The plan provisions chart comparison should be used as a general guide only. Please refer to the SHIP and/or UIGRADCare Coverage Manuals for further information. If the information provided in this summary chart differs from the coverage manual, the SHIP and/or UIGRADCare Wellmark Coverage Manual Document will govern.

Common Medical Plan Terms and Definitions

Deductible

Amount of money you pay out-of-pocket for care before plan begins to pay for benefits. 

Coinsurance

Percentage you pay for covered services after you've reached your deductible.

Copay

Flat dollar amount you'll pay for covered services at the time of service.

OPM

Most you pay for covered services in plan year after paying deductibles, copays & coinsurance. 

Plan Provisions

SHIP vs. UIGRADCare Plan Provisions
  SHIP UIGRADCare
PROVIDERS

You may see any provider you wish nationwide. 

(Wellmark Classic Blue network)

Must use Student Health or UIHC Providers.
Providers outside the UI Health Care network will not be covered by the plan. 
DEDUCTIBLE $300
(Applies to inpatient admission
only and is taken once per admission.)
$125 daily deductible followed by 10% coinsurance
 
COINSURANCE

10%

10%
COPAY Office Visit: $10
Emergency Room: $50
Other Services: $15
Office Visit & Other Services: $10
Emergency Room: $50
OUT-OF-POCKET MAXIMUM (OPM)
 
Health:
$1,700 single / $3,400 family.
Prescription Drugs:
$1,000 single / $2,000 family

UIHC Providers:
$1,000 single / $1,700 family
Prescription Drugs:
$1,000 single / $1,700 family

The Provider and Drug OPM's accumulate separately.
Premiums, balance-billed charges, and health care
from providers that UIGRADCare does not cover will
not count towards your OPM. 

PRE-APPROVAL of INPATIENT ADMISSIONS Pre-approval is REQUIRED for both SHIP and UIGRADCare for Inpatient Admissions. 
SECOND SURGICAL OPINION Voluntary for both SHIP and UIGRADCare
DEPENDENT CHILD AGE LIMIT Effective Jan. 1, 2021, the dependent child is covered up to age 26.
SHIP or UIGRADCare will not allow coverage for full-time student
dependent child(ren) after age 26.

 Preventive Care Services

SHIP and UIGRADCare Preventive Care Comparison
  SHIP UIGRADCARE
IMMUNIZATIONS $0 UI Health Care: $0
Out-of-Network: Not covered
WELL-CHILD CARE
(TO AGE 7)
$0 UI Health Care: $0
Out-of-Network: Not covered
GYNECOLOGICAL PELVIC
EXAMS AND PAP SMEARS
$0
(one per calendar year, unless
medically necessary)

UI Health Care: $0
Lab Tests/Materials: 10% coinsurance
(unlimited Gynecological visits)

Out-of-Network: Not covered

ROUTINE PREVENTIVE EXAMS
 
$0
(one per calendar year, unless
medically necessary. Mammograms
are unlimited.)
UI Health Care: $0
(unlimited preventive exams and mammograms)

Out-of-Network: Not covered
ROUTINE EYE & HEARING EXAMS Not Covered.  UI Health Care: $0
Other: $10 copay

Hospital Services

Hospital Services
  SHIP UIGRADCare
ROOM & BOARD
(SEMI-PRIVATE)
$300 deductible,
followed by 10% coinsurance
$125 daily deductible,
followed by 10% coinsurance
PHYSICIANS SERVICES 10% coinsurance 10% coinsurance
INPATIENT/OUTPATIENT
SURGERY & SUPPLIES
10% coinsurance 10% coinsurance

Outpatient Services

Outpatient Services
  SHIP UIGRADCare
AMBULANCE $15 copay 10% coinsurance
ALLERGY TREATMENTS $15 copay $10 copay
IMAGING AND LAB $15 copay 10% coinsurance
DENTAL ACCIDENT CARE $15 copay;
Treatment must be completed within 12 months of injury.
10% coinsurance
Treatment must be completed within 12 months of injury.
DURABLE MEDICAL EQUIPMENT $15 copay 10% coinsurance
SPEECH, OCCUPATIONAL, RESPIRATORY, AND PHYSICAL THERAPY $15 copay 10% coinsurance
OFFICE VISIT, CHIROPRACTOR VISIT $10 copay $10 copay
MENTAL HEALTH OFFICE VISIT $10 copay 0% coinsurance at UIHC or Wellmark Health Plan of Iowa Provider;
50% coinsurance out-of-network;
Out-of-network mental health and substance abuse limited to 50 visits per calendar year
PRESCRIPTION DRUGS

Tier/what you pay per tier:
Tier 1 drugs: 25% 
Tier 2 drugs: 30% 
Tier 3 drugs: 50%
Tier 4 drugs: 50%

$7 or 25% coinsurance, whichever is greater
HOME HEALTH CARE* $5 copay; maximum of 30 days/calendar year 10% coinsurance
EMERGENCY SERVICES $50 copay $50 copay followed by 10% coinsurance
ORGAN TRANSPLANTS Prior approval; cornea, kidney coverage only Prior approval
SKILLED NURSING SERVICES* 10% coinsurance; Maximum of 30 visits per calendar year 10% coinsurance after $125 daily deductible
NOT COVERED Eyeglasses, Hearing Aid, Infertility Treatment, Travel Vaccinations and Immunizations Eyeglasses, Hearing Aid, Infertility Treatment

*Inpatient benefit limit of 180 days per calendar year including skilled nursing and home health visits. 

Transgender Coverage

All of the health plans offered through the University of Iowa, which are administered by Wellmark Blue Cross and Blue Shield of Iowa, provides coverage of medically necessary covered services associated with gender transition-related treatment.

Wellmark Blue Cross and Blue Shield of Iowa follows the national standards set forth by the World Professional Association for Transgender Health (WPATH) when deeming if a covered service is medically necessary.

Covered services, when ordered by a health professional and deemed medically necessary associated with gender transition-related treatment, may include the following:

  • Hormone therapy;
  • Mental health services; and
  • Chest/breast and genital surgeries when ordered by a health professional.

Please contact Wellmark Blue Cross and Blue Shield of Iowa at 800-643-9724 for more information and to discuss the gender transition medical policy within the Interqual Prior Approval program to assure you have met all qualifications. 


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 you may contact Wellmark Blue Cross/Blue Shield at 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.