Employee healthcare

Employee healthcare

Arizona State University offers comprehensive medical insurance plans, as well as dental, vision, pharmacy and health spending
accounts. Employees may enroll in these benefits within 30 calendar days of hire, qualified life event or during the annual open enrollment period.

kscheuri Tue, 10/31/2017 - 16:07

Medical plans

Medical plans

ASU offers two medical plan options for 2022. Within 30 calendar days of your eligibility, hire date, a qualified life event or during the annual open enrollment period, you may enroll in one of the two medical plan options. Both medical plans provide the option to choose Blue Cross Blue Shield or United Healthcare medical networks. Please refer to the eligibility and enrollment section for information about coverage effective dates.

2022 medical plan options 

Download details of the Triple Choice Plan and High Deductible Health Plan. These medical plans took effect on Jan. 1, 2021, and will remain the same in 2022.  

2022 medical plan resources

2022 plan year deductibles and copays

Triple Choice Plan and HDHP with HSA out-of-network benefits are subject to reasonable and customary charges as defined by the insurance industry.

 Deductibles as of Jan. 1, 2022
  Triple Choice Plan HDHP with HSA
  Tier 1 in-network Tier 2 in-network Tier 3, out-of-network In-network Out-of-network
Individual $200 $1,000 $5,000 $1,500 $5,000
Family aggregate $400 $2,000 $10,000 $3,000 $10,000
Out-of-pocket maximum as of Jan. 1, 2022
  Triple Choice Plan HDHP with HSA
  Tier 1 in-network Tier 2 in-network Tier 3, out-of-network In-network Out-of-network
Individual $7,350 $7,350 $8,700 $3,500 $8,700
Family aggregate $14,700 $14,700 $17,400 $7,000 $17,400
Office visits - preventative
  Triple Choice Plan HDHP with HSA
  Tier 1 in-network Tier 2 in-network Tier 3 out-of-network In-network Out-of-network
PCP $0 $0 50% after deductible. $0 50% coinsurance after deductible.
OBGYN $0 $0 50% subject to deductible. $0 50% coinsurance after deductible.
Specialist $0 $0 50% after deductible. $0 50% coinsurance after deductible.
Non-preventative services
  Triple Choice Plan HDHP with HSA
  Tier 1 in-network Tier 2 in-network Tier 3 out-of-network In-network Out-of-network
PCP $20 after a deductible. $20 after a deductible. 50% after deductible. 10% coinsurance after deductible. 50% coinsurance after deductible.
OBGYN $20 after a deductible. $20 after a deductible. 50% after deductible. 10% coinsurance after deductible. 50% coinsurance after deductible.
Specialist $40 after a deductible. $40 after a deductible. 50% after deductible. 10% coinsurance after deductible. 50% coinsurance after deductible.
Outpatient services
  Triple Choice Plan  HDHP with HSA
  Tier 1 in-network Tier 2 in-network Tier 3 out-of-network In-network Out-of-network
Ambulance $0 $0 $0 10% coinsurance after deductible. 10% coinsurance after deductible.
ER $200 after deductible.
Fee is waived if admitted.
$200 after deductible.
Fee is waived if admitted. 
$200 after deductible.
Fee is waived if admitted.
10% coinsurance after deductible. 10% coinsurance after deductible.
Urgent care $75 after deductible. $75 after deductible. 50% after deductible. 10% coinsurance after deductible. 50% coinsurance after deductible.
Hospital admissions
  Triple Choice Plan HDHP with HSA
  Tier 1 in-network Tier 2 in-network Tier 3 out-of-network In-network Out-of-network
Admission $250 after deductible. $250 after deductible. 50% after deductible. 10% coinsurance after deductible. 50% coinsurance after deductible.
International coverage
Triple Choice Plan HDHP with HSA
Tier 1 in-network Tier 2 in-network Tier 3 out-of-network In-network Out-of-network
Coverage for emergency services only.
Mammogram - preventative
Triple Choice Plan    HDHP with HSA
Tier 1 in-network Tier 2 in-network Tier 3 out-of-network In-network Out-of-network
$0 $0 50% after deductible. $0 50% coinsurance after deductible.
Durable medical equipment
Triple Choice Plan HDHP with HSA
Tier 1 in-network Tier 2 in-network Tier 3 out-of-network In-network Out-of-network
$0 $0 50% after deductible. 10% coinsurance after deductible. 50% coinsurance after deductible.
Chiropractic - limited to 20 visits-plan year
Triple Choice Plan

