict.There is no set enrollmentperiod for HSAs. You canestablish an HSA, andchange your contributionamount, at any time of theyear if are on the Classic orBasic plan. You also do notneed to re-enroll in an HSAevery year.Employees can adjusttheir contributionamount anytime duringthe year.Re-EnrollmentEmployees do not haveto re-enroll their HSAevery year.Rollover of fundsUnused funds roll overyear-to-year.When can I use funds?You must have the fundsin your account in orderto use them.Connection to employerYou can take your HSAwith you as you changeemployers. You own youraccount.Eligible Expenses2020 ARBenefits Open Enrollment Guide (PSE)The HSA administratorfor your school districtcan provide a list ofeligible and non-eligibleexpenses.HSA & FSAWhile you cannot contributeto an HSA and a HealthCare Flexible SpendingAccount (FSA) at the sametime, HSA holders can electto have a Limited-PurposeFSA. A Limited-Purpose FSAcan only be used for eligibledental and vision expenses.However, you cannot doubledip and use your HSA andLimited-Purpose FSA for thesame expense.You can check with yourschool district to see whatFSA options are available toyou.HSA and MedicareYou are able to contribute toyour HSA until you enroll inMedicare. Active employeeswho still wish to contributeto their HSA after they turn65, need to make sure tonot be enrolled in MedicareParts A or B. Once MedicareParts A or B go into effect,contributions to an HSAneed to have stopped.While you can no longercontribute to your HSA afterenrolling in Medicare, youcan still use the funds thatyou previously contributed.13
Links to FormsClick on the forms below to bring up a PDF version of the form that you can use to fill out for Open Enrollment. All forms must be submitted no later than October 31, 2019 to be counted as valid Open Enrollmentelections. More information can be found in the Forms & Publications section of the www.ARBenefits.orghome page.ARBenefitsARBenefits Enrollment FormARBenefits Retiree Enrollment FormARBenefits Spousal AffidavitARBenefits Summary Plan Document (SPD)2020 ARBenefits Schedule of Benefits - Premium2020 ARBenefits Schedule of Benefits - Classic2020 ARBenefits Schedule of Benefits - Basic2020 Full Rate SheetsActive Employee w/ WellnessActive Employee without WellnessNon-Medicare RetireeMedicare Primary Retiree*Posted rate sheets for active employees are based upon your school district paying the 2020 minimum districtcontribution of 161.87. If your district contributes over minimum, they will provide you with your district specificrates.Voluntary ProductsConnectYourCare HSA Enrollment Form2020 ARBenefits Open Enrollment Guide (PSE)14
Open Enrollment is the time of year employees can enroll, or make changes to their health plan without the need of a qualifying event. 2020 Plan Year Open Enrollment Health Insurance/ConnectYourCare HSA: October 1-31, 2019 Open Enrollment gives employees the opportun
