Public School Employee Health Insurance Benefit Overview

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Public School Employee Health Insurance Benefit
Overview

• Summer/Fall 2006
• For Plan Year Beginning 10-01-2006

Provided by Employee Benefits Division (EBD) of
Ark. DFA Ashli Davis, Communications Director
www.ARBenefits.org
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Health Insurance Enrollment -Content Overview

• Public School Employee health benefits
• How to enroll
• Plan changes for the new year

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Look for this booklet in the mailalso available
online now!
It will contain important health insurance
benefit information including rates, contacts and
instructions!
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Summary Plan Description (SPD)
This booklet gives details about health insurance
coverage, such as exclusions, limitations and
plan rules. Coming to your mailbox in the fall.
Also available online.
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Online Info 24/7

• www.ARBenefits.org
• Enroll and make changes online!
• All health insurance publications, contact
  information, forms, updates, and more!
• Bookmark this site for future reference.

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Health Maintenance Organization (HMO)

• Choice of
• Health Advantage, NovaSys Health or
  QualChoice/QCA
• In-Network benefits provided through Primary Care
  Physician (PCP)
• No out-of-network benefits except in emergencies
• Referrals to Specialists must be obtained from
  PCP to be paid
• Office Visits 20 Co-pay Primary Care Physician
  (PCP)
• (eff. 10-01-06) 25 Co-pay Specialist Care
• Hospital Outpatient 100 Co-pay
• Hospital Inpatient 250 Co-pay 10
• Out of Pocket Maximum 1000 Individual / 1,500
  Family

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Point-of-Service (POS)

• Choice of Health Advantage, NovaSys Health,
  QualChoice/QCA
• Offers wide range of healthcare services.
  Requires primary care physician referral to
  maximize the POS benefit. No referrals required
  if in-network. Out-of-network benefits are
  subject to deductible and reimbursed at 70 of
  approved charges.

Some restrictions apply.
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Preferred Provider Organization (PPO)

• Choice of Blue Cross Blue Shield NovaSys
  Health
• More traditional plan with deductible and
  co-insurance. Offers large network of hospitals,
  physicians, and other providers. Does not
  require members to have Primary Care Physician.
  Offers wide range of comprehensive healthcare
  services.

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High Deductible PPO Plan (HD PPO)

• Offered by NovaSys Health
• High deductible plan with co-insurance after
  deductible is met. Offered by NovaSys Health.
  Does not require members to have Primary Care
  Physician. Participation in Health Savings
  Account with minimum 20 contribution required.

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All plans have Rx benefits

• HMO POS PPO plans
• Three tier co-payment structure for 31-day
  supply
• 10 for generic medications
• 25 for preferred name brand drugs
• 50 for non-preferred name brand drugs

Find preferred drug listing online at
www.NMHC.com Click on Member Services then
State and Public School Employees Preferred Drug
List.
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All plans have Rx benefits (contd)

• High Deductible PPO plan (HD PPO)
• Prescription costs apply toward deductible
• Pay discounted retail cost until deductible is
  met, then pay 20 co-insurance
• Deductible restarts every October 1st
• No pre-set co-payments like other plans

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Included with all plans

• StarEAP (Employee Assistance Program)
• Tobacco Cessation program (ARQuit Now)
• Health Improvement Programs
• Balance (6 weeks, weight management)
• Nourish (8 weeks, weight management
• Go to www.Corphealth.com/Arwellness

Also, 100 coverage for annual wellness exams!
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How to enroll

• New employees can enroll in health benefits upon
  hire (have 30 days to enroll)
• Existing employees can enroll, drop or make other
  changes annually during August open enrollment
  period
• Open enrollment changes go into effect on October
  1st

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How to enroll(contd)

• Enroll online at www.ARBenefits.org
• Set up individual password security
• Enroll, drop, add/delete dependents, change
  plans, select primary care physician
• Print and sign enrollment or change form
• Turn into business office by the deadline
• Or use paper forms available online or from
  district business office

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General Information

• May enroll yourself and dependents in any plan
  with no medical questions, no pre-existing
  condition limitations
• Can change to a different plan or company with no
  medical questions or limitations

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Coming in October New combined Medical and Rx
I.D. card!

• All plan participants will get new card
  automatically
• Use this card for doctor, hospital and pharmacy
  visits

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Health Risk Assessment (HRA)

• HRA completed annually for discount next plan
  year (voluntary participation)
• Take HRA August 1-31st
• Provides 10 ea/month rate discount per employee
  and covered spouse
• Additional 10 ea/month available based on
  wellness score

HRA available online at www.ARBenefits.org Or by
phone 24/7 _at_ 1-866-456-3950 (Spanish version also
available.)
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Dental and Vision Screenings

• For HMO and POS plan participants only
• Preventative dental screenings every 6 months for
  25/copayment
• Preventative vision screenings every 24 months
  for 25/copayment
• Must be in-network with your benefit coordinator
  (Health Advantage, NovaSys Health or
  QualChoice/QCA)

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Contact us we can help!We manage your health
benefits.

• Employee Benefits Division of DFA

Customer Service Toll Free (877)
815-1017 Little Rock area [phone] Email
AskEBD_at_dfa.state.ar.us On the
web www.ARBenefits.org