HDHP with HSA

Tier 1 in-network Tier 2 in-network Tier 3 out-of-network In-network Out-of-network
$40 after deductible. $40 after deductible. 50% after deductible. 10% coinsurance after deductible. 50% coinsurance after deductible.
Radiology
Triple Choice Plan     HDHP with HSA  
Tier 1 in-network Tier 2 in-network Tier 3 out-of-network In-network Out-of-network
$100 after deductible. $100 after deductible. 50% after deductible. 10% coinsurance after deductible. 50% coinsurance after deductible.
Home health services
Triple Choice Plan HDHP with HSA
  Tier 1 in-network Tier 2 in-network Tier 3 out-of-network In-network Out-of-network
Days during plan year. 42, $0 42, $0 42, 50% coinsurance after deductible. 42 days, 10% coinsurance after deductible. 42 days, 50% coinsurance after deductible.
Bariatric surgery
Triple Choice Plan  HDHP with HSA
Tier 1 in-network Tier 2 in-network Tier 3 out-of-network In-network Out-of-network
20% Not covered. Not covered. 20% coinsurance after deductible. Not covered.
Behavioral health
Triple Choice Plan HDHP with HSA
  Tier 1 in-network Tier 2 in-network Tier 3 out-of-network In-network Out-of-network
Inpatient $250 after deductible. $250 after deductible. 50% after deductible. 10% coinsurance after deductible. 50% coinsurance after deductible.
Outpatient primary care $20 after deductible. $20 after deductible. 50% after deductible. 10% coinsurance after deductible. 50% coinsurance after deductible.
Outpatient specialist $40 after deductible. $40 after deductible. 50% after deductible. 10% coinsurance after deductible. 50% coinsurance after deductible.
asoenair Tue, 10/31/2017 - 16:08

Medical plan premiums

Medical plan premiums

2021-2022 Triple Choice Plan rates per pay period

Coverage level   Employee Employer
Employee only  $26.17 $270.53
Employee, plus spouse $71.49 $557.12
Employee, plus one child $57.30 $362.34
Family $121.61 $630.83


2021-2022 High deductible health plan rates per pay period

Coverage level  Employee Employer, plus HSA
Employee only $10.15, plus HSA $182.68, plus $27.69
Employee, plus spouse $30.46, plus HSA $378.62, plus $55.38
Employee, plus one child $25.89, plus HSA $247.50, plus $55.38
Family $56.35, plus HSA $421.83, plus $55.38

 

twill100 Thu, 05/28/2020 - 16:33

Medical management

Medical management

Case management
This is a collaborative process whereby a case manager from your designated medical management vendor works with you to assess, plan, implement, coordinate, monitor and evaluate the services you may need. Often, case management is used with complex treatments for severe health conditions. The caseworker uses available resources to achieve cost-effective health outcomes for both the member and the medical plans.

Disease management
The purpose of disease management programs is to reach out to you and your dependents who want help managing their health conditions or information about complex or chronic health conditions. The programs are typically designed to improve self-management skills and help make lifestyle changes that promote healthy living. The following disease management programs are available to all members, regardless of their selected networks:

  • Asthma.
  • Chronic obstructive pulmonary disease.
  • Congestive heart failure.
  • Coronary artery disease.
  • Diabetes.
  • Pregnancy-maternity.
     

If you are eligible or become eligible for one of the programs above, a disease manager from your designated medical management vendor will assess your needs and work with your physicians to develop a personalized plan. Your personalized plan will establish goals and steps to help you positively change your specific lifestyle habits and improve your health. Your assigned disease manager may provide the following services:

  • Assist with understanding your doctor’s treatment plan.
  • Help you to maintain your necessary medical tests and annual exams.
  • Offer tips on how to manage stress and help control the symptoms of stress.
  • Provide tips on how to keep your diet and exercise program on track.
  • Review and discuss medications, how they work and how to use them.

Participation is optional, private and tailored to your specific needs. Generally, a disease manager will work with you as quickly or as slowly as you like allowing you to complete the program at your own pace. Over the course of the program, participants learn to incorporate healthy habits and improve their overall health.
 

Medical management services 
When you choose medical coverage, you get more than basic health care coverage. You get personalized medical management programs at no additional cost. Each medical network provides medical management services as follows:

  • American Health Holding serves Blue Cross Blue Shield of Arizona network only.
  • UnitedHealthcare serves only UnitedHealthcare members.

Professional, experienced staff work on your behalf to make sure you are getting the best care possible and that you are properly educated on all aspects of your treatment.

