Health Insurance FAQ

Open Enrollment

I’m currently a district employee. I don’t have the district’s health insurance and I don’t want it. Do I have to do anything?

No. You should be aware that, effective January 1, 2015, any employee not covered by any health insurance plan may be subject to an IRS fine. This is a provision of the new Affordable Care Act. 


I want to join the district’s health insurance plan. When can I sign up?

Not until October 1, 2014. The month of October is the period of open enrollment for health insurance coverage to be effective January 1, 2015. If you wish to enroll in the district’s health insurance plan, you must do so during the month of October.

NOTE: This will be your only opportunity to enroll in the district’s health insurance plan until next October unless you have a qualifying status change event called a “qualifying event” (marriage, divorce, birth, death, and spouse’s gain/loss of health insurance coverage). To be eligible to purchase the health insurance, you must work at least 30 hours per week during the school year.


I’m already participating in the district’s health insurance plan, but I want to make some changes that are not due to a qualifying event. When can I make changes?

Not until October 1, 2014. The month of October is the period of open enrollment for health insurance coverage to be effective January 1, 2015. If you wish to make changes (switch to a different plan, add or drop a spouse or dependent), you must do so during the month of October.

NOTE: This will be your only opportunity to make changes until next October unless you have a qualifying status change event called a “qualifying event” (marriage, divorce, birth, death, and gain/loss of group coverage).


If I enroll or make changes, what will be the effective date?

Any election made during the October open enrollment will be effective January 1, 2015.


When do the new health insurance premiums go into effect?

The new health insurance rates are effective January 1, 2015


What are my choices for health insurance? 

You have three plans and all three are administered by Health Advantage for EBD. The three plans go by the names of Premium, Classic and Basic.


What’s “EBD”? My health insurance card says ARBenefits?

EBD stands for “Employee Benefits Division”. EBD is a state agency that administers the district’s health insurance under the name of ARBenefits. It’s the same agency. The district’s business office uses the EBD term because that office deals directly with them, but plan participants and insurance carriers may know them by the ARBenefits name.


What are the basic differences between the three plans?

  • Premium: When you go to the doctor (including a specialist), you pay an office visit fee called a “co-pay”. For hospital services, you pay 20% of the discounted price after you have paid a deductible specified by the plan. However, be careful because some doctor visits become so extensive, you may have to pay more than the co-pay and start paying towards your deductible. Prescription benefits are available in a 4-tiered system. For any prescribed drug, you pay a set payment of $15, $40, $80 or $100, depending on the type of drug prescribed.
  • Classic: No co-pays. Employee only plans: You pay an annual individual deductible of $2,000 (in-network) or $3,000 (out-of-network). Employee + Family (spouse/children/both) plans: You pay an annual family deductible of $3,000 (in-network) or $6,000 (out-of-network). After meeting your deductible, you pay 20% of the bill. Prescription cost will be applied to the same deductible, until met; then you pay 20% of the bill. A Health Savings Account is required to be established with the Classic Plan. Brand drugs with an equivalent generic available are non-covered on the Classic and Basic plans.
  • Basic: No co-pays. Employee only plans: You pay an annual individual deductible of $4,250 (in-network) with no out-of-network coverage. Employee + Family (spouse/children/both) plans: You pay an annual family deductible of $8,500 (in-network) with no out-of-network coverage. After meeting your deductible, you pay 20% of the bill. Prescription cost will be applied to the deductible, until met; then you pay 20% of the bill. A Health Savings Account is required to be established with the Basic Plan. Brand drugs with an equivalent generic available are non-covered on the Classic and Basic plans.

What are the rates for the three plans?

You can see the full breakdown of plans and rates here.

If I just want to keep the same health insurance that I currently have and don’t have any changes to make, do I have to do anything?

Truthfully, you can’t keep the “same health insurance”. You need to realize that your current 2014 plan will have a new name and it will have many changes that are discussed throughout this FAQ. However, you will automatically be enrolled in a new plan as described below:

If you are in the Gold Plan for 2014, you are automatically enrolled in the Premium Plan for 2015.

If you are in the Silver Plan for 2014, you are automatically enrolled in the Premium Plan for 2015.

If you are in the Bronze Plan for 2014, you are automatically enrolled in the Classic Plan for 2015.

If this is your intention, you don’t have to do anything. If this is not the plan you wish to be moved to, you must complete and submit a new enrollment for during the October enrollment period.


I’m currently participating in the district’s health insurance. These plans look familiar, but the plans have different names. How do the Gold, Silver and Bronze 2014 plans relate to the Premium, Classic and Basic 2015 plans?

