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.
You may elect to apply for either single or family coverage. Dependents eligible for family coverage are:- Your spouse
- Your domestic partner
- Your dependents. Dependents are:
- Your unmarried children under age 19.
- Your unmarried children that are full-time student regardless of their age.
The age restriction is waived if your dependent is totally and permanently disabled prior to age 19.
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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-HRE 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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Depending upon your bargaining status and location, you have up to six different health plans to chose from in 2008.
AFSCME, AFSCME Judicial, Judicial Non-Contract, and PPME |
UE/IUP |
Non-Contract (Excludes Judicial) |
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| Indemnity Plan | Program 3 Plus | Deductible 3 Plus | Deductible 3 Plus |
| PPO Plan | Iowa Select | Iowa Select | Iowa Select |
| MCO Plans | Blue Access Blue Advantage UHC Choice HMO UHC Heritage Select |
Blue Access Blue Advantage UHC Choice HMO UHC Heritage Select |
Blue Access Blue Advantage UHC Choice HMO UHC Heritage Select |
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MCO Plans
The designs for all the MCO plans are identical. There are two types of MCO - Primary Care and Open Access. It is important that you understand the differences between the types of MCOs to ensure that you choose the plan that best fits your needs.
Primary Care MCOs
MCO plans that use the primary care model are:
- Wellmark Blue Advantage
- UnitedHealthcare Heritage Select
These plans 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.
Open Access MCOs
MCO plans that use the open access model are:
- Wellmark Blue Access
- UnitedHealthcare Choice HMO
These plans allow you to obtain care from any provider who participates in the MCO’s network. No PCP referral is required. You can go to any provider in their network at any time.
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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 provider directories for any plans that interest you to ensure that there are participating doctors, specialists, labs, hospitals, clinics, etc. in your area. IMPORTANT: Services will not be paid by the carrier if you do not go to participating providers for all your health care needs.
2008 Managed Care (MCO) Service Area Map
2008 Managed Care (MCO) Service County Table
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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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Health Insurance Certificates
For detail information about the different health plans, refer to the health plans benefit certificates.
- Blue Access (effective 01/01/2007)
- Blue Advantage (effective 01/01/2007)
- Deductible 3 Plus (effective 01/01/2007)
- Iowa Select (effective 01/01/2007)
- Program 3 Plus (effective 01/01/2007)
- UnitedHealthcare Choice HMO
- UnitedHealthcare Heritage Select
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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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UnitedHealthcare Contact Information and Web Sites |
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| UnitedHealthcare Choice HMO | Enrollment: 866-873-3903 Customer Service: 866-473-9027 |
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| UnitedHealthcare Heritage Select | Enrollment: 866-873-3903 Customer Service: 800-747-1446 |
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Monthly Premiums
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 little or no premium. 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 plans you are considering.
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COBRA
COBRA Continuation Coverage RightsCOBRA rates
For More Information:
For questions regarding your particular plan please contact your Personnel Assistant.
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Updated: 05/14/2008