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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 

 
 
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Wellmark Blue Cross and Blue Shield is an Independent Licensee of the Blue Cross and Blue Shield Association doing business in Iowa and South Dakota.
 
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