As a new retiree, retired member, or as an eligible surviving spouse of the System, you have healthcare coverage options available to you; see Option 1 to 3, as applicable, under Choosing Coverage below. You may also be entitled to a Premium Benefit (Subsidy), which is the portion of the medical or dental coverage (vision coverage cannot be subsidized) that the System will pay, based on your elections and coverage level. However, if your monthly insurance premium(s) is less than your eligible subsidy, we can only subsidize up to the premium amount (you do not receive the difference of the subsidy). If you are eligible for coverage under Option 1 or 3 stated below, under most circumstances (depending what is allowed by the employer or ADOA), we may be able to offset your medical and/or dental monthly premium(s) by the subsidy.
Retired members and survivors that are currently receiving a monthly retirement benefit (not deferred annuity) from the System will receive an open enrollment packet in approximately October of each year and it is during this time that you may elect coverage; however, it is very important that you review this packet each year to familiarize yourself with any plan changes or requirements. Members may also make changes during the plan year due to a “qualifying event.” To understand what is considered a qualifying event and the timeframe to make these changes, refer to the Guide Book provided in Option 2.
Option 1) As a new retiree, retired member, or surviving spouse, the employer you retired from may offer retiree or Cobra coverage; please contact your employer for cost and plan coverages. If you elect this option, premiums may be deducted directly from your monthly retirement payments, less the subsidy, or the subsidy may be sent to your employer, but the employer will direct the System how to apply your premiums and subsidy by completing the ER SUB Form.
Option 2) The System does not administer a group insurance plan; however, the System utilizes the group insurance program provided by the Arizona State Retirement System (ASRS). To learn more about these plans, please visit the ASRS website here. However, the Enrollment Forms and questions regarding the insurance deductions will need to be directed to our office; please Contact Us. Should you choose this option, the premiums, less the subsidy, will be deducted from your monthly retirement payment. If your premiums exceed your monthly retirement payments, you will be billed for the premiums, less the applicable subsidy.
Enrollment Forms and Guides
INSTRUCTIONS to complete 2019 Medical and Dental Enrollment Forms
Provider Contact Directory
If you elect a medical plan that requires you to select a medical provider, please visit the ASRS website here. If you elect a dental plan that requires you to select a dentist, please visit the Sun Life Financial (fka Assurant) website here.
Certificate of Coverage and Evidence of Coverage
For the Non-Medicare Choice and Navigate Plans Certificate of Coverage (COC) and Summary of Benefits, please visit the ASRS website here.
For the Medicare Group Medicare Advantage HMO plan Evidence of Coverage (EOC) (be sure to select the PSPRS plan) and the Medicare Senior Supplement plan Certificate of Coverage (COC), please visit the ASRS website here.
Formularies for Prescription Drugs
For the Non-Medicare plans, members may visit the UHC website at www.myuhc.com. If you are a non-member and need assistance, please contact our office.
For the Medicare plans, members and non-members may visit the UHC website at www.uhcretiree.com/asrs (use ASRS as a PSPRS retiree).
Timeframe to Make Elections Under Option 2
If you are eligible and you elect medical or dental insurance under Option 2, you may return the enrollment form(s) provided by the PSPRS by mail, fax, or scan/email the enrollment form(s) to the System (it is not required to mail the originals).
Medical enrollment form must be received no later than the 10th of the effective month of the qualifying event.
Medical enrollment form and copy of your Medicare card showing Parts A and B are required to be received by our office by no later than the last business day of the month prior to your effective month.
Option 3) If you currently have active insurance through the Arizona Department of Administration (ADOA), or if you are retiring from the EORP, you may elect retiree insurance through ADOA. Please note that if you do not elect medical or dental insurance through ADOA at the time of your retirement and in accordance to ADOA’s enrollment timelines, or in the future you cancel both medical and dental coverage(s) with ADOA, you will permanently cancel all future insurance options with ADOA. We can deduct the premiums (less the subsidy) from your retirement payments, or we can direct the subsidy to ADOA to offset your premiums costs. ADOA will instruct our office how this will be handled. To view these plans, contact ADOA at www.benefitoptions.az.gov, or (602) 542-5008, option 2.
