Retiree ISU Plan Merit
Retired ISU Faculty, Professional & Scientific, Supervisory/Confidential Merit employees with 5 continuous years of participation in the medical and dental plans up to their retirement date.
Two options for medical coverage are available. Both are provided through Wellmark Blue Cross and Blue Shield.
Wellmark BluePPO - Renamed effective 1/1/2019
The ISU PPO Plan is a managed care plan that gives you a choice each time you need health care to access a Blue Cross/Blue Shield Preferred Provider or to use any provider. If you access a Blue Cross/Blue Shield Preferred Provider the plan pays a higher benefit. If you use out-of-network providers, benefits are generally payable, but at a lower level. This plan is often selected by individuals and their families who are comfortable selecting a Blue Cross/Blue Shield Preferred Provider and still wish to have coverage when unable to access a Blue Cross/Blue Shield Preferred Provider.
- This plan design has a network of participating physicians throughout the U.S.A.
- In-Network: no deductible, $20 office co-payment (does not apply to out-of-pocket maximum) and/or 10% co-insurance, coverage of routine services (annual physical exams and any related lab tests, hearing and eye exams)
- Out-of-Network: $300 single/$600 spouse/partner/child/family contract deductible, 20% co-insurance, no coverage for routine services
- Out-of-pocket maximum (in-network) of $1,500 per single contract and $3,000 per spouse/partner, child or family contract on eligible medical expenses
- Out-of-pocket maximum (out-of-network) of $3,000 per single contract and $6,000 per spouse/partner, child or family contract on eligible medical expenses
- $100 emergency room co-payment (waived if admitted)
- Self-referral allowed
Wellmark BlueHMO - Renamed effective 1/1/2019
The ISU HMO Plan is a managed care plan that requires you to receive all your health care through a network of physicians. Most services are paid at 100%. You pay the full cost of any care you receive outside the network except for emergency care when you are traveling out of the service area. This plan is often selected by individuals and their families whose needs can be satisfied by physicians within a specific network.
- This plan design has a network of participating physicians based in Iowa. Current participation is 99% of hospitals (acute care), 93% of primary care physicians (includes pediatricians), 91% of OB/GYN provider and 93% for specialist that are participating in the network.
- Each member in the contract is required to designate a primary care physician (PCP). Female participants may elect to also designate a primary OB-GYN physician for their yearly exams.
- Services directed by your PCP: $10 co-pay for office calls – preventative, outpatient mental health/chemical dependency, $10.00 co-pay for in-network chiropractic care and acupuncture services, $0 deductible and $0 co-insurance
- $100 emergency room co-payment (waived if admitted)
- In-Network Specialists: you may see a provider in the Network with referral from PCP
- Out-of-Network Specialists: If you require services that are not available from a specialist within the Network, you will be referred to a provider outside the Network who has expertise in diagnosing and treating your condition. Wellmark must approve out-of-Network referrals before you receive services or the services will not be covered
- Referrals are not required for chiropractor visits, hearing exams, vision exams or acupuncture.
- Guest membership: this is an added benefit while away from home for 90 or more consecutive days. 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. This 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
On June 26th, the Iowa Board of Regent Institutions were informed by the Iowa Department of Administrative Services (DAS) that all merit employees who retire on or after July 1, 2017 would need to be offered retiree medical nad dental plans administered by their respective schools.
Given the short notice and the need to move all current merit claims experience to the ISU plan, ISU has created an ISU Merit plan exactly like the plans offered to the retired Faculty, P&S and Supervisory Merit staff. While the plans are exactly the same, we have modified the Pre-Medicare rates for the added merit retirees to support the overall plan. To that end, all Pre-Medicare merit retirees will see a cost difference between their ISU Merit plan premiums and those of other faculty and staff Pre-Medicare retirees. It is necessary that this differential be built into our premiums in order for ISU to determine the long-term impact of the decision recenlty made by DAS.
We do not anticipate any premium differential between ISU Merit retirees and Faculty and P&S staff retirees with Medicare as their primary plan.
Wellmark Blue Cross and Blue Shield
1331 Grand Ave.
Des Moines, Iowa 50309-2565
Prescription Drug Plan
The ISU prescription drug plan offers a pharmacy program that is administered separately from your medical plan. There is not a separate premium to pay for prescription coverage. The cost of the health and prescription plans is combined into the health premium. The percent of co-insurance is determined by Express Scripts or Humana at the point of sale: either at a participating retail pharmacy or through mail order.
Identification Cards: you will have a separate prescription benefit card. Cards will be issued in the contract holder's name and mailed to your U.S. home address. Enrolled family members have identifcal cards.
Member Service Phone Number - see back of Humana Membership card
Mail order through Humana
Two dental plan options are available, which are both administered by Delta Dental of Iowa.
Basic Plan: $0 deductible, $750 annual maximum benefit per person/year.
Comprehensive Plan: $25 annual deductible, $1500 annual maximum benefit per person/year, $2000 lifetime maximum for orthodontics.
All Delta Dental subscribers have access to a vision discount program through EyeMed Vision Care
9000 Northpark Drive
Johnston, IA 50131-9010