2018 Plan Materials

(Coverage Year: January 01, 2018 to December 31, 2018) 

As a member of University Care Advantage (UCA), you will find documents and links below to provide you with information related to your benefits and the health plan.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. 


2018 Annual Notice of Changes

The Annual Notices of Changes (ANOC) booklet tells about the changes between plan benefit years 2017 and 2018. Please select your county below to review changes to plan benefits.

Documents by County

Cochise County English Español
Gila County  English Español
Graham County English Español
Greenlee County English Español
La Paz County English Español
Pima County English Español
Pinal County English Español
Santa Cruz County English Español
Yavapai County English Español
Yuma County English Español

2018 Evidence of Coverage

This booklet gives you the details about your Medicare and Arizona Health Care Cost Containment System or AHCCCS (Medicaid) health care and prescription drug coverage from January 1, 2018 – December 31, 2018. It explains how to get coverage for the health care services and prescription drugs you need. This is an important legal document.

Evidence of Coverage Documents (By County)

Medicare Special Needs Plans and Medicaid/AHCCCS (Acute)*

Cochise/Gila/Graham/Greenlee/La Paz Counties English Español
Pima County English Español
Pinal County English Español
Santa Cruz/Yavapai/Yuma Counties English Español

Medicare Special Needs Plans and Medicaid/AHCCCS (Arizona Long Term Care)*

Cochise/Gila/Graham/Greenlee/La Paz Counties English Español
Pima County English Español
Maricopa and Pinal Counties English Español
Santa Cruz and Yuma Counties English

Español

 *Addendum to your Evidence of Coverage and Summary of Benefit Booklets

Includes the following updates from Medicare:

  • Medicare Diabetes Prevention Program (MDPP) Services
  • Medicare Premium and Cost Sharing Amounts: Changes from 2017 to 2018

Addendum English  Español


2018 Drug Formulary (Comprehensive)

(Coverage Year: January 01, 2018 to December 31, 2018)

The drug formulary contains information about the drugs we cover in this plan.

A drug formulary is a list of covered medications selected by University Care Advantage in consultation with a team of health care providers. The drug formulary represents the prescription therapies believed to be a necessary part of a quality treatment program. 

Our plan will usually cover the drugs listed in our formulary as long as the drug is medically necessary. The prescription is filled at a University Care Advantage network pharmacy, and other plan rules are followed.

You must generally use network pharmacies to use your prescription drug benefit. Benefits, formulary, pharmacy network, and/or co-payments/co-insurance may change on January 1, 2018, and from time to time during the year.


Related Documents

Comprehensive Drug Formulary (May 2018)

(Updated 4/02/2018; Effective 5/01/2018)

English

Español

Prior Authorization Criteria (May 2018)

(Updated 4/02/2018; Effective 5/01/2018)

English

 

 

Step Therapy Criteria (May 2018)

(Updated 4/02/2018; Effective 5/01/2018)

English

 

Future Formulary Changes (May 2018)

(Updated 2/01/2018; Effective 5/01/2018)

Future Formulary Changes (June 2018)

(Updated 3/01/2018; Effective 6/01/2018)

Future Formulary Changes (July 2018)

(Updated 4/02/2018; Effective 7/01/2018)

 English

 

English

 

English




 

2018 Provider and Pharmacy Directory

You can find a network provider and/or pharmacy by using our online, searchable directories by using the links below. Our most current version of providers and pharmacies will always be updated online. 


The print version of the directory was last updated on 8/01/2017. To access the most recent version of providers, please use the links above. 

 If you would like a Provider and Pharmacy Directory mailed to you, or if you need help finding a network provider and/or pharmacy, please call our Customer Care Center. You may also email your request for the directory at UAHPRequests@bannerhealth.com


2018 Summary of Benefits

This is a summary of drug and health services covered by University Care Advantage (HMO SNP) January 1, 2018 to December 31, 2018. The benefit information provided is a summary of what we cover and what you pay. It does not list every service that we cover or list every limitation or exclusion. To get a complete list of services we cover, see the “Evidence of Coverage.”

This information is not a complete description of benefits. Contact the plan for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

You must continue to pay your Medicare Part B premium. The monthly Part B premium is paid for by State in some cases. Your cost-sharing is determined by your level of Medicaid eligibility.

Premium, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.

Summary of Benefits Documents (By County)

Medicare Special Needs Plans and Medicaid/AHCCCS (Acute)*

Cochise/Gila/Graham/Greenlee/La Paz Counties English Español
Pima County English Español
Pinal County English Español
Santa Cruz/Yavapai/Yuma Counties English Español

Medicare Special Needs Plans and Medicaid/AHCCCS (Arizona Long Term Care)*

Cochise/Gila/Graham/Greenlee/La Paz Counties English Español
Pima County English Español
Maricopa and Pinal Counties English Español
Santa Cruz and Yuma Counties English Español

 *Addendum to your Evidence of Coverage and Summary of Benefit Booklets

Includes the following updates from Medicare:

  • Medicare Diabetes Prevention Program (MDPP) Services
  • Medicare Premium and Cost Sharing Amounts: Changes from 2017 to 2018

Addendum English       Español

 

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