School Employees
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Forms: |
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ARBenefits: |
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2020 PSE Open Enrollment Guide |
10/07/2019 |
Affidavit of Spousal Health Care Coverage |
10/5/2017 |
ARBenefits RX Member Reimbursement Form |
10/8/2014 |
Authorization to Release Health Information |
11/12/2019 |
Enrolling Online With ARBenefits |
08/15/2017 |
Member Appeal Request Form |
01/19/2018 |
Notice of Termination and Retirement Form |
10/7/2014 |
AR Benefits Primary Care Provider Form |
04/27/2018 |
2020: |
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ARBenefits: |
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2020 Active State & Public School Change Form |
11/05/2019 |
2020 Active State and School Enrollment Election Form |
09/25/2019 |
HSA/FSA |
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Connect Your Care HSA Enrollment Form |
09/27/2019 |
Colonial Life |
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Colonial Life Enrollment Form |
12/03/2019 |
Colonial Life PSE Rates |
12/03/2019 |
PSE Basic and Enhanced Basic Coverage Brochure |
12/03/2019 |
PSE Supplemental Coverage Brochure |
12/03/2019 |
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2019: |
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ARBenefits: |
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2019 Active State & Public School Change Form |
09/19/2018 |
2019 Active State and School Enrollment Election Form |
08/27/2019 |
HSA |
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Connect Your Care HSA Enrollment Form |
09/24/2018 |
CYC Transfer of Assets Form |
12/03/2018 |
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2018: |
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ARBenefits: |
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2018 Active State & Public School Change Form |
08/09/2018 |
2018 Active State and School Enrollment Election Form |
08/24/2017 |
HSA/FSA: |
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2018 DataPath HSA Election Form |
03/12/2018 |
DataPath HSA Claim Form |
08/18/2017 |
DataPath Transfer of Assets |
08/18/2017 |
Securian: |
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Minnesota Life - Beneficiary Designation and Change Request |
08/24/2017 |
Minnesota Life Certificate of Coverage |
08/24/2017 |
Minnesota Life Conversion Form |
08/24/2017 |
Minnesota Life Enrollment & Change Form |
07/27/2018 |
Minnesota Life Evidence of Insurability Form |
08/24/2017 |
Minnesota Life Portability Form |
08/24/2017 |
2017: |
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HSA/FSA: |
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DataPath Transition FAQ |
12/7/2016 |
2016: |
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HSA/FSA: |
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WageWorks PSE FAQ |
12/3/2015 |
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Preferred Drug List: |
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2019: |
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2019 PDL – Preferred Drug List |
02/22/2019 |
Rates: |
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2018: |
2018 Plan Year | Active w/o Wellness Visit | Effective 01/01/2018 |
07/6/2017 |
2018 Plan Year | Active w/Wellness Visit | Effective 01/01/2018 |
07/6/2017 |
2018 Plan Year | Cobra Rates | Effective 01/01/2018 |
07/6/2017 |
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Schedule of Benefits: |
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2020 |
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2020 PSE Schedule of Benefits - Basic |
09/25/2019 |
2020 PSE Schedule of Benefits - Classic |
09/25/2019 |
2020 PSE Schedule of Benefits - Premium |
09/27/2019 |
2019 |
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2019 PSE Schedule of Benefits - Basic |
05/08/2019 |
2019 PSE Schedule of Benefits - Classic |
05/08/2019 |
2019 PSE Schedule of Benefits - Premium |
05/08/2018 |
2018: |
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2018 PSE Schedule of Benefits - Basic |
02/27/2018 |
2018 PSE Schedule of Benefits - Classic |
02/27/2018 |
2018 PSE Schedule of Benefits - Premium |
02/27/2018 |
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Summary Plan Descriptions: |
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2018: |
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2018 ARBenefits Summary Plan Description (effective 1/1/18) |
04/27/2018 |
Summary of Benefits and Coverage - PSE Basic 2018 |
04/27/2018 |
Summary of Benefits and Coverage - PSE Classic 2018 |
04/27/2018 |
Summary of Benefits and Coverage - PSE Premium 2018 |
04/27/2018 |
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