The UIChoice plan is a comprehensive health care program that covers hospital, medical, surgical, outpatient, and other health care services such as physical therapy. Coverage is also provided for routine physicals, newborn care (including inoculations, scheduled visits, etc.), well-child checkups, treatment of mental health conditions, treatment of chemical dependency, and prescription drugs.
- 2017 UIChoice Health Insurance Summary of Benefits (pdf)
- 2016 UIChoice Health Insurance Summary of Benefits (pdf)
- 2017 UIChoice Coverage Manual (pdf)
- 2016 UIChoice Coverage Manual (effective 01/01/2016-08/31/2016) (pdf)
- 2016 UIChoice Coverage Manual (effective 09/01/2016-12/31/2016) (pdf)
- Wellmark/Blue Cross Patient Claim form #C-5321f (pdf)
- UIChoice Prescription Reimbursement Claim Forms (pdf)
- International Claim Form
- Wellmark/Blue Cross Patient form #C-4614 (Lodging Reimbursement Form for Transplant-Related Expenses) (pdf)
How an Individual Uses UIChoice
Health care under the UIChoice plan may be obtained from any provider you wish. This plan includes three benefit levels. The provider or facility category you use automatically determines the plan benefit level within UIChoice.
- UIeCare = Receive care from a UIHC provider 24/7 from a smartphone or computer with webcam at no cost to UIChoice members.
- Plan Benefit Level 1 = University of Iowa Hospitals and Clinics, UI QuickCare (effective 1/1/2017), Carver College of Medicine (CCOM) and UI Community Medical Services Clinics (CMSC), Pediatric Associates of the University of Iowa Children's Hospital (PAUICH), UI Health Alliance Facilities and Primary Care Clinics.
- Plan Benefit Level 2 = Providers from the Wellmark Blue Choice Network not included in Level 1. Locally, Level 2 includes Mercy Hospital and most Iowa City community providers.
- Plan Benefit Level 3 = Any provider worldwide that does not belong to Level 1 or 2.
YOU DO NOT HAVE TO PICK A PLAN LEVEL – THE PROVIDER YOU CHOOSE AUTOMATICALLY DETERMINES AT WHICH LEVEL THAT PARTICULAR CLAIM IS PROCESSED.
You can use any provider. Plan Levels 1 and 2 will result in lower out-of-pocket costs for you. While you can use any provider you want, there are also advantages to using providers who have contracts with Blue Cross and Blue Shield.
In Iowa, participating providers will accept payment arrangements and file claims for you with Blue Cross and Blue Shield. Payment is made directly to these providers.
Non-participating providers do not have contracts with Blue Cross and Blue Shield. They do not agree to accept payment arrangements and are not responsible for filing claims for you. Non-participating providers may charge more for health care than participating providers. Payment is made to you and you are responsible for paying the provider. Non-participating providers can bill you for the difference between what Blue Cross and Blue Shield will pay for a service and what they charge (balance billing).
When you are out-of-state, participating Blue Cross and Blue Shield providers will result in lower out-of-pocket costs for you and the out of pocket maximum for Levels 1 and 2 will apply to these providers. If it is a state that allows balance billing, using a participating Blue Cross and Blue Shield provider should result in a lower balance bill.
In an emergency, if you cannot reasonably reach a participating provider, care received in an emergency room during the course of the emergency will be reimbursed as though the service was received from a participating provider.