  • The Gold plan has one distinguishing benefit; it has no deductible. New state law requires all plans to have a deductible. Therefore, the Gold plan cannot be offered after December 31, 2014. Consequently, there is no new plan to compare to the current Gold plan. If you are currently in the Gold plan and you do nothing during open enrollment, EBD will automatically enroll you in the Premium plan. If that’s OK with you and you are NOT required to drop your spouse as detailed in Q19, you’re done. If you want to change from that plan, you must complete and submit a new enrollment form during the open enrollment period of October.
  • The Silver plan, with its hybrid of co-pays and deductibles, is comparable to the new Premium plan. However, there are differences; so review the Premium plan closely. If you are currently in the Silver plan and you do nothing during open enrollment, EBD will automatically enroll you in the Premium plan. If that’s OK with you and you are NOT required to drop your spouse as detailed in Q19, you’re done. If you want to change from that plan, you must complete and submit a new enrollment form during the open enrollment period of October.
  • The Bronze plan is a “high deductible” plan and is comparable to the new Classic plan, which is also a “high deductible” plan. Again, there are differences; so review the Classic plan closely. If you are currently in the Bronze plan and you do nothing during open enrollment, EBD will automatically enroll you in the Classic plan. If that’s OK with you and you are NOT required to drop your spouse as detailed below, you’re done. If you want to change from that plan, you must complete and submit a new enrollment form during the open enrollment period of October.
  • The Basic plan is a new “high deductible” plan, but you may want to call it a “very high deductible” plan. The plan mostly compares to the current Bronze plan, with significantly higher deductibles, higher maximum “out of pocket” costs and no “out of network” coverage. This plan is so unattractive that no current plan will be automatically enrolled into the Basic plan. If you want to be in the Basic plan, you must complete and submit a new enrollment form during the open enrollment period of October. Before you enroll in the Basic plan, please review it carefully. It may be the cheapest plan available to you, but that doesn’t mean that is good plan. The expression “you get what you pay for” comes to mind. Make sure you can live with the risks associated with this plan.

If I enroll in the Premium plan, do my “co-pays” count towards my deductible?

No. Here are a couple of over-simplified statements about how the Premium plan works:

  • If paying medical expenses as a co-pay, the amount you paid counts towards your maximum out of pocket, BUT NOT your deductible.
  •  If paying medical expenses that didn’t qualify for the co-pay, the amount you paid counts towards both your maximum out of pocket AND your deductible. 

I understand that a health insurance deductible represents my “out of pocket” medical costs that I must pay before the plan pays 80% of the discounted medical cost. Are there any limits to the medical costs that I may have to pay at this 20% level?

Yes, after the deductible is met, you are paying your 20% share of the “co-insurance” portion. Depending on your plan, there is a limit to the amount of “co-insurance” medical costs that you must pay. After you’ve reached this annual limit for your plan, all medical costs are paid by the plan. The total of your deductible and your share of the co-insurance equals your “maximum out of pocket” costs. Here’s a list of the co-insurance limits for in-network providers for each plan:

Premium*Individual$2,500 for a maximum out of pocket of $3,500
 Family$5,000 for a maximum out of pocket of $7,000
ClassicIndividual$4,450 for a maximum out of pocket of $6,450
 Family$6,675 for a maximum out of pocket of $9,675
BasicIndividual$2,200 for a maximum out of pocket of $6,450
 Family$4,400 for a maximum out of pocket of $12,900 

*Please note that the Premium plan’s medical maximum out of pocket does include the medical co-pay portions you must pay. However, it does not include any prescription medicine costs. In the Premium plan, prescription costs (paid in the various tiers) have a separate maximum out of pocket cost of $3,100 for individuals and $6,200 for families.


How do I enroll in or make changes to the district’s health insurance?

You have a couple of options:

  1. Starting October 1, 2014, you can go to the following website: www.arbenefits.org and click on “Log In”. Complete the requested information. After completing the requested information, you will then be able to enroll or make changes to your health insurance. A social security number and documentation such as a birth certificate for children and a marriage license for a spouse will be needed during the online enrollment. Please have a scanned copy available to upload while you are enrolling online.
  2. Print the 2015 open enrollment form from your PCSSD email or www.arbenefits.org
    Once you completed the form, you will need to fax the form to EBD at 501-683-0983

I need more information on the benefits of each plan. How can I get more information?

While you can always call EBD at 877-815-1017, please remember that October is a particularly busy month for them, so it may take quite a while to get through to them or to get a response. The ARBenefits website (www.arbenefits.org) has a schedule of plan benefits for each plan in a link called “Summary Plan Description” under the heading of “Plan Documents” on the home page. In addition, EBD has also provided the various venues of information that can be found following the links listed below:

Please review the plans and ask your questions as early as possible. Too many times, the district’s business office is not able to timely answer your questions because of the high volume of calls received the last week of October. Please don’t wait until the October 31st deadline. 

Adding/Deleting a Spouse and/or Children

I want to add my spouse and/or children to my health insurance plan during open enrollment. What documentation will be required?

