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Iowa State University Retiree Group Medical Insurance
Information for 2024 Open Enrollment
Opening October 15, 2023 – Closing December 7, 2023
Please read the ISU medical/prescription insurance information within this guide. The dental
plan information will be mailed separately to all those currently enrolled. If you have questions,
please contact the ISU Benefits Office by calling 515-294-4800 or by emailing
[email protected]. We anticipate a high volume of calls in October and November, so please
be patient and leave a message. The active employee open enrollment period is November 1-
17, so the month of November is very busy for the Benefits Office staff. If you leave a message,
we will make every effort to return your call within two business days.
Impact to ISU Retirees:
• Premium changes for 2024. Some tiers will have a premium decrease for 2024.
See page 5 for the premium tables.
• Medical plan design changes for 2024. Medicare eligible individuals should be minimally
impacted due to Medicare being primary payer.
• Wellmark will be issuing new ID cards for both PPO and HMO members. The HMO ID
cards are being updated to list the contract holder name only and will not be
individualized for dependents on the coverage.
• Humana stage 3 (catastrophic level) will be moving to $0 cost share for all tiers of
medications.
PLEASE NOTE: If you are not making any changes for 2024, you do not need to complete the
Open Enrollment Form. Your existing coverage will continue for 2024.
Steps if you want to make changes to your ISU Plan for January 1, 2024:
o Complete the Open Enrollment Form included in this packet, indicating your new choice.
o If adding a Medicare-eligible person to the plan for January 1, 2024, such as a spouse or
partner or other eligible dependent, please request a Humana application from the ISU
Benefits Office. It is not included in this packet.
o Mail the form to ISU Benefits Office, 3810 Beardshear Hall, 515 Morrill Rd, Ames IA
50011.
Steps to enroll in coverage elsewhere for January 1, 2024:
o Visit with Senior Health Insurance Information Program (SHIIP) consultants or insurance
brokers selling individual insurance plans.
o Fill out forms for those companies, as needed.
o So that we have a record of your intentions, please submit the drop form included in this
packet by December 7, 2023 to: ISU Benefits Office, 3810 Beardshear Hall, 515 Morrill
Rd, Ames IA 50011
A recorded presentation on the 2024 benefits is available for viewing on the
ISU webpage. https://www.hr.iastate.edu/retiree-open-enrollment
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If you drop the ISU Wellmark plan, you will not be offered another opportunity to enroll in
the coverage again. If you drop the ISU Wellmark plan, you must also drop the prescription
plan. If you’re covering a spouse/partner or dependent children, their coverage will end as
well.
Lifelong Coverage?
ISU Retiree insurance is not guaranteed, although ISU hopes to continue to provide group
medical benefits to retirees and their family members for years to come. With more than 3,000
retirees/spouses on the retiree insurance currently, the ISU Plan is projected to remain stable
for the foreseeable future.
Who may you insure on the ISU insurance plans?
• Spouse or domestic partner
o If the spouse/partner is insured on the retiree’s plan at the time of the retiree’s
death, the surviving spouse/partner should contact the ISU Benefits Office to
report the death. The surviving spouse/partner would then complete a form to
transfer the policy to their name.
• Eligible child(ren) may be insured through the end of the year in which they turn age 26.
o After age 26, only an unmarried, full-time student, or a permanently disabled
child is eligible for coverage on the retiree policy. Contact the ISU Benefits Office
to remove your child when their eligibility changes.
• Disabled children may continue on the retiree’s plan if: there has not been any lapse in
coverage for the child and prior to reaching age 26; the disability is verified by the child’s
physician to be total and permanent; and the verification is provided to ISU Benefits
Office.
Midyear Qualifying Events:
Events that occur outside of open enrollment must be reported to the ISU Benefits Office
within 31 days of the event. Coverage is effective the first of the month following satisfactory
evidence of the event as determined by the ISU Benefits Office. Contact the ISU Benefits Office
to discuss your event. Some examples of qualifying events are:
• Marriage or divorce
• Spouse/partner loses or gains other coverage
• Dependent over age 26 and no longer a full-time student
• Move outside of the HMO network – eligible to move to the PPO plan
Becoming Medicare Eligible in 2024
ISU sends information to those turning age 65, typically three months before your birth month.
If eligible for Medicare prior to 65, please alert the ISU Benefits team.
