You must complete a Domestic Partner Affidavit to enroll a domestic partner. If you wish to enroll your domestic partner's child, you must first enroll your domestic partner. You must then complete a Child of Domestic Partner Declaration for each child you enroll.
Plan Documents
Imputed Income
Dependents you cannot claim on your federal income tax return are referred to as “non-tax-qualified dependents.” The IRS considers the University’s contribution toward insurance coverage for a non-tax-qualified dependent (such as a domestic partner or the child of a domestic partner) as your imputed income.
Imputed income increases your taxable gross income and is subject to federal and state income taxes and FICA (Social Security and Medicare) taxes.
Medical Insurance
The UA Alternative Medical Plan is a UnitedHealthcare HMO. If you elect this plan, OptumRx will be the provider of pharmacy benefits. Enrollment is automatic.
Medical Plan Documents
- Certificate of Coverage (PDF)
- Prescription Drug List (PDF)
- Summary of Benefits and Coverage Nondiscrimination Addendum (PDF)
- Provider Search
Annual Deductible: $400/couple or family
UA Alternative Plan (Domestic Partners) Medical Copays, 2024
UA Alternative Plan (Domestic Partners) Prescription Drug Copays
| Quantity | Generic | Preferred Brand Name | Non-Preferred Brand Name |
|---|---|---|---|
| Retail 30 Days | $10 | $35 | $60 |
| Retail 90 Days | N/A | N/A | N/A |
| Mail Order 90 Days | $25 | $87.50 | $150 |
Save Money with Virtual Visits!
UnitedHealthcare offers a telehealth app designed to diagnose and treat minor medical conditions. You can access a physician using your computer or smartphone for a free real-time consultation (prescriptions have the normal copay). To learn more, log into myuhc.com or the UnitedHealthcare Health4Me app available from Google Play or the Apple App Store. You can also call the phone number on the back of your insurance card for assistance.
Dental and Vision Insurance
Delta Dental—Preferred Provider Organization (PPO)
- May see any licensed dentist
- Preventive services not subject to annual deductible
- Restorative services subject to annual deductible, then plan pays a percentage of post-deductible expenses for basic and major restorative services.
Additional Information
Avesis Vision Insurance
You may choose from a participating network provider or non-provider.
- Participating network providers are contracted with Avesis to provide services at a reduced rate for Avesis members.
- Co-payments, deductibles, or coinsurance fees may be charged when services are used.
- When using out-of-network providers, you must pay the provider and submit an itemized statement to Avesis for reimbursement of covered expenses.
Additional Information
Contact Information
| Provider | Customer Service | Group Number |
|---|---|---|
| UnitedHealthcare | 866-633-2446 | 730610 |
| Delta Dental Plan of Arizona | 800-352-6132 | 4602 |
| Avesis, Inc. | 800-828-9341 | 1101-2182 |