Student Health and Dental Insurance Plans for Graduated Students
IMPORTANT: There is a provision for health insurance through The University of Iowa after you graduate from school. If a University of Iowa student wishes to utilize this option, complete the application. The continuation application must be made within 45 days of graduation.
The University of Iowa is concerned about the potential threat the high cost of health and dental care may pose to a graduate's financial well-being. For this reason, the University offers health and dental insurance coverage to recent graduates through The University of Iowa Student Health Insurance Plan (SHIP), a group policy administered by Wellmark Blue Cross and Blue Shield of Iowa, and Student Dental Insurance Plan, a group policy administered by Delta Dental of Iowa.
The premium for a student-only health policy is $125.00 per month while the dental policy is $25.00 per month. After graduating from The University of Iowa, you may continue coverage up to 12 months. You may seek care from any provider you choose. However, if you use an Iowa "Alliance Select Provider" or Delta Dental provider, your costs will generally be much lower. The University of Iowa Hospitals and Clinics (UIHC), Mercy Hospital, and Family Practice Clinics are Alliance Select Providers in Iowa City. The College of Dentistry is a Delta Dental provider in Iowa City.
Once you have enrolled in the plan you will be sent a membership card to present to care providers. The card includes phone numbers to call if you have questions or require pre certification for certain procedures.
If you decide this insurance is suitable for your situation, your signed and completed enrollment form must be returned to the University Benefits Office by the appropriate enrollment deadline (see below). For additional information, you may contact the University Benefits Office. The University of Iowa recommends that all graduates be covered under some type of health insurance. We urge you to give this information your immediate attention.
Health Insurance Rates
|Type of Contract||
|Student & Spouse/Domestic Partner||
|Student & Children||$640.00|
|Student, Spouse/Domestic Partner, & Children||$920.00|
Dental Insurance Rates
|Type of Contract||
|Student & Spouse/Domestic Partner||
|Student & Children||$46.00|
|Student, Spouse/Domestic Partner, & Children||$67.00|
Effective September 1, 2012 through August 31, 2013
To enroll, simply complete a continuation enrollment form and return it to The University of Iowa, University Benefits Office, 120 University Services Building, Suite 40, Iowa City, Iowa 52242-1911 during the appropriate enrollment period. In order to apply for the student insurance continuation if you leave The University of Iowa without graduating, you must supply a proof of prior coverage along with your application. This must be done within 45 days of you leaving The University of Iowa.
- Coverage will begin the first day of January, June, or September if applications are received within the open enrollment period.
- Rates are valid from September 1, 2012 until August 31, 2013.
Questions regarding premium charges should be directed to the University Benefits Office at 120 University Services Building Suite 40 or call 319-335-2676 or toll-free at 877-830-4001.
STUDENT HEALTH INSURANCE PLAN
SHIP is available to students who have recently graduated from The University of Iowa. SHIP is an Alliance Select Plan, which provides coverage for preventive care, hospitalization, surgery, maternity, well-baby/well-child care, emergency care for accident or illness, medically necessary physician care, prescription drugs, and mental health.
How an Individual Uses the Ship Plan
Health care under this plan is provided by various groups of health care practitioners, suppliers, agencies, programs, and facilities called Select Providers who have agreed to join with Wellmark Blue Cross and Blue Shield of Iowa to offer each student affordable health care.
To receive the greatest benefits from SHIP, we advise you to use the physicians from the Alliance Select Provider list which can be accessed at www.wellmark.com .
How Much an Individual Pays for Health Care Services
Per Service Co-payment/Co-insurance Amounts
|Select Provider||Non-Select Provider|
Office Visit: $10 co-payment per visit for office visits and diagnostic imaging and lab services
Office Services: $30 co-payment per visit for office visits and diagnostic imaging and lab services
Outpatient Facility: $50 co-payment per visit for surgery, emergency room, and ambulatory surgical centers
Outpatient Facility: $150 co-payment per visit for surgery and ambulatory surgical centers
Hospitalization: 10% co-insurance after $300 deductible
Hospitalization: 20% co-insurance after $600 deductible
Prescription Drugs (3-Tier Plan)
|1. Generic Drugs||25%|
|2. Name brand formulary drugs||30%|
|3. Name brand non-formulary drugs||50%|
Formulary drugs are drugs that are on Wellmark's preferred list available at www.wellmark.com.
