Description of Plans
PLAN | UISELECT (Blue HMO) | UICHOICE (Blue POS) |
---|---|---|
DESCRIPTION AND HIGHLIGHTS | UISelect is designed for employees who value high-quality coverage and want more say over their spending to meet financial needs. Members would pay lower monthly premiums than UIChoice, and if they use their coverage, they will pay a higher out-of-pocket cost for medical services. **Employees MUST live in Iowa to enroll in this plan. Highlights:
| UIChoice is a high-quality plan with extensive coverage inside and outside Iowa. Premiums for UIChoice are higher than UISelect, and the out-of-pocket costs for medical services are lower. Highlights:
|
Active Employee Premium Rates
Type | *2025 UISelect | *2025 UIChoice |
---|---|---|
Employee only | $0 | $90 |
Employee + spouse | $320 | $431 |
Employee + child(ren) | $261 | $352 |
Employee + family | $343 | $462 |
Double spouse family | $0 | $231 |
*The rates listed above are active employee rates. Premium rates are effective from Jan. 01, 2025, to Dec. 31, 2025. Please visit the Retiree Health Insurance Rates page to review retirees' rates.
Plan Provisions
UISELECT (Blue HMO) | UICHOICE (Blue POS) | |||||
---|---|---|---|---|---|---|
PROVIDERS | Level 1: University of Iowa Hospital and affiliated Clinics, UI Health Care Medical Center Downtown, UI Urgent Care, | Level 2: Providers in the Wellmark Blue HMO network | Level 3: Not covered, except in emergencies. (Dependent children attending college, long-term travelers, | Level 1: University of Iowa Hospital and affiliated Clinics, UI Health Care Medical Center Downtown, UI Urgent Care, | Level 2: Providers from the Wellmark Blue POS network | Level 3: Participating providers from the BlueCard network. |
ANNUAL DEDUCTIBLE | Level 1: Single: $500 Family: $1,000 | Level 2: Single: $950 Family: $1,900 | None. Deductible for inpatient care only for levels 1, 2, and 3. See Inpatient Care Deductible below. | |||
ANNUAL INPATIENT CARE DEDUCTIBLE | Level 1: See Deductible above. | Level 2: See Deductible above. | Level 1: $500 deductible, followed by 10% coinsurance | Level 2: $750 deductible, followed by 10% coinsurance | Level 3: $1,000 deductible, followed by 40% coinsurance | |
COINSURANCE | Level 1: 15% | Level 2: 25% | Level 1: 10% | Level 2: 20% | Level 3: Varies based on location & service | |
COPAY | Level 1: Primary care Specialists: | Level 2: Primary Care Specialists: | Level 1: $15 copay | Level 2: $30 copay | Level 3: No copay. Subject to coinsurance depending on service. | |
ANNUAL OUT-OF-POCKET MAXIMUM (OPM) | Level 1: Single: $2,300 Family $4,000 | Level 2: Single: $3,500 Family: $7,000 | Levels 1 and 2: Single: $2,000 Family: $4,000 Non-participating Providers: N/A | Level 3: Single: $2,500 Family: $5,000 All level 3 providers participating and non-participating are now under the Level 3 OPM effective Jan. 1, 2025 |
UISelect (Blue HMO) | UIChoice (Blue POS) | |||||
---|---|---|---|---|---|---|
PREVENTIVE CARE | Level 1: $0 copay Not subject to deductible | Level 2: $0 copay Not subject to deductible | Level 1: $0 copay
| Level 2: $0 copay | Level 3: Participating Providers: Non-participating Providers: | |
Balance billing may apply to non-participating providers. | ||||||
DOC ON DEMAND | Level 1: $0 copay | Level 2: $0 copay | Level 1: $0 copay | Level 2: $0 copay | Level 3: $0 copay | |
UI QUICKCARE | Level 1: $10 copay | Level 2: N/A | Level 1: $10 copay | Level 2: N/A | Level 3: N/A | |
URGENT CARE | Level 1: $15 copay | Level 2: $40 copay | Level 1: $15 copay | Level 2: $30 copay | Level 3: 50% coinsurance | |
OFFICE VISITS | Level 1: Primary Care Level 1: Specialists Care | Level 2: Primary Care Level 2: Specialists Care | Level 1: $15 copay | Level 2: $30 copay | Level 3: 50% coinsurance | |
ROUTINE EYE & HEARING EXAMS | Level 1: $40 copay | Level 2: $55 copay | Level 1: $15 copay | Level 2: $30 copay | Level 3: 50% coinsurance | |
MENTAL HEALTH CARE VISITS | Level 1: $0 copay | Level 2: $0 copay | Level 1: $0 copay | Level 2: $0 copay | Level 3: 50% coinsurance | |
EMERGENCY ROOM VISITS | Level 1: $150 copay followed by 10% coinsurance | Level 2: $150 copay followed by 10% coinsurance | Level 1: $125 copay followed by 10% coinsurance | Level 2: $125 copay followed by 10% coinsurance | Level 3: $125 copay followed by 10% coinsurance |
Prescriptions Drugs
Plan Formulary Name:
- Blue Rx Value Plus (UISelect)
- Blue Rx Complete (UIChoice)
To review each specific Wellmark formulary drug list, please visit the Wellmark Prescription and Drug Lists webpage. Then, scroll down and choose the specific drug plan link you wish to access and enter the name of the drug in the top left-hand corner to begin your search.
Note: Formulary Drug Lists are best viewed in Chrome.
Pharmacy Program Plan | 2025 UISelect Blue Rx Value Plus | 2025 UIChoice Blue Rx Complete |
---|---|---|
Tier 1 Generic Drugs | $0 copay | $0 copay |
Tier 2 Name-brand drugs | 30% coinsurance | 30% coinsurance |
Tier 3 Name-brand, non-formulary drugs | 50% coinsurance | 50% coinsurance |
Tier 4 Name-brand, non-formulary drugs | N/A | 50% coinsurance |
Pharmacy Out-of-Pocket Maximum | Employee: $2,450 Family: $4,900 | Employee: $1,850 Family: $3,700 |
ABOUT OUR SITE:
The information presented on our website describes only the highlights of the plans and does not constitute official plan documents. Additional terms and conditions may apply. If there are any discrepancies between the information contained herein and the official plan documents, the plan documents will govern. For more detailed information, contact Wellmark Blue Cross/Blue Shield at the toll-free number 800-524-9242 (TTY: 888-781-4262), Monday through Friday, from 7:30 a.m. to 5:00 p.m. (Central Time). For more efficient service, please have your member ID number handy - it can be found on the front of your card.