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Blue Access® for the hawk-i Program

The following amendment to your coverage manual is effective October 14, 2012, except as noted otherwise.

Blue Access Coverage
Benefit Period Deductible

None

Coinsurance

None

Out-of-Pocket Maximum

None

Lifetime Benefit Maximum

Unlimited

Type of Plan

Open-Access Managed Care*

Prescription Drugs

You pay nothing for generic drugs, or for brand name drugs specifically listed on the hawk-i Wellmark Drug List.

Hearing

Covered

Vision

Covered

Preventive Care

Covered

Well Child Care

Covered

Chiropractic Care

Covered

Mental Health and Chemical Dependency

Covered

Emergency Care

Covered anywhere in the world; $25 copay if the visit is not a medical emergency and you pay for your hawk-i coverage

Out of Area Coverage

Covered through the BlueCard® program ONLY if services are for a medical emergency*

Notification Requirements

Generally, notification requirements are handled for you. However, you are responsible for notification requirements when you require or obtain emergency or non-emergency treatment in a facility that is not in the Wellmark Health Plan of Iowa network

* Under Blue Access, coverage is only available if you receive services from health providers who are part of the Wellmark Health Plan of Iowa network. Benefits are NOT available if you go out-of-network. Also, certain benefits apply only when provided by a Primary Care Physician (PCP)-type provider or Obstetrics and Gynecology (OBGYN)-type provider. Benefits are not available if you go out of network.


Do You Qualify?

For more information, call
1-800-257-8563 or visit www.hawk-i.org. leave site


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