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.
Health insurance offers two levels of coverage:
- Single
- Family
Dependents eligible for coverage in a Family plan 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 are eligible for domestic partner coverage)
- Your dependent child (children)
Eligible Dependent Child (Children)
An eligible dependent child is:
- 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.
A dependent child must be unmarried and must be one of the following:
- Under age 19
- Between ages of 19 through 25, not a full-time student, and resides in the state of Iowa
- A full-time student in an accredited institution of postsecondary education regardless of age
- Totally and permanently disabled, physically or mentally, regardless of age. The disability must have existed before the dependent child turned age 25 or while the dependent child was a full-time student.
Annually, DAS-HRE requires written verification that a dependent child, age 19 or older, is a full-time student. The verification process requires the employee to provide a copy of the dependent child’s most recent transcript or class schedule.
The verification will be mailed to the employee’s home and must be returned to DAS-HRE before the end of the dependent child’s birth month. Failure to return the required verification information results in the dependent child’s termination from insurance on the first day of the month following the dependent child’s birthday.
Non-Qualified Tax Dependents
There are tax consequences if an unmarried dependent, between ages 19 through 25, who is not a full-time student, is enrolled in your health insurance plans.
The IRS does not permit favorable tax treatment for an unmarried dependent that is between the ages of 19 through 25 and not a full-time student. These individuals are not considered “dependents” by the IRS. Since these individuals are not tax dependents per the IRS, you will be taxed on the value of the dependent’s coverage. The state has determined the fair market value of dependent coverage and will include the value of the non-qualified tax dependent’s coverage in your gross income. You may want to consult your tax advisor if you have any questions.
The value of the non-qualified dependent’s coverage is based on:
- The number of non-qualified tax dependents enrolled on your plan
- The insurance plan you have elected
Detailed information on the tax treatment of non-qualified tax dependents including the added value table, form and an example is available at the DAS Benefits Web site.
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Double Spouse Credit
When spouses are employed by the state, at the option of the couple, one family plan may be elected. The state's contribution to double-spouse family coverage will be the full premium. When spouses are employed by the state and one spouse is a full-time employee and one spouse is a benefits-eligible part-time employee, at the option of the couple, one family plan may be elected. The state's contribution to the above stated double-spouse family coverage will not exceed the full family premium. If both spouses are benefits-eligible part-time employees, the state's share of the premium for each employee will be one-half of the state’s share of the full-time double-spouse family premium. When spouses are employed by the state, and one spouse is a non-Regents employee and the other spouse is a non-merit Regents employee, at the option of the couple, one family plan may be selected. The family plan selected shall come from those plans administered by the Department of Administrative Services.
If both Spouses are Eligible Employees of the State
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. Employees have four coverage choices under the health plans:
- Each spouse may enroll separately in single coverage.
- One spouse may elect single coverage and the other spouse may enroll themselves and dependent(s) in family coverage. The spouse selecting single coverage may not be listed as a dependent on the family plan.
- One spouse may elect to waive coverage and the other spouse may enroll both spouses and dependent(s) in family coverage.
- Both spouses may elect family coverage for themselves and their dependent(s) under double-spouse family coverage with one spouse being the contract holder and one being the contributing spouse.
More information about the double spouse family credit is available at the DAS Benefits Web site.
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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.
To enroll in a health care plan, please see your Personnel Assistant for enrollment forms.
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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.
If you experience a qualified life event, you can request changes that are consistent with the life event by notifying your Personnel Assistant within 30 days after the date of the event (60 days for birth and adoption.) If you do not notify your Personnel Assistant within the required timeframe following the event, you will not be able to change your benefits until the next enrollment and change period.
For additional information on qualified life events, review the DAS Qualified Life Events Web site.
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Health Plans
You have a choice of one of the following medical plan design types.
| Indemnity | You are free to choose any health care provider (doctors, hospitals, etc.)
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| Preferred Provider Organization (PPO) | You are free to choose any health care provider but you pay lower coinsurance if your provider is a part of Wellmark’s Alliance Select network. |
| Managed Care Organization (MCO) | Services are provided by a network of health care providers with the exception of emergency care.
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You have up to four different health plans to chose from in 2009.
| AFSCME AFSCME Judicial Judicial Non-Contract PPME |
Non-Contact (Non-Judicial) UE/IUP |
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| Indemnity Plan | Program 3 Plus | Deductible 3 Plus |
| PPO Plan | Iowa Select | Iowa Select |
| MCO Plans | Blue Access Blue Advantage |
Blue Access Blue Advantage |
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MCO Plans
The plan design for Blue Access and Blue Advantage are identical.
Blue Access 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 their network at any time.
Blue Advantage provides 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.
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MCO Service Area
The following map and table links indicate the counties that have adequate participating providers to offer services as noted. Please check the Wellmark provider directory to ensure that there are participating doctors, specialists, labs, hospitals, clinics, etc. in your area.
2009 Managed Care (MCO) Service Area Map
2009 Managed Care (MCO) Service County Table
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.
