5 Tips for Picking a Health Insurance Plan
UIChoice has a higher monthly premium than UISelect, but UIChoice members won’t pay as much for medical services when they use them. UISelect has a lower monthly premium than UIChoice, but UISelect members will pay more when they use medical services.
As a general rule, plans such as UISelect (with low premiums and higher out-of-pocket costs) can save money for individuals who are healthy and don’t often see a doctor. Plans with significant premiums and low out-of-pocket costs, like UIChoice, can save money for individuals who are also covering their family, have health conditions, or see a doctor often.
Below is a list of tips to help you determine which health plan is the best fit for you and your family.
5 Tips for Picking a Health Insurance Plan
When it comes to health insurance, who pays for what can be very confusing. Before you make any decisions, it may be helpful to review the following terms: Premium, Deductible, Copayment (Copay), Coinsurance, Out-of-Pocket Maximum, Inpatient Facility Services.
You can find some definitions from the following sources:
To choose whether UISelect or UIChoice is best for you, it’s important to know what medical expenses you expect to have and whether you’re covering only yourself or also members of your family.
If you’re currently a UIChoice member, consider creating a myWellmark account if you haven’t already done so. Wellmark administers the university’s health plans and so keeps a record of all UIChoice member hospital visits, services, payments, prescriptions, and more. By logging into myWellmark, you can conveniently access those records and see how much you’ve paid out-of-pocket for medical services in the last year.
If you use University of Iowa Health Care, you may already have a MyChart account, which is an online system that manages doctor’s appointments, prescription renewals, expense statements, and more. If you haven’t already, consider creating or checking your MyChart history.
Otherwise, consider going through your calendar, hospital statements, doctor’s appointment summaries, credit card bills, or anything else that can help you answer the following questions.
- do you or a member of your family see a doctor?
- are you or members of your family sick?
- have you or members of your family visited the emergency room in the last few years?
Do you or a family member…
- have a chronic condition or conditions? (These could include diabetes, back pain, joint problems, hearing loss, cancer, heart issues, etc.)
- have any prescriptions?
- have any specialty drug prescriptions? (These could include Humira or Enbrel for rheumatoid arthritis, Ibrance for cancer treatment, Tecfidera for multiple sclerosis, etc.)
- use mental health services?
- need medical coverage outside Johnson County? Outside Iowa?
Ask yourself the following questions about what medical services you or a member of your family might need in the next year.
Are you or a member of your family…
- planning to move out of Johnson County or the State of Iowa?
- planning to start a family?
- expecting to have surgery?
- going to need to change medications or start new ones in the near future?
Now that you have a strong sense of the medical services you and your family are likely to need, it’s time to compare the costs of those medical services.
After clicking on the link below, pay special attention to the providers at the top of the page; the level of provider you use can make a big difference in costs. Also, if you use a specialty prescription drug, note the links at the bottom of the page that guide you to which plan covers your prescription.
Also keep in mind that many services will be free of charge to you no matter which health plan you use. That includes preventative care like annual check-ups. Here are services that are free of charge to employees no matter which health plan is chosen:
- Gynecological exams
- Hearing exams
- Well-child care
- Doctor on Demand
- Generic drugs
The university gives every regular employee that is benefits-eligible (Faculty, P&S, and Merit staff) a monthly $90 General Benefit Credit. In addition, individuals who have dental insurance but are not enrolled in a university dental insurance plan may receive a $25 a month Shared Savings Credit, and individuals whose salary is over $25,000 and who elect $50,000 in group life insurance receive $40 per month in Shared Savings Credits.
These credits may be used to help lower out-of-pocket costs for insurance plans that are selected or defaulted into a Health Care Flexible Spending Account. The account may also be used for eligible medical expenses. When you incur qualified expenses, you can file for reimbursement from the account.
The university also allows you to deposit pre-tax money from your wages into a monthly Flexible Spending Account. Deposits to these accounts avoid all federal, state, local and Social Security/Medicare taxes. When you incur qualified expenses, you can file for reimbursement from the account. Make sure to set up the account in advance and request reimbursement before April of the following year.
A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. (Examples: Allergist, Cardiologist, Dermatologist, Neurologist, Ophthalmologist, Orthopedics, etc.)
A non-physician specialist is a provider who has more training in a specific area of health care. (Examples: Chiropractor, Physical Therapist, Speech Pathologist, Occupational Therapist, etc.)
*NOTE: For UISelect, chiropractors, physical therapists, speech pathologists and occupational therapists’ office copay amount is the same as the office PCP copay.
There are technically no age restrictions. There are times with certain populations where it could be more likely that Doctor on Demand would advise the person to seek in person care due to potential complications, for example a newborn or an elderly person with multiple health issues. In general, there are no specific age restrictions.
*NOTE: Another resource available exclusively to Wellmark members is BeWell 24/7. Health Care professionals can help answer your questions. The phone number can be found on the back of your health insurance card.
Office-based physical therapy will be covered with an office copay amount being owed.
Facility-based physical therapy when received in a hospital will be covered as ‘inpatient or outpatient’ with coinsurance being owed.
*NOTE: For UISelect, facility-based physical therapy covered as ‘inpatient or outpatient’ will be subject to the deductible.
UISelect: One preventive physical exam (includes separate female gyn exam and pap smear) and one preventive mammogram per benefit period (calendar year) is covered.
UIChoice: Preventive physical exams, including female gyn exams and pap smears, and preventive mammograms have no benefit period (calendar year) limit.
The process in how the claims are handled for retirees will be the same for either UIChoice or UISelect regarding coordination of benefit. Depending upon the medical service received and the coverage of the medical service, and if the medical service is subject to the deductible, there could be an amount owed under either plan. However, it should not be greater than the deductible for covered medical services.