County Extension ISU Plan

Medical Information
Prescription Drug Plan
Dental Insurance
Insurance Tools

Medical

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

2024 Medical Plan Monthly Premiums

Note: The amounts shown above are total monthly premiums. Extension Councils will determine the employee and employer contributions, and County Paid Employees will need to check with their employing offices to determine their actual contribution for the plans they elect.

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.

Wellmark BluePPO plan is part of the Preferred Provider Organization, a national network of participating medical service providers. Use IZU as the prefix when looking at https://www.wellmark.com/finder.
In-Network: $400 single/$800 spouse/partner, child or family contract deductible, $25 office copay and/or 20% co-insurance inpatient or out-patient facility.
Out-of-Network: $800 single/$1,600 spouse/partner/child/family contract deductible, 40% co-insurance.
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 copay plus coinsurance (copay waived if admitted).
Self-referral allowed.

Wellmark BluePPO Summary of Benefits and Coverage

Wellmark BluePPO Coverage Manual

Wellmark BlueHMO

The ISU HMO Plan is a managed care plan that requires use of the Wellmark Health Plan of Iowa (WHPI) network. 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. This network has a medical service provider presence in every county in Iowa and in the contiguous counties that border Iowa. Current network participation is 99% of hospitals (acute care), 93% of primary care physicians (includes pediatricians), 91% of OB/GYN providers and 93% for specialists.
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. It is recommended that you verify your primary care physician is participating with the WHPI network, and locate the provider code (called the enrollment ID on Wellmark's site) when you choose to participate in the Wellmark BlueHMO. Use XQW as the prefix when looking at https://www.wellmark.com/finder.
In-Network: $250 single/$500 spouse/partner, child or family contract deductible, $15 office copay and/or 10% co-insurance inpatient or out-patient facility.
Out-of-Network: No coverage out of network
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.
$125 emergency room copay plus 10% coinsurance (copay waived if admitted).
In-Network Specialists: you may see a provider in the Network without a referral from PCP.
Out-of-Network Specialists: If you require services that are not available from a specialist within the Network, 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: An added benefit while away from home for 90 or more consecutive days. A guest membership provides access to Blue Cross and Blue Shield participating hospitals, physicians and other health care providers from which you can receive covered services. A guest membership is a valuable service for: long-term, out-of-state travelers (away from home up to 180 days); dependent children who attend college, out of state; and family members who reside in another state but are covered under this health plan. For more information or to arrange the guest membership, contact Wellmark customer service at 1-800-494-4478.

Wellmark BlueHMO Summary of Benefits and Coverage

Wellmark BlueHMO Coverage Manual

Doctor On Demand

With Doctor on Demand, you and your family members can speak with a board-certified doctor who can treat the most common medical conditions and prescribe medication if needed¹. Using Doctor on Demand is easy and available 24 hours a day, 7 days a week, 365 days a year. You’ll love the convenience, and your Wellmark benefits apply automatically for you and your covered family members. Review Wellmark's Virtual Visit FAQ.

Get treatment for:

Cold and flu
Bronchitis and sinus infections
Urinary tract infections
Sore throats
Allergies
Fever
Headache
Pink eye
Skin condition
Mental health²

Doctor On Demand physicians do not prescribe Drug Enforcement Administration-controlled substances, and may elect not to treat or prescribe other medications based on what is clinically appropriate.
Includes treatment for certain psychological conditions, emotional issues and chemical dependency. Services performed by psychologists are covered. Psychiatry, which may include the use of prescription drugs, is not covered. For more information, call Wellmark at the number on your ID card.

Getting started is easy.

Download the Doctor on Demand app or visit DoctorOnDemand.com.
Have your Wellmark member ID card ready. You’ll be asked to enter your full Wellmark ID number, including the three character prefix.
Create an account or sign in.

So, the next time you have a sore throat or the little one’s running a fever, pick up your smartphone and connect virtually with Doctor on Demand, any time, day or night.

Watch the Doctor On Demand video from Wellmark!

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

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Prescription Drug Plan

The prescription plan is administered by Express Scripts.

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 at the point of sale: either at a participating retail pharmacy or Express Scripts Home Delivery.

Identification Cards: you will have a separate prescription benefit card from Express Scripts. Cards will be issued in the contract holder's name and available digitally. You will receive an email from Express Scripts with a link to register. Once registered, you can access your digital cards. Enrolled family members have identical cards.

Summary of Benefits:

No Deductible

Out-of-pocket maximum (separate from applicable medical plan out-of-pocket)

$2,000 single contract/year
$4,000 spouse/partner/child/family contract/year

30-day supply - Retail Pharmacy: for prescription medications used on a short term basis

$15 copay for generic
30% coinsurance for preferred brand name ($125 maximum copay/prescription)
50% coinsurance for non-preferred brand name ($250 maximum copay/prescription)

90-day supply - Retail Pharmacy: for prescription medications used on a regular basis

$45 copay for generic
30% coinsurance for preferred brand name ($375 maximum copay/prescription)
50% coinsurance for non-preferred brand name ($750 maximum copay/prescription)

90-day supply - Express Scripts Home Delivery Pharmacy: for prescription medications used on a regular basis

$0 copay for generic
25% coinsurance for preferred brand name ($300 maximum copay/prescription)
33% coinsurance for non-preferred brand name ($600 maximum copay/prescription)

The prescription coverage has clinical programs that add step therapy and/or prior authorization requirements. These programs enhance health and safety through greater medication compliance and adherence to prescribed therapies. This helps patients avoid negative outcomes as a result of incorrect dosing, drug interactions or treatments prescribed for non-approved indications or treatment guidelines. The programs target conditions that are considered chronic and complex, many of which are treated with specialty medications.

Express Scripts
Member Service Phone Number: 1-800-987-5248
For Refills: Please call the phone number listed on your prescription bottle. If not available, call the Member Services number above.

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