If continuing the ISU retiree plan, Medicare Part A and B must be the primary insurance for
those Medicare-eligible individuals. The ISU retiree Wellmark plan becomes secondary.
Medicare would receive the medical service claim first and once the claim is processed by
Medicare, the claim is electronically filed to Wellmark in most cases. For providers not
participating with Medicare, the patient may be instructed to file their own claim.
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If you are Medicare eligible and continuing with the ISU Wellmark medical plan, you must have
the ISU Group Medicare Part D Prescription Drug Plan (PDP) with Humana.
Insurance Premium changes for those with Medicare and Low Income or High Income
Medicare Part A is usually at no cost to those eligible. Medicare Part B and Part D premiums for
any Part D plan (including ISU’s Humana Part D plan) are income-based and annually assessed
by Social Security. The premium for our Humana plan is rolled into the premium you pay to
Wellmark, but there could be an adjustment due to the income level you had in 2022.
For those Medicare participants with high modified adjusted gross income reported in 2022, an
Income-Related Monthly Adjustment Amount (IRMAA) will be assessed in 2024. The Centers for
Medicare & Medicaid Services (CMS) notifies the member of this annually applied assessment
for Medicare B and D. If assessed the fee and the participant does not agree to have the fee
deducted from the SSI, CMS would advise Humana to terminate the Medicare Part D, which
would be your ISU Humana group plan. Any appeal regarding this assessment is directed to the
Members might qualify for a low-income subsidy (LIS) for the Medicare Part D PDP based on
2022 income. The premiums listed in this document do not reflect the LIS. CMS notifies
Humana when a member qualifies as LIS. ISU then receives notice from Humana, then alerts
Wellmark to have the member charged a lower premium. The LIS is based on the reduction of
the cost for the Humana plan for the applicable member.
The Iowa State University Medical Insurance Choices
Wellmark Blue Cross and Blue Shield of Iowa administer both plan options.
1. Wellmark BluePPO (a Blue Cross/Shield Association Preferred Provider Organization)
• Nationwide network
• In-network and out-of-network coverage
• Coverage abroad
2. Wellmark BlueHMO (a Wellmark Health Plan of Iowa network)
• Iowa-based network - includes some bordering states.
• Required to designate Primary Care Physician (PCP) - contact Wellmark to update PCP
in the future.
• For services outside of the network, only emergencies or prior-authorized care will be
covered.
• Guest membership for long-term absence from Iowa. Contact Wellmark directly for
more details.
Visit our website for the detailed plan certificates.
https://www.hr.iastate.edu/retiree-benefits
The member is responsible for the timely payment of all premiums. Consider setting up
automatic payments with Wellmark. Wellmark can provide an automatic payment form
upon request. If you have changes to your automatic payment on file, you will need to call
Wellmark Customer Service. ISU does not have access to your payment information.
Wellmark Customer Service Phone Number: 1-800-494-4478
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Blue365
®
Member Discounts and Services: https://www.blue365deals.com/WellmarkBCBS/
Medical Plan Design Changes for 2024
While there are no coverage changes, there will be member cost share changes. Medicare
eligible individuals should be minimally impacted due to Medicare being the primary insurance
payer. See page 6 and 7 for the plan design comparison.
Plan design changes specific to:
• Deductible
• Coinsurance
• Copay application
• Out-of-pocket maximum
The Iowa State University Prescription Drug Coverage
The ISU Plan members have prescription drug coverage with either Express Scripts or Humana.
Medicare eligibility determines which plan you are required to be in.
1. Express Scripts is the plan for retired/disabled members and the family members on
the plan who are not yet Medicare eligible.
Member Service Phone Number: 1-800-987-5248
2. Humana is the ISU Group Medicare Part D Prescription Drug Plan (PDP) for
retired/disabled members and the family members on the plan who are Medicare
eligible. CMS does not allow more than one PDP.
For the comprehensive Humana formulary, please use the website or call the customer
service number on your ID card. The web link is:
https://www.humana.com/pharmacy/insurance-through-employer/tools/druglist/
Humana Discounts and Services
Humana will send information at the beginning of the plan year
You might have a prescription that your pharmacy may indicate is not covered by Humana due
to coverage by Medicare Part B. For prescriptions considered to be under Part B, Wellmark will
follow Medicare. An example of this type of prescription may be diabetes test strips or
transplant auto-immune suppressive medications. However, if neither Part B nor Part D covers
your prescription, Wellmark will not cover the expense. There would be no coverage for the
prescription.
