Health Insurance

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.

How can I access the Machine Readable Files for my health plan?

Here you can download the files you need for the agency where you work:

State Health Insurance Plans

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: 

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

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. 

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. 

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.

Travel

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.

More Information

For more information about health insurance, please contact Wellmark customer service at 800-622-0043.

Health Insurance COVID-19 Update

Wellmark Guidelines for No-Cost COVID-19 Testing

Wellmark Blue Cross and Blue Shield® is now providing COVID-19 tests with no member cost share. 

What tests are covered by Wellmark? 

• Community-based testing. Test Iowa has drive-up locations throughout the state and online assessments developed in coordination with the Iowa Department of Public Health.  
• Health care provider testing. COVID-19 tests provided through the member’s doctor or hospital will be processed through insurance and covered in full. 
• OTC tests approved by the Food and Drug Administration (FDA). Check the FDA's website and enter "OTC" to view the tests that qualify. 

How can you get a test without paying money up-front?  

• The federal government has made free at-home COVID-19 tests available. Visit this site to submit an order. 
• In addition, Wellmark has partnered with CVS Caremark® to provide members with a streamlined purchase experience where members will not have to pay up-front for the OTC COVID-19 test in most situations. You must purchase the test from the pharmacy counter of an in-network pharmacy to be covered with no out-of-pocket costs. Please note: some pharmacies may not be ready to process point-of-sale claims. Also, if the test is purchased at a check-out register other than the pharmacy counter, you will need to pay retail price and submit a claim to CVS Caremark for reimbursement. 

What tests are not covered by Wellmark? 

• Wellmark will not cover OTC COVID-19 tests used for employment purposes, meaning that if you're required to test for COVID-19 weekly or other routine basis, you should not be purchasing those and submitting them to CVS Caremark for reimbursement.  
• COVID-19 testing performed for travel purposes, including, but not limited to, flying internationally or boarding a cruise, is not a covered health plan benefit. 
• OTC COVID-19 tests only qualify for coverage and reimbursement if the test is both self-administered and self-read at home — no laboratory or health care provider is involved.
• Coverage and reimbursement of OTC COVID-19 tests is limited to eight OTC COVID-19 tests per member per month, claims totaling more than that will not be reimbursed by Wellmark. 

Learn more by reading this article from Blue^SM online, visit the Wellmark website for COVID information, or contact Wellmark Customer Service at 800-622-0043.

COVID-19 Vaccines and Vaccine Administration 
The federal government, through Operation Warp Speed, is working to distribute COVID-19 vaccines across the country. While the federal government intends to pay for the initial vaccination doses for all Americans (and providers cannot bill health plans for such doses), Our health plan will pay for the administration of the COVID-19 vaccination at no cost-share to its members, consistent with the CARES Act. Once the federal government stops paying for COVID-19 vaccination doses, our health plan will also cover COVID-19 vaccination doses at no member cost-share as an ACA preventative service.

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.

updated11/09/2022