Nurse Line
A dedicated team of physicians, nurses and dietitians are available 24/7 for member consultations. Individuals needing medical advice or who have treatment questions can call the toll-free nurse line:

  • American Health Holding 866-244-8977.
  • UnitedHealthcare 800-401-7396.

Utilization management
AHH  and UnitedHealthcare provide prior authorization and utilization review when members require non-primary care services. Prior to any elective hospitalization and/or certain outpatient procedures, you or your doctor must contact your designated medical management vendor for authorization. Please refer to your plan document for the specific list of services that require prior authorization. Each vendor has a dedicated line to accept calls and inquiries:

  • American Health Holding 866-244-8977.
  • UnitedHealthcare 800-896-1067.
asoenair Thu, 05/28/2020 - 17:01

Medical plan FAQs

Medical plan FAQs

How do I obtain medical ID cards? 

Visit the following carriers online for information about how to obtain your insurance cards. 

  • BCBS of AZ.  If you have a different last name, notify the provider you are covered under the employee listed on the card. Contact BCBS of AZ for confirmation of coverage.
  • UHC

How do names appear on issued medical ID cards?
BCBS of AZ issues two cards in the employee’s name only. Additional cards may be obtained. If the employee requires additional cards then the employee will need to contact BCBS of AZ to request the card. For those with different last names, they will need to notify the provider they are covered under that employee listed on the card and to contact BCBS of AZ for confirmation of coverage.
UHC issues separate cards for the employee and each covered dependent in their names.

How do I change my doctor? 
An employee enrolled in the Triple Choice Plan(TCP) or HDHP with HSA— BCBS of AZ and United Healthcare—has access to any physician in the network without a referral or without having to notify the plan administrator.
 

I am turning 65 in October but still plan to work until January. Should I enroll in Medicare and how does it work?
You can defer enrolling in Part B while you are actively employed. You should apply for Part B three months prior to retiring. The SSA will provide you with a form for your employer to verify that you have been covered by a group medical plan. Fax the form to 480-993-0008. 

asoenair Thu, 05/28/2020 - 17:16

Pharmacy plan

Pharmacy plan

Mail-order pharmacy

You may fill your prescription via the MedImpact mail order service. You must submit a 90-day written prescription along with two copayments using the mail service prescription order form
HSA members: Available only when co-payments apply. 

Other forms and services

  • Prescription mail order fax form
  • Prescription reimbursement form.

Retail pharmacy

If you elect and enroll in any medical plan, MedImpact will be the network of drugstores, supermarkets and discount stores for pharmacy benefits to fill prescriptions at a network pharmacy. You will be required to present your medical card in order to have prescriptions filled. The cost of prescriptions filled out-of-network will not be reimbursed. 

HSA members: Preventive prescriptions have a copay. Nonpreventive prescriptions are subject to a deductible.  

Generic

$15 retail, 30-day supply

$37.50 retail, 90-day supply

$30 mail-order, 90-day supply 

Preferred formulary

$40 retail, 30 day supply

$100 retail, 90 day supply

$80 mail-order, 90 day supply

Nonpreferred, nonformulary

$60 retail, 30 day supply

$150 retail, 90 day supply 

$120 mail-order, 90 day supply

Note: If your doctor prescribes a brand name drug and indicates that the generic equivalent is acceptable, but you decline the generic, you will be responsible for the copay, plus the retail cost of the brand name minus the retail cost of the generic. 

Preventive prescriptions

Some preventive prescriptions will be covered at 100% for the Triple Choice Plan. The HSA will have a copay associated with preventive drugs. Visit MedImpact for details. 

Limited prescription drug coverage

Prescription drug coverage will generally be limited to medications that do not have an equally effective over-the-counter substitute. If traveling outside of the U.S., pharmacy benefit coverage applies only to emergencies on a reimbursement basis.

Noncovered drugs 

Certain medications are not covered as part of the plan. If you find such a drug has been prescribed for you, discuss alternative treatment with your doctor. 

Formulary 

The formulary is the list of medications chosen by a committee of doctors and pharmacists to help you maximize the value of your prescription benefit. Formulary changes can occur during the plan year. Medications that no longer offer the best therapeutic value are deleted from the formulary. Ask your pharmacist to verify the current copay amount when your prescription is filled. Sharing this information with your doctor helps ensure you get the best value, which saves you and your plan money.

