Frequently Asked Questions

Over 90% of the people who enroll in ARHealthNetworks are able to do so for just $25 per month. There is no other program that offers as much benefit for as low a cost as this. Enrollees with higher incomes are required to pay a higher premium since they earn more.

For $25 per month, the program offers significantly more benefit than competitive programs. Most of the people who enroll in ARHealthNetworks don’t have any medical benefits, so the program provides hospital, physician, and prescription benefits at a low cost. If a person needs and can afford more benefits than what ARHealthNetworks offers, there are other options available in the market.

The ARHealthNetworks program was designed to offer the benefits that people need the most. While it is a limited benefit program, it provides more benefits than 93% of Arkansans will use in an average year. We encourage people to buy more coverage elsewhere if they can afford more coverage and if they can qualify for it.

The simplest way to get a birth certificate is to go to any of the multiple websites that deal in public documents, such as www.vitalchek.com. The person can get a receipt showing that they have ordered their birth certificate and NovaSys will give them credit as though they had their birth certificate in hand today. However, the member will need to provide a copy of the birth certificate once it is received in order to stay enrolled at the lower premium.

The person will need a charge card in order to order their documents from the website. Many employers help their employees do this and then deduct the money from their paycheck in order to get the group benefits started.

All employees who work full-time for a qualified employer are eligible for coverage regardless of their income. If a household makes less than the qualifying income amount, then they pay the lowest premium – just $25 per month. If their household incomes are above the qualifying income amount, then they are required to pay more. They all qualify for coverage, but a few from each group usually have to pay a higher premium.

Only full-time workers who do not already have coverage are required to enroll. The program requires that all eligible employees who qualify for the lowest premium have to enroll in order for the group to qualify. The program allows some employees whose household incomes are higher to waive their coverage and still allow the group to enroll. This can get complicated, so the best thing is just to call the ARHealthNetworks sales support staff and let us help you try to get this group enrolled if possible.

They can be enrolled in ARHealthNetworks but are not eligible for the state subsidies which make the price so low. They would basically be able to enroll at the same cost as Arkansas citizens whose incomes are above the qualifying income limit.

ARHealthNetworks does not require for the employer to pay for the benefits as some commercial plans do. However, your employer still is providing a benefit by sponsoring your program and handling any billing responsibilities that are needed.

Because of the high value of the ARHealthNetworks program, there are some companies who would want to cancel the major medical programs that their employees already have in order to enroll in this program. Allowing them to enroll would seem to squash competition and reduce benefits for hard working Arkansans. So the program requires groups to wait for 12-months before they can enroll.

ARHealthNetworks must be “sold” by licensed sales agents. If you have an active insurance license and want to become appointed, then contact us at arhealthnetworks@novasyshealth.com. NovaSys Health will provide you with an email password and on-line access to all the necessary documents to get a group enrolled.

You can use this website to easily search for providers of all types all over the state. Get started by using the search box in the sidebar.

ARHealthNetworks does not exclude any pre-existing condition from being covered. There will also be no medical questions that employees have to answer to be eligible for coverage.

If you have employees that are already covered by a major medical insurance program, either through a spouse’s employer group health plan or on an individual basis, they will be exempt from participating in ARHealthNetworks. Every eligible uncovered employee must agree to take the ARHealthNetworks coverage in order for the group to receive the coverage.

Every 12 months, ARHealthNetworks will cover the following:

• 7 Inpatient Days Per Year
• 2 Major Outpatient Services Per Year, including emergency room and major services performed in the office.
• 6 Physician Office Visits Per Year
• Two Prescriptions Per Month
• Maximum Annual Benefit of $100,000
• Renewable each 12 months

Deductible and Co-Insurance for ARHealthNetworks:

• $100 annual deductible (does not apply to office visits & Rx)
• After deductible, 15% co-insurance will be required
• $1,000 maximum out of pocket annually, including deductible
• NovaSys Health providers must be used for benefits to be paid (including ER)
• Ongoing discounts apply after benefits are exhausted

Pharmacy Benefits for ARHealthNetworks:

• Two monthly prescriptions
• Subject to Co-Pay (but not deductible)
• $5 Generic
• $10 Brand Formulary
• $30 Brand Non-Formulary
• Program administered by Express Scripts
• Wide choice of pharmacies (no mail order)

Additional Features for ARHealthNetworks:

• No medical underwriting
• No one can be turned down for coverage for existing medical issues
• No waiting period for initial enrollment
• Benefits begin on the first day the insurance becomes effective, usually the first of the month after the member signs their forms.

