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2018 Health and Dental Insurance

Beginning January 1, 2018, the State of Iowa will offer all employees (except SPOC employees) a new health insurance plan. 

Resources

Health Insurance Options Side-by-Side Comparison Recording: 2018 Health Insurance webcast (09/05/2017)
Frequently Asked Questions (FAQs) 2018 Health Insurance Presentation PowerPoint
HealthCare.gov Preventive health services  
Summary of Benefits and Coverage (SBC) Iowa Choice  
Summary of Benefits and Coverage (SBC) National Choice  

Quick Links to the Site

One Plan, Two Options 
New Health Benefit - Telemed (Doctor on Demand) 
2018 Health Insurance Options Premiums 
Double Spouse 
Health Insurance Opt-Out 
Dental Insurance 
Information/Resources


One Plan, Two Options

All State employees will be offered the same health coverage (one plan) with a choice between two network options: 

  • 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.
  • 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. 

All of the health care services covered currently in 2017 will continue to be covered next year (though the cost share amounts you pay for services may differ.) Refer to the Health Insurance Options Side-by-Side Comparison.

The 2018 enrollment and change period will be held Oct. 16-Nov. 17, 2017. During this time, all benefit-eligible State of Iowa employees must actively elect or decline medical coverage for 2018.  More information will be available closer to the enrollment and change period.


New Health Benefit - Telemed (Doctor on Demand)

A new benefit in 2018 will be Telemed (Doctor On Demand).  The service allows you to visit a doctor on your smartphone or tablet from almost anywhere. Through this new service, you may get treatment for cold and flu, bronchitis and sinus infections, urinary tract infections, sore throats, allergies, fever, headache, pink eye, skin conditions, and more. Telemed (Doctor on Demand) also provides mental health services.  More information is available at Feeling Better Should Be Easy.

There is a $10 copay per visit for this service.  More information will be available later this year about this new benefit.


2018 Health Insurance Options Premiums

The 2018 monthly premiums for the new plan network health options will be:

Full-time Employees Total Premium State Share % Employee Share %
Iowa Choice
Single $712.00 $672.00 94% $40.00 6%
Family $1,668.00 $1,518.00 91% $150.00 9%
National Choice
Single $765.00 $672.00 89% $93.00 11%
Family $1,791.00 $1,518.00 85% $273.00 15%

 

Part-time Employees
(20 - 29 hrs)
Total Premium State Share % Employee Share %
Iowa Choice
Single $712.00 $336.00 47% $376.00 53%
Family $1,668.00 $759.00 46% $909.00 54%
National Choice
Single $765.00 $336.00 44% $429.00 56%
Family $1,791.00 $759.00 42% $1,032.00 58%

Double Spouse 

The double spouse credit will not be available.   If you and your spouse are both employees of the State of Iowa, there will be no reduction in the employee share of the premium.  Employees cannot be covered as both an employee and a dependent under the state’s health and dental insurance plans.

Double Spouse Credit and the Regents Institutions
Beginning in 2018, the double spouse credit will not be available if either the employee or the spouse is an employee of the Board of Regents.

More information will be available during the 2018 enrollment and change period.

  Full-Time Part-Time
2018 Double Spouse Premiums Total Premium State Share Employee Share Total Premium State Share Employee Share
Iowa Choice
Contract Holder $834.00 $759.00 $75.00 $834.00 $379.50 $454.50
Contributing Spouse $834.00 $759.00 $75.00 $834.00 $379.50 $454.50
National Choice
Contract Holder $895.50 $759.00 $136.50 $895.50 $379.50 $516.00
Contributing Spouse $895.50 &759.00 $136.50 $895.50 $379.50 $516.00

Health Insurance Opt-Out

Beginning in 2018, all eligible employees can elect to opt-out of coverage in a state-sponsored health insurance plan and receive a monthly payment of $125.

Eligibility
To be eligible to opt-out of health insurance and receive the $125 payment, you must be:

A full-time (work 30 or more hours per week) benefit-eligible employee
AND
Not be covered by any state-sponsored (active, retiree, and Board of Regents) health insurance plan through a family member, including a domestic partner.

More information will be available during the 2018 enrollment and change period.


Dental Insurance

There are no changes in the dental benefits for 2018.

The 2018 enrollment and change period is an open dental enrollment period.  During the open dental enrollment and change period, you can:

  • Enroll in dental insurance, if not currently enrolled in dental insurance
  • Change from family to single coverage
  • Change from single to family coverage
  • Add or remove eligible family members from your coverage

Your dental elections will be effective January 1, 2018.

  Full-Time Part-Time
2018 Dental Premiums  Total Premium State Share Employee Share Total Premium State Share Employee Share
Single $29.55 $29.55 $0.00 $29.55 $14.79 $14.76
Family $79.43 $39.73 $39.70 $79.43 $19.27 $60.16
Double Spouse
Contract Holder $39.72 $20.45 $19.26 $39.72 $9.64 $30.08
Contributing Spouse $39.71 $20.46 $19.26 $39.72 $9.63 $30.08

Information/Resources

The following resources and information will help you determine which network option is best for you. 

Wellmark

At the Wellmark website, you can find:

Find a Doctor or Hospital
Prescription Drug Information 
- MyWellmark (registration required)

Copays

This is the amount you pay each time you receive care. The copay for primary care providers is $15, while the specialist copay is $30. 

Understanding Jargon: Copay (Wellmark YouTube video)

Coinsurance

This is the amount you pay for certain covered services. With Iowa Choice and National Choice, in-network coinsurance is 10 percent.  Out-of-network care for National Choice is 20 percent.  

Understanding Jargon: Coinsurance (Wellmark YouTube video)

Deductible

This is the annual amount you pay for health care services before your medical benefits start. The single deductible is $250 and the family is $500.  Services subject to copay will not apply to a deductible. 

Understanding Jargon: Deductible (Wellmark YouTube video)

Out-of-Pocket Maximum (OPM)

This figure is the maximum amount you’ll pay for health care services in a benefit year. Your OPM includes deductibles, copays, and coinsurance. The annual medical OPM is $1,000 for single coverage and $2,000 for family coverage.  The annual pharmacy OPM is separate and is $5,850 for single coverage or $11,700 for family coverage. Once you reach your out-of-pocket maximum, your out-of-pocket costs are 100 percent covered.  

Understanding Jargon: OPM (Wellmark YouTube video)
Understand Your Out-of- Pocket Costs (Wellmark flyer)

Specialty Drug

Specialty drugs require special handling, administration or monitoring.  These drugs treat complex, chronic and often costly conditions.

Specialty Drug Ordering and Delivery (Wellmark flyer)
Make Your Visit to the Pharmacy Surprise-Free (Wellmark flyer)Return to top


For More Information

If you have questions or need additional information about the 2018 Health Insurance Plan:

  • Call Wellmark's Customer Service at 800.622.0043 | 888.781.4262 (TTY).
  • Send an email to employee.benefits@iowa.gov.
  • Attend one of the onsite meetings on the Capitol Complex or through a Benefit Education webcast.

 


09/24/2017