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Non-Medicare Plan Documents

2026 Legal Notices

(jump to 2025 Legal Notices)

TITLEDESCRIPTION2026
Summary of Benefits and Coverage (SBC) & Uniform GlossaryAs 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
Summary Plan DescriptionThe 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
Summary Plan DescriptionThe 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
Summary Plan DescriptionThe 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
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: May 2026

Archived Prescription Drug List (PDL)History of prior Prescription Drug Lists (PDL). January 2026
September 2025
May 2025
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) OfferYou 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 CoverageIf 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 CoverageUnitedHealthcare 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 NoticeThis notice informs members of their nondiscrimination rights and how to request language assistance.Nondiscrimination and Languages and Accessibility Notices Document


2025 Legal Notices

TITLEDESCRIPTION2025
Summary of Benefits and Coverage (SBC) & Uniform GlossaryAs 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
Summary Plan DescriptionThe 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
Summary Plan DescriptionThe 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
Summary Plan DescriptionThe 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
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: September 2025
Archived Prescription Drug List (PDL)History of prior Prescription Drug Lists (PDL).May 2025
January 2025
September 2024
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.2025
Medicaid and the Children’s Health Insurance Program (CHIP) OfferYou 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.2025
Medicare Notice of Creditable CoverageIf 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.2025
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.2025
No Surprises Act (Consolidated Appropriations Act of 2021)This notice describes your rights and protections against surprise medical bills.2025
Transparency in CoverageUnitedHealthcare 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 NoticeThis notice informs members of their nondiscrimination rights and how to request language assistance.Nondiscrimination and Languages and Accessibility Notices Document
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