Retirees
Summary of Benefits
Rates
- 2022 Plan Rates
Public School Employee (PSE) - 2022 Plan Year – Non-Medicare Retiree
- 2022 Plan Year – Medicare Retiree
- Arkansas State Employee (ASE)
- 2022 Plan Year – Non-Medicare Retiree
- 2022 Plan Year – Medicare Retiree (Medical and Pharmacy Coverage)
- 2022 Plan Year – Medicare Retiree (Medical Coverage)
- 2021 Plan Rates
- Public School Employee (PSE)
- 2021 Plan Year- Non-Medicare Retirees
- 2021 Plan Year – Medicare Retiree
Arkansas State Employee (ASE)- 2021 Plan Year- Non-Medicare Retirees
- 2021 Plan Year – Medicare Retiree
- 2021 Plan Year – Medicare Retiree with ARBenefits Drug 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
