Inside Iowa State: Iowa State University

November 8, 2002

Time to review insurance plans, make changes

Once you've seen the doctor, it's usually time to have a prescription filled, like these customers are doing at the Clinic Pharmacy.
Photo by Bob Elbert.

by Debra Gibson
It's time to tag the tree, tote home the turkey and take stock of your health insurance plans for 2003.

University merit employees have until 5 p.m. Monday, Nov. 18, to change to a different medical plan; the enrollment period for faculty and P&S staff began Nov. 4 and runs through Dec. 6. (Watch the Nov. 22 issue of Inside for information on faculty/P&S health and dental plans.)

Merit employees can review their current enrollment status by logging on to AccessPlus (http://www.accessplus.iastate.edu) or by contacting the Benefits Office at 4-7680. Actual merit plan changes for 2003 cannot be made online; a new enrollment form must be submitted to the Benefits Office, 1031 Wallace Road Office Building, Room 100, by the deadline.

Once again, there are three types of medical plans from which merit employees can 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.
Preferred Provider Option (PPO) (Blue Cross/Blue Shield 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. It also covers routine eye and hearing exams, which are not covered under the Program 3 Plus plan. Using these providers means less costs for plan members.
Managed care organizations (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 the insurer may not cover it. According to Diane Muncrief, human resources manager, there are a few changes to this year's managed care options. Those currently enrolled in the Secure Care plan (only about 12 this year) will need to switch to another plan, since Secure Care has been bought out by United Health Care of the Midlands. Also, John Deere is now offering a second managed care plan.

Because enrollment in a dental plan is not an annual option for merit employees, only those wishing to drop dental coverage can make a change in their 2003 plan. Merit employees also are encouraged to participate in the flex program ( see Oct. 11 Inside); that enrollment deadline also is 5 p.m., Monday, Nov. 18.

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

Your sister has been offered a position at the university, but she is concerned that her diabetes will prevent her from being insured immediately.

Typically, plans take effect the first of the month following 30 days of service. Here's when her coverage will kick in, because of that pre-existing condition:

Indemnity: 11 months after employment begins.
PPO: In-network: 11 months; out-of-network: 11 months.
MCO: Immediately.

Life at your house is one big sneeze fest: you, your spouse and both kids have allergies. Consequently, your pharmacist knows you on a first-name basis.

Here's your part of the pharmacy bill:

Indemnity: $5 for preferred generic; $15 for preferred brand; $30 for non-preferred brand, plus the difference in cost if you are taking a brand-name or non-preferred drug over an available generic drug; separate $500 out-of-pocket limit for prescription drugs that does not apply to medical out-of-pocket limit.
PPO: In-network and out-of-network: same as indemnity.
MCO: $5 for generic; $15 for formulary brand; $30 or 25 percent of non-formulary brand, whichever is higher; prescription must be from plan physician in plan pharmacy; no separate out-of-pocket limit; copayments do not count toward plan's $1,500 family out-of-pocket maximum.

You're pregnant! But what's it going to cost?

Here's your part of the bill (assuming no complications):

Indemnity:
- Physician: 20 percent, no deductible for pre- and post-natal visits and delivery
- Hospital room and board: 20 percent after $300 deductible, precertification of admission required
- Inpatient supplies, drugs, etc.: 20 percent after deductible
- Inpatient tests, specialized care, etc.: 20 percent, after deductible.
PPO:
- In-network:
  - Physician: 10 percent, deductible waived in office setting for pre- and post-natal visits
  - Hospital room and board: 10 percent after $250 deductible, precertification of admission required by select provider
  - Inpatient supplies, drugs, etc.: 10 percent after deductible
  - Inpatient tests, specialized care, etc.: 10 percent after deductible.
- Out-of-network:
  - Physician: 20 percent after $250 deductible;
  - Hospital room and board: 20 percent after deductible, precertification of admission required;
  - Inpatient supplies, drugs, etc.: 20 percent after deductible;
  - Inpatient tests, specialized care, etc.: 20 percent after deductible.
MCO:
- Physician: Free delivery (seriously) when in network or an emergency; $10 copayment for initial visit; remaining pre-and post-natal visits paid in full
- Hospital room and board: free if authorized; semi-private basis unless medically necessary to use private room
- Inpatient supplies, drugs, etc.: free if authorized
- Inpatient tests, specialized care, etc.: free, if authorized.

That nasty cough won't go away, and your physician suspects pneumonia.
Here's your part of the bill:

Indemnity: Office call: 20 percent, no deductible; X-ray and lab: 20 percent, no deductible.
PPO:
MCO: Office call: $10 copayment; X-ray and lab: free if in network, 100 percent if not in network.

That evening trip to the skate park ends in a nasty gash for your son and a trip to the ER.
Here's your part of the bill:

Indemnity: ER care: free, no deductible; accident treatment: free, no deductible for all treatment within 72 hours of accident.
PPO:
MCO: ER care: $50 copayment, waived if admitted; accident treatment: free.

What it costs

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. 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 2003:

Indemnity	$242.90
PPO	$173.44

MCOs
Blue Advantage	$0
John Deere Open Access Choice	$265.98
John Deere Primary Care Select	$ 38.86
Coventry -- Open Access	$ 96.90
Coventry -- Primary Care	$ 69.84