Human Resources
Health Insurance
The State of Iowa's health insurance plans offers you a variety of health benefits, plan designs and out-of-pocket costs that allows you to choose the best health coverage that meets the needs of you and your family.
Eligibility
You are eligible for health insurance if you are a permanent or probationary employee and work 20 hours or more a week. You should contact your personnel assistant to verify your eligibility for coverage.
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Coverage
Health insurance offers two levels of coverage:
- Single
- Family
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Eligible Dependents
Dependents eligible for health insurance coverage are:
- Your spouse (A husband or wife as the result of a marriage that is legally recognized in Iowa. This does not include a spouse from whom you are legally separated or divorced.)
- Your domestic partner (same sex or opposite sex)
- Your dependent children
- Your natural child
- A child placed with you for adoption or a legally adopted child
- A child for whom you have legal guardianship
- A stepchild
- A foster child
You may be required to provide documentation that a dependent is eligible as defined above.
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Dependent Children Eligibility
- Your dependent child may be covered for health insurance through the end of the year in which they turn age 26.
The dependent child under age 27 can be:
- A student or non-student
- Live in Iowa or outside Iowa
- Be unmarried or married (a dependent's spouse is not eligible for coverage)
- Your dependent child who is an unmarried, full-time student in an accredited institution of postsecondary education may be covered regardless of age.
- Your unmarried dependent child who is totally and permanently disabled, physically or mentally, may be covered regardless of age. (The disability must have existed before the dependent child turned age 27 or while a full-time student.)
Over Age 26 Full-Time Student Verification
You must provide documentation that your unmarried full-time student over the age of 26 is a full-time student.
Your personnel assistant will give you the Certification of Full-Time Student Status form. In addition to verifying that your dependent adult child is unmarried, you must provide a copy of your dependent’s most current semester/quarter transcript or class schedule to confirm their full-time student status.
Failure to return the verification form will mean that your dependent child will not be covered under the state’s health insurance plan.
Potential Tax Consequences of Covering Your Unmarried Full-Time Student Over Age 26
Domestic partner or same-sex spouse enrolled in your health coverage may qualify as Internal Revenue Code dependent provided certain qualifying conditions are met. There are no tax consequences for enrolling your dependent child up to the age 26 in health coverage. However, for your unmarried full-time student over the age of 26, there may be tax consequences.
More information about potential tax consequences in enrolling your unmarried full-time student over the age of 26, domestic partner or same-sex spouse can be found at the Tax Treatment of Non-Qualified Dependents website.
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Enrollment
You may enroll in a health care plan during the first 30 days of your employment. You may add dependents during your initial enrollment or as a result of a qualifying event.
When spouses are both employed by the state, they must enroll under the same family coverage. Employees cannot be covered as both an employee and a dependent under the State’s health and welfare benefit plans. For additional information, review the DAS Duplicate Coverage website.
To enroll in a health care plan, please contact your personnel assistant.
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Qualified Life Events
When you enroll in health insurance, your elections remain in effect to the end of the calendar year. You cannot make any changes until the next enrollment and change period unless you experience a qualified life event and the benefit change you request is consistent with the event.
For additional information on qualified life events, review the DAS Qualified Life Events website.
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Health Plans Available
There are three types of health plans available for you to elect. All of the State-sponsored health plans are provided by Wellmark Blue Cross and Blue Shield.
Blue Access |
These plans are Managed Care Organization (MCO) plans which provide comprehensive health care services within a state-wide network of health care providers. |
| Iowa Select | These plans are Preferred Provider Organization (PPO) plans which provide comprehensive health care services by any health care provider but you have lower coinsurance if you use Wellmark's Alliance Select network providers. |
| Program 3 Plus Deductible 3 Plus |
These plans are Indemnity plans that provide comprehensive health care services by any health care provider. These plans provide the most flexible coverage and subsequently have the highest premiums. |
Health Plan Choices
State of Iowa employees have a choice of one of the following health plans for 2013.
