Know Your Benefits

Blue Choice^® – What You Need to Know

Multi-level plan

With Blue Choice, you designate a Wellmark Health Plan of Iowa primary care provider (PCP) to help coordinate your care. From there, you have three levels of coverage to choose from:

	Coverage Level		Description
	Level 1		You receive care from: Your designated Wellmark Health Plan of Iowa PCP A facility participating in the Wellmark Health Plan of Iowa network Your designated OB/GYN for preventive gynecological exams* A network optometrist or opthalmologist for preventive vision exams* *Benefits for other preventive care are available only when provided by your designated PCP.
	Level 2		You visit any provider in the Wellmark Health Plan of Iowa network.
	Level 3		You may: Visit a provider or facility outside the Wellmark Health Plan of Iowa network Pay a higher coinsurance amount Be billed for the difference between the provider’s charge and what Wellmark will pay

When is a referral necessary?

In the following situations, your provider is required to notify Wellmark Health Plan of Iowa about referrals to assure you receive Level 2 benefits:

• Home/durable medical equipment, prosthetic appliances, and, if applicable, orthotics in excess of $250 — The Wellmark Health Plan of Iowa provider notifies Wellmark of the referral for the rental or purchase of home durable medical equipment. Wellmark must be notified of the referral prior to receiving services.
  
• Out-of-network providers — On those occasions when the required care is beyond the scope of services available through a network provider; the PCP must notify Wellmark of referrals to any provider outside the network. The referral must be approved by Wellmark prior to receiving services. Level 2 benefits apply to these services for which the referral is approved.

Level 3 benefits will apply to home/durable medical equipment, prosthetics, and orthotics in excess of $250 and out-of-network services without a referral.

See your PCP

Each person in your family selects a PCP from our list of general/family practice physicians, internists, and pediatricians that are part of the Wellmark Health Plan of Iowa network.

In addition to choosing a PCP, female members can also designate a network obstetrician/gynecologist (OB/GYN).

Changing your provider

You can change your PCP or OB/GYN at any time by calling customer service. The change takes effect the first of the month following your request.

Pay your copayment

When you receive services in a Wellmark Health Plan of Iowa provider’s office, remember your office visit copayment is due at the time of service.

See also:

• Blue Choice Downloadable Fact Sheet (PDF)

Blue Choice is available only in the following Iowa counties: Appanoose, Benton, Black Hawk, Boone, Bremer, Buchanan, Butler, Cedar, Clarke, Clayton, Clinton, Dallas, Davis, Delaware, Grundy, Guthrie, Iowa, Jackson, Jasper, Jefferson, Johnson, Jones, Keokuk, Linn, Louisa, Lucus, Madison, Mahaska, Marion, Marshall, Mills, Monroe, Muscatine, Polk, Pottawattamie, Scott, Shelby, Story, Tama, Van Buren, Wapello, Warren, Washington, Wayne.

Note: If your benefit plan has not renewed yet in 2005, your Blue Choice plan may have a different benefit structure. For more information, refer to your benefits certificate or contact customer service.