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
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:
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
- 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
To determine at what level a prescription will be covered, go to one of
these Web sites:
Three medical, two dental plans
Faculty, P&S and supervisory Merit employees have three medical plans from
which to choose:
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
- 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.
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:
- Indemnity: $300 deductible (unless it's already been met) plus 20 percent
of what the provider considers a maximum allowable fee.
- PPO: $10 copay (Mayo Clinic is a preferred provider).
- 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?
- Basic plan: Nope. (But services can be paid with pre-tax flex spending
- Comprehensive plan: Will reimburse orthodontist up to 50 percent of
services, up to $1,500 (the lifetime maximum for your daughter), after a $50
- That lingering high school football injury required reconstructive
surgery on your left knee. Now your surgeon says physical therapy is a
Here's your part of the PT bill:
- Indemnity: 20 percent (after deductible).
- PPO: In-network: 10 percent; out-of-network: 20 percent (after
- 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:
- 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.
- 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
- HMO: 0 percent, pre-authorization required and services must be directed
by your primary care physician; lifetime benefits maximum of
- Your spouse has been diagnosed with depression, and outpatient therapy is
Here's your part of the bill:
- Indemnity: 20 percent (after deductible); pre-treatment review required.
- 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.
- HMO: 0 percent; limited to 20 visits per year; pre-treatment review
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,
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:
Ames, Iowa 50011, (515) 294-4111
Published by: University Relations,
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