The State of Iowa offers all employees (except SPOC employees) the same health coverage (one plan) with a choice between two network options.
Wellmark will maintain the following COVID-19 plan benefits through August 31, 2020 for all State-sponsored health insurance plans (including the plan for SPOC-Covered employees)
- Covering COVID-19 tests and related services. Members have no cost-share for appropriate testing and related services to diagnose or detect COVID-19. This is required by the FFCRA and the CARES Act and remains in place as long as we are in a public health emergency, as declared by the federal government.
- Encouraging virtual visits. To avoid spread of the coronavirus, Wellmark will continue to be financially responsible for members’ virtual visit cost-share as long as the group uses our standard virtual visit approach, including the use of Doctor on Demand®.
- Covering inpatient treatment only. The waiver of members’ cost-share (copay, coinsurance and deductible) will be related only to inpatient treatment of COVID-19 with an in-network provider from June 17, 2020, through Aug. 31, 2020.
- Extending accidental dental benefits. In recognition that non-emergent dental procedures have been delayed due to the COVID-19 pandemic, treatment windows for accidental dental injuries expiring between March 16, 2020, and August 31, 2020, will be extended by 90 days or until August 31, 2020, whichever is later. Treatment windows for accidental dental injuries that start, or otherwise apply (but not expire), between March 16, 2020, and August 31, 2020, will also be extended by ninety (90) days.
Health Insurance Premiums
|2021 Iowa Choice and National Choice (All employees except SPOC-covered)|
|2021 Alliance Select (SPOC-covered employees)|
|2020 Iowa Choice & National Choice (All employees except SPOC-covered)|
|2020 Alliance Select (SPOC-covered employees)|
Health Insurance Resources
|2021 Iowa Choice - National Choice Benefit Comparision|
|Health Insurance Options Side-by-Side Comparison|
|2021 Iowa Choice Summary of Benefits and Coverage (SBC)|
|2020 Iowa Choice Summary of Benefits and Coverage (SBC)|
|2020 Iowa Choice Booklet|
|2021 National Choice Summary of Benefits and Coverage (SBC)|
|2020 National Choice Summary of Benefits and Coverage (SBC)|
|2020 National Choice Booklet|
|Alliance Select (SPOC-covered employees)|
|Alliance Select Summary|
|2021 Alliance Select Summary of Benefits and Coverage (SBC)|
|2020 Summary of Benefits and Coverage (SBC)|
|Alliance Select Benefit Booklet|
Health Insurance Information
|Helpful Links||Understanding your health insurance benefits|
|ACA Preventive Services List (June 2020)||Comparing the Cost of Care|
|Wellmark: Drug List (Formulary: Blue Rx Completesm)||Explanation of Benefits: If it’s not a bill, then what is it?|
|Wellmark: Find a Doctor or Hospital||Your Baby Will Depend On You|
|You’re ready to Quit Tobacco. We can help for free.|
Health Insurance Notices Required by Law
|Health Insurance Marketplace Notice|
|HIPAA Privacy Practice Notice|
|“Michelle's Law” Notice|
|Wellmark's Notice of Information Privacy Policies and Practices|
|Women's Health and Cancer Rights Act|
|Health Insurance Options Side-by-Side Comparison|
|Doctor on Demand|
|Important Information about Iowa Choice|
|Guest Membership for Iowa Choice|
|Travel Out of the Country|
All State employees (except employees covered by the SPOC contract) are offered the same health coverage (one plan) with a choice between two network options:
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.
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 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.
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.
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.
Guest Membership for Iowa Choice
Members traveling long-term within the USA, any dependent student attending school out-of-state, or qualified spouses/dependents residing in another state are eligible to become a guest member any time they are outside the Wellmark Health Plan Network area for at least 90 days. Guest membership is not intended for contract holders whose permanent residence is out of the state of Iowa. If your permanent residence is out of the state of Iowa, you will need to select the National Choice PPO plan. Please contact Amy Liechti in the Department of Administrative Services at 515-422-7156 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 Health Plan Network area, call Wellmark Customer Service at 800-622-0043 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.
The Department of Administrative Services – Human Resources Enterprise is providing this information about the State of Iowa’s benefits. The information on this web page is subject to change. Nothing herein shall be construed as a guarantee of benefits. This webpage is not a complete description of the State of Iowa’s benefit plans. Nothing on this web page supersedes or changes any of the terms and conditions of any plan documents, insurance policies, or other legal agreements. If the wording in this web page contradicts any plan documents, laws, regulations, administrative rules, insurance policies, or other legal agreements, the wording in the official documents and agreements will govern.