State of Iowa Plan


Medical Insurance
Prescription Drug Plan
Dental Insurance
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Eligibility

Non-Supervisory Merit (Organized) employees appointed to positions with an appointment of 1/2 time or greater and a duration of at least nine continuous calendar months, are eligible to participate in the following benefit programs, unless otherwise indicated.  

Employees can enroll within 31 days of their hire date, with a qualifying life event or during the annual Open Change Period.

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Medical Insurance

Three options for medical coverage are available. All are provided through Wellmark Blue Cross and Blue Shield.

Blue Access – Managed Care Organization (MCO)

  • Blue Access is an “open access” plan meaning employees can choose any provider that is participating in the Wellmark Health Plan of Iowa (WHPI) network
  • Self-referral to in-network providers. Services received from non-participating providers will NOT be paid by the insurance carrier
  • Guest membership: this is an added benefit while away from home for 90 or more consecutive days and must be requested in advance. The guest membership includes access to Blue Cross and Blue Shield participating hospitals, physicians and other health care providers from which you can receive covered services .The guest membership is a valuable service for: long-term out-of-state travelers (traveling up to 180 days), dependent children who attend college full-time out of state, and family members who reside in another state but are covered under the same health plan.

Iowa Select – Preferred Provider Organization (PPO)

is a Blue Cross/Blue Shield Alliance Select Plan. If you utilize a physician and/or a hospital participating in the nationwide network, you will be covered by one set of deductibles and co-insurance. If you utilize a non-PPO physician or hospital (out-of-network) or one not contracting with the Blue Cross/Blue Shield Association, you will be covered by a different level of benefits. Referral to a specialist is not required with this plan.

Program 3 Plus – an Indemnity Plan

is a Blue Cross/Blue Shield Classic Plan. You may seek treatment from any licensed physician anywhere in the world. Benefits will be based on maximum allowable fees for the service area in which the physician practices. If the physician charges more than maximum allowable fee and is not participating with the insurance company, you will be liable for the excess charges. Referral to a specialist is not required with this plan.

Non-Supervisory Merit Medical Benefit Comparison (2017)

Plan Certificates & Summary of Benefits

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Medical/Rx Plan Premiums

Tier of Coverage Prgram 3 Plus Iowa Select Blue Access
Single$20.00$20.00$20.00
Family$335.00$328.00$20.00
Family Double Spouse* $20.00$20.00 $20.00

*Only the contract holder pays premium; both non-supervisory merit employees 

Presciption Drug Plan

Prescription drug coverage is included in your medical coverage through Wellmark Blue Cross and Blue Shield.  Please see the medical benefit comparison above for details.  

Wellmark Blue Cross and Blue Shield
1331 Grand Ave
Des Moines, Iowa 50309-2565
Customer Service:  1-800-622-0043  7:30a.m. - 5:00 p.m.
Pre-Certification:  1-800-558-4409

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Dental Insurance

Dental coverage is provided through Delta Dental of Iowa.

There is a maximum benefit of $1,500.00 per covered individual per year, except orthodontia, which has a separate lifetime maximum.

Once the benefit maximum is used in a benefit year any additional services will be patient liability.

Limitations may apply for any service, see certificate of coverage or contact Delta Dental Customer Service before approving service.

Diagnostic and Preventive Services - Payable at 100% of UCR

  • Dental cleanings allowed twice in a benefit period
  • Oral evaluation allowed twice in a benefit period
  • Limitations may apply for any service, see certificate of coverage before approving service
  • X-rays
  • Once every 12 months – topical fluoride applications, only for unmarried dependent children under age 19

Routine and Restorative Services - Payable at 80% of UCR

  • Emergency treatment for relief of pain
  • Fillings
  • Extractions
  • Anesthesia
  • Other basic repair work
  • Space maintainers for children under age 14
  • Topical application of sealants for children under age 15

Major Restorative Services - Payable at 50% of UCR

  • Endodontics
  • Non-surgical Periodontal
  • Cast Restorations
  • Crowns
  • Surgical Periodontal
  • Bridges
  • Dentures

Orthodontic Treatment – Payable at 50% of UCR

 

  • Available only to dependent children up to age 19
  • No deductible
  • Lifetime maximum of $1,500.00 per person

Exclusions

  • Treatments for cosmetic purposes that are unnecessary for dental health
  • There may be limitations to procedures listed, refer to certificate located on the Benefits web page

All Delta Dental subscribers have access to a vision discount program through EyeMed Vision Care.

Dental Plan Premiums

Tier of CoverageEmployee share per month
Single$0.00
Family$38.53

Family Double Spouse (both non-supervisory
merit - organized)

$9.85 (each)

Certificate

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