UNIVERSITY OF ARIZONA ALTERNATIVE HEALTH PLANS
You must complete a Domestic Partner Affidavit to enroll a domestic partner. If you wish to enroll a child of your domestic partner, you must first enroll your domestic partner. You must then complete a Child of Domestic Partner Declaration for each child you enroll.
Health Plans General Information
|Provider||Customer Service||Group Number|
|United Healthcare||(800) 357-0971||730610|
|Delta Dental Plan of Arizona||(800) 352-6132||4602|
|Total Dental Administrators||(888) 422-1995||680110|
|Avesis, Inc.||(800) 828-9341||1101-2182|
General questions or requests for assistance can be directed to Ginnet Ahumada at (480) 257-1524 or GAhumada@griffinbenefits.com.
The UA Alternative Medical Plan is a United Healthcare HMO. If you elect this plan, OptumRx will be the provider for pharmacy benefits. Enrollment is automatic.
Annual Deductible: $200/couple or family
|Routine Preventive Health Care||$0|
|- Primary Care Physician (PCP)||$20|
|- Mental Health Provider||$20|
|- Therapist (occupational, physical, respiratory, speech)||$40|
|- Other Specialist||$40|
|Hospital & Outpatient Services|
|- Urgent Care||$75|
|- Emergency Room||$200|
|- Radiology (CAT, MRI, PET)||$100|
|- Outpatient Services||$50|
|- Inpatient Hospital Services||$250|
|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|
Prescription Drug List - See Advantage 3 Tier
Provider Search: Select “United Healthcare Choice Plus” as your plan.
Total Dental Administrators—Pre-Paid Plan
- Restricted to selected Primary Dental Providers
- Reduced costs for services (co-payments)
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.
The UA Alternative Vision Plan is offered through Avesis
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.