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Blue Choice®
A Point-of-Service (POS) Product
Perfect for those groups transitioning employees from a traditional
health plan to a managed care plan, Blue Choice gives you the preventive
care of a primary care provider model, the flexibility of an open access
model and the out-of-network coverage of a managed indemnity plan. That
means no matter what kind of participating provider your employees want to
see, they're covered.
As the group administrator of a large employer group, you have great
flexibility in customizing a Blue Choice plan to meet your group's unique
needs. You can customize:
- Deductibles
- Coinsurance amounts
- Covered and noncovered services
- Prescription drug coverage
Five Points You Need to Know About Blue Choice:
- Three plans rolled into one. Once your employees choose a
primary care provider (PCP) to coordinate their care, they'll have
three options to consider when they need medical care. Benefits vary
based on the level of coverage chosen:
Level 1. To
receive Level 1 benefits, employees must receive care from
their designated PCP. Women
may also select an OB/GYN for obstetrical and gynecological services.
Benefits for preventive services are available only when those services
are provided by the designated PCP.
Level 2. Allows the member to visit any other provider in the
Wellmark Health Plan of Iowa network. Referrals are
required for certain services to receive Level 2 benefits.
Level 3. Allows the member to receive care from a provider
who is not in the Wellmark Health Plan of Iowa network.
- See network providers. When employees use Wellmark Health
Plan of Iowa network providers, they receive either
Level 1 or Level 2 benefits, keeping their
out-of-pocket
costs
lower.
- Prescription drug plan included. Blue Rx Preferred prescription
drug coverage has a three-tier copayment structure to encourage your
employees to use
generic or lower-priced drugs. Different copays apply for generic
drugs, specially selected brand name drugs, and all other brand name
drugs. Blue Rx Preferred provides convenient access to a large pharmacy
network that includes both national retail chains and independent
pharmacies.
- Preventive services covered. Blue Choice emphasizes
preventive care with benefits designed to keep your employees healthy — which
translates into a healthier workforce for you and helps control health
care costs. These preventive benefits include routine physicals, well-child
care, immunizations, mammograms, and well-female exams. Benefits for
preventive care services are only available when those services are
provided by the member's designated PCP or OB/GYN.
- Coverage for routine vision exam. Because Wellmark is committed
to total health, we include coverage for a routine vision exam in all
Blue Choice health plans and offer separate vision options as
well.
Contact your Wellmark account manager or
broker to find out if Blue Choice meets your needs.
Please note: This information is only a summary of the benefits of Blue
Choice health insurance coverage from Wellmark
Health Plan of Iowa; it is to be used for descriptive purposes only.
Benefits and general provisions described herein are subject to terms of
the actual policy and benefits certificate.
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