  • Preferred Drug List has commonly prescribed medications within select classes of drugs covered on your formulary. The formulary is updated regularly and is subject to change without advance notice.
  • Specialty Drug List is monitored to ensure that employees receive the most clinically effective medications at the lowest cost. The Specialty Drug List is updated regularly and is subject to change without advance notice. All Specialty Drug List medications are provided through a MedImpact Direct Specialty network pharmacy. Members may enroll in services by calling 877-391-1103.
  • Essential Health Benefits List, ACA is in compliance with healthcare reform requirements under the Affordable Care Act, certain preventive medications are covered at zero-copay under the pharmacy benefit as needed. State-specific requirements may vary.
  • HSA Safe Harbor Preventive Drug List is prescribed for people who are at risk for certain diseases but not yet showing signs and symptoms. These are used to prevent a disease or condition, a complication from a disease, or prevent a recurrence of a condition. These drugs are typically not used to treat an existing illness. You will not pay the full cost of these drugs and the copays will not accumulate to meet the HSA deductible. Only the normal flat dollar copay will apply to these drugs as shown in the list.

Medication prior authorization may require clinical approval before it can be filled, even with a valid prescription. These prescriptions may be limited to quantity, frequency, dosage or may have age restrictions. The authorization process may be initiated by you, your local pharmacy, or your physician by calling MedImpact at 888-648-6769. 

Step therapy program promotes the use of safe, cost-effective and clinically appropriate medications. Members use generic, alternative medication that is safe and equally effective before a brand-name medication is covered. Refer to the Formulary Lookup in the MedImpact member portal for a complete list of drugs under this program.

MedImpact member portal benefits

  • Determine drug coverage and obtain a cost estimate for a selected medication. 
  • Find a pharmacy without registration. Select General Pharmacy Locator. 
  • Health tips plus info on diseases and health conditions. 
  • Personal Health Rx® – Print your prescription history for a physician visit or tax reporting. 
  • Pharmacy locator – Find a participating pharmacy near you. 
  • Research more than17,000 medications. 
  • View your current copayment amounts and other pharmacy benefit considerations. 
kscheuri Tue, 10/31/2017 - 16:09

Mayo Clinic medical networks

Mayo Clinic medical networks

One of the advantages of our medical plans is access to the Mayo Clinic, hospital and providers. Under the Triple Choice Plan, each provider may be placed into a different tier by the two networks—Blue Cross Blue Shield or UnitedHealthcare. Here's what you need to understand about this coverage.

Blue Cross Blue Shield 

The Blue Cross Blue Shield network offers all providers in the Mayo Clinic health system in Tier 1 for the TCP Plan. Similarly, all providers in the Mayo system are in-network on the High Deductible Health Plan. The Mayo Clinic health system includes multi-specialty community clinics, physicians, durable medical equipment suppliers, general acute care hospitals and transplant centers.

Some Mayo Clinic physicians have elected not to be shown in the directory and will not appear in a provider search. Most elect not to be shown because they may not be accepting new patients or just want to be assigned patients by the clinic instead of members requesting the provider. These providers are still considered Tier 1 providers. 

UnitedHealthcare 

All Mayo Clinic providers are in-network for the Triple Choice Plan and for the High Deductible Health Plan. However, not all providers are Tier 1 for the TCP.  UHC evaluates physicians individually. Services under the TCP will be processed based on the individual Mayo provider’s tier as indicated on UHC’s website, and will not automatically fall under Tier 1 as was previously communicated. 

General tier information - not Mayo specific

Tier 1 providers and facilities 

These in-network providers and facilities are always considered Tier 1 for both networks:

  • Ambulance services.
  • Behavioral health, mental health and substance abuse services
  • Chiropractors.
  • Emergency room.
  • General acute care hospitals in Arizona.
  • Surgery services that require the use of a Centers of Excellence, UHC, or BlueDistinction Specialty Care, BCBSAZ.
  • Telehealth services or virtual visit providers including Doctor on Demand, Amwell, Teladoc and BlueCare Anywhere.

The websites for both networks show the proper tier status for each provider. If a provider is in Tier 1, the status will not change throughout the calendar year. If during the calendar year, a Tier 2 provider meets the qualifications to become a Tier 1 provider, the status can be updated midyear. 

Both UHC and BCBS have nationwide networks of providers. UHC has designated Tier 1 providers throughout their network. BCBS providers may not have a Tier 1 designation outside of Arizona. If you are looking for a Tier 1 provider for BCBS outside of Arizona, please look for the BlueDistinction Center + symbol as an indicator of the Tier 1 status.

Use the following custom websites and phone numbers for our plans to find a provider:

Blue Cross Blue Shield  or 866-287-1980
UnitedHealthcare or 800-896-1067

Partnership

Arizona State University is pleased to partner with Mayo Clinic to bring its employees options for in-network access to Mayo Clinic’s integrated medical expert teams.

