| |
Wellmark Blue Cross and Blue Shield
|
Wellmark Health Plan of Iowa
|
| Plan Name |
Classic Blue® |
Alliance SelectSM |
Blue PrioritySM |
Blue Choice® |
Blue Access® |
Blue Advantage® |
| Plan Type |
Traditional Indemnity |
Preferred Provider Organization (PPO) |
Consumer-Driven |
Point-of-Service (POS) |
Open Access |
Primary Care |
|
How Plan Works
|
Comprehensive plan provides more freedom to choose the providers your employees know and trust.
|
Offers employees access to an extensive provider network and the freedom to see any provider and still receive benefits.
|
Combines a qualified high-deductible health plan with a health care account (HSA or HRA) to encourage employees to make cost-conscious decisions.
|
Combines the freedom of choice offered by traditional coverage with the affordability and preventive health features of managed care plans.
|
Offers referral-free access to a managed-care provider network, with no Primary Care Physician (PCP) requirement.
|
Comprehensive coverage with an emphasis on preventive care. Employees choose a Primary Care Physician (PCP) to coordinate all care and refer them to specialists.
|
|
Network
|
Access to any hospital or provider
|
100% of hospitals and 99% of physicians in Iowa.
BlueCard® Network: More than 90% of hospitals and 80% of doctors nationwide.
|
Wellmark Health Plan of Iowa: 100% of hospitals and 96% of physicians in Iowa.
BlueCard Network: More than 90% of hospitals and 80% of doctors nationwide.
|
Wellmark Health Plan of Iowa: 100% of hospitals and 96% of physicians in Iowa.
BlueCard Network: For emergency care only. No out-of-network coverage except for emergency care.
|
| Provider Choice |
Direct access to any hospital or provider with no referral requirements. Participating providers offer lower out-of-pocket costs, file claims, and fulfill notification requirements. |
PCP coordinates care. Females may also choose a network OB/GYN. Employees must see PCP for preventive services: can self-refer to in-network or out-of-network providers for specialist care. |
No PCP requirement. Can visit Wellmark Health Plan of Iowa provider for care without a referral. Referrals required for chiropractic care and out-of-network services. |
PCP coordinates care. Females may also choose a network OB/GYN. Referrals required for specialist care, chiropractic care, and out-of-network services. |
| Benefit Levels |
Benefits for covered services from any provider. |
In- and out-of-network coverage. Tiered benefit design with levels for care from Alliance Select providers and non-PPO providers. |
Employer and/or employee funds an account to pay for medical expenses. Deductible applies to all services except preventive care. When account is gone, employee is responsible for remaining deductible and out-of-pocket maximum. |
In- and out-of-network coverage. Tiered benefit design with levels for primary care, in-network, and out-of-network services. |
Network-only coverage |
Network-only coverage |
| Coverage |
Recommended plan designs include coverage for preventive care, office visits, lab work and X-rays, surgery, hospital stays, and prescription drugs. Customize plan with deductible, coinsurance, and copay choices. |
| Lifetime Maximum |
Unlimited
|
| Prescription Drug Coverage |
Blue Rx PreferredSM: Prescription drugs are covered with a range of cost share options. Mail Service Program available. |
Blue Rx Preferred for HRA.
Drugs covered under health for HSA.
|
Blue Rx Preferred: Prescription drugs are covered with a range of cost share options. Mail Service Program available. |
| Health & Wellness |
All plans include Health & Wellness Programs
|
