| |
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.
|
|
