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My Benefits | Health

Self-Insured Health Plans

Administered By Wellmark Blue Cross and Blue Shield of Iowa

The university offers eligible employees two self-insured plans to cover health expenses.

Eligibility Criteria for UNI PPO (Alliance Select) and UNI Blue Advantage (HMO)

Non-temporary Employees

Non-temporary employees must work at least 20 (50%) hours per week and have an appointment for nine (9) months or greater.

Temporary Faculty

Temporary faculty must meet one of the following eligibility criteria:

  1. they are appointed for nine (9) months working 20 hours (50%) a week or more or;
  2. they are appointed for a second consecutive semester at 20 hours (50%) a week or more.

Affordable Care Act (ACA) Eligibility

If you don’t meet one of the above criteria, you could still be eligible for ACA health insurance.

Life EventCoverage StartsDays to Initiate a Change
Health Benefits Coverage Starts
New HireBased on your start date, coverage begins the first day of the next month.30 Days After the Event
Qualifying Employment EventBased on the event date, coverage begins the first day of the next month30 Days After the Event
Qualifying Life EventsBased on the event date, coverage begins the first day of the next month.30 Days After the Event
Adoption, Placement for AdoptionCoverage starts as of the date on the adoption decree.60 Days After the Event
BirthCoverage starts the date the baby is born.60 Days After the Event
Open EnrollmentChanges not associated with a life event must be made during the Annual Open Enrollment period. These changes will be effective January 1 of the upcoming year.Defined Open Enrollment Period
Life EventCoverage Ends
Health Benefits Coverage Ends
Reduction in Working HoursCoverage ends the last day of the month the appointment is no longer eligible.
Separation of EmploymentCoverage ends the last day of the separation month.
Qualifying Life EventsCoverage ends the last day of the month in which the qualifying event occurred.
Open EnrollmentIf there are changes to end coverage during the Annual Open Enrollment period, coverage will end December 31 of the current year.

If someone on the UNI health insurance plans becomes ineligible for coverage they will be offered coverage through the Consolidated Omnibus Budget Reconciliation Act (COBRA).

Coverage

Coverage is available for:

  • Yourself
  • Your spouse
  • Common law spouse or domestic partner
  • Children to age 26;
    • Children who are unmarried full-time students over the age of 26;
    • Qualified children over age 26 who are totally and permanently disabled, provided the disability existed prior to age 26.

Returning to Work

If a retiree returns and is eligible for benefits, they can either:

  1. Select the active employee benefits and waive retiree coverage
    or
  2. Waive the active employee benefits and continue with the retiree benefits.

Once the retiree coverage is waived, the retiree cannot re-enroll in retirement coverage.

An employee can only retire from UNI once.

What Does Self-insured Mean?

Health Premium Payroll Deductions

Health premiums are withheld from your pay as a pre-tax deduction, which reduces your taxable income and the amount of taxes you pay at the time of payroll. This is a default selection by the university. If you would like to opt out of the pre-tax premium option, please complete the After-Tax Premium Option form and submit to the Human Resource Services Office.

Health Insurance Plan Details

UNI PPO (Alliance Select) Plan

Plan Information Effective: January 1, 2020 through December 31, 2020

Plan Highlights

The self-insured UNI PPO plan is a Preferred Provider Organization (PPO) plan and is administered by Wellmark Blue Cross and Blue Shield. This health plan:

  • Contracts with a network of "preferred" providers in the Alliance Select network from which you can choose.
  • Does not require you to select a Primary Care Physician.
  • Does not require referrals to see other providers in the network.
  • Consists of 99% of physicians and 100% of hospitals in Iowa covered in the network, and 92% of physicians and 96% of hospitals who participate nationwide.
  • If you receive your care from a doctor in the Alliance Select network you will be responsible for an annual deductible and any applicable coinsurance, or a copayment for your visit.
  • If you get health services from a doctor or hospital that is not in the preferred network (known as going "out-of-network") you will pay a higher coinsurance amount, and you may need to pay the doctor directly and file a claim with the Wellmark BCBS to get reimbursed.
  • Access to doctors and hospitals in nearly 200 countries and territories around the world through the Blue Cross Blue Shield Global Core program.
Premiums January 1, 2020 - December 31, 2020
CoverageEmployee 1/12 Annual PremiumEmployee Annual PremiumUNI Annual Premium
Single$21.45$257.40$9,093.72
Family$364.80$4,377.60$17,505.96
Shared Family$182.40$2,188.80$19,694.28

