Non-Medicare Plan Documents
2027 Legal Notices
| TITLE | DESCRIPTION | 2027 | |
| Summary of Benefits and Coverage (SBC) | The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered healthcare services. |
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| Summary Plan Description | The summary plan description (SPD) is an important document that tells participants what the plan provides and how it operates. It provides information on when a member can begin participating in the plan and how to file a claim for benefits. | Coming Soon | |
| Summary Plan Description | The summary plan description (SPD) is an important document that tells participants what the plan provides and how it operates. It provides information on when a member can begin participating in the plan and how to file a claim for benefits. | Coming Soon | |
| Prescription Drug List (PDL) | The easiest way to find out if a prescription is covered is to check the Prescription Drug List (PDL) — which takes the most commonly prescribed medications and organizes them into cost tiers. | Prescription Drug List | |
| Notification of Rights Under the Women’s Health and Cancer Rights Act (WHCRA) | This notice describes mandated benefits for mastectomy-related services and informs individuals that services are available for such treatment and services, including reconstructive surgery, prosthesis, and lymphedema treatment, and explains how to obtain a detailed description of the mastectomy-related benefits under the Plan. | 2027 | |
| Medicaid and the Children’s Health Insurance Program (CHIP) Offer | You may be eligible for State assistance paying ASRS’ healthcare premiums for eligible family member(s). If you or a covered family member(s) are eligible or enrolled in Medicaid, this Notice provides the contact information for program(s) in your State. | 2027 | |
| Medicare Notice of Creditable Coverage | If you or a covered family member(s) are eligible for Medicare Parts A, B, C, and D, this Notice provides information to help you decide whether to join Medicare’s drug plan or remain on an ASRS plan. Because ASRS’ prescription coverage is Creditable Coverage, if/when Medicare Part D is elected, there will be no higher premium (penalty) charged. | 2027 | |
| Health Insurance Portability and Accountability Act (HIPAA) | This notice protects the privacy of individually identifiable health information and establishes who can use personal health information and how it can be used. | 2027 | |
| No Surprises Act (Consolidated Appropriations Act of 2021) | This notice describes your rights and protections against surprise medical bills. | 2027 | |
| Transparency in Coverage | UnitedHealthcare creates and publishes the Machine-Readable Files on behalf of The Arizona State Retirement System. | To link to the Machine-Readable Files, please click here | |
| Nondiscrimination and Languages and Accessibility Notice | This notice informs members of their nondiscrimination rights and how to request language assistance. | Link to Nondiscrimination and Languages and Accessibility Notices Document | |
2026 Legal Notices
| TITLE | DESCRIPTION | 2026 | |
| Summary of Benefits and Coverage (SBC) & Uniform Glossary | As part of the Affordable Care Act (ACA), the federal government announced new rules regarding the disclosure of the Summary of Benefits and Coverage (SBC) and Uniform Glossary. These regulations require group health plans and health insurance issuers that offer coverage for groups and individuals to provide access to the SBC and Uniform Glossary. | Summary of Benefits & Coverage page | |
| Summary of Benefits and Coverage (SBC) | The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered healthcare services. |
Choice Premier Choice Value Choice Economy |
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| Summary Plan Description | The summary plan description (SPD) is an important document that tells participants what the plan provides and how it operates. It provides information on when a member can begin participating in the plan and how to file a claim for benefits. | Choice Premier Choice Premier Combo |
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| Summary Plan Description | The summary plan description (SPD) is an important document that tells participants what the plan provides and how it operates. It provides information on when a member can begin participating in the plan and how to file a claim for benefits. | Choice Value Choice Value Combo |
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| Summary Plan Description | The summary plan description (SPD) is an important document that tells participants what the plan provides and how it operates. It provides information on when a member can begin participating in the plan and how to file a claim for benefits. | Choice Economy Choice Economy Combo |
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| Prescription Drug List (PDL) | The easiest way to find out if a prescription is covered is to check the Prescription Drug List (PDL) — which takes the most commonly prescribed medications and organizes them into cost tiers. | Current PDL: January 2026 Upcoming New PDL: May 2026 |
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| Archived Prescription Drug List (PDL) | History of prior Prescription Drug Lists (PDL). | September 2025 May 2025 January 2025 |
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| Notification of Rights Under the Women’s Health and Cancer Rights Act (WHCRA) | This notice describes mandated benefits for mastectomy-related services and informs individuals that services are available for such treatment and services, including reconstructive surgery, prosthesis, and lymphedema treatment, and explains how to obtain a detailed description of the mastectomy-related benefits under the Plan. | 2026 | |
| Medicaid and the Children’s Health Insurance Program (CHIP) Offer | You may be eligible for State assistance paying ASRS’ healthcare premiums for eligible family member(s). If you or a covered family member(s) are eligible or enrolled in Medicaid, this Notice provides the contact information for program(s) in your State. | 2026 | |
| Medicare Notice of Creditable Coverage | If you or a covered family member(s) are eligible for Medicare Parts A, B, C, and D, this Notice provides information to help you decide whether to join Medicare’s drug plan or remain on an ASRS plan. Because ASRS’ prescription coverage is Creditable Coverage, if/when Medicare Part D is elected, there will be no higher premium (penalty) charged. | 2026 | |
| Health Insurance Portability and Accountability Act (HIPAA) | This notice protects the privacy of individually identifiable health information and establishes who can use personal health information and how it can be used. | 2026 | |
| No Surprises Act (Consolidated Appropriations Act of 2021) | This notice describes your rights and protections against surprise medical bills. | 2026 | |
| Transparency in Coverage | UnitedHealthcare creates and publishes the Machine-Readable Files on behalf of The Arizona State Retirement System. | To link to the Machine-Readable Files, please click here | |
| Nondiscrimination and Languages and Accessibility Notice | This notice informs members of their nondiscrimination rights and how to request language assistance. | Nondiscrimination and Languages and Accessibility Notices Document | |