If you purchase a brand name drug when an FDA-approved "A"-rated generic equivalent is available, you are responsible for your co-payment or co-insurance, plus any difference between the billed charge for the brand name drug and the billed charge for the generic. This can result in you paying substantially higher costs than if you had chosen the generic drug.
If your physician feels it is important for you to have the brand name drug, they can write the prescription for the brand name drug with the direction "Dispense as written" on the prescription. In this situation you will not be responsible for the difference between the billed charge for the brand name drug and the billed charge for the generic drug. Self-administered, self-injectable drugs are covered under your medical insurance with 10% co-insurance.
Identification Cards & Policy Information
Insured graduates will receive identification (ID) cards. A Coverage Manual that details complete information on benefits, definitions, terms, and exclusions is available from the University Benefits Office and on this site at . A list of providers may be accessed at www.wellmark.com
All premiums will be charged on a monthly basis. You will receive a bill from The University of Iowa for your health insurance premium. You may choose to have premiums deducted from a savings or checking account by completing the appropriate section on the enrollment form or an Authorization for Prepayment of Insurance Premium form, available in the University Benefits Office or from our forms page.
Privacy Notice and Release Forms
Changes in federal law require individuals to sign a release form before any information can be released regarding their health benefit information. No information will be given to a spouse/domestic partner, parent, child, or other representative unless that form is on file in The University of Iowa Benefits Office. If you wish health information released to anyone, complete the Personal Health Information Release Form.
Coverage can be cancelled for the following reasons:
- You become ineligible for the continuation coverage under the policy twelve months after graduation (i.e. if a student graduates in May 2012 and begins their continuation policy effective June 1, 2012, their insurance coverage will terminate on May 31, 2013 as they have exhausted the continuation benefit of the health insurance plan).
- The student may cancel coverage by providing a written request to The University of Iowa Benefits Office. Coverage will terminate the last day of the month in which the request is made. The termination cannot be retroactive. No refund of premiums will be given.
- The University of Iowa Benefits Office will cancel coverage for non-payment of premium.
SHIP is designed for you to be responsible for some of the direct costs of your health care through per-service co-paymants, deductibles and co-insurance provisions as explained below.
Per-Service Co-payment: A per-service co-payment is an amount that you pay to your provider each time you receive care. Wellmark Blue Cross and Blue Shield of Iowa provides benefits after you have paid the co-payment amount. You pay a lesser co-payment amount when you use an Alliance Select facility or practitioner.
Deductibles: A deductible is the amount you pay for covered services for each separate admission to a hospital or nursing facility. This amount is subject to the benefit maximums and differs according to whether you use a Select Provider or Non-Select Provider. Deductible amounts apply only to inpatient admissions.
Co-insurance: Co-insurance is the amount calculated using a fixed percentage that you pay for covered services after you have met the deductible responsibility.
Out-of-Pocket Maximum (OPM): The OPM is the highest dollar amount you would pay for covered services during an inpatient hospital stay. Your OPM equals your per-service deductible plus the co-insurance amounts that are paid during the hospital stay. The OPM pertains to each separate admission to a hospital or nursing facility.
Medical Necessity Provision: The benefits available through SHIP apply only to medically-necessary care. Only your medical condition is considered in determining the medical necessity of a covered service. Non-medical factors, such as your financial or family situation, are not considered.
The fact that a physician may prescribe or recommend a service does not mean it will automatically meet the standards for medical necessity. You should discuss the medical necessity of services with Wellmark 1-800-535-6099 before treatment or services are performed.
The following is a description of the Alliance Select notification components with which you need to comply when you use non-Select facilities or providers.
Pre-certification: (Non-Emergency Admission) Before you are admitted to a hospital or nursing facility for a non-emergency procedure, or before you use home health care or hospice program services, you must contact Wellmark Blue Cross and Blue Shield of Iowa and receive pre-certification to determine if your care is medically-necessary. Participating Alliance Select practitioners and hospitals must do this for you; non-participating providers are not required to do so, so you must do it.