During the 2024 year or any year, if you receive notice that you have been or are being
dropped from your ISU Express Scripts or Humana plan and you did not take this action to
terminate the coverage yourself, please contact the ISU Benefits Office. Further, if an assisted
living facility, nursing home or other facility wants to enroll you or your dependent in a
different prescription plan because the facility is not participating with the ISU Humana Part D
plan, remember that it is necessary to keep our prescription plan to be in our group medical
plan. Humana can assist you in working with the long-term care provider.
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2024 ISU PLAN MONTHLY PREMIUMS for former Merit staff of ISU
and Affiliated Board of Regents Institutions
Prices include either Express Scripts or Humana pharmacy -
based on Medicare eligibility
BluePPO
and Rx
BlueHMO
and Rx
Retiree Only
Not Medicare eligible
$851.00
$825.00
Medicare eligible
$348.00
$332.00
Retiree and Spouse or Partner – Two people
Two not Medicare eligible
$1,938.00
$1,886.00
Two people - one with Medicare/one without Medicare
$1,193.00
$1,151.00
Two Medicare eligible
$690.00
$658.00
Retiree and Child(ren) only – Two or more
Retiree is not Medicare eligible
$1,514.00
$1,476.00
Retiree is Medicare eligible
$1,011.00
$983.00
Family - Retiree, Spouse/Partner & child(ren) – Three or more
Three or more - none are Medicare eligible
$2,483.00
$2,397.00
One with Medicare and others without Medicare
$1,738.00
$1,662.00
Two Medicare eligible and others without Medicare
$1,235.00
$1,169.00
NOTE: RIO & SRIP Participants – your premiums will be reflected on your change form in this
packet.
Former Faculty, Professional and Scientific, and Supervisory/Confidential Merit have a different
premium than former Merit retirees. This is due to the limited history of the Merit retirees’ claims
experience. As the plan experience and trends are evaluated over a longer period of time, the
expectation is the two groups will be blended to eventually have the same premiums.
2024 ISU PLAN MONTHLY PREMIUMS for former Faculty, Professional and Scientific,
Supervisory or Confidential Merit staff of ISU and Affiliated Board of Regents Institutions
Prices include either Express Scripts or Humana pharmacy -
based on Medicare eligibility
BluePPO
and Rx
BlueHMO
and Rx
Retiree Only
Not Medicare eligible
$697.00
$674.00
Medicare eligible
$348.00
$332.00
Retiree and Spouse or Partner – Two people
Two not Medicare eligible
$1,585.00
$1,541.00
Two people - one with Medicare/one without Medicare
$1,039.00
$1,000.00
Two Medicare eligible
$690.00
$658.00
Retiree and Child(ren) only – Two or more
Retiree is not Medicare eligible
$1,238.00
$1,206.00
Retiree is Medicare eligible
$889.00
$864.00
Family - Retiree, Spouse/Partner and child(ren) – Three or more
Three or more - none are Medicare eligible
$2,030.00
$1,959.00
One with Medicare and others without Medicare
$1,484.00
$1,418.00
Two Medicare eligible and others without Medicare
$1,135.00
$1,076.00
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ISU PLAN MEDICAL PLANS - Effective January 1, 2024
This is a limited comparison of benefits. The Summary of Benefit and Coverage for each plan is available on the ISU web page.
Benefits will be administered as described in each plan coverage manual. Refer to those documents or call Wellmark Blue
Cross/Blue Shield. If there are discrepancies between this comparison and Wellmark’s Coverage Manual, the Manuel will govern
in all cases.
NOTE: For retiree plan participants eligible for Medicare, Medicare is your primary insurance.
The ISU Plan, following Medicare, usually leaves no patient liability, such as the copay or coinsurance shown below.
Some exceptions may occur.
PLAN
PROVISIONS
BluePPO
BlueHMO
*Primary Care Physician
designation required
In - Network
Out-of-Network
Benefits from non-
participating
providers
Limited:
You are responsible for any
amounts between the billed
charge and the maximum
allowable fee paid by Wellmark.
These amounts will not
accumulate towards the medical
out-of-pocket limit.
