Agents
Group
- Agreement to protect PHI
- Billing adjustment form
- Blueprint for Employers registration form
- Change request form
- COBRA election form
- Common ownership certification
- Dental claim form
- Employee application
- Employee application — Spanish version
- Enrollment application with medical questionnaire
- Enrollment application with medical questionnaire -- Spanish
- Health claim form
- Life employee application
- Newborn enrollment request
- Physician's incapacity letter
- Plan confirmation form
- Prescription claim form
- Reinstatement application
- Subscriber's incapacity form
- State of Arkansas Continuation of Coverage election form
- Vision claim form
- Quick Start Guide - ABCBS Group
- Quick Start Guide - HA Group
2025 Schedule of Benefits
Platinum
- ABCBS Platinum 1500 Elite
- ABCBS Platinum 1000 Elite
- ABCBS Platinum 500 Value
- ABCBS Platinum 500 Essential
- ABCBS Platinum 500 Elite
- ABCBS Platinum 250 Elite
Gold
- ABCBS Gold 4000 Elite
- ABCBS Gold 3500 Elite
- ABCBS Gold 3400 HDHP
- ABCBS Gold 3400 HDHP Value
- ABCBS Gold 3000 Essential
- ABCBS Gold 2850 HDHP
- ABCBS Gold 2500 Essential
- ABCBS Gold 2000 Value
- ABCBS Gold 2000 Essential
- ABCBS Gold 2000 Elite
- ABCBS Gold 1700 HDHP
- ABCBS Gold 1500 Value
- ABCBS Gold 1500 Essential
- ABCBS Gold 1500 Elite
- ABCBS Gold 1000 Value
- ABCBS Gold 1000 Essential
- ABCBS Gold 1000 Elite
Silver
- ABCBS Silver 8500 HRA
- ABCBS Silver 6000 HDHP
- ABCBS Silver 6000 Essential
- ABCBS Silver 5100 HDHP
- ABCBS Silver 5000 Elite
- ABCBS Silver 4700 HDHP
- ABCBS Silver 4000 Elite
- ABCBS Silver 3500 HDHP
- ABCBS Silver 3500 Express
- ABCBS Silver 3000 Express
- ABCBS Silver 3000 Essential
- ABCBS Silver 3000 Elite
- ABCBS Silver 2500 Essential
- ABCBS Silver 2500 Elite
- ABCBS Silver 2000 Essential
- ABCBS Silver 2000 Elite
Bronze
2024 Schedule of Benefits
Platinum
- ABCBS Platinum 1000 Elite
- ABCBS Platinum 500 Value
- ABCBS Platinum 500 Essential
- ABCBS Platinum 500 Elite
- ABCBS Platinum 250 Elite
Gold
- ABCBS Gold 4000 Elite
- ABCBS Gold 3000 Essential
- ABCBS Gold 3200 HDHP
- ABCBS Gold 3200 HDHP Value
- ABCBS Gold 2750 HDHP
- ABCBS Gold 2000 Value
- ABCBS Gold 2000 Essential
- ABCBS Gold 2000 Elite
- ABCBS Gold 1600 HDHP
- ABCBS Gold 1500 Value
- ABCBS Gold 1500 Essential
- ABCBS Gold 1500 Elite
- ABCBS Gold 1000 Value
- ABCBS Gold 1000 Essential
- ABCBS Gold 1000 Elite
- ABCBS Gold 1500 Elite
Silver
- ABCBS Silver 8500 HRA
- ABCBS Silver 6000 HDHP
- ABCBS Silver 6000 Essential
- ABCBS Silver 5100 HDHP
- ABCBS Silver 5000 Elite
- ABCBS Silver 4700 HDHP
- ABCBS Silver 4000 Elite
- ABCBS Silver 3500 HDHP
- ABCBS Silver 3000 Express
- ABCBS Silver 3000 Essential
- ABCBS Silver 3000 Elite
- ABCBS Silver 2500 Essential
- ABCBS Silver 2500 Elite
- ABCBS Silver 2000 Essential
- ABCBS Silver 2000 Elite
- HA Silver 3000 Elite
Bronze