Admission Review: (Emergency and Maternity Admissions) If you are admitted on an inpatient basis to the hospital for emergency or maternity services, your admission does not need to be pre-certified to receive the maximum benefits. However, Wellmark Blue Cross and Blue Shield of Iowa must be notified by you or your provider within 24 hours of your admission. The toll-free telephone number is printed towards the back of this brochure and on your identification card (ID). Alliance Select providers agree to be responsible for this notification.
If you or your provider do not notify Wellmark as required, you may have to pay as much as 25% of the cost of your care yourself in addition to the deductible and co-insurance amounts you are required to pay. You will be responsible for care that is determined not to be medically-necessary. These are excellent reasons to seek care from an Alliance Select participating provider.
More detailed information is provided in the Coverage Manual located on our forms page or by contacting the University Benefits Office. The benefit summary in this brochure provides a brief description of the important features of your Coverage Manual. This brochure is not your Coverage Manual. Only the actual benefit provisions in your Coverage Manual will determine your benefits. Please read your Coverage Manual carefully.
Limitations and Exclusions
The following are limited, excluded, or not considered medically-necessary by Wellmark Blue Cross and Blue Shield of Iowa and are not covered under SHIP.
- Services provided for the treatment of illness or injury arising out of or in the course of a covered person's employment for which an employer is required to furnish health care services or benefits (including Worker's Compensation benefits) or for which the employer is liable under any applicable federal, state, municipal, or other law.
- Services which you obtain, or may be entitled to obtain, through a governmental program, except Medicaid.
- Services under this policy if you are eligible for Medicare, even though you do not enroll in Medicare or waive or fail to claim Medicare benefits.
- Custodial or sanitaria care, travel, or rest cures.
- Services for cosmetic or beautifying surgery, except as specified and limited in the Coverage Manual.
- Dental services, except as specified and limited in the Coverage Manual.
- Services furnished to you prior to the effective date of the Coverage Manual.
- Services furnished to you if, on the effective date of the policy, you are an inpatient of a hospital or a nursing facility until you are discharged.
- Services or supplies under this policy to the extent they are payable by another insurance policy in force on the date of admission to the hospital or nursing facility.
- Hospital services or supplies for those days you are on leave from the hospital or nursing facility but have not been discharged.
- Percentage reductions for covered services furnished in a non-participating facility.
- Eyeglasses or eye refractions, surgery for refraction, hearing aids, orthopedic shoes, arch supports, trusses, or examinations for the prescription or fitting of such items.
- Wigs and artificial hairpieces.
- Services or supplies for the diagnosis or treatment of infertility.
- Purchase or rental of personal convenience items.
- Services of private duty nurses.
- Services or supplies for organ transplants including, but not limited to, bone marrow, liver, heart, single lung, heart-lung and pancreas, or involving mechanical or non-human organs. This does not apply to services or supplies for cornea and kidney transplants.
- Services for recreational or educational therapy or non-medical self-help programs.
- Hospital or nursing facility admissions which are primarily for diagnostic evaluation, physical therapy, or occupational therapy.
- Investigational procedures.
- Marital and family counseling or training.
- Surgical treatment for morbid obesity, except as specified and limited in the Coverage Manual.
Other Facts you Should Know
- Coverage is available for services and supplies associated with transplant surgery involving the cornea and kidney when treatment is performed in a facility approved by Wellmark Blue Cross and Blue Shield of Iowa.
- We may terminate your coverage without advance notice for fraudulent use of your policy.
- You become ineligible for continuation coverage under the policy twelve months after graduation.
- Wellmark Blue Cross and Blue Shield of Iowa will coordinate benefits with other group health carriers when duplicate coverage exists. Total payment from this coverage and all other group health coverages under which you are enrolled shall not exceed 100 percent of the cost of the covered services.
This is a general description of your coverage. It is not a statement of contract. Your actual coverage is subject to the terms and conditions specified in the policy between The University of Iowa and Wellmark Blue Cross and Blue Shield of Iowa.
A repatriation benefit applies to the student, spouse/domestic partner, or child covered under the policy. This must be applied toward those expenses incurred in returning the body to the person's place of residence in his or her home country including, but not limited to, the cost of embalming, coffin, and transportation of the body.
