Description of Health Plan for Academic Administrators, Institutional Officials, Merit Supervisory, and P&S

Employees who work at least half-time or more and are appointed for nine (9) months or longer are eligible for health insurance through the University. Coverage is effective on the first day of the month following the date of employment, providing you enroll within 30 days of your date of employment.

Coverage is available for yourself; your spouse, common law spouse or domestic partner; children to age 26; unmarried full-time students; and qualified children over age 26 who are totally and permanently disabled, provided the disability existed prior to age 26.

The University health insurance plans have no waiting period of exclusions for pre-existing conditions for new employees who enroll within 30 days of their qualifying appointment. Employees and their eligible dependents have full coverage as of the effective date. Employees who do not enroll within the first 30 days may have an 18 month waiting period for coverage for treatment of pre-existing conditions. This waiting period applies to the employee and all dependents.

Eligible employees may choose between two optional health insurance programs:

• UNI Preferred Provider Organization (PPO) Plan
• UNI Blue Advantage
  

UNI Preferred Provider Organization (PPO) Plan

The UNI PPO Health Plan is a preferred provider organization (PPO) plan administered by Wellmark BCBS. This health plan has contracts with a network of "preferred" providers in the Alliance Select network from which you can choose. You do not need to select a PCP and you do not need referrals to see other providers in the network.

If you receive your care from a doctor in the Alliance Select network you will be responsible for an annual deductible and any applicable coinsurance, or a copayment for your visit. If you get health services from a doctor or hospital that is not in the preferred network (known as going "out-of-network") you will pay a higher coinsurance amount, and you may need to pay the doctor directly and file a claim with the Wellmark BCBS to get reimbursed. For plan overviews, please refer to the Benefit overviews. For plan details, please refer to the Coverage Manuals.

UNI Blue Advantage Plan

Blue Advantage is a Health Maintenance Organization (HMO) administered by Wellmark Blue Cross/ Blue Shield of Iowa. This plan requires members to designate a Primary Care Physician (PCP) and this person becomes the gate keeper for your health care. Referrals to specialists in the Blue Advantage network must be coordinated by your PCP. Females covered by the plan may also designate an OB/GYN physician as an additional PCP

A list of participating providers may be found on Wellmark's website. You may also ask providers whether they are part of the Blue Advantage network or contact Wellmark at (800) 600-4149 to inquire about the status of specific providers.

UNI Health Plan

This plan is only available to Academic Administrators, Institutional Officials, Merit Supervisory, and P&S whose effective date of employment commences before July, 1, 2011. Once an employee selects the UNI PPO plan or the UNI Blue Advantage plan, they cannot re-enroll into the UNI Health plan. Wellmark Blue Cross/ Blue Shield of Iowa is the plan administrator. UNI Health is an indemnity plan, which means that you may access any licensed physician or hospital. However, if you select providers (physicians, clinics and hospitals) which “participate” with Wellmark, those providers have agreed to:

• File all claims for you. Benefit payments will be sent directly to the provider(s) and you will be responsible only for the deductibles and/or coinsurance, and

• Accept what Wellmark considers usual, reasonable and customary as payment in full – you will not be responsible for any out of pocket costs other than the deductibles and coinsurance.

A list of participating providers may be found at http://www.wellmark.com. You may also ask providers whether they have a participating agreement with Wellmark or contact Wellmark at (800) 600-4149 to inquire about the status of specific providers.

SPECIAL NOTE: Once a current employee selects the UNI PPO plan or the UNI Blue Advantage plan they cannot re-enroll into the UNI Health plan.