New Wellmark BC/BS ID’s: As a reminder, in 2024, we will get new ID cards. All cards – even for BlueHMO - will be printed in the member’s name only. If your family needs more than two cards, you can order new cards or access them on your mobile device by logging into your myWellmark account or call Wellmark Customer Service at 1-800-494-4478.
Wellmark BluePPO
The ISU PPO Plan is a managed care plan that gives you a choice each time you need health care to access a Blue Cross/Blue Shield Preferred Provider or to use any provider. If you access a Blue Cross/Blue Shield Preferred Provider the plan pays a higher benefit. If you use out-of-network providers, benefits are generally payable, but at a lower level. This plan is often selected by individuals and their families who are comfortable selecting a Blue Cross/Blue Shield Preferred Provider and still wish to have coverage when unable to access a Blue Cross/Blue Shield Preferred Provider.
Wellmark BluePPO plan is part of the Preferred Provider Organization, a national network of participating medical service providers. Use IZU as the prefix when looking at https://www.wellmark.com/finder.
Wellmark BlueHMO
The ISU HMO Plan is a managed care plan that requires use of the Wellmark Health Plan of Iowa (WHPI) network. Most services are paid at 100%. You pay the full cost of any care you receive outside the network except for emergency care when you are traveling out of the service area. This plan is often selected by individuals and their families whose needs can be satisfied by physicians within a specific network.
- This plan design has a network of participating physicians based in Iowa. This network has a medical service provider presence in every county in Iowa and in the contiguous counties that border Iowa. Current network participation is 99% of hospitals (acute care), 93% of primary care physicians (includes pediatricians), 91% of OB/GYN providers and 93% for specialists.
- Each member in the contract is required to designate a primary care physician (PCP). Female participants may elect to also designate a primary OB/GYN physician for their yearly exams. It is recommended that you verify your primary care physician is participating with the WHPI network, and locate the provider code (called the enrollment ID on Wellmark's site) when you choose to participate in the Wellmark BlueHMO. Use XQW as the prefix when looking at https://www.wellmark.com/finder.
- Guest membership: An added benefit while away from home for 90 or more consecutive days. A guest membership provides access to Blue Cross and Blue Shield participating hospitals, physicians and other health care providers from which you can receive covered services. A guest membership is a valuable service for: long-term, out-of-state travelers (away from home up to 180 days); dependent children who attend college, out of state; and family members who reside in another state but are covered under this health plan. For more information or to arrange the guest membership, contact Wellmark customer service at 1-800-494-4478.
| Provisions |
BluePPO Plan In-Network |
BluePPO Plan Out-of-Network
|
BlueHMO Plan |
|---|
|
Annual Deductible
- Single/Family
|
$400/$800
|
$800/$1,600
|
$250/$500
|
|
Coinsurance
- Inpatient or outpatient services
|
20% |
40% |
10% |
|
Annual Out-of-Pocket Maximum
- Single/Family
|
$2,000/$4,000
|
$4,000/$8,000
|
$1,500/$3,000
|
| Office Copay* |
$25 copay per provider per date of service |
$40% coinsurance |
$15 copay per provider per date of service |
| Emergency Room |
$125 copay plus 20% coinsurance |
$125 copay plus 20% coinsurance |
$125 copay plus 20% coinsurance |
| Peventive Care (includes routine annual physical, immunizations, mammogram, colonoscopy) |
$0 |
40% coinsurance |
$0 |
| *Office visit copays apply to any office service per provider per date of service. This could include radiology, laboratory services, allergy shots, mental health services, physical therapy, occupational therapy, speech therapy. |
Wellmark BluePPO Summary of Benefits & Coverage (PDF)
Wellmark BluePPO Coverage Manual (PDF)
Wellmark BlueHMO Summary of Benefits & Coverage (PDF)
Wellmark BlueHMO Coverage Manual (PDF)
