School Forms and Publications

Arkansas State | Public School

School Employees

expand FormsPosted
ARBenefits RX Member Reimbbursement Form6/28/2013
Continuation Of Coverage2/8/2013
Datapath HSA Application & Salary Reduction Agreement | Plan Year 20158/12/2014
Datapath HSA FAQ's & Top 10 Reasons | Plan Year 20149/18/2013
Election Form4/22/2014
Minnesota Life Certificate of Coverage1/15/2014
Minnesota Life Evidence of Insurability Form12/13/2013
expand NewslettersPosted
EBD Buzz | Spring 20146/26/2014
E-Newsletter – January 20143/26/2014
EBD Buzz, Spring 2012 1/22/2013
E-Newsletter – October 20133/26/2014
expand Preferred Drug ListPosted
2014 PDL – Preferred Drug List6/17/2014
expand RatesPosted
2014 Plan Year | Act 331 | Effective 01/01/201410/1/2013
2014 Plan Year | Cobra | Effective 01/01/2014 10/1/2013
2015 Plan Year | Active With Wellness Visit | Effective 01/01/20158/4/2014
2015 Plan Year | Cobra | Effective 01/01/20158/8/2014
expand Schedule of BenefitsPosted
2015 PSE Schedule of Benefits | Classic8/4/2014

School Retirees

expand FormsPosted
Authorization to Release Health Information2/8/2013
Minnesota Life Certificate of Coverage1/15/2014
Minnesota Life Portability Form3/11/2014
Retirement Health Enrollment Information & Instructions4/7/2014
expand NewslettersPosted
E-Newsletter - April 20144/28/2014
E-Newsletter – March 20143/26/2014
EBD Buzz, Open Enrollment 2012 1/8/2013
expand Preferred Drug ListPosted
2013 PDL - Preferred Drug List1/2/2014
expand PresentationsPosted
Thinking About Retiring? | Plan Year 20146/9/2014
expand RatesPosted
2013 Plan Year | Medicare Retiree | Effective 01/01/2013 1/9/2013
2014 Plan Year | Act 331 | Effective 01/01/201410/1/2013
2014 Plan Year | Medicare Retiree | Effective 01/01/20148/26/2013
2015 Minnesota Life Rates | Retiree | effective 1/1/20158/19/2014
2015 Plan Year | Medicare Primary Retirees | Effective 01/01/20158/4/2014
expand Schedule of BenefitsPosted
2015 PSE Schedule of Benefits | Basic8/4/2014
2015 PSE Schedule of Benefits | Premium & Premium Retiree8/8/2014
expand Summary Plan DescriptionsPosted
2014 Summary Plan Description7/23/2014
Spanish Summary of Benefits and Coverage - Gold 2014 (Resumen de beneficios y cobertura - Oro)12/23/2013
Summary of Benefits and Coverage - Bronze 201410/2/2013
Summary of Benefits and Coverage - Silver 201412/23/2013

School Insurance Representatives

expand FormsPosted
Authorization to Release Health Information2/8/2013
Datapath HSA Application & Salary Reduction Agreement | Plan Year 20158/12/2014
Minnesota Life – Leave Without Pay Form8/18/2014
Non AASIS Matching Form11/28/2012
expand ManualsPosted
IRS/SSA/CMS Data Match Book11/28/2012
Minnesota Life FAQs11/28/2012
PSE Open Enrollment Q/A11/28/2012
expand Preferred Drug ListPosted
2014 PDL – Preferred Drug List6/17/2014
expand RatesPosted
2014 Plan Year | Active | Effective 01/01/20141/15/2014
2015 Minnesota Life Rates | Active Employee | Effective 1/1/20158/19/2014
2015 Plan Year | Active With Wellness Visit | Effective 01/01/20158/4/2014
2015 Plan Year | Cobra | Effective 01/01/20158/8/2014
2015 Plan Year | Non-Medicare Retiree| Effective 01/01/20158/4/2014
expand Schedule of BenefitsPosted
2015 PSE Schedule of Benefits | Classic8/4/2014
expand Summary Plan DescriptionsPosted
2013 Summary Plan Description1/2/2014
Spanish Summary of Benefits and Coverage - Bronze 2014 (Resumen de beneficios y cobertura - Bronce)10/28/2013
Spanish Summary of Benefits and Coverage - Silver 2014 (Resumen de beneficios y cobertura - Plata)12/23/2013
Summary of Benefits and Coverage - Gold 201412/23/2013