60% coverage to MAF (maximum
allowable fee) after deductible
You are responsible for any amounts
between the billed charge and the
maximum allowable fee paid by
Wellmark. These amounts will not
accumulate towards the medical out-
of-pocket limit.
None, unless prescribed
and referred by a
participating physician and
approved by Wellmark, or
in an emergency medical
situation
Yearly Deductible
(Member pays)
$400 single / $800 other
levels
$800 single / $1,600 other levels
*Does not aggregate with in-network
deductible
$250 single / $500 other
levels
Copayment
(Member pays)
$25
N/A – deductible/coinsurance
$15
Coinsurance
(Member pays)
20% of Maximum Allowable
Fee, after deductible
40% of Maximum Allowable Fee,
after deductible
10% of Maximum
Allowable Fee, after
deductible
Yearly Out-of-
Pocket (OOP)
Maximum
Copays, deductible &
coinsurance apply to
yearly OOP
maximum.
$2,000 single / $4,000 other
levels
*Separate OOP for prescription
$4,000 single / $8,000 other levels
*Does not aggregate with in-network
OOP maximum
*Separate OOP for prescription
$1,500 single / $3,000
other levels
*Separate OOP for prescription
Lifetime maximum
Unlimited
Unlimited
Unlimited
PREVENTATIVE SERVICES
Member pays:
Routine annual
physicals
$0
(100% coverage)
40% coinsurance, after deductible
$0
(100% coverage)
Labs,
colonoscopies,
sigmoidoscopies
$0
(100% coverage)
40% coinsurance, after deductible
$0
(100% coverage)
Routine pap
smears, routine
mammography
$0
(100% coverage)
40% coinsurance, after deductible
$0
(100% coverage)
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PLAN
PROVISIONS
BluePPO
BlueHMO
*Primary Care Physician
designation required
In-Network
Out-of-Network
PHYSICIAN SERVICES
Member pays:
Office exams,
includes mental
health services
$25 copay
40% coinsurance, after
deductible
$15 copay
Telehealth (visual &
audio required)
$25 copay
40% coinsurance, after
deductible
$15 copay
X-ray, lab, and
outpatient surgery
20% coinsurance, after
deductible
40% coinsurance, after
deductible
10% coinsurance, after
deductible
Routine eye exam
(eyeglasses not
covered)
$25 copay
40% coinsurance, after
deductible
$15 copay
Routine hearing
exam (hearing aids
not covered)
$25 copay
40% coinsurance, after
deductible
$15 copay
INPATIENT SERVICES
Member pays:
Inpatient surgery
20% coinsurance, after
deductible; prior approval
required for certain
procedures
40% coinsurance, after
deductible; prior approval
required for certain procedures
10% coinsurance, after
deductible; prior approval
required for certain procedures
Physician services,
room and board,
other inpatient care
20% coinsurance, after
deductible
40% coinsurance, after
deductible
10% coinsurance, after
deductible
MISCELLANEOUS SERVICES
Member pays:
Acupuncture
Not covered
Not covered
$15 copay
$500 benefit maximum per
benefit year/member
Allergy treatment
$25 copay
40% coinsurance, after
deductible
$15 copay
Emergency room
care
$125 copay, plus 20%
coinsurance
*Copay is waived if admitted
$125 copay, plus 20%
coinsurance
*Copay is waived if admitted
$125 copay, plus 10%
coinsurance
*Copay is waived if admitted
Chiropractic care
$25 copay
40% coinsurance, after
deductible
$15 copay
Outpatient
chemotherapy
20% coinsurance, after
deductible
40% coinsurance, after
deductible
10% coinsurance, after
deductible
Speech, physical,
occupational, and
respiratory
therapy
$25 copay
*Non-office setting,
coinsurance may apply.
40% coinsurance, after
deductible
$15 copay
*Non-office setting, coinsurance
may apply.
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2024 (1-1-2024 to 12-31-2024) Iowa State University
Humana Medicare Part D Prescription Drug Plan
Note: This is not a complete description of benefits. If a discrepancy arises between this information and the
actual Evidence of Coverage, the Evidence of Coverage will prevail in all instances.
