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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

2018 Rates

Imputed Income for Non-Tax-Qualified Dependents

Contact Information: University of Arizona Alternative Plans
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 Jeff Griffin at (480) 257-1501 or

Medical Insurance

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.

UA Alternative Plan (Domestic Partners) Medical Copays, 2018
Service 2018
Routine Preventive Health Care $0
Office Visit
 - Primary Care Physician (PCP) $20
 - Therapist (occupational, physical, respiratory, speech) $20
 - Chiropractor $20
 - Other Specialist $40
Hospital & Outpatient Services
 - Urgent Care $75
 - Emergency Room $200
 - Radiology (CAT, MRI, PET) $100
 - Outpatient Services $50
 - Inpatient Hospital Services $250


UA Alternative Plan (Domestic Partners) Prescription Drug Copays, 2018

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

Medical Plan Information

Certificate of Coverage

Summary of Benefits and Coverage Nondiscrimination Addendum

Prescription Drug List

2018 United Healthcare Choice HMO Summary of Benefits and Coverage

Provider Search: Select “United Healthcare Choice Plus” as your plan.

Dental Insurance

The UA Alternative Dental Plan offers a choice of coverage through Total Dental Administrators or Delta Dental.

Dental Plan Comparison

Total Dental AdministratorsPre-Paid Plan

  • Restricted to selected Primary Dental Providers
  • Reduced costs for services (co-payments)

Total Dental Administrators Plan Summary

Total Dental Administrators Plan Summary Amendment 1

Total Dental Administrators Plan Summary Amendment 2

Provider Search

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.

Delta Dental Summary of Benefits

Provider Search

Vision Insurance

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.

Plan Summary

Provider Search