If your medical and/or dental coverage is under Option 2 and, at any time during the plan year, if you would like to cancel either coverage, you will need to provide a letter to the System to cancel your election(s). The letter will need to specifically state that you would like to cancel your medical and/or dental insurance and the date in which you want the coverage to end - take into consideration that that the System issues benefit payments at the end of the month (e.g., if a retirement payment is dated December 31, that payment represents the December 1 check). The letter will also need to include your identifying information such as your name, address, last four of your social security number, phone number(s) and your signature (we cannot accept an electronic signature). If your spouse was receiving medical coverage from your account under a medicare supplement plan, it is required that your spouse sign the letter. This letter must be received prior to the 1st of the effective month and may be sent by mail, fax, or scan/email.
If your medical and/or dental coverage is under Options 1 or 3, you will need to contact the applicable agency to request the cancellation. In turn, the agency will notify the System of your cancellation and your benefit payments will be updated, as applicable.
As part of your benefits, the System provides a health insurance premium benefit (commonly referred to as insurance subsidy), which is provided to you to supplement the cost of your medical and/or dental insurance. The amount of the subsidy that you are eligible to receive is based on the coverage level (single or family coverage), Medicare eligibility and, in some cases, your years of service credit. To receive this benefit, you must be participating in an insurance plan administered by your former employer, the ASRS, or ADOA.
Premium Benefit Amounts
|Without Medicare||With Medicare A & B||Retiree & Dependents|
|Years of Service||Retiree Only||Retiree & Dependents||Retiree Only||Retiree & Dependents||Retiree & Dependents One with Medicare, the other(s) without||Retiree & Dependents with Medicare, other dependents without|
|Arizona State Retirement System (ASRS) Members|
|5.0 - 5.9||$75.00||$130.00||$50.00||$85.00||$107.50||$107.50|
|6.0 - 6.9||$90.00||$156.00||$60.00||$102.00||$129.00||$129.50|
|7.0 - 7.9||$105.00||$182.00||$70.00||$119.00||$150.50||$150.50|
|8.0 - 8.9||$12.00||$208.00||$80.00||$136.00||$172.00||$172.00|
|9.0 - 9.9||$135.00||$234.00||$90.00||$153.00||$193.50||$193.50|
|Elected Officials’ Retirement Plan (EORP) Members|
|5.0 - 5.9||$90.00||$126.00||$60.00||$102.00||$129.00||$129.00|
|6.0 - 6.9||$112.50||$195.00||$75.00||$127.50||$161.25||$161.25|
|7.0 - 7.9||$135.00||$234.00||$90.00||$153.00||$193.50||$193.50|
|Corrections Officer Retirement Plan (CORP) Members|
|Public Safety Personnel Retirement System (PSPRS) Members|
Additional Insurance Information
Combination of Options as a new retiree and retired member, as applicable: If you would like medical insurance from one agency and dental from another, you may elect those options, but you will need to complete the appropriate forms and return it to the applicable agency.
Dual Retiree: If you are retired from another state retirement system (ASRS, PSPRS, CORP or EORP), or plan to retire from another state retirement system in the future, contact our office because you may qualify for a subsidy from both retirement plans.
Return to Work: If you return to work with a PSPRS employer, your former employer, or through a PSPRS employer that utilizes Arizona Department of Administration (ADOA) insurance, and you meet the return to work guidelines, we may be able to apply the subsidy to your active medical and/or dental coverage. However, new members with (or a survivor of the system whose deceased spouse has) a membership (hire) date on/after September 13, 2013 will not be eligible for the Premium Benefit when they retire and if they become re-employed with a PSPRS employer and participate in active health care coverage provided by the members or survivors PSPRS employer. Contact our office to assist in this process.