Retirees
Summary of Benefits
Rates
- 2022 Plan Rates
Public School Employee - 2022 Plan Year – Non-Medicare Retiree
- 2022 Plan Year – Medicare Retiree
- Arkansas State Employee
- 2022 Plan Year – Non-Medicare Retiree
- 2022 Plan Year – Medicare Retiree (Medical and Pharmacy Coverage)
- 2022 Plan Year – Medicare Retiree (Medical Coverage)
Retiree Forms and Resources
General Forms
- Affidavit of Spousal Coverage Form
- Authorization to Release Information
- Bank Draft Authorization Form
- Retiree Change of Address Form
- Retiree Health Enrollment and Instructions
- State Retiree Packet
- School Retiree Packet
- Retiree Election Form
- ARBenefits RX Reimbursement Form
