Inside Iowa State: Iowa State University

INSIDE IOWA STATE
November 9, 2001

Change window for medical, dental plans closes Dec. 7

by Debra Gibson
As your Palm Pilot no doubt has informed you, it's time for faculty, P&S and supervisory Merit employees to review their medical and dental insurance options for next year. The 2002 enrollment period, which began Nov. 5, ends at 5 p.m. Friday, Dec. 7.

All changes become effective Feb. 1, 2002. At that time, the catastrophic plan will be discontinued, due to low enrollment. Individuals currently enrolled in that plan will be moved to the Indemnity plan unless they choose to enroll in another plan during the open change period (see other options below).

Rising costs also are affecting prescription drug coverage. Beginning Feb. 1, a three-tier co-payment plan will be implemented, applicable to all three medical plans. They are:

Generic drugs, co-payment remains $7 per 30-day supply.
Preferred brand name drugs, co-payment remains $15 per 30-day supply.
Non-preferred brand name drugs, co-payment of $30 per 30-day supply.

If you have been prescribed a medication to control specific, ongoing conditions, you still will be able to purchase a 90-day supply for two co-pays ($14/$30/$60).

To determine at what level a prescription will be covered, go to one of these Web sites:

Wellmark: http://www.wellmark.com/products/pharmacy/alpha_order.htm.
Health Alliance: http://www.healthalliance.org/services/members/members.asp.

Three medical, two dental plans
Faculty, P&S and supervisory Merit employees have three medical plans from which to choose:

Indemnity. Known as Wellmark's "Classic Blue" plan, those covered can choose any licensed physician, hospital or other medical facility. This is the least cost-effective plan for the university.
Preferred Provider Organization (PPO). This managed care plan, also administered by Wellmark Blue Cross/Blue Shield, offers both in- and out-of-network coverage. If subscribers choose a BCBS preferred provider, the plan pays higher benefits.
Health Maintenance Organization (HMO). Offering managed care through Health Alliance, this plan requires subscribers to obtain health care from a primary care physician or to get a referral to another approved physician within the network. Most services are paid entirely by the plan.

Now is a good time to review dental insurance coverage as well. The ISU Plan offers basic and comprehensive programs; those enrolling in the comprehensive plan must remain in that plan for at least three years.

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

You're not convinced your stomach problems have been properly diagnosed, and you make an appointment at the Mayo Clinic.
Here's your part of the office visit bill:
1. Indemnity: $300 deductible (unless it's already been met) plus 20 percent of what the provider considers a maximum allowable fee.
2. PPO: $10 copay (Mayo Clinic is a preferred provider).
3. HMO: 100 percent, although an appeals process is available for those who wish to seek out-of-network treatment.
The family's summer vacation fund now has been re-labeled your daughter's orthodontia account. Can dental insurance help?
1. Basic plan: Nope. (But services can be paid with pre-tax flex spending dollars.)
2. Comprehensive plan: Will reimburse orthodontist up to 50 percent of services, up to $1,500 (the lifetime maximum for your daughter), after a $50 deductible.
That lingering high school football injury required reconstructive surgery on your left knee. Now your surgeon says physical therapy is a must.
Here's your part of the PT bill:
1. Indemnity: 20 percent (after deductible).
2. PPO: In-network: 10 percent; out-of-network: 20 percent (after deductible).
3. HMO: 0 percent; limited to 20 visits per year with a network therapist and a referral from your primary care physician.
Your physician has recommended you undergo costly infertility treatments. Here's your part of the bill:
1. Indemnity: After $300 deductible has been met, 20 percent of costs, with an annual out-of-pocket maximum of $1,500. Insurance benefits end after a $15,000 lifetime maximum.
2. PPO: In-network: 10 percent up to $1,500 annual out-of-pocket maximum; out-of-network: after $300 deductible has been met, 20 percent up to $1,500 annual out-of-pocket maximum; lifetime benefits maximum of $15,000 for both options.
3. HMO: 0 percent, pre-authorization required and services must be directed by your primary care physician; lifetime benefits maximum of $15,000.
Your spouse has been diagnosed with depression, and outpatient therapy is recommended.
Here's your part of the bill:
1. Indemnity: 20 percent (after deductible); pre-treatment review required.
2. PPO: In-network: $10 co-pay per visit plus 10 percent; out-of-network: 20 percent after $300 deductible is met; pre-treatment review required.
3. HMO: 0 percent; limited to 20 visits per year; pre-treatment review required.

The next step
If you want to retain your current benefits plan, do nothing. To make changes, either enroll online through Access Plus or by contacting the benefits office, 1031 Wallace Road Office Building, 515-294-7680, benefits@iastate.edu.

Rates: 2002 vs. 2001
Medical and dental costs continue to increase for faculty, P&S and supervisory Merit coverage. Medical price tags have grown by 6 to 14 percent, and dental costs have risen 4 percent for the coming year. To help combat these higher costs, ISU will increase its contribution to medical benefit credits by 9.5 percent.

So what will all this cost you come February? A PDF file comparing 2002 medical rates to 2001 is available online at: http://www.iastate.edu/~hrs_info/benefits/2001_ISUPlan_Rates_Comparison.pdf.