Yes, but there is always a requirement that the program enroll at least one person who qualifies for the subsidies that keep the pricing low. So, if the one person in the group qualifies for the $25 pricing, then the group can be enrolled.

All income should be disclosed in determining household income. However, we generally don’t include income that is not earned on a regular basis, such as overtime and bonus income. Also, we won’t include disability income provided for a spouse or child, but in that case we won’t include the person at all, so it as if they don’t exist in the household.

Generally speaking, we just need to know the number of family members who live in the household; that would usually be the parents plus the number of dependents under the age of 19. But there are different scenarios which must be considered.

If an employee is a grandparent and the grandchildren live with them even though they do not have legal custody, the grandchildren can be included in the household total, even though we never provide benefits for children.

If an employee has to pay child support and is financially responsible for the children but they do not live with the employee, the child cannot be counted in the number of people living in that household.

If an employee has joint custody and the child spends half the time with the employee and half the time with the ex spouse, we can count the child as a member of household.

If an employee has a live-in partner but is unmarried, we do not count the partner in either the household total or the income total as that is not considered as married under the state law.

If an employee has a grown child over the age of 19 (even if they are enrolled in college) who lives with the family, then we do not count the adult child in either the household total or the income total as they are eligible for adult status.

Please submit a copy of the tax returns.

Yes, if they provide a copy of their business license and estimated payroll information on company letterhead and have been in business for at least 60 days.

A self employed individual, by the plan's guidelines, is someone that is working for themselves on an average of at least 30 hours a week, and is not being paid on a W2 basis. Some examples of this, but not limited to, would be farmers, contractors, ministers, insurance agents, barbers and cosmetologists, landscapers, and truck drivers.

To be eligible for the subsidies and qualify for the lowest premium, the employee must provide proof of citizenship (either a birth certificate, a passport, or a certificate of naturalization). If they will not or cannot provide this proof, they can still be covered, but the premium cost will be higher. If the employee is a citizen and wants to cover their spouse, and the spouse is NOT a citizen, then the cost for both of the members will be at the higher premium cost. The same answer will apply if the employee is a non-citizen and wants to cover a spouse who is a citizen. Both will pay the higher premium cost. All spouses who claim to be citizens must provide the same proof of citizenship as employees do.

If the employee has had a permanent resident card (also known as a green card) for five years, then they will be eligible for the subsidy and therefore the lowest premium cost, depending on their income. Green cards with less than five years of residency will still qualify the member for coverage, but at the higher premium cost.

Employees who receive their wages on a W-2 from their employee are eligible for ARHealthNetworks provided they work at least 30 hours per week. If the business owner works 30 hours or more per week at the business in question, then the business owner can be considered as an employee as well.

Only employees who are between 19 and 65 can enroll in ARHealthNetworks. However, the group can still enroll on the plan and once the employee turns 19, he can be added for coverage on the first of the month following his 19th birthday. The member may qualify for ARKids First, which offers benefits to eligible members until the 19th birthday. Members who turn 65 should enroll in Medicare and won’t be eligible for coverage under ARHealthNetworks at that time.

Yes, as long as they have separate tax IDs.

Each group enrolls for a 12-month period. The first date of coverage is called the effective date. That is the first date that members are eligible for medical benefits. Premiums for the group will be guaranteed until the end of the contract period, beginning with their effective date.

Any group is free to terminate their coverage at the end of their contract period. It should be remembered, however, that once you terminate your coverage you are not allowed to re-enroll in ARHealthNetworks for a 12-month period.

No; ARHealthNetworks does not have penalties for pre-existing conditions. Also, there are no medical questions that need to be answered.

Call 1-800-540-7566 and speak to the ARHealthNetworks Customer Service staff.