The UIGRADCare Plan is a comprehensive health care program that covers hospital, medical, surgical, outpatient, and other health care services such as physical therapy. Coverage is also provided for routine physicals, newborn care (including inoculations, scheduled visits, etc.), well-child checkups, and prescription drugs.
How an Individual Uses the UIGRADCare Plan
Health care under this plan is provided by primary care physicians, physician assistants, advanced registered nurse practitioners, certified nurse midwives and the specialists at The University of Iowa Hospitals and Clinics.
The graduate student must select a primary care clinic for all primary care services from The University of Iowa Student Health Service, Family Practice and Internal Medicine at the UIHC, or Community Medical Service Clinics. Spouses and children may select their provider from Family Practice, Internal Medicine, Pediatrics, or Community Medical Service Clinics. If a Graduate Student wishes to obtain OB/GYN care, either the Student Health Center or the OB/GYN department at the UIHC may be used. Female spouses and dependents who want an OB/GYN clinic that is separate from their Primary Care Clinic must select the UIHC OB/GYN department.
All specialist care must be obtained from a provider located at UIHC. No referrals are needed for this care.
Care by non-participating providers needed due to medical necessity (examples: referrals or ambulance transportation) may involve higher cost to you. Non-participating providers do not have contracts with Blue Cross and Blue Shield. They do not agree to accept payment arrangements and are not responsible for filing claims for you. Non-participating providers may charge more for health care than participating providers. Payment is made to you and you are responsible for paying the provider. Non-participating providers can bill you for the difference between what Blue Cross and Blue Shield will pay for a service and what they charge (balance billing).
Referrals are needed for:
- Out-of-network providers – Except for emergencies, benefits are only available from providers outside of the network for care that is beyond the scope of services available from UIGRADCare providers. Prior approvals are needed for all referrals outside the network.
How Much an Individual Pays for Health Care Services
Insureds will pay a $10.00 co-payment for physician charges associated with an office visit, and routine eye and hearing exams. Co-payment is waived for preventive exams and well-child care.
Insureds will pay 10% of the costs for most other health care services that are covered by the plan.
When care is necessitated by an emergency or an accident, the individual's share of the costs will be 10% of the charges without regard to where the services are provided and who provides the care. However, when an individual goes to an emergency room, the insured will also pay a co-payment of $50 and then 10% of the remaining charges for treatment unless the individual is admitted to the hospital.
Whenever an insured is admitted to the UIHC, the individual will pay the first $125 of the hospital charges each day. After the first $125 of the daily hospital room charge is paid, the individual will pay 10% of the charges.
Out-of-Pocket Maximum (OPM) Expenses for Individuals and Families
The UIGRADCare Plan provides an annual maximum limit for the OPM expense for both individuals and families.
The OPM for an individual's expenses is $1,200. The OPM for all other contracts is $1,800.
When the amount paid by the insured equals the applicable OPM, the plan pays 100% of the charges for most additional medically necessary expenses incurred during the remainder of the calendar year.
Amounts an insured pays as deductibles and as the 10% portion of charges are cumulated when determining the annual OPM expense. Co-payments do not apply toward meeting the OPM and continue once the OPM is met.
Coverage for Prescription Drugs
When prescription drugs are purchased from pharmacies that are participating in the plan, the individual will either pay $7 or 25% of the amount charged, whichever is higher. Cost could be higher if the individual uses a non-generic or non-formulary drug. Most pharmacies in Iowa City, Coralville, and North Liberty participate in this plan.
The OPM expense provision for prescription drugs is separate from the medical OPM. The OPM for prescription drugs is $1,200 for single coverage, and $1,800 for all other contracts. Once the OPM has been met, the plan pays 100% of the expenses incurred for drugs during the rest of the calendar year.
The pharmacy is responsible for submitting your prescription claims electronically.
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 coinsurance, 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 essential 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.
Providers at The University of Iowa Hospitals and Clinics
A provider works with each patient to develop a comprehensive and coordinated plan for health care. When care is provided at The University of Iowa Hospitals and Clinics, residents and medical students may play a role in the individual's care. When an individual is hospitalized, residents and medical students are an integral part of the staff which provides support for treatment by the faculty.
Health Care for Individuals Who are Away from Iowa City
The UIGRADCare Plan provides coverage when
- an individual is traveling
- a dependent is attending college or a university
Care for an accident or an emergency will be covered as if the incident had happened in the Iowa City area. Out-of-area hospitalization will not be authorized unless it results from an accident or an emergency. An emergency can be considered to be 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. The emergency services must be provided in an emergency room setting.
For covered individuals who are temporarily living away from the Iowa City area while attending school, it is necessary to notify The University of Iowa Benefits Office at the beginning of the residency. Furthermore, when health care necessitates an admission to a hospital in situations which do not involve an emergency or an accidental injury, prior approval must be secured by telephoning the Plan's toll-free number.
In general, an individual must arrange for routine health care - such as annual physical examinations - to be done by the individual's clinic or location. However, scheduled "newborn" or "well-child" care - such as immunizations - will be covered regardless of where the services are provided.
Medical Evacuation Benefit
UIGRADCare will cover medical evacuation services in the event of illness or injury to students if necessary and adequate medical care cannot be provided at the location when the illness or injury occurs.
Medical evacuation benefits cover expenses to the nearest appropriate medical facility. Precertification of medical evacuation services is required.
Repatriation benefits cover 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, the coffin, and transportation of the body.