| Blue Access |
| Blue Advantage |
| Iowa Select |
For AFSCME-covered employees in the Executive or Judicial Branches, Non-Contract employees in the Judicial Branch, or PPME-covered employees, your indemnity choice is:
| Program 3 Plus |
For UE/IUP-covered employees or Non-Contract (Non-Judicial) employees, your indemnity choice is:
| Deductible 3 Plus |
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Voluntary Premium Contribution Health Plans Non-contract (non-Judicial) employees have the option of electing a Voluntary Premium Contribution Program health insurance plan. The Voluntary Premium Contribution Program health insurance plan allows Non-contract (non-Judicial) employees an opportunity to voluntarily elect to pay 20% of their premiums for single or family health insurance. The plans are indicated by “V” in their title. The designs and benefits of the Voluntary Premium Contribution Program plans are identical to the regular health plans except for the additional benefit of preventive health services at no copay or coinsurance. In addition, the Voluntary Premium Contribution Program health insurance plans cover some services that are not covered under the regular health insurance plans offered by the State. Following are the additional benefits covered by Voluntary Premium Contribution health insurance plans. Blue Access-V and Blue Advantage-V
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MCO Plans
The plan design for Blue Access and Blue Advantage are identical.
Blue Advantage and Blue Advantage-V provide services that are managed by a primary care physician (PCP). You must select a PCP for each covered individual. In certain situations, you must obtain a referral from your PCP for you to receive services from participating specialists.
Blue Access and Blue Access-V allows you to obtain care from any provider who participates in the Blue Access network. No PCP referral is required. You can go to any provider in the network at any time.
Blue Access and Blue Advantage Service Area
Regardless of your location in Iowa, you can enroll in either Blue Access or Blue Advantage.
Important: It is your responsibility to ensure that providers you seek services from are part of the Wellmark Health Plans of Iowa MCO network. Services received from non-participating providers will not be paid by Wellmark. Visit the Wellmark website to check participating providers in your area.
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MCO Guest Membership
If you are enrolled in either Blue Access or Blue Advantage and you and/or your dependents are out of the service area for at least 90 consecutive days, but no more than 180 days; Wellmark has a Guest Membership benefit. Guest Membership allows you access to Blue Cross and Blue Shield participating hospitals, physicians, and other health care providers from which you can receive covered services. Guest Membership is only available to members traveling or residing outside Iowa, but still within the United States. It’s important to note preventive services are not covered unless performed by your designated Wellmark Health Plan of Iowa primary care provider (PCP).
Guest Membership is a valuable benefit for:
- Dependents attending school out of state, full-time, in an accredited institution of higher learning (There is no time limit for students.)
- Members traveling for at least 90 consecutive days but no more than 180 days
- Family members who reside in another state, but are covered under the same health plan
To locate a participating physician outside of Iowa while on Guest Membership, please call 1-800-810-BLUE (2583) or visit the Blue National Doctor & Hospital Finder at www.bcbs.com. You’ll need to select providers that are listed as Traditional on this website.
Here are some more important things to remember about your Guest Membership:
- Whenever you receive services out of state, make sure you visit your designated PCP and network providers in order to receive benefits.
- Preventive services need to be provided by your Iowa PCP; they are not payable while you are a Guest Member out of state – unless specified differently in your Blue Access or Blue Advantage benefit booklets.
- Present your Wellmark ID card upon receiving services.
- Inpatient admissions, home health services, hospice services, private duty nursing, and home infusion therapy must still be pre-certified by calling the number on your ID card.
- If you change your permanent residence from Iowa, you’ll need to contact your personnel assistant and change health plans.
- You will need to contact Customer Service for address changes or when you return to Iowa.
- Your benefits (non-emergency) are not transferable to any state where you happen to be traveling. They are approved only for the state where you have signed up for a Guest Membership.
How to Request Guest Membership
Notify a Wellmark Health Plan of Iowa Customer Service representative if you or your dependent will be living away from home for at least 90 consecutive days, but no more than 180 days.
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Blue Card
As a member of Wellmark Blue Cross Blue Shield, you have the benefit of the BlueCard Program. When you travel outside Wellmark’s service area, you can take advantage of savings that the local Blue Plan has negotiated with doctors and hospitals in the area. More than 90 percent of all hospitals and 80 percent of physicians throughout the United States contract with Blue Cross and Blue Shield plans. To find nearby doctors and hospitals, call BlueCard Access at 1-800-810-2583 or visit the BlueCard Doctor and Hospital Finder at http://provider.bcbs.com/
When you receive care at a provider in the Blue Cross and Blue Shield Network, show your Wellmark ID card to receive these advantages:
- The physician or hospital will file the claim for you.
