Inside Iowa State: Iowa State University

INSIDE IOWA STATE
October 26, 2001

It's time to choose health, dental plans

by Debra Gibson
As inevitable as blizzards in January and taxes in April, the time to review insurance plans is here. University Merit employees have until Nov. 5 to change their health and dental plans; the enrollment period for faculty and P&S staff will run from Nov. 5 to Dec. 7. (Watch the Nov. 9 issue of Inside for information on faculty/P&S health plans.)

For the first time in four years, Merit employees can join or add family members to the Delta Dental Plan of Iowa. (This is not an annual option.) Single coverage is free; family coverage will cost $28.02 per month. Coverage for new enrollees begins Jan. 1, 2002.

Merit employees have three medical plans from which to choose:

Indemnity (Blue Cross/Blue Shield Program 3 Plus). The indemnity plan offers individuals the most flexibility in choosing health care providers; it also runs up the highest tab for the university (see story below).
Preferred Provider Option (PPO) (Iowa Select), both in-network and out-of-network. The Iowa Select program is similar to the Program 3 Plus plan except that its health care providers are under contract for reduced fees. Using these providers means less costs for plan members.
Managed care organization (MCO). The MCO offers contracted health care providers for an even lower cost, both to the university and plan members. Care must be received in the network or it will not be covered by the insurer.

So what is the best plan for you? The following scenarios may help you decide.(Note: Scenarios based on providers participating in all mentioned medical plan options.

Suddenly yesterday's pick-up basketball game doesn't seem like such a good idea. You have an appointment with your chiropractor after work.
Here's your part of the bill:
1. Indemnity: 20 percent, no deductible.
2. PPO: In-network: 10 percent, deductible waived in office setting; Out-of-network: 20 percent, after $250 deductible for single person.
3. MCO: $10 co-payment per visit with approved referral.
Your wife convinces you that a driver's license vision test probably isn't comprehensive enough. You're headed for a routine eye exam.
Here's your part of the bill:
1. Indemnity: 100 percent.
2. PPO: In-network: 10 percent, deductible waived; Out-of-network: 20 percent, deductible waived.
3. MCO: $10 co-payment.
Your 10-year-old daughter spends her Saturday lying on the sofa, complaining of a stomachache. By late afternoon, her pediatrician's clinic is closed, and she's feeling worse. You head to the local emergency room, and a few hours later your daughter undergoes an emergency appendectomy.
Here's your part of the bill:
1. Indemnity: 20 percent (after $300 of the family's $400 annual deductible) of physician services, inpatient surgery, room and board, inpatient supplies, inpatient tests, operating room and specialized care; maximum cost for her care is $600 of the $800 annual family out-of-pocket maximum.
2. PPO: In-network: 10 percent (after your daughter's $250 share of the family's $500 deductible) of above-mentioned services; maximum cost for her care is $600 of the $800 annual family out-of-pocket maximum; Out-of-network: 20 percent (after your daughter's $250 share of the family's $500 deductible) of above-mentioned services; maximum cost for her care is $600 of the $800 annual family out-of-pocket maximum.
3. MCO: 0 percent of above-mentioned services, once authorized.
Your cancer surgery appears successful, but you decide to follow up with outpatient chemotherapy treatments.
Here's your part of the bill:
1. Indemnity: 20 percent, no deductible.
2. PPO: In-network: 10 percent, deductible waived in office setting; Out-of-network: 20 percent, after deductible.
3. MCO: $10 copayment per visit.
It's time to take your preschooler for his annual physical who's consoled only by the fact there are no "shots" this time.
Here's your part of the bill:
1. Indemnity: 20 percent, no deductible, up to 7 years old.
2. PPO: In-network: 10 percent, deductible waived in office setting, up to 7 years old; Out-of-network: 20 percent, no deductible, up to 7 years old.
3. MCO: $10 copayment.

Insurance at a premium
So what will it cost you next year to be medically insured? If you're enrolled in a single Merit plan, Iowa State pays the full cost of your coverage. And if both you and your spouse are State of Iowa employees, your medical insurance also comes at no cost to you.

Families enrolled in Iowa State's Merit plan will pay the following monthly premiums in 2002:

Indemnity	$211.28
PPO	$150.82
MCOs:
Blue Advantage	$0
John Deere Health Plan	$202.70
Coventry, Open Access	$96.62
Coventry, Primary Care	$72.66
SecureCare of Iowa	$0
United HealthCare of the Midlands	$154.78

In addition, the state of Iowa and ISU are offering a monthly cash incentive for single plan and double spouse plan subscribers to switch from the indemnity to the PPO plan. Single plan holders who make the change will receive $12.92 per month (one-half the difference between the total premiums for the indemnity and PPO plans). Using the same equation, $30.23 per month will be given to the contract holder for double spouses making the switch.

Why the incentives?
"The whole point of encouraging employees to move to the PPO or the MCO is because they represent managed care," explained Diane Muncrief, benefits manager. "Those providers have agreed to charge lower prices for services than what we would pay on the open market. Those discounts amount to a lower cost for the university. With the indemnity plans, the university potentially could be paying full costs for services."