UNI Blue Advantage (HMO) Plan

Plan Information Effective: January 1, 2020 through December 31, 2020

Plan Highlights

The self-insured Blue Advantage is a Health Maintenance Organization (HMO) administered by Wellmark Blue Cross & Blue Shield of Iowa. This plan:

  • Requires members to designate a Primary Care Physician and this person becomes the gatekeeper for your health care. If your PCP is not available you may schedule with another provider within the same clinic without being penalized.
  • Requires that referrals to specialists outside of the Blue Advantage network be coordinated by your Primary Care Physician.
  • Allows females to designate both a Primary Care Physician and OB/GYN.
  • Allows coverage outside of the network for emergencies.
  • A list of participating providers may be found on Wellmark's website.
  • Allows coverage for members who will be out of the network for 90 consecutive days or more through a Guest Membership.
Premiums January 1, 2020 - December 31, 2020
CoverageEmployee 1/12 Annual PremiumEmployee Annual PremiumUNI Annual Premium
Single$0.00$0.00$9,093.72
Family$192.60$2,311.20$17,505.96
Shared Family$20.10$241.20$19,694.28

Prescriptions

UNI’s health plans cover prescriptions the same on each plan. The BlueRx Complete Formulary is utilized for prescription coverage.

Telehealth/Virtual Doctor

Both of UNI’s self-insured health plans cover telehealth visits. Wellmark contracts with Doctor on Demand for telehealth services. You can utilize Doctor on Demand to speak to a board certified physician, or team of psychiatrists/psychologists.

Blue365® Health and Wellness Deals

If you are a member of a health insurance plan offered at UNI, then you are eligible for savings through the Blue Cross and/or Blue Shield Companies member discounts. Discounts may be available for vision materials purchases. Some deals will give you a coupon code instantly on the Blue365® site. This coupon code can be applied directly to a purchase on a vendor’s website or will provide a discounted option on a product or service.

Other deals may take you to a vendor’s website directly to make a discounted purchase or enroll in a special discounted program instantly.

Blue365® Categories

  • Fitness
  • Healthy Eating
  • Personal Care
  • Lifestyle
  • Financial Health
  • Wellness

Find a Provider

How to Find a Provider

You can find a provider or facility using your myWellmark account, or by using the provider and facility search operated by Healthsparq®. Healthsparq® is an independent company providing provider, cost and quality information on behalf of Wellmark.

Getting Started with the Provider and Facility Search

    1. First enter the location of the provider or facility.
    2. Next, enter your plan information. Your plan information is a three digit code based on your enrolled health plan. For the UNI PPO (Alliance Select) health plan (Image 1, letter A), the code is UONW (Image 1, letter B). For the UNI Blue Advantage (HMO) plan (Image 2, letter C), the code is XQWW (Image 2, letter D).
    3. The search automatically defaults to All Categories. You can narrow your search results by doctors by name, doctors by specialty, places by name, or places by type.
    4. In the search field, enter in the doctors, hospitals and clinics by name or specialty.
    5. Finally, click or tap the search icon or press enter to run the search.
  • UNI PPO Insurance Card Example Image 1 UNI HMO Insurance Card Example Image 2

To see which health plan you are enrolled in, log in to Benefits Self-Service and click View My Current Benefits.

How to Change Your Provider with Wellmark

If you are enrolled in the UNI Blue Advantage (HMO) health insurance plan and would like to change your Primary Care Physician (PCP), please call the Wellmark customer service 800 number located on the back of your card.