Medical Evaluation Benefit
Medical evacuation services will be covered in the event of illness or injury to participants if necessary and adequate medical care cannot be provided at the location where the illness or injury occurs.
Medical evacuation benefits cover expenses to the nearest appropriate medical facility and/or to the participant's home country. Pre-certification of medical evacuation services is required.
Out-of-Pocket Maximum (OPM) Expenses for Individuals
SHIP provides a $1,000 OPM per hospital admission. The OPM equals the per-service deductible plus the co-insurance amounts paid during each inpatient hospital stay. co-paymants are not applied to the OPM.
When the amount paid by the insured equals the OPM, the plan pays 100% of the maximum allowable fee for covered charges incurred for that admission. The maximum allowable fee is the amount established by Wellmark using various methodologies for covered services and supplies.
Health Care for Individuals Who Are Away from Iowa
SHIP provides coverage worldwide. For covered services received in other states or outside of the USA, the provider category may be Select or Non-Select when determining payment amounts. Choosing a Select provider can be an advantage when receiving treatment.
The insured is responsible for telephoning the Blue Cross and Blue Shield of Iowa toll-free number before being admitted to a hospital for non-emergency care and within 24 hours of emergency and maternity admissions.
HEALTH INSURANCE OPTIONS
|Co-insurance Percentage||10% for Select inpatient hospital
20% for non-Select inpatient hospital
|Out-of-Pocket Maximums||$1,000 per hospital stay|
|Pre-existing Condition Waiting Period||None|
|Pre-approval of Inpatient Admissions||Required|
|Second Surgical Option||Voluntary|
|Benefits Available from Non-member Providers||Co-payment deductibles and co-insurance are higher plus individual is responsible for charges above the maximum allowable fee|
|Immunizations||Covered, $0 co-pay|
|Well-Child Care||Covered, $0 co-pay|
|Gynecological Pelvic Exams and Pap Smears||Covered; $0 co-pay (one per calendar year unless medically necessary)|
|Routine Physicals||Covered, $0 co-pay (one per calendar year unless medically necessary);
10% co-insurance for imaging and lab
|Not Covered||Routine Eye Exam
|Room and Board Semi-private Room||10% co-insurance after $300 deductible for Select hospital;
20% co-insurance after $600 deductible for non-Select hospital
|Physicians Services||Included in hospital deductible and co-insurance|
|Inpatient Surgery||10% co-insurance after $300 deductible for Select hospital;
20% co-insurance after $600 deductible for non-Select hospital
|Outpatient Surgery||$50 co-payment for Select hospital; $150 co-paymant for non-Select hospital|
|Inpatient Supplies, Drugs, ICU, Operating Room, and Specialized Care||10% co-insurance after $300 deductible for Tests, Select Hospital;
20% co-insurance after $600 deductible for non-Select hospital
The following services have a $10 co-payment for Select providers; $30 co-payment for non Select providers:
Allergy Treatments; Chiropractor; Ambulance; Speech, Occupational and Respiratory Therapy; Office Calls; Dental Accident Care (completed within 6 months); and Physical Therapy
|Durable Medical Equipment||$10 co-payment for Select providers; $30 co-payment for non-Select providers|
|Imaging and Lab||Diagnostic only; $10 co-payment for Select providers; $30 co-payment for non-Select providers|
|Prescription Drugs/Oral Contraceptives|
|Emergency Room Services||$50 co-payment|
|Home Health Care||Maximum of 30 visits per calendar year|
|Organ Transplants||Prior approval; cornea, kidney coverage only|
|Skilled Nursing Facility||Maximum of 30 days per calendar year|
|Blood||10% co-insurance after $300 deductible for Select hospital; 20% co-insurance after $600 deductible for non-Select hospital|
|Domestic Partner||Yes, same sex or opposite sex|
|Dependent Child Age Limit||End of calendar year after the individual turns 26 or unlimited if full-time student|
DENTAL INSURANCE PLAN
How an Individual Uses the Dental Insurance Plan
Dental care under this plan can be obtained from any provider; however, there are advantages to using participating providers who have contracts with Delta Dental of Iowa, the dental insurance plan administrator. A list of plan providers may be accessed on the Delta Dental of Iowa website ( Go to Subscriber Information, Dentist Search, and select Delta Dental Premier to search for a dentist in your area.)
