Retiree ISU Plan Merit

Two options for medical coverage are available (Plan Comparison). Both are provided through Wellmark Blue Cross and Blue Shield.

For the 2018 plan year and since, ISU merit retirees, previously insured by the State of Iowa retiree insurance are offered the ISU retiree plan for medical and dental. Due to the limited claims history from the State for the merit retirees, it became necessary to have a premium differential for the Merit retirees, not yet enrolled in Medicare compared to the retired, Pre-Medicare, Faculty, P & S and Supervisory/Confidential Merit retirees. There is still a difference in premium for the 2020 plan year as the claims data is not sufficient to change the practice.

Wellmark BluePPO

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.
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Wellmark BluePPO Summary of Benefits & Coverage

 

  • This plan design has a network of participating physicians throughout the U.S.A.
  • In-Network: no deductible, $25 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: $400 single/$800 spouse/partner/child/family contract deductible, 20% co-insurance, no coverage for routine services
  • Out-of-pocket maximum (in-network) of $2,000 per single contract and $4,000 per spouse/partner, child or family contract on eligible medical expenses
  • Out-of-pocket maximum (out-of-network) of $4,000 per single contract and $8,000 per spouse/partner, child or family contract on eligible medical expenses
  • $125 emergency room co-payment (waived if admitted)
  • Self-referral allowed
     

 

Wellmark BlueHMO

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.
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Wellmark BlueHMO Summary of Benefits & Coverage

 

  • 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: $15 co-pay for office calls – preventative, outpatient mental health/chemical dependency, $15.00 co-pay for in-network chiropractic care and acupuncture services, $0 deductible and $0 co-insurance
  • $125 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
     

2023 Medical/Prescription Plan Monthly Premiums

 

Wellmark Blue Cross and Blue Shield
1331 Grand Ave.
Des Moines, Iowa 50309-2565
Phone: 1-800-494-4478