You and your dependents can receive the very best health care from some of the nation’s leading physicians at Mayo Clinic who are contracted with all medical networks – Blue Cross Blue Shield of Arizona and United Healthcare. Mayo Clinic and ASU have developed a strong collaborative partnership over the past several years, working together on a wide range of joint initiatives, including:

  • An ASU Nursing program on Mayo Clinic’s Phoenix campus.
  • Dual degree programs, including M.D., J.D., M.D., MBA and bioinformatics
  • Multiple collaborative research projects

Mayo Clinic is known for its unique, integrated approach, with physicians working together as a team on behalf of patients and their families. Since expanding to Arizona in 1987, Mayo Clinic evolved into the Valley’s premier academic medical center, serving over 100,000 patients each year. Mayo delivers healthcare services in more than 65 medical and surgical specialties, including nationally recognized cancer treatment and organ transplantation programs.

Mayo also has outstanding programs in medical education and research, including clinical trials led by world-class Mayo Clinic investigators that allow eligible participants access to new research treatments in addition to playing an active role in their own healthcare. Mayo Clinic has several facilities located throughout the valley. 

Visit the Mayo Clinic for more information.

Appointments

Call 480-301-8484 or 800-446-2279.

Request an appointment online.
In some cases, your insurance plan will require a physician referral.

Locations

Mayo Clinic Family Medicine | Thunderbird

92nd St. and Thunderbird

  • Cardiac rehab.
  • Newborn and pediatric care.
  • Obstetrical care.
  • Primary care.
  • Women’s health, internal medicine

Mayo Clinic Family Medicine | Arrowhead at 75th and Glendale avenues

  • Anticoagulation monitoring.
  • Laboratory.
  • Newborn and pediatric care.
  • Primary care.
  • X-rays.

Mayo Clinic | Phoenix campus at 56th Street and Mayo Boulevard.

  • Mayo Clinic Hospital, inpatient care.
  • Mayo Clinic Specialty Building, outpatient.

Mayo Clinic | Scottsdale campus at 134th Street and Shea Boulevard.

  • Mayo Clinic Building – outpatient specialty care
  • 240 exam rooms, pharmacy
asoenair Tue, 10/31/2017 - 16:10

Dental plans

Dental plans

Within 30 calendar days of your eligibility-hire date or a qualifying life event or during the annual open enrollment period, you may enroll in one of the two dental plan options. There are two plan types: prepaid-dental health maintenance organization and the indemnity-preferred provider organization.

How to choose the best dental plan for you and your family.

When choosing between a prepaid DHMO plan and an indemnity PPO plan, you should consider the following: Dental history, level of dental care required, costs-budget and provider in the network.

Make sure your current dentist participates in the plan you are considering.

Dental plans

Prepaid-DHMO Plan, Cigna Dental

  • No annual deductible or maximums.
  • No claim forms.
  • Specific copayments for services.
  • Specific lab fees for prosthodontic materials.
  • The dentist you select must participate in the DHMO plan.
  • You must use a participating dental provider to provide and coordinate all of your dental care.

Cigna dental member services 800-244-6224.

Each family member may choose a different general dentist. You can select or change your dentist by visiting the Cigna directory.

Select Find a dentist, choose your location, select Cigna Dental Care HMO plan and select search.
Cigna online registration guide.

Indemnity-PPO Plan, Delta Dental PPO Plus Premier

  • Benefits may be based on reasonable and customary charges.
  • There is a maximum lifetime benefit of $1,500 per person for orthodontia.
  • You may see a licensed dentist anywhere in the world.
  • You have a maximum benefit of $2,000 per person per plan year for dental services. Maximum annual benefit will exclude preventive class — services, which include office visits, oral exams, cleaning, fluoride treatment and X-rays.

Delta Dental claim form 800-352-6132.

More than 85% of Arizona’s licensed dentists participate in the Delta Dental PPO Plus Premier plan and agree to accept Delta’s allowable fee as payment in full after any deductibles or copayments are met. Amounts billed by network providers in excess of the allowable fee will not be billed to the patient.

If you see a non-participating dentist, Delta will still provide benefits, although typically at reduced levels. You may need to submit a claim form for eligible expenses to be paid.