To make these changes during open enrollment, the following documents will be required for these three common occurrences:

  • Marriages and divorces – If you are adding a spouse, EBD is going to require the spouse’s social security number plus a copy of your marriage license and a signed affidavit referenced below. If you’ve recently divorced and you need to drop the ex-spouse, EBD is going to require a copy of your divorce decree.
  • New dependents – If you are adding a new dependent, EBD is going to require a social security number and documentation of the new dependent. Specifically, they require a birth certificate (or adoption papers if applicable). EBD will initially accept a hospital-issued birth announcement for a newborn. However, eventually, you must send EBD a social security number and a birth certificate.

Are there any restrictions for adding my spouse to my health insurance plan?

Yes. If your spouse is eligible for health insurance through his/her employer and the coverage meets the qualifications under the Affordable Care Act, then your spouse is not eligible to be added to your health insurance plan. If you wish to include your spouse in your health insurance plan, you must sign an affidavit attesting that your spouse does not have access to coverage through his/her employer. If you need a copy of this affidavit, it’s available on the ARBenefits’ website for you to print off, complete, sign and send to EBD.


I currently have my spouse on my health insurance plan and I received a letter from ARBenefits asking questions about my spouse. I completed the affidavit and mailed it back to ARBenefits (EBD). What will that mean to my health insurance?

A new state law does not allow you to carry your spouse on your health insurance if your spouse CAN (not does, but CAN) get health insurance from his/her employer.

If you indicated to EBD that your spouse can get health insurance from his/her employer, EBD will automatically drop your spouse from your coverage effective January 1, 2015. If you don’t proactively change your plan during open enrollment, EBD will not know the tier of health insurance plan you desire to move to (for example, if you are in a “Employee + Family” plan, do you want “Employee + Children or Employee Only”? Also, do you want to move to different type of plan?).

After open enrollment ends, if EBD does not have a spouse affidavit on file from you, EBD will send a letter one last time letting you know your spouse will be dropped and you will be enrolled in a 2015 health insurance plan as follows:

  • Family Coverage (Gold/Silver) enrolls into Employee/Children Premium
  • Family Coverage (Bronze) enrolls into Employee/Children Classic
  • Employee/Spouse Coverage (Gold/Silver)enrolls into Employee Only Premium
  • Employee/Spouse Coverage (Bronze) enrolls into Employee Only Classic

Therefore, if your spouse is dropped, your spouse needs to get health insurance at his/her place of work to be effective January 1, 2015 (to avoid potential IRS fines for not having health insurance) AND you also need to change your health insurance plan with EBD during open enrollment.

Your health insurance plan will remain the same (except for the automatic change previously discussed) if you indicated to EBD that your spouse is not able to buy health insurance from his/her employer. This is also true if you indicated to EBD that your spouse is a Public School Employee (PSE) in any Arkansas school district or an Arkansas State Employee (ASE).

Wellness Visits and the Wellness Discount

Why are two 2015 health insurance rates listed for each plan – one “with Wellness Discount” and one “without Wellness Discount”?

If you, as the employee, go to a doctor and have a wellness visit, then your premium will be discounted $75.00 per month. If you don’t go see a doctor for a wellness visit, then you will have to pay the plan’s full rate. Wellness visits taken by your spouse and/or dependents don’t count towards this discount.


When is the deadline to have a wellness visit in order to get the wellness discount?

October 31, 2014.


I’m a new hire. Am I required to have a wellness visit to get the wellness discount?

No. A new hire to the district automatically receives the wellness discount. For the purpose of receiving the wellness discount, the definition of a “new hire” is an employee hired to start working for the district on July 1, 2014 or after.


I worked for a different Arkansas public school district in 2013-14 and now I’m a “new hire”. Am I required to have a wellness visit in order to get the wellness discount?

If you had no break in coverage in your current 2014 health insurance plan, the answer is YES, you are required to have a wellness visit to get the wellness discount. However, if you had a break in coverage in your current 2014 health insurance plan, the answer is NO. In this case, you are treated as a “new hire” and will automatically receive the wellness discount.


What qualifies for a wellness visit?

It’s complicated, but the simplest approach is to recommend to the employee that he/she emphasize to the doctor and the doctor’s office staff that he/she is there for a “wellness visit” and he/she requests that the doctor’s office code the visit as a “wellness visit” when the insurance is filed.

EBD has also indicated that the wellness visit must be conducted by a doctor (or a nurse practitioner) to qualify for the wellness discount. The discount is honored only if the doctor files a claim on your current health insurance plan through EBD. Therefore, you should request that the doctor’s office code the claim as a “wellness” exam during your visit.

If you are currently on the district’s group health insurance plan, this wellness visit should be paid 100% by the plan. You shouldn’t be required to pay anything – not even the co-pay.

