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
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.
Learn more by reviewing this Imputed Income flyer (PDF).
|Provider||Customer Service||Group Number|
|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 the help line at (877) 481-6781 or Ginnet Ahumada at GAhumada@griffinbenefits.com.
The UA Alternative Medical Plan is a UnitedHealthcare HMO. If you elect this plan, OptumRx will be the provider for pharmacy benefits. Enrollment is automatic.
Annual Deductible: $400/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|
Provider Search: Select “UnitedHealthcare 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.