| Medical |
| Back to Retiree FAQs |
| Q. |
I left the ADOA Benefit Program several years ago. Can I enroll in the new plan? |
| A. |
Currently, State law prohibits retirees from returning to the ADOA program once they have declined to enroll. |
| |
|
| Q. |
What medical plans will be available? |
| A. |
Retirees are able to choose from an Exclusive Provider Organization (EPO), a PPO (Preferred Provider Organization), or Medicare Advantage. The EPO provides services just like an HMO. Participants may be asked to select a primary care physician who will organize all of the participant’s care. A PPO provides flexible access to care without a primary care physician. The networks that are available vary by the retiree’s county of residence. |
| |
|
| Q. |
Can I cancel my medical plan and still keep my dental? |
| A. |
Yes |
| |
|
| Q. |
The State offers “open access” in all of the EPO plans. What does this mean? |
| A. |
Open Access refers to how you “access” physicians. Instead of getting a referral from your Primary Care Physician (PCP) to see a specialist, you may schedule an appointment directly with the specialist of your choosing. The specialist MUST be contracted within your network. However, if you wish to obtain specialist referrals through your PCP, you may do so. |
| |
|
| Q. |
If my PCP refers me to a specialist or medical provider that is NOT within my EPO network, am I responsible for the medical charges? |
| A. |
Yes. In the EPO plan, all the medical services received must be contracted network medical providers. If your PCP has scheduled an appointment for x-rays, laboratory tests, or specialists, you must make sure they are within your medical network. If you are enrolled in the PPO plan, you may obtain out-of-network services and pay 30 percent of the covered charges, after you have met your deductible. |
| |
|
| Q. |
I have been contacted by someone and asked if I want to participate in a disease management program. What is disease management? |
| A. |
Disease Management is a voluntary service provided through an organization contracted with the State of Arizona, which assists members with treatment needs for chronic conditions. If you are being treated for any of the conditions below, you will be contacted by the Disease Management staff with further information on the program. This is a free service to provide you with information, assistance and resources to manage the following conditions:
- Asthma
- Congestive Heart Failure
- Diabetes
Prenatal Care (before or after the birth of baby) |
| |
|
| Q. |
My preferred doctor is not in any of the networks. What can I do? |
| A. |
If you provide us the name, address, and phone number of your physician, we will forward this information to the contracted networks to see if they can add your doctor to their networks. Networks continue to expand so please check the physician search of the network that you selected on a periodic basis. |
| |
|
