Program Details: The ARBenefitsWell program has two requirements that BOTH active employees and any covered spouse on the ARBenefits policy must meet in order to qualify for the discount.
1. Employees and covered spouses BOTH must have a wellness exam conducted by a doctor.
2. Employees and covered spouses BOTH must take the online Health Assessment (HA) administered by GuidanceResources®.
A new requirement for the 2017 wellness discount is any covered spouse on the ARBenefits policy must have a wellness exam conducted by a doctor. Beginning June 2016, the ARBenefits Plan will begin reviewing medical claims processed through the ARBenefits health plan from November 1, 2015 through October 31, 2016 for all active ASE and PSE employees and covered spouses. An active employee and covered spouse, who had an office visit with their primary care physician or specialist during that timeframe, will meet the wellness visit requirement.
NOTE: While preventive health services will continue to be covered at no cost to the member per the Plan guidelines, they may not meet the Wellness visit requirement if not conducted in an office setting. For example, a mammogram would not meet this requirement since it was not performed in an office setting, thus establishing a relationship with a doctor.
The HA can be accessed at www.guidanceresources.com. Returning employees and spouses need to login with their username and password. New users must register using the Organization Web ID “ARBEN” when prompted. Please remember that both the employee and spouse must create separate accounts using different email addresses when registering. Instructions for logging in can be accessed at the link below. Anyone needing assistance logging into GuidanceResources® or completing the HA can contact GuidanceResources® at 1-877-247-4621.
Instructions for logging into GuidanceResources®: http://portal.arbenefits.org/newsDocuments/20150313News_HealthAssessment.pdf
NOTE: You have not completed the HA until you reach the screen that provides a Certificate of Completion showing your name and completion date.
Although it is recommended that you complete the Health Assessment online for the most accurate and immediate reporting, you may complete it on paper. If you don’t have access to a work computer, you may complete the Health Assessment using your home computer, smart phone, tablet or any other public computer. If you don’t have access to any of the above, please call the toll free number, 1-877-247-4621 to order a paper Health Assessment. The process to complete the paper Health Assessment requires more time; please allow four to six weeks to complete.
Enrollment: Participants are not required to fill out any forms or sign up for the program. Entrance into the program is based on claims data, which will show when a participant visited the doctor and what procedures were administered during that visit.
An active employee and covered spouse have until October 31, 2016 to obtain a wellness exam that qualifies the employee for the discount. The employee will not be required to provide any additional documentation to verify the visits. When the claim for each visit processes, it will automatically update the ARBenefits system.
Be aware that providers have up to six months to submit a claim. To avoid paying a higher premium at the beginning of the 2017 plan year, participants may wish to complete their wellness visit prior to June 30, 2016. While participants who complete a wellness visit after June 30, 2016 will receive the discount, they run the risk of paying a higher premium until the claim is processed. Once the claim processes the wellness discount will be applied retroactively and the employee will be refunded any monies owed.
An active employee and covered spouse have until October 31, 2016 to complete the Health Assessment. GuidanceResources® will provide notification of completion of the HA and it will automatically update the ARBenefits system.
An employee and covered spouse whose claims process through the ARBenefits health plan meeting the required criteria and who complete the Health Assessment will be placed into a group that is eligible for a monthly discount. Employees may follow up with their Health Insurance Representative (HIR) or contact EBD after allowing appropriate amount of time to verify eligibility for the discount.
New Hires: New state or public school employees hired after July 1, 2016, will automatically receive the premium discount for the entire 2017 plan year. An employee who transfers to another agency or school district and has a break in service will be considered a new hire. An employee who transfers to another agency or school district, but does not have a break in service is not considered a new hire and will be required to meet the criteria to be eligible for the discount.
Employee Discount Notification: Active ASE and PSE employees will receive letters from ARBenefits stating whether or not they are eligible to receive the discount for the 2017 plan year. These letters will be mailed directly to the employee and will explain whether or not the employee will receive the discount. Both eligible and ineligible employees will receive letters.
Failure to Meet the Deadline: If an active employee or covered spouse fails to obtain a wellness exam, and fails to complete the online Health Assessment that process through the ARBenefits health plan before the deadline of October 31, 2016, that employee will be ineligible to receive a monthly discount for any part the 2017 plan year.
Appeals: Employees who believe they are eligible for the discount, but have not been included in the approved database may appeal to the ARBenefits Plan, following the written appeal process as described in the Summary Plan Description.
NOTE: Appeals regarding the ARBenefitsWell program discount will only be accepted if an adverse benefit determination has occurred. For example:
A participant should not submit an appeal unless they have received an Explanation of Benefits (EOB) for the date of service of the wellness visit. If the participant has not received an EOB then the claim has not been processed and EBD is unable to verify that the participant has met the requirement.
A participant should not submit an appeal before three weeks have passed since completion of the online Health Assessment and no less than six weeks have passed since completion of a paper assessment.
NOTE: If a participant waits until the deadline approaches to complete the Health Assessment, EBD may not be able to provide confirmation that their assessment has been processed until after the deadline has passed.
Additional Resources: A list of appropriate recommended preventative services that are covered by ARBenefits at no cost to members (no deductible, co-pay or co-insurance) and meet the wellness requirement can be accessed at http://portal.arbenefits.org/Pages/PreventativeWellnessServices.aspx. Detailed instructions and Frequently Asked Questions for completing the Health Assessment can be accessed at http://portal.arbenefits.org/Benefits/HAGuide.pdf.