PLAN | SHIP | UISELECT | UICHOICE |
---|---|---|---|
Providers | Any Provider | Level 1 - All UI Health Care providers Level 2 - Blue Access Network Level 3 - not covered |
Level 1 - All UI Health Care providers |
Deductible | None - visit inpatient deductible below |
Level 1 - Level 2 - |
None - visit inpatient deductible below |
Inpatient Care Deductible |
$300 followed by 10% coinsurance |
N/A - see above |
Level 1 - $400 |
Out-of-Pocket Maximum (OPM) |
Single: $1,700 Family: $3,400 |
Employee: $2,000 Family: $3,400 |
Employee: $1,700 Family: $3,400 Non-participating providers: |
Coinsurance | 10% | Level 1 - 15% Level 2 - 25% |
Level 1 - 10% |
Preventive Care includes preventive exams, gynecological exams, immunizations, mammograms & well-child care |
$0 copay (gyno and routine physical exams are one per calendar year unless medically necessary) |
$0 copay | $0 copay |
Doctor on Demand | N/A | $0 copay | $0 copay |
UI QuickCare | $10 copay | Level 1 - $5 copay Level 2 - N/A |
Level 1 - $5 copay Level 2 - N/A Level 3 - N/A |
UI UrgentCare | $10 copay | Level 1 - $10 copay Level 2 - N/A |
Level 1 - $10 copay Level 2 - N/A Level 3 - N/A |
Emergency Room Services (Copay waived if admitted) |
$50 copay | Level 1 & 2 - $100 copay followed by 10% coinsurance |
Level 1, 2 & 3 - $100 copay followed by 10% coinsurance |
Routine Eye and Hearing Exams | Not Covered | Level 1 - Level 2 - |
Level 1 - $10 copay |
Office Visits | $10 copay (includes Chiropractic) |
Level 1 - Primary Care: Level 2 - Primary Care: (primary care will apply to chiropractic care, physical, speech & occupational therapies) |
Level 1 - $10 copay Level 2 - $25 copay Level 3 - 50% coinsurance |
Mental Health Care Visit | $10 copay | Level 1 - $10 copay Level 2 - $10 copay |
Level 1 - $0 copay |
Gender Transition
All of the health plans offered through the University of Iowa provide benefits for medically necessary covered services associated with gender transition when ordered by a health professional. Please contact Wellmark Blue Cross and Blue Shield at 800-643-9724 for more information and to discuss the gender transition medical policy.
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 apply. If there are any discrepancies between the information contained herein and the official plan documents, the plan documents will govern.