Prescription Tiers
See description
below in Tier
Details
Retail Pharmacy
30-Day Supply (90-day cost)
Mail Order – CenterWell Pharmacy
90-Day Supply
Stage 1 = $0 to Initial Coverage Limit (ICL):
When total drug cost reaches $5,030
Tier 1
Generic or Preferred Generic
$10 ($30) Maximum
$0
Tier 2
Preferred Brand
30% up to $50 maximum out-of-
pocket per prescription
(30% up to $150)
20% up to $100 maximum out-of-pocket per
prescription
Tier 3
Non-Preferred Drug
50% up to $50 maximum out-of-
pocket per prescription
(50% up to $150)
33% up to $100 maximum out-of-pocket per
prescription
Tier 4
Specialty
50% up to $50 maximum
out-of-pocket per prescription
N/A - Limited to a 30-day supply
Stage 2 = Coverage Gap – Begins when the yearly drug cost total
(What you and the plan have paid) reaches $5,030
Tier 1
Generic or Preferred Generic
$10 ($30)
$0
Tier 2
Preferred Brand
30% up to $50 maximum out-of-
pocket per prescription
(30% up to $150)
20% up to $100 maximum out-of-pocket per
prescription
Tier 3
Non-Preferred Drug
30% (30%)
30%
Tier 4
Specialty
30% (N/A)
N/A
All Tiers
Stage 3 = Catastrophic to Unlimited - Begins
when your true out-of-pocket cost reaches $8,000
$0
Annual Maximum
Out-of-Pocket
(MOOP)
$2,500 - After your out-of-pocket drug costs reach this total,
Humana pays 100% of your total drug costs.
Tier Details
Tier 1: Generic or brand drugs that are available at the lowest cost share for this plan
Tier 2: Generic or brand drugs that Humana offers at a lower cost than Tier 3 drugs
Tier 3: Generic or brand drugs that Humana offers at a higher cost than Tier 2 drugs
Tier 4: Some injectable medications and other higher-cost drugs
Out of Network
If a drug is purchased at an out-of-network pharmacy in an emergency situation: a)
member pays the same coinsurance as would have applied at a network pharmacy but
at the out-of-network pharmacy price and/or b) member will pay copayment as would
have applied at a network pharmacy, plus the difference between the out-of-network
pharmacy price and the network pharmacy price, not to include maximums.
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2024 ISU Plan Express Scripts Prescription Drug Plan
The Patient Protection and Affordable Care Act (ACA) requests employers provide a notice to
retirees regarding coverage options available through a Marketplace. The Department of
Labor’s notice is available by request or at the ISU benefits website for your review:
https://www.hr.iastate.edu/required-notices-and-resources
Prescription Drug Coverage Required Notice
Iowa State University has determined that both the Express Scripts and Humana prescription
drug coverage with the ISU Plan are as good as or better coverage than the standard Medicare
prescription drug coverage (Part D). This means that your ISU Plan coverage is considered
“creditable coverage” and that you will not pay extra if you later decide to leave our plans and
timely enroll in an individual Medicare prescription drug plan. (Please see enclosed Notice of
Creditable Coverage.)
Pharmacy Benefit Manager
EXPRESS SCRIPTS
Express Scripts determines the tier
of each medication.
Drug Tiers:
Tier 1 is Generic drugs
Tier 2 is a Preferred Brand Name drugs
Tier 3 is Non-Preferred Brand Name drugs
Specialty drugs may be Tier 2 or 3.
Deductibles
$0
Prescription Coinsurance/Pay
Maximum Out-of-Pocket (MOOP)
$2,000 single/benefit year
$4,000 total/benefit year for other levels
30-day Supply
Participating Retail Pharmacy
*If you’re on a maintenance medication,
you may qualify for Smart90 where you
will be required to move to a 90-day
supply at retail or mail order
Tier 1 - $15 copay / script
Tier 2 - 30% coinsurance
up to $125.00 maximum copay / script
Tier 3 - 50% coinsurance
up to $250.00 maximum copay / script
Above applies until MOOP is reached.
90-day Supply
Participating Retail Pharmacy
Tier 1 - $45 copay / script
Tier 2 - 30% coinsurance
up to $375.00 maximum copay / script
Tier 3 - 50% coinsurance
up to $750.00 maximum copay /script
Above applies until MOOP is reached.
90-day Supply
Express Scripts by Mail
(Home Delivery)
Using Express Scripts by Mail
Tier 