You will receive an ID card from Delta Dental of Iowa which you should present to your provider when you receive care.
Participating providers will accept payment arrangements and file claims for you. Payment is made directly to these providers.
Non-participating providers have not agreed to accept Delta Dental's payment arrangements. This means you are responsible for any difference between your dentist's covered charges and the Delta Dental allowance. These dentists are not responsible for filing your claims. Claims are settled directly with you and you are then responsible for making payment to your provider.
How Much an Individual Pays for Dental Services
Insureds will pay nothing out-of-pocket for diagnostic and preventive services, which includes dental cleaning, oral evaluation, imaging, diagnostic tests, fluoride applications (under age 19), sealant applications (under age 19), space maintainer (under age 14), and biopsy of oral tissue.
There is a $25 deductible per person, with a maximum deductible of $75 for a family, for restorative services (cavity repair, tooth extraction, root canals, treatment of gum and bone disease). In addition, the insured pays 20% of the remaining covered services.
For high cost restorations, such as crowns, inlays, dentures, and bridges there is a $25 deductible per person, with a maximum of $75 for a family. In addition, you pay 50% co insurance for the remainder of covered services.
There are no benefits for orthodontics.
This plan will pay a maximum of $1,000 per covered individual per year.
QUESTIONS AND ANSWERS
Q: Can the premium be charged to my Ubill?
A: No, you will receive a bill monthly in the mail from The University of Iowa.
Q: Did I have to be on the SHIP or Student Dental plan prior to graduation to be eligible for the continuation privilege?
A: No, the continuation plan is an option for all University of Iowa graduates.
Q: Will all my expenses be covered by insurance?
A: No. "Insurance" does not mean "all your medical care is free." Review the information about what is and is not covered. If you have questions about a specific service or procedure, call Wellmark Blue Cross and Blue Shield at 1-800-535-6099 or Delta Dental of Iowa at 1 800 544 0718.
Q: What do I do if I get a bill and I can't pay?
A: Call the doctor, dentist, or hospital's billing office. Generally, they will try to set up a payment plan that you can afford. If you meet certain low-income guidelines and have small children, you may be eligible for help from the county, state, or federal government. Check listings in the phone book for places to contact.
If your insurance has not paid their portion of the claim, contact them to see if there is a problem. Pay the co-paymant or co-insurance for which you are responsible and contact the doctor, dentist, or hospital's billing office to explain the situation.
DON'T IGNORE THE BILL. It won't go away and may end up on your credit report, which could affect your ability to rent an apartment or buy a house or car.
WHO TO CONTACT
This policy is administered by The University of Iowa for the benefit of recent graduates of The University of Iowa. If you have questions about claims or specific questions about your SHIP coverage, you should call Wellmark Blue Cross and Blue Shield of Iowa.
Wellmark Blue Cross and Blue Shield of Iowa
P. O. Box 9232
Des Moines, IA 50306-9232
Claims Inquiries (toll-free)
For Pre-certification call (toll-free)
Prescription Mailing Address:
Catalyst Rx Claims Department
P. O. Box 1069
Rockville, MD 20849-1069
Mail order prescription claim mailing address:
Immediate Pharmaceutical Services I
Questions about claims or specific dental coverage:
If you have questions about claims or specific questions about your dental coverage, you should call Delta Dental of Iowa.
Delta Dental of Iowa
P. O. Box 9000
Johnston, IA 50131-9000
Questions about SHIP or dental coverage, eligibility, adding dependents, brochures and enrollment forms, enrollment periods, or premium charges:
The University of Iowa Benefits Office
120 University Services Building, Suite 40
Iowa City, IA 52242-1911
Toll- free: 877-830-4001
The University of Iowa prohibits discrimination in employment, educational programs, and activities on the basis of race, national origin, color, creed, religion, sex, age, disability, veteran status, sexual orientation, gender identity, or associational preference. The University also affirms its commitment to providing equal opportunities and equal access to University facilities. For additional information contact the Office of Equal Opportunity and Diversity at 319 335-0705.
Page last updated January 2012