- All participating doctors and hospitals are paid directly.
- Participating providers agree to accept payment arrangements of the Blue plan in their home state. You’re only responsible for your applicable deductibles, copayments, or coinsurance.
For more information on the BlueCard program, contact Wellmark’s customer service at the phone number located on your Wellmark ID card.
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Health Insurance Terms to Know
Coinsurance. The percentage of the covered expenses you must pay.
Copayment (Copay). The amount that you must pay at the time a service is rendered. For example, some plans have a $10 copayment for each doctor’s office visit.
Deductible. The amount you pay each year toward your initial covered expenses before the plan begins to pay benefits. Some plans do not have a deductible, or it applies to inpatient services only.
Maximum Allowable Fee. The amount that equals the lesser of the covered charge for a service or supply, or an amount that the insurance company establishes annually under its schedule for the same service or supply.
Out-of-Pocket Limit. The most you would ever have to pay for covered medical expenses in a year. (These amounts are different for single and family contracts.) Once you reach the out-of-pocket limit, you will not pay for any covered expenses for the rest of the year. In some plans, pharmacy expenses and other copayments are not applied to the out-of-pocket limit.
Pre-Existing Condition. Any condition for which you or an eligible dependent has received medical advice, consultation, or treatment within the six months prior to the date you first become eligible for medical benefits under this plan. (This may be offset by proof of other creditable coverage.)
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Summary of Benefits and Coverage
The Affordable Care Act (ACA) requires Wellmark to provide you information about the health insurance coverage of the different plans in a standardized and consistent format. The Summary of Benefits and Coverage (SBC) has several key sections and features, including:
- Important questions and answers
- Coverage details for common medical events
- Covered and excluded services
- Two coverage examples with questions and answers to help you understand your share of costs
| Summary of Benefits & Coverage | |
| Blue Access | Blue Access-V |
| Blue Advantage | Blue Advantage-V |
| Iowa Select | Iowa Select-V |
| Program 3 Plus | Program 3 Plus-V |
| Deductible 3 Plus | Deductible 3 Plus-V |
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Prescription Drug Benefits
All of the State of Iowa's health plans provide prescription drug coverage. All of the health plans (except for Deductible 3 Plus) provide benefits through a three-tier program and include a mail order option.
More information about the State of Iowa's health plan prescription drug benefits is available at the DAS Prescription Drug website.
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Monthly Premiums
2013 Monthly Health Insurance Premiums
2013 Monthly Health Insurance Premiums (Non-contract (non-Judicial) employees
When you and your spouse are both employed by the State of Iowa, you may want to take advantage of the double spouse family credit. The double spouse family credit provides family health insurance coverage with no employee share towards the monthly premium for a full-time employee. Contact your personnel assistant if you have any questions or need an enrollment form.
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Wellmark Contact Information
Contact Wellmark customer service at 1-800-622-0043 directly if you need additional information about the different health insurance plans.
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Wellmark's Wellness Services
Wellmark provides a number of services and tools to assist you in improving or maintaining you and your family's health. More information about Wellmark's wellness services is available at the DAS Healthy Opportunities Wellness Services website.
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Things to Consider in Electing a Health Insurance Plan
- If you are interested in additional information about any of the health insurance plans, contact Wellmark customer service.
- If you or a member of your family have special medical needs, contact Wellmark's customer service about coverage for those particular needs.
- If you want to stay with your current doctor, call and ask if he or she is in any of the offered plans.
- Check the National Committee for Quality Assurance website to see a Report Card for the Managed Care plan you are considering.
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COBRA
COBRA Continuation Coverage Rights
The federal Consolidated Omnibus Budget Reconciliation Act (COBRA) provides for continuation of health benefits coverage after your coverage with the state ends. More information about COBRA is available at the DAS COBRA website.
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For More Information
For questions or more information, contact your personnel assistant.
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Last updated 03/25/2013