Faculty, Staff, and Merit Supervisory/Exempt
Health Insurance Benefit Comparison
Effective January 1, 2013
Plan Provisions : Office Care : Hospital Services : Miscellaneous
| Plan Provisions |
UIChoice |
CHIP II |
| Care Providers |
Any Provider: The provider or facility category you use determines the plan benefit level. This is one plan with three different benefit levels:
Benefit Providers covered at this level
Level:
Level 1 University of Iowa Hospitals and Clinics, Carver College of Medicine (CCOM) and UI Community Medical Services Clinics (CMSC)
Level 2 Blue Choice Network Providers not included in Level 1
Level 3 Any provider outside of Level 1 or 2
Blue Cross/Blue Shield (BC/BS) providers can result in lower out-of-pocket costs. For non-BC/BS providers, insured pays charges over the maximum allowable fee. |
Any provider; BlueCross/BlueShield (BC/BS) providers can result in lower out-of-pocket expenses
For non-BC/BS providers, insured pays charges over the maximum allowable fee |
| Deductible Single/Family |
None |
$1200 single/ $3600 other family status |
| Co-insurance Percentage |
Level 1-10%
Level 2-10%
Level 3-40% |
10% |
Out-of-Pocket Limit
Single/Family |
Combined OPM for Level 1 & Level 2 Services-$1,700 / $3,400;
OPM for Level 3 Services-$2,000 / $4,000;
OPM for prescription drugs-$1,100 / $2,200 |
$4,200 single / $8,400 other family status |
| Pre-existing Condition Waiting Period |
None |
None |
| Pre-approval of Inpatient Admissions |
Required (Subscriber must obtain approval from BC/BS) |
Required (Subscriber must obtain approval from BC/BS) |
| Domestic Partner coverage for same and opposite-sex Domestic Partners |
Available |
Available |
| Second Surgical Opinion |
Voluntary |
Voluntary |
| Maternity |
Handled the same as all other medical claims |
Handled the same as all other medical claims |
| Organ Transplants |
Prior approval required |
Prior approval required |
| Dependent Child Age Limit |
End of the year they turn 26; unlimited if a full time single student or disabled before age 27 |
End of the year they turn 26; unlimited if a full time single student or disabled before age 27 |
| Emergency Defined as: |
a medical condition that a prudent layperson (with an average knowledge of health and medicine) could reasonably expect to result in serious jeopardy to a person’s health in the absence of immediate medical attention. |
a medical condition that a prudent layperson (with an average knowledge of health and medicine) could reasonably expect to result in serious jeopardy to a person’s health in the absence of immediate medical attention. |
| Office Care |
UIChoice |
CHIP II |
| Office Calls |
Level 1-$5 co-pay
Level 2-$20 co-pay
Level 3-40% coinsurance |
10% coinsurance after $1,200 deductible |
| Routine Physicals |
Level 1 & 2 & 3 - $0 co-pay |
0% coinsurance |
| Imaging and Labs |
Level 1 & 2-10% coinsurance
Level 3-40% coinsurance |
10% coinsurance after $1,200 deductible |
| Well Child Care |
Level 1 & 2 & 3 - $0 co-pay |
0% coinsurance |
| Immunizations |
Level 1 & 2 & 3-$0 co-pay |
0% coinsurance |
Routine Eye /
Hearing Exam |
Level 1-$5 co-pay
Level 2-$20 co-pay
Level 3-40% coinsurance |
10% coinsurance after $1,200 deductible |
| Hospital Services |
UIChoice |
CHIP II |
| Emergency Room Care |
Level 1 & Level 2-$50 co-payment (waived if admitted) followed by 10% coinsurance
Level 3-Same as Level 1 or 2 if coded as an emergency; if not coded as an emergency, $50 co-payment followed by 40% coinsurance |
After $50 co-payment (waived if admitted) and $1,200 deductible 10% coinsurance |
| Room and Board |
Level 1-$400 deductible
Level 2-$600 deductible
Level 3-$800 deductible
semi-private room; followed by coinsurance |
10% coinsurance after $1,200 deductible;
semi-private room |
| Inpatient and Outpatient Surgery, Physician Care, Supplies, Labs, & Imaging |
Level 1-10% coinsurance
Level 2-20% coinsurance
Level 3-40% coinsurance |
10% coinsurance after $1,200 deductible |
| Miscellaneous Services |
UIChoice
|
CHIP II
|
| Prescription Drugs |
3-tiered coinsurance plan;
- 1-Generic drugs have 0% coinsurance; provided at no cost to plan member;
- 2-Name-brand Wellmark Formulary drugs have 30% coinsurance;
- 3-Name-brand non-formulary drugs have 50% coinsurance
|
10% co-insurance after $1,200 deductible;
0% co-insurance for generic
medications; Generic medication will
be provided at no cost to plan
members - you will be fully reimbursed after submission to
Wellmark. Deductibles do not apply to generic drugs. |
| Chiropractor |
Level 1-no provider
Level 2-$20 co-pay
Level 3-40% coinsurance |
10% coinsurance after $1,200 deductible |
| Hearing Aid |
20% coinsurance;
maximum benefit of $2,000 every 5 years |
20% coinsurance after $1,200 deductible; maximum benefit of $2,000 every 5 years |
| Outpatient Physical Therapy, Speech, Occupational, and Respiratory Therapy |
Level 1 & 2-10% coinsurance
Level 3-40% coinsurance |
10% coinsurance after $1,200 deductible |
| Home Health Care/Ambulance/Hospice |
Level 1 & 2-10% coinsurance
Level 3-40% coinsurance |
10% coinsurance after $1,200 deductible |
| Durable Medical Equipment |
20% coinsurance |
20% coinsurance after $1,200 deductible |
| Infertility ($25,000 lifetime Maximum) |
Level 1-10% coinsurance
Level 2-30% coinsurance
Level 3-40% coinsurance
Does not count against OPM |
10% coinsurance after $1,200 deductible
Does not count against OPM |
| Imaging and Lab to Third Party Providers |
Level 1 & 2-10% coinsurance
Level 3-40% coinsurance |
10% coinsurance after $1,200 deductible |
Questions? Need Help?
If you have questions or concerns regarding the enrollment
process, please contact:
University Benefits
120-40 USB
Email: benefits@uiowa.edu
Phone: 319-335-2676 or
877-830-4001 (toll free)
Fax: 319-335-2776
Page last updated 2/2012