Health Savings Accounts

I’ve heard that I must establish a Health Savings Account (HSA). What is this?

If you choose the Classic or Basic plan, then you must (by Arkansas statute) establish an HSA if you are eligible for an HSA. Conceptually, it’s a way for you to save up money to pay your medical costs (like your annual deductible) using pre-tax dollars, so it’s a beneficial requirement.

To start one, you must complete an HSA Application and Salary Reduction Agreement and send it to the PCSSD Insurance Department (not EBD). The PCSSD Insurance department will send all HSA forms to Data Path, the company that administers HSA for the District.

Once established and funded, you can then use this money to pay for your medical expenses. You are mailed a debit card to swipe when you incur medical costs (e.g. go to the doctor or pharmacy). “Established and funded” means that you must have funds in your account for your debit card to be accepted. In other words, you can’t use your HSA debit card to pay your medical expenses at the point of service unless actual funds are in your HSA account.

Unfortunately, if you do not have QUALIFIED High Deductible Health Plan (HDHP) coverage you CANNOT open, or contribute to, a HSA. To have qualified HDHP coverage you must: (1) have Classic or Basic coverage through EBD AND (2) no first-dollar coverage excluding preventative services through any other source. * This means that, in addition to Classic or Basic coverage, you CANNOT have the following coverage: Medicare, NON-HDHP coverage through a spouse’s employer, NON-HDHP coverage through an individual policy, Tri-Care or Champs VA and have received services in the last three (3) months, or have a non-HDHP compliant supplemental Hospital Indemnity Plan– that’s the law – but you are allowed to spend down the remaining balance of your HSA.

*You cannot have any first-dollar coverage, with the exception of preventative services, until your Out of Pocket (OOP) hits $1,300/ $2,600 for 2015.

Flexible Spending Accounts are a violation of the HDHP.

Unfortunately, if you are 65 years old or older and enrolled in any part of Medicare, you are not allowed to establish an HSA – that’s the law.


If I must have an HSA, is there a minimum contribution? Is there a maximum contribution?

It appears that there is no minimum contribution to establish an HSA with DataPath except that the HSA must be opened. After the HSA is open, it appears that no other minimal annual contribution is required.

If you are eligible to open an HSA, you must establish an HSA during the month of October (open enrollment) for your coverage to be in effect January 1, 2015. If you don’t establish an HSA during October, it may delay the effective date of your 2015 health insurance coverage. To be compliant with the law, EBD cannot allow you to be enrolled in the Classic or Basic plan if you’ve not established an HSA unless you are not otherwise eligible to establish an HSA. Therefore, you won’t have health insurance in 2015 if you don’t establish an HSA before 2015.

The maximum contribution by law for 2015 is $3,350 for individual plans and $6,650 for family plans. An additional $1,000 annual contribution is available to eligible participants that are 55 years old or older. While contributions can be withheld evenly for every pay period, HSAs allow increases and decreases in monthly contributions throughout the year until the maximum contribution is reached. However, some like to “front load” his/her HSA by making bigger contributions (payroll withholdings) in early 2015, so that money is in the account available to be spent if any early 2015 medical expenses occur.


I’m going to be in the Premium Plan. Can I establish to an HSA?

No. However, the Premium Plan participants may establish a Section 125 Flexible Spending Account (FSA) that is also called an Unreimbursed Medical Account (URM).


How much can I spend from my HSA each year?

The only spending limit is your HSA account balance. You can only withdraw up to the amount in your account at that point in time. Any unused funds roll over from year to year. You do not lose any funds if they are not used by the end of the year.


I have money withheld from each check for my unreimbursed medical flex spending account (FSA). Since I have chosen to move to the Classic or Basic plan, can I have an HSA too?

No. You cannot have an HSA and an FSA at the same time. If you are required to establish an HSA (Classic or Basic Plan), you must wait until your FSA period is closed and all FSA withdraw opportunities have expired. Pulaski County Special School District FSA account is also called Consolidated Admin Services (CAS). We also go by the name of “cafeteria plan” or Section 125 cafeteria plan”. If you currently have an FSA, you must wait until PCSSD’s plan year expires (February 28, 2015).


 I want more details on HSAs. Where can I get more information?

To go directly to the source, you can contact DataPath at 501-687-6954. You can also email them at benefits@datapathadmin.com or on the web at www.datapathadmin.com.


I have a health insurance question that hasn’t been covered. What number can I call?

We have found the best way to ask a specific question about the health insurance plans is to email EBD at AskEBD@dfa.state.ar.us or you may call EBD at 501-682-9656 and Press 1. EBD reviews these emails daily and typically responds the same day (some issues are so complex, more time is needed). Please review the plans and ask questions as early as possible. Please don’t wait until the October 31st deadline is close at hand.