County Extension ISU Plan

    Medical

    Two plan options are available:  PPO vs HMO Plan Comparison (PDF).  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.

    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.
    • 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

     

    Medical Plan
    Provisions BluePPO Plan In-Network BluePPO Plan Out-of-Network BlueHMO Plan
    Annual Deductible: Single/Family $400/$800 $800/$1,600 $250/$500
    Coinsurance: inpatient or outpatient services 20% 40% 10%
    Annual Out-of-Pocket Maximum: Single/Family $2,000/$4,000 $4,000/$8,000 $1,500/$3000
    Office Copay* $25 copay per provider per date of service 40% coinsurance $15 copay per provider per date of service
    Emergency Room $125 copay plus 20% coinsurance $125 copay plus 20% coinsurance $125 copay plus 10% coinsurance
    Preventive care (includes routine annual physical, immunizations, mammogram, colonoscopy $0 40% coinsurance $0
    *Office visit copays apply to any office service per provider per date of service. This could include radiology, laboratory services, allergy shots, mental health services, physical therapy, occupational therapy, speech therapy.

    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.

    1. Download the Doctor on Demand app or visit DoctorOnDemand.com.
    2. Have your Wellmark member ID card ready. You’ll be asked to enter your full Wellmark ID number, including the three character prefix.
    3. 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

    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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    Dental

    Two dental plan options are available (Plan Comparison). Both are provided through Delta Dental of Iowa.

    2024 Dental 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.

    Basic Plan: $25 deductible, $750 annual maximum benefit per person/year

    Comprehensive Plan: $50 annual deductible, $1,500 annual maximum benefit per person/year, $2,000 lifetime maximum for orthodontics.

    ** 3-year participation required upon enrollment  **

    Basic and Comprehesive Plan Coverage Manual

    All Delta Dental subscribers have access to a vision discount program through EyeMed Vision Care.

    Delta Dental
    9000 Northpark Drive
    Johnston, IA 50131-9010
    Phone: 1-800-544-0718