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Health Plans Comparison
To assist you in selecting a plan that best fits your individual and family needs, a side-by-side comparison of the different health plans below.
Health Plans Side-by-Side Comparison
The chart compares coverage of each plan in areas such as:
| Deductible | The amount you pay each year toward your initial covered expenses before the plan begins to pay. |
| Coinsurance | The percentage of the covered expenses you must pay. |
| Copayment | The amount you must pay at the time a service is rendered. |
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Prescription Drug Benefits
All of the state of Iowa's health plans provide prescription drug coverage. All of the plans, except 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 can be found at DAS Benefits Prescription Drug Web site.
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Disease Management Program
A disease management program provides individualized care plans for you or your family members with treatable chronic diseases to improve their health outcomes. The program provides personalized contact with a nurse, educational materials, and other services to educate individuals while supporting their physician’s plan of care. A disease management program is offered to state of Iowa employees and retirees enrolled in a Wellmark Blue Cross Blue Shield health plan. Participation in the disease management program is voluntary and there are no additional costs to participate in the disease management program. Review the frequently asked questions for more information about the disease management program.
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Health Insurance Certificates
For detail information about the different health plans, refer to the health plans benefit certificates.
- Blue Access (effective 01/01/2008)
- Blue Advantage (effective 01/01/2008)
- Deductible 3 Plus (effective 01/01/2008)
- Iowa Select (effective 01/01/2008)
- Program 3 Plus (effective 01/01/2008)
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Provider Contact Information
If you need additional information about the different plans available, contact the insurance company directly either by phone or using their Web site.
Wellmark Blue Cross and Blue Shield Contact Information and Web Site |
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| Blue Access | 800-553-7801 |
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| Blue Advantage | 800-553-7801 |
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| Deductible 3 Plus | 800-622-0043 |
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| Iowa Select | 800-622-0043 |
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| Program 3 Plus | 800-622-0043 |
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Monthly Premiums
AFSCME-covered, AFSCME Judicial-covered, Judicial (Non-Contract) and PPME-covered
Non-Contract (Non-Judicial) and UE/IUP-covered
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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Things to Consider
- Make sure you choose a plan that serves your area.
- Check the Health Benefit Comparison Chart for a summary comparison of health benefit plans
- If you are interested in additional information about any of the carriers, please see your Personnel Assistant or contact the insurance company directly either by telephone or using their web site (telephone numbers and addresses are listed below).
- If you or a member of your family have special medical needs, call the carriers to ask 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.
- The MCO Service Area Chart shows which plans are available in each county.
- Check the National Committee for Quality Assurance web site to see a Report Card for the Managed Care plan you are considering.
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COBRA
COBRA Continuation Coverage Rights
If you leave state employment, the federal Consolidated Omnibus Budget Reconciliation Act (COBRA) provides for continuation of health benefits coverage at the group premium rate after your coverage with the state ends. However, certain events must occur for any persons covered under your contract to be eligible.
| COBRA Qualifying Events | Maximum Eligibility Period Beyond Termination |
| Employee Termination/ Resignation | The employee and covered dependents have 18 months of COBRA eligibility. If the employee meets the Social Security Administration’s definition of disabled at any time during the first 60 days of COBRA coverage, the employee and covered dependents have 29 months of COBRA eligibility. |
| Death or Divorce of Employee | The covered dependents have 36 months of COBRA eligibility. |
| Employee Reduces Work Hours; No Longer Eligible for Coverage | The employee and covered dependents have 18 months of COBRA eligibility. |
| Employee’s Dependent No Longer Eligible (Age 19 to 25 and no longer a full-time student, marries, or no longer resides in the state of Iowa) | The covered dependent has 36 months of COBRA eligibility. |
| Employee on Active Military Duty | The employee and covered dependents have 24 months of COBRA eligibility. |
The state’s share of the premium payment for health and dental benefits will cease at the end of the month in which the qualifying events occurs, and you will be responsible for full payment of the premium.
2009 Health Insurance COBRA rates
COBRA coverage begins the first of the month following the qualifying event. The COBRA election period is 60 days after the later of:
- the date coverage would otherwise end, or
- the date of the COBRA Notification/Election Form.
If your employment ends, DAS will mail a COBRA Notification/ Election Form to you within two weeks following your last paycheck. The notification includes monthly benefit costs and election instructions. In the event of the death of an active employee, the family will receive notice of their COBRA rights. If an employee divorces, reduces hours, or has a dependent that is no longer eligible for coverage, the employee must notify his or her Personnel Assistant within 60 days following the event so that the Personnel Assistant can send the COBRA information.
NOTE: COBRA rights will not be extended to a Domestic Partner or his/her children, if the relationship terminates, if the employee terminates from state employment, or if the domestic partner’s children have an event that makes them ineligible for employee’s plan.
For More Information:
For questions regarding your particular plan please contact your Personnel Assistant.
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Site updated 07/27/2009