The open enrollment information sent Oct. 30 details important information for all benefit eligible employees of Drake University. Participation in Drake’s Health Plan requires that participants designate a primary care provider. While the plan is not changing, the network utilized by the plan is changing from the Alliance Select Network to the Blue Choice Network effective January 1, 2021. Following is a brief overview of what this means for you and the steps you must take to ensure coverage for the 2021 plan year.
WHAT IS CHANGING
Primary Care Provider (PCP) Designation
Employees and family members must select a designated PCP in the Blue Choice network during the open enrollment period. Primary Care Providers include general or family practice physicians, internists, pediatricians, nurse practitioners and physician assistants. Women may also select an obstetrician or gynecologist as a co-care provider. Click here to learn more about designating a PCP.
Preventive Care Services
Preventive exams and non-specialist services must be performed by the designated PCP, or a partner provider within the same health system (e.g. Mercy, Unity Point, Iowa Clinic, Broadlawns etc.) if the PCP is not available. Coverage will not be available for annual physical exams provided by non-network providers.
Immunizations
Flu, shingles and pneumonia immunizations may be administered by a PCP or a Wellmark network pharmacy. Immunizations such as those received during well child visits must be provided by the member’s designated PCP.
Plan Enhancement
The Plan will now aggregate in-network and out-of-network annual deductibles and out-of-pocket maximums. Although these amounts will accumulate separately, they will no longer be mutually exclusive. For example, deductible amounts paid for in-network services can be used to satisfy the out-of-network deductible, and vice versa. Should you meet your annual in-network deductible ($1000) and subsequently receive services out of network, the $1000 amount already paid will be applied to the $2500 out-of-network limit. Likewise, with annual out-of-pocket costs
New ID Card
New ID cards will be issued indicating participation in the Blue Choice network. Member ID numbers will begin with the letters XQW – instead of DRO. The group number and prescription drug information will remain the same. Member PCP’s will be printed on the new ID card.
WHAT IS NOT CHANGING
Access to Out-of-Network Providers
The Plan continues to provide access to out-of-network services. If you see a provider who is not in the Blue Choice network, the service will be covered at the out-of-network cost ($50 co-pay or 30% coinsurance). You may also be balance-billed for charges over the allowed amount. The Plan will likewise continue to provide out-of-network coverage and emergency services at in-network levels. If you anticipate obtaining additional services from out-of-network providers during the 2021 Plan Year, we encourage you to participate in Drake’s Health Care Flexible Spending Account (FSA) Plan. Such expenses could be paid with pre-tax contributions, reducing your overall cost with immediate tax savings.
Cost of Care
Co-pays, annual deductibles and out-of-pocket amounts remain unchanged during the 2021 Plan Year. Utilization of Blue Choice providers may lower your overall cost for care.
Prescription Drug Benefit
The Plan’s current prescription drug coverage will remain unchanged. Members continue to have access to Wellmark’s Blue RX Formulary.
Flexible Spending Account Plans
The maximum contribution limit for Drake’s FSA Plans remains unchanged during the 2021 Plan Year. The maximum contribution for the Dependent Care FSA is $5000. The Health Care FSA will allow participants to carry over up to $550 of unused contributions to the 2021 Plan Year. Contributions carried over, in addition to newly elected amounts, may be used to pay for eligible expenses incurred during the 2021 Plan Year. To learn more about the money-saving features of these plans, see this FSA Fact Sheet
Telehealth Visits
Members continue to have access to telehealth services from in-network and out-of-network providers during the 2021 Plan Year.
Monthly Contribution Rates
Monthly contribution rates will not increase during the 2021 Plan Year.
To learn more about Drake’s Health Plan basics, see Wellmark’s Open Enrollment Video.