ARBenefits User Manual
Contents
1. ARBenefits User Manual How to Use the Online Declination Form Created February 16 2006 Declination Form The ARBenefits Declination Form is used to enter new and existing members into ARBenefits who are declin ing benefit coverage The Declination Form link can be found from your ARBenefits Home Page under Manage Benefits Web Forms and Reports Declination Form Key points to remember about the Declination Form The Declination Form is only available to existing employees during your agency district s enrollment period The Declination Form is available at all times to new employees who are not already in ARBenefits Employees who are already in ARBenefits have access to their own version of the online form but declination information will not go into the system until you the representative have approved it You as a representative can give new employees access to their online forms by using the Member Pre Qualification Form If an employee experiences a qualifying event and chooses to cancel coverage the Change Form must be used ARBenefits User Manual Declination Form Page 1 of 11 Declination Form Search Screen Once you have selected the Declination Form you will arrive at the screen below To Decline Coverage for a New Hire e Enter the social security number in the SS text box e Click the Search button Note Group ID should display your group ID number If you are a representative for mo2. effective Note Employee is not required but available to use for your record e Click the Approve button ARBenefits User Manual Declination Form Page 3 of 11 Declination Form Printing the Form Approval completed successfully gt gt Print a copy of the Declination Form gt gt Back to Enrollment Form list gt gt Decline a new member This is the message you should see after approving a form You have the option of printing the form going back to the Enrollment Form pending list forms that have been saved but not approved or enrolling a new member ARBenefits User Manual Declination Form Page 4 of 11
3. re than one group you will need to change the Group ID to the group you are enrolling the member in by clicking on the washboard icon and selecting the appropriate group To Decline Coverage for an Existing Member during Open Enrollment Enter any of the following fields e Click the Search button Note Group ID should display your group ID number If you are a representative for more than one group you would need to change the Group ID to the group in which the member belongs to by clicking on the washboard icon and selecting the appropriate group Declination Form Member Search 5S Member ID Last Name First Name Group Id Es co ARBenefits User Manual Declination Form Page 2 of 11 Declination Form Employee Information Screen z Family ID 999786624 Declination Form uik Last Name Date of Birth mmiddiyyyy First Name Gender Male Female Middle hiia Marital Status Single Married Address Group Name STATE HWY amp TRANSPORTATION DEPT Employee cp SS Y Hire Date T imm ddiyyyy State Arkansas gt eae ae Zip Code mmiddiyyyy i Print Name Home Phone Work Phone Approve This is the first and only page of the Declination Form The social security number displays at the top labeled Family ID Enter employee information in all available fields o Effective Date is the date enrollment in the plan will become
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