The State of Iowa offers all employees (except SPOC employees) the same health coverage (one plan) with a choice between two network options. All of the State-sponsored health insurance plans are provided by Wellmark Blue Cross and Blue Shield.
Health Insurance Premiums & Resources
Plan Design Change
Benefit election made during this Open Enrollment period are effective:
- Weight loss medications will no longer be covered under the plan. Reminder, please use the new Wellmark card issued to you.
Iowa Choice
Offers access to a large selection of doctors and hospitals in Iowa and in counties sharing a border with Iowa. Iowa Choice includes coverage should you have an emergency while out of the state. The provider network includes 100 percent of Iowa hospitals and 96 percent of Iowa doctors. Not all providers in the counties sharing a border with Iowa participate in the Iowa Choice network. Iowa Choice is a managed care plan. As such, health care services are provided by a statewide network of participating health care providers. Providers who participate in these plans are called Wellmark Health Plan Network providers. Benefits for covered services are available only when received from Wellmark Health Plan Network providers. It is your responsibility to ensure that providers you seek services from are part of the Wellmark Health Plan managed care network. Services received from non-participating providers will not be paid by Wellmark. Visit the Wellmark website to check participating providers in your area. Services received from out-of-network providers may be covered in the case of accidental injuries or emergencies.
National Choice
Offers access to a large selection of doctors and hospitals in Iowa and nationwide. With National Choice, you may seek health care from any provider located in the United States. In Iowa, in-network care can be received at 100 percent of hospitals and 99 percent of doctors. Outside of the state, you'll have access to 96 percent of hospitals and 93 percent of doctors. Keep in mind with this option you can see any provider you choose, but you will have lower out-of-pocket expenses if you choose a network provider.
Alliance Select (SPOC Covered Only)
Alliance Select offers access to a large selection of doctors and hospitals in Iowa and nationwide. You may seek health care from any provider located in the United States. In Iowa, in-network care can be received at 100 percent of hospitals and 99 percent of doctors. Outside of the state, you'll have access to 96 percent of hospitals and 93 percent of doctors. Keep in mind with this option you can see any provider you choose, but you will have lower out-of-pocket expenses if you choose a network provider.
Understanding Your Health Insurance
Wellmark: Drug List (Value Plans)
Wellmark: Find a Doctor or Hospital
PrudentRx: Specialty Prescription Benefits
Comparing the Cost of Care: ER or Urgent Care
Explanation of Benefits: If it’s not a bill, then what is it?
You’re ready to Quit Tobacco. We can help for free.
Additional Resources
Blue365
As a member of Wellmark Blue Cross Blue Shield, you have access to discounts and services through Blue365, a program designed by the Blue Cross Blue Shield Association. Blue365 is designed to take you beyond your health care coverage to offer you easy access to trusted health and wellness resources. As a member, you enjoy discounts and savings on health care resources, healthy living programs, recreation and travel.
For the most current list of vendors or more information, visit www.wellmark.com/blue365.
The products and services offered by Blue365 are not endorsed or guaranteed by the State of Iowa. Any disputes regarding the products and services should be directed to Wellmark, Blue Cross and Blue Shield.
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:
|
|
|---|
1Doctor 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.
2 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.
Travel
Guest Membership for Iowa Choice
Members traveling long-term, any covered dependents attending college out of state, or covered family members living apart are eligible to become a guest member any time they are outside the Wellmark Blue HMO network area for at least 90 days. The time limit of Guest Membership for members traveling long term is six months. The time limit of Guest Membership for covered dependents attending college out of state is one year. To extend Guest Membership beyond the above timeframes, call the Customer Service number on your ID card. Unless an extension is obtained, claims for Participating or Out-of-Network providers submitted after expiration of your Guest Membership may deny.
If you permanently relocate, you will no longer be eligible for the Guest Membership and may be able to enroll in the National Choice Plan. Please contact the Employee Benefits mailbox at employee.benefits@iowa.gov if this occurs during the plan year.
To receive covered services under the Guest Membership program, you must receive the service(s) from a Participating Provider. Before you leave the Wellmark Blue HMO network area, call the Customer Service number on your ID card to set up a guest membership.
Please note that not all services covered under your medical benefits are covered under Guest Membership. To determine which services are covered under the Guest Membership program, contact Wellmark BCBS. Guest Membership is not available outside the USA. Guest membership benefits are not transferable to any state where members happen to be traveling, they are approved only for the state where the member has signed up for guest membership.
Travel Out of the Country
National Choice and Alliance Select: Under the National Choice plan, you have access to doctors and hospitals in more than 200 countries around the world through the Blue Cross Blue Shield Global™ (BCBS Global™) Core Program. With the BlueCard Program, you can locate international doctors and hospitals by visiting bcbs.com and searching the National Doctor and Hospital Finder or by calling 800-810-BLUE (2583). When you receive non-emergency care from providers outside the BlueCard service area, these services would be covered at the out of network level and you will typically have to pay the providers and submit the claims yourself to obtain reimbursement for these services.
Iowa Choice: Under the Iowa Choice program, you are only covered for emergency care or care for an accidental injury when you receive care in a foreign country.
For more information about health insurance, please contact Wellmark customer service at 800-622-0043.
Machine Readable Files
Here you can download the files you need for the agency where you work:
| CBC 1 | CBC 2 | CBC 3 | CBC 4 |
|---|---|---|---|
| CBC 5 | CBC 6 | CBC 7 | CBC 8 |
| Central Payroll | DOT | Fair Board |