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State of Iowa Plan
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.
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.
Medical/Rx Plan Premiums
|Tier of Coverage||Prgram 3 Plus||Iowa Select||Blue Access|
|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.
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
Routine and Restorative Services - Payable at 80% of UCR
Major Restorative Services - Payable at 50% of UCR
Orthodontic Treatment – Payable at 50% of UCR
All Delta Dental subscribers have access to a vision discount program through EyeMed Vision Care.
Dental Plan Premiums
|Tier of Coverage||Employee share per month|
Family Double Spouse (both non-supervisory