ARKANSAS WELFARE FUND

PLAN DOCUMENTS

Delta Dental ACTIVE/ARK

Summary Plan Description

Summary of Benefits & Coverage, 2022

FORMS

2020 Arkansas Annual Claim Form

2021 Arkansas Annual Claim Form

2022 Arkansas Annual Claim Form

MAILINGS

2022 Mailings

6/15/22 COBRA Rate Change, ARK

3/18/22 Summary of Material Modification ABA Therapy and Residential Treatment 

2/28/22 Sleep Study Reminder

2021 Mailings

12/1/21 Summary of Material Modification-No Surprises Act

11/29/21 Summary Annual Report - Welfare

11/16/21 Surprise Medical Billing Annual Notice

10/18/21 Summary of Material Modification Specialty Medications

10/18/21 Notice of Children's Health Insurance Program (CHIP)

10/18/21 Notice of Prescription Drug Coverage and Medicare

10/18/21 Notice of the Plan's Use and Disclosure of PHI

10/18/21 Women's Health and Cancer Rights Act

10/18/21 Newborns' and Mothers' Health Protection Act

6/9/21 COBRA rate change

3/24/21 Summary of Material Modification for Weight Loss Benefits

3/24/21 Temporary Changes to Claims, Appeals & COBRA revised

3/5/21 Temporary Changes to Claims, Appeals & COBRA

2/26/21 Change to New PBM AnWINS Rx

2/26/21 Summary of Materials Modification AnWINS Rx Changes

2020 Mailings

11/23/20 Notice of Children's Health Insurance Program (CHIP)

11/23/20 Notice of Prescription Drug Coverage and Medicare

11/23/20 Notice of the Plan's Use and Disclosure of PHI

11/23/20 Women's Health and Cancer Rights Act

11/23/20 Newborns' and Mothers' Health Protection Act

6/24/20 Network Changing to Aetna 

6/15/20 COBRA Rate Changes, 2020

2019 Mailings

2019 Summary of Material Modification re: Gene Therapy

2018 Mailings

11/27/18 Immunization Information

11/27/18 Summary of Materials Modification- OOP max and ER coverage

10/26/18 Summary of Materials Modification-Vision, Rx, A&S, ST & Hospital Room Changes

10/23/18 Summary Annual Report - Welfare Fund

2017 Mailings (newest to oldest)

11/29/17 Summary Annual Report - Welfare Fund

10/3/17 Summary of Materials Modification - Merger

7/10/17 COBRA Rate Change

2016 Mailings (newest to oldest)

12/2/16 Summary Annual Report for Arkansas

11/15/16 2017 Annual Claim Form

 

FIND A PROVIDER

Meritain

Delta Dental 

AmWINS RX

PAS (Personal Assistance Services)

PAS Flyer

Frequently Asked Questions

How much is my deductible?

Your deductible is $500

Has my deductible been met?

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How much is my out of pocket?

Your maximum out of pocket is $4,000.

Do all providers have to be in-network.

Yes, all providers have to be in-network, otherwise there is no coverage.

What are considered wellness benefits and how are they paid?

Wellness benefits are paid at 100%. Examples of a Wellness benefit are annual visits to your primary care physician for a well visit, annual pediatrician visit for a well visit, colonoscopy, and mammogram.