Health Insurance Coverage - What To Do When Traveling Internationally

PlanCoverageEmergency Coverage
International Health Insurance Emergency Coverage
UNI PPOOffers coverage nationally and internationallyOffers coverage nationally and internationally
UNI Blue Advantage (HMO)Iowa and South Dakota onlyOffers coverage nationally and internationally

Being a member of either of the two UNI health insurance plans ensures coverage when traveling and an emergency occurs. The UNI Blue Advantage (HMO) plan only offers coverage outside of the state of Iowa for accidental injuries and emergencies. While on the PPO health plan you can receive coverage nationwide and around the world.

If you traveling outside of the United States on the PPO Plan, and need coverage, please complete the following steps:

  1. Call the number on the back of your Wellmark ID.
    • Explain your situation and ask about coverage.
    • Ask for steps in order to pay for the service.
  2. Access the International Claim Form.

In the case of a true emergency please always seek help immediately.

UNI Employee Benefits Self-Service

Benefits Self-Service System is designed to help you enroll, make changes, and view your current benefit elections all in one location. For additional support, visit the Benefits Self-Service Help site.

 

Frequently Asked Questions

  1. 1Q: How do I request a new health insurance ID card?

    Order new insurance ID cards online through your myWellmark account or by calling customer service at 1-800-355-2031.

  2. 2Q: Does our Wellmark health insurance cover the shingles vaccination?

    Yes, both the Zostavax and Shingrix vaccinations are covered for members age 50 and older under both of the UNI plans.

  3. 3Q: If I am making a mid-year change to my health plan, does what I've contributed to my deductible and out-of-pocket maximum transfer to the new plan?

    Wellmark to Wellmark deductible credit applies. Deductible credits transfer from one Wellmark employer group to another Wellmark employer group. Wellmark to Wellmark Out-of-Pocket credit also applies.

  4. 4Q: Is the Blue Rx Complete Drug List limited to Hy-Vee and CVS pharmacies?

    No, members of the UNI Blue Advantage and UNI PPO plans can utilize any pharmacy they wish to fill their prescriptions. Hy-Vee and CVS negotiate with drug companies for lower prices that would save you, and the plan, money. Please consider price comparing among pharmacies prior to filling a prescription.

  5. 5Q: Do you have to have a referral to see a specialist on either health plan?

    No, our plans do not require referrals when receiving services from a specialist. Some specialists may have their own requirement that a referral be obtained prior to the appointment.

  6. 6Q: How do I add/drop a dependent?

    You may add or drop dependents within 30 days of a qualifying life event. Qualifying events may include marriage, birth, death, divorce, a dependent’s return to full-time student status and a spouse’s loss of group coverage. Only the dependents that are affected by the event may be added. Other changes to your plan must be made during the open enrollment period. To make a change due to a life event, please utilize the Benefits Self-Service System to make your election changes.

  7. 7Q: When can I make changes to my plan?

    You are only allowed to make changes to your health insurance when a life event such as birth, death, marriage, or divorce takes place. You must contact the Human Resources Office within 30 days of the life event. All other changes must be made during the Open Enrollment period.

  8. 8Q: When does coverage begin?

    Coverage begins on the first day of the month following the date of employment, or change in eligibility providing you enroll within 30 days.

  9. 9Q: When is the Open Enrollment Period?

    The University conducts an open enrollment period annually. Information is sent to employees each October outlining the provisions of the open enrollment period. Informational sessions are also held each year. Changes and new enrollments are effective January 1.

  10. 10Q: How do I change my address with Wellmark?

    To ensure that all covered individuals receive information properly and efficiently, it is important that you notify HRS of any address changes.

    • Active Faculty and Staff
      Home address information can be viewed and updated via MyUNIverse and UNI Employee Self Service.
    • Retirees
      Please fill out a Health, Dental & Vision Plan Enrollment Form and return to HRS. The Benefits department will make the necessary changes within the UNI and Wellmark systems; there is no need to contact Wellmark with an address change.
  11. 11Q: On the PPO Plan, when someone meets the deductible, $350 for in-network services, and then goes out-of-network, do they have to meet the entire $700 out-of-network deductible? Or since they have already met $300, do they need to pay $300 more?

