SHIP and UIGRADCare Comparison

 Provisions

  SHIP UIGRADCare
Coinsurance Percentage 10% 10%
Out-of-Pocket Maximums Single/Family $1,700 for single / $3,400 for family
Prescription Drugs:
$1,000 for single and $2,000 for family
$1,000 for single/$1,700 for family
Prescription Drugs:
$1,000 for single/$1,700 for family
Pre-approval of Inpatient Admissions Required Required
Second Surgical Opinion Voluntary Voluntary
Benefits Available from Out of Network Providers Individual is responsible for charges above the maximum allowable fee Not available without approved referral
Dependent Child Age Limit End of calendar year in which the individual turns 26 or unlimited if full-time student End of calendar year in which the individual turns 26 or unlimited if full-time student

 Preventive Care Services

  SHIP UIGRADCare
Immunizations $0 copay $0 copay
Well-Child Care (to age 7) $0 copay $0 copay
Gynecological Pelvic Exams and Pap Smears $0 copay
(1 per calendar year unless medically necessary)
$0 copay
(lab tests and materials 10% coinsurance)
Routine Preventive Exams $0 copay
(1 per calendar year unless medically necessary)
$0 copay
(lab tests and materials 10% coinsurance)
Routine Eye & Hearing Exam Not covered $10 copay
($0 copay at UIHC)

Hospital Services 

  SHIP UIGRADCare
Room and Board Semi-private 10% coinsurance after $300 deductible 10% coinsurance after $125 daily deductible
Physicians Services 10% coinsurance 10% coinsurance
Inpatient / Outpatient Surgery & Supplies 10% coinsurance 10% coinsurance

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 and what you pay per tier:
Tier 1: 25%
Tier 2: 30%
Tier 3: 50%
Tier 4: 50%
$7 or 25%, 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.

Contact Information

University Benefits Student Insurance

Fax
319-335-2776
Campus Address
120 USB
Mailing Address

120 University Services Building
Iowa City, IA 52242-1911
United States

Hours
Monday-Friday, 8 a.m.-5 p.m.