Dental plans comparison

  Cigna Delta Dental
Plan type DHMO PPO
Dental premiums per pay period - 26 pay periods
  Employee Employee
Employee only $1.64 $14.30
Employee plus spouse $3.29 $30.33
Employee plus child $3.08 $23.34
Employee plus family $5.46 $48.26
Plan year deductibles None $50, $100 or $150
Annual combined basic and major services No dollar limit. $2,000 per person.
Orthodontia lifetime No dollar limit. $1,500 per person.
Employee cost for care
Preventive care class one    
Oral exam $0 $0 Deductible waived.
Emergency exam $0 Pain treatment $55 after-hours office visit. $0 Deductible waived.
Prophylaxis-cleaning $0 $0 Deductible waived.
Fluoride treatment $0 $0 to age 18 deductible waived.
X-rays $0 $0 Deductible waived.
Sealants $12 per tooth 20% to age 19
Fillings Amalgam: $0 Resin: $0 20%
Extractions Simple: $12. Surgical: $53 20%
Periodontal gingivectomy $91 for one-three teeth, $180 for four or more teeth 20%
Oral surgery $12 to $850 20%
Crowns $150 to $500 50%
Dentures $680 upper and lower 50%
Fixed bridgework $135 per unit 50%
Crown-bridge repair $43 50%
Implant body $1,025 50%
Orthodontia Coverage for adults and children.
24-month treatment fee. See the charge schedule.
See lifetime.
TMJ exam-services $330 occlusal orthotic device. Not covered.
External bleaching $165 Not covered.

Dental premiums

Delta Dental PPO Plan
  Employee cost per pay period Employee cost monthly Employer cost monthly Total cost monthly
Employee only $14.30 $30.98 $4.96 $35.94
Employee plus spouse $30.33 $65.71 $9.92 $75.63
Employee plus child $23.34 $50.56 $9.92 $60.48
Family $48.26 $104.56 $13.70 $118.26
Cigna Dental DHMO Plan
  Employee cost per pay period Employee cost monthly Employer cost monthly Total cost monthly
Employee only $1.64 $3.56 $4.96 $8.52
Employee plus spouse $3.29 $7.12 $9.92 $17.04
Employee plus child $3.08 $6.67 $9.92 $16.59
Family $5.46 $11.84 $13.70 $25.54

 

Dental plan FAQs

How can I choose the best dental plan for my needs?

When choosing between a prepaid or DHMO plan and an indemnity or PPO plan, consider the following: dental history, level of dental care required, costs and budget and a provider in the network. If you have a preferred dentist, make sure he or she accepts the plan you are considering.

Is my dentist in-network?

Cigna Dental providers are located nationwide.

  1. Visit Cigna and log in. Select Find a Doctor at the top of the screen.
  2. Select: For plans offered through work or school. Choose the Dentist tab.
  3. Enter search location: city, state or zip code.
  4. Select Pick, then select Cigna Dental Care HMO and select Choose.
  5. Review the lists given by specialty or narrow your search by typing in provider name, specialty or office name. You can further refine your search results by selecting the following filters:
    • Distance – Years in practice.
    • Specialty – Additional languages.
  6. Select a dentist’s name for more details. Such as office hours and location listings with map view. Call your current dentist. Your current dentist could be in-network. Call the office and ask if they are contracted in the Cigna Dental HMO network.

PPO Plan | Delta Dental

More than 85% of Arizona’s licensed dentists participate in the Delta Dental Plan and agree to accept Delta’s allowable fee as payment in full after any deductibles or copayments are met. Amounts billed by network providers in excess of the allowable fee will not be billed to the patient.

  • A maximum annual benefit of $2,000 will exclude Preventive Class I services, which include office visits, oral exams, cleaning, fluoride treatments and x-rays.
  • Benefits may be based on reasonable and customary charges.
  • Deductible or out-of-pocket payments apply. 
  • There is a maximum lifetime benefit of $1,500 per person for orthodontia.
  • You have a maximum benefit of $2,000 per person per plan year for dental services.
  • You may see a licensed dentist anywhere in the world.
  • You may need to submit a claim form for eligible expenses to be paid.
  • Visit Delta Dental and set up an ID and password to have access to the Delta online features.

When should I receive my ID card?

New enrollees should receive a card within 10 to 14 business days after the benefits become effective.

The following list of states and territories are not covered under the Cigna DHMO plan: Alaska, Idaho, Maine, Montana, New Hampshire, New Mexico, North Dakota, South Dakota, Puerto Rico, US Virgin Islands, Vermont, West Virginia and Wyoming.

Routine visits, exams and cleanings, and fluoride treatments are covered two times per plan year at 100%. Emergency exams are covered once per plan year at 100%. Bitewing and periapical X-rays are covered once per plan year at 100%.

Subject to both the benefit year allowance and the lifetime maximum limit, $1,000 per tooth. Subject to all provisions, terms and conditions of the plan description.

Visit Cigna fee schedule for details. 

asoenair Tue, 10/31/2017 - 16:11

Vision plans

Vision plans

Within 30 calendar days of your eligibility-hire date, a qualifying life event, or during the annual open enrollment period, you may enroll in the Avesis Advantage Program.

Please refer to the Enrollment and Administration section for information about coverage effective dates.

Avesis Advantage Program

Employees are responsible for the full premium of this voluntary plan.

Program highlights

  • Extensive provider access throughout the state.
  • $750 maximum allowance for LASIK surgery.
  • Hearing discount plan.
  • Increased in-network contact lens allowance.
  • Unlimited discounts on additional optical purchases.
  • Yearly coverage for a vision exam, glasses or contact lenses.

How to use the Advantage Program

Visit Avesis to find a provider. Using in-network providers allows you to maximize your vision care benefit. Next, schedule an appointment with your chosen provider for services and identify yourself as an Avesis member employed by the state of Arizona.

Out-of-network benefits and claim form

If services are received from a non-participating provider, you will pay the provider in full at the time of service and submit a claim to Avesis for reimbursement. The out-of-network claim form and itemized receipt should be sent to Avesis within three months of the date of service to be eligible for reimbursement. The Avesis claim form can be obtained at the website. Reimbursement will be made directly to the member.

Avesis benefits details

In-network benefits
Avesis Vision Plans Advantage Vision Care
Frequency and copay
Examination frequency Once every 12 months
Lenses frequency Once every 12 months
Frame frequency Once every 12 months
Examination copay $10 copay
Optical materials copay - lenses and frames combined $0
Standard spectacle lenses  
Single vision lenses 100% covered
Bifocal lenses 100% covered
Trifocal lenses 100% covered
Lenticular lenses 100% covered
Standard progressive lenses Covered up to $50, plus 20% off retail
Selected lens tints and coatings Up to 20% discount
Frame  
Frame
Covered up to $100 to $150 retail value - $50 wholesale cost allowance

Contact Lenses - in lieu of frame-spectacle lenses
 
Elective 10% to 20% discount and $150 allowance
Medically necessary 100% covered
Lasik-PRK  
Lasik-PRK

$750 maximum allowance for one or both eyes.

This benefit is in addition to the corrective eyewear benefit.

   

 

Out-of-network benefits
Avesis Vision Plans Advantage Vision Care
Frequency and copay
Examination frequency Once every 12 months
Lenses frequency Once every 12 months
Frame frequency Once every 12 months
Examination  Up to $50 reimbursement
Standard spectacle lenses  
Single vision lenses Up to $33 reimbursement
Bifocal lenses Up to $50 reimbursement
Trifocal lenses Up to $60 reimbursement
Lenticular lenses Up to $110 reimbursement
Standard progressive lenses Up to $60 reimbursement
Selected lens tints and coatings No benefit
Frame  
Frame
Up to $50 reimbursement

Contact Lenses - in lieu of frame/spectacle lenses
 
Elective Up to $150 reimbursement
Medically necessary Up to $300 reimbursement
Lasik-PRK  
Lasik-PRK

Up to $750 reimbursement

International coverage Covered as out-of-network. Reimbursed based on the Avesis reimbursement schedule.

 

Vision Premiums

Advantage Vision Care

  Pay Period Monthly
  Employee University Employee University
Employee $1.72 N/A $3.73 N/A
Employee and spouse $5.70 N/A $12.35 N/A
Employee and one child $5.65 N/A $12.24 N/A
Family $7.11 N/A $15.41 N/A

 

asoenair Tue, 10/31/2017 - 16:12

Health care accounts

Health care accounts

Enroll in one of three health care accounts within 30 calendar days of your eligibility or hire date or a qualifying life event or during the annual open enrollment period.

  • Health care flexible spending account.
  • Optum health savings account.
  • Limited health care flexible spending account.

You contribute on a pre-tax basis and then reimburse yourself on a tax-free basis for eligible expenses. Refer to the eligibility and enrollment section of the benefits guide for details about coverage effective dates.