    The PPO and Non-PPO deductible amounts aggregate and apply to each other. So in your example below, the member would only have to pay $350 more towards the Non-PPO if they already met the $350 PPO deductible.

  12. 12Q: Clarification on what this meant from the Pre-Certification section of the PPO Coverage Manual:
    If you receive any other covered services (i.e., services unrelated to an inpatient admission) from a PPO or Participating provider outside Iowa or South Dakota, you or someone acting on your behalf are responsible for notification requirements.

    If a member is outside of Iowa/South Dakota, currently the member would be the person that is responsible for making sure that any pre-certifications that need to occur have happened. In Iowa/South Dakota it is written into the provider contracts that this is a provider responsibility. But outside of Iowa/SD that may not be the case so the member needs to make sure that any pre-certs have been completed. Typically providers take care of this for the member.

  13. 13Q: Is there a time limit for submitting a secondary insurance claim? Did it reduce from 365 to 180 days. Whose responsibility is it to file that claim?

    For secondary insurance, the claim must be received within 180 days of the primary carrier’s process date to be considered timely filed. The typical process would be that the provider submits the claim to the primary insurance, once the primary pays, the provider then submits the claim to secondary insurance. That process depends on whether the provider is in or out of network but in general, that is how that happens. The member can always call the provider and make sure that this has occurred. The change from 365 to 180 days was effective in 2015.

  14. 14Q: If a member already received pre-approval for a prescription, if he moves to another plan will they have to go through pre-approval again?

    The member is already a UNI member and has a prior approval on file for the drug, they would not need a new one if they switch from one UNI plan option to another. The Wellmark ID for the member stays the same so the approval will follow them between the plan options at UNI.

  15. 15Q: Would Blue Card Worldwide cover transportation home if an individual became ill abroad while covered by UNI PPO?

    There could be extenuating circumstances but generally, no.

  16. 16Q: What is the difference between pre-authorization and pre-approval?

    There really isn’t a distinct difference for a member. In general, we use the words prior approval for services/treatment plans that need to be reviewed for medical necessity. We use the word pre authorization for radiology services that need reviewed for medical necessity as well as for prescription drugs that require a review.

  17. 17Q: Would a member on a guest membership of the HMO plan have to come back to Iowa for a surgery that was not an emergency?

    No, they would need to call Wellmark prior to the service, but would not need to travel back to Iowa for coverage.

  18. 18Q: How would Doctor On Demand be covered for a UNI Retiree who is on Medicare and has the PPO as secondary insurance? If Medicare did not pay would they still only pay their copay for the service through the secondary insurance?

    Doctor on Demand does not file claims to Medicare or coordinate secondary insurance. Wellmark is currently working through a claims process to allow claims to go through without a Medicare denial. The member would be responsible for the applicable copay as though the UNI plan was primary.

  19. 19Q: If I am still working at age 65, does Medicare become primary or secondary coverage?

    As long as you are still covered on a UNI health insurance plan, Medicare would be secondary coverage. This also applies to any Medicare eligible spouse you are covering. You are not required to sign up for Part B while covered on a group plan. Please see the I am Turning 65 and My Spouse is Turning 65 web pages for more information.

  20. 20Q: If I am still working at age 65, am I required to sign up for Medicare?

    As long as you are still covered on a UNI health insurance plan, you are not required to sign up for Medicare Part B. You are eligible to sign up for Medicare Part A which covers hospital care, skilled nursing facility care, nursing home care, hospice, and home health services. Medicare Part A is at no cost to you. Please see the I am Turning 65 and My Spouse is Turning 65 web pages for more information.

  21. 21Q: How do I apply for a Guest Membership while on the Blue Advantage plan?

    Call the number on the back of your Wellmark ID to set up a Guest Membership.

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