Medical plans

ASU offers two medical plan options for 2023-24. 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.

Medical plan options 

Download details of the 2023 Plan year Triple Choice Plan and High Deductible Health Plan

Download details of the 2024 Plan year Triple Choice Plan and High Deductible Health Plan.

2023-24 medical plan resources

2023–24 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.

 Annual deductibles
  Triple Choice Plan HDHP with HSA
  Tier 1 in-network Tier 2 in-network Tier 3, out-of-network In-network
2023
In-network
2024
Out-of-network
Individual $200 $1,000 $5,000 $1,500 $1,600 $5,000
Family aggregate $400 $2,000 $10,000 $3,000 $3,200 $10,000
Annual out-of-pocket maximum
  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.

Book traversal links for Medical plans