Note: In order to enroll in the HSA Option, you must elect the High Deductible Health Plan medical plan. If you are an HSA option medical plan participant, your FSA election is limited to a limited health care flexible spending account for dental and vision expenses only. The IRS will not allow the submission of the same eligible expenses to both an HSA and a Health care FSA in the same plan year.

asoenair Tue, 10/31/2017 - 16:13

Flexible spending account

Flexible spending account

Health care flexible spending account and limited health care flexible spending account 
An FSA allows you to use pre-tax dollars for health care expenses not covered by your insurance. It reduces your taxable income, which saves you money. Eligible health care expenses can be reimbursed by submitting claims and supporting documentation to the claims administrator, ASIFlex. Some health care expenses can be paid at the point of service with an ASIFlex-issued debit card.  More information on the debit card and documentation requirements can be found on the ASIFlex Debit Card website.

New enrollment is required each year during the annual open enrollment period for the next calendar plan year, January to December. If you elect a limited health care flexible spending account, reimbursement is restricted to dental and vision expenses.

Contribution limits

  • You may contribute up to $2,750 to pay uninsured, eligible health care expenses for both you and your tax-qualified dependents each calendar year, January to December.
  • If you and your spouse both work and a plan is offered by both employers, you can each contribute $2,750.
  • If you contributed to another employer’s FSA during the calendar year, you may contribute up to $2,750 through ASU’s plan. Please note: your contributions cannot exceed $2,750 for the calendar year.  

Use-it-or-lose-it-rule

Any unused balance remaining in the participant’s FSA at the end of the 2020 and 2021 plan years will be carried over to the succeeding plan year for reimbursement of medical care expenses incurred during the subsequent plan year.

Participants should estimate their expenses carefully using ASIFlex’s tax savings calculator. Claims must be submitted by April 30 each year for expenses incurred in the previous calendar year, FSA eligible expenses. 

Employment ineligibility or separation

If you become ineligible during the plan year, your deductions and participation will cease. Your last deduction will be withheld from the paycheck issued for the pay period in which you became ineligible. Claims for eligible expenses incurred during the plan year must be submitted by April 30, following the end of the plan year.

FSA resources 

kscheuri Fri, 05/22/2020 - 16:33

Health savings account

Health savings account

Optum health savings account

HSA monies are used to pay uninsured health care expenses for you and your tax-qualified dependents using a debit card. Fees may apply for using the savings account. Optum is required under Section 326 of the USA Patriot Act to confirm some of your personal information to establish your account.

If you misplace or did not receive your welcome packet, enroll online. Select Open an HSA at the top of the webpage. Call Optum Bank at 866-610-4839 for any additional assistance. The group number is A04791AS. 

Eligible participants can enroll, increase, decrease or stop contributions to their health savings account at any time by submitting a completed HSA payroll deduction authorization form to HR benefits online or fax the form to 480-993-0007. The annual election amount remains in effect until a new HSA payroll deduction authorization form is completed and submitted to HR Benefits. HSA funds roll over from year-to-year. 

Contributions and annual election amounts are as follows below:  

  • Participants cannot have any health insurance other than an HDHP to be able to contribute pre-tax dollars to their HSA.
  • Participants no longer can contribute pre-tax dollars to their HSA if enrolled in Medicare part A or B.
  • Participants may continue to withdraw funds from their HSA to help pay for medical expenses after enrollment in Medicare. 
  • Payroll-deducted contributions are withheld on a pre-tax basis and will be effective on the first day of the pay period following receipt of the completed form.
  • The contribution remains in effect until a new authorization is received or until coverage in the High Deductible Health Plan medical plan ends.
  • The annual election amount is divided by the number of biweekly pay dates in the calendar year. If effective the first pay period that ends in January, the amount is divided by 26.
  • For faculty paid more than nine months during an academic year, no contributions are made during the summer. Upon return to work during the fall, the annual election remaining balance is divided by the number of pay dates remaining in the calendar year.

Contributions limits

Annual contribution limits are established every year by the IRS based on the HSA medical option plan level of coverage. It is each participant’s responsibility to manage contributions in accordance with federal guidelines to ensure that contributions do not exceed the limits.

2022 HSA IRS annual maximum contributions University annual mandatory contributions Employee annual voluntary contributions under 55 years old Employee annual voluntary contributions age 55 or older - additional $1,000
Single coverage: $3,650 Up to $720 Up to $2,930 Up to $3,930
Non-single coverage $7,300 Up to $1,440 Up to $5,860 Up to $6,860
2021 HSA IRS annual maximum contributions University annual mandatory contributions Employee annual voluntary contributions under 55 years old Employee annual voluntary contributions age 55 or older - additional $1,000
Single coverage: $3,600 Up to $720 Up to $2,880 Up to $3,880
Non-single coverage $7,200 Up to $1,440 Up to $5,760 Up to $6,760
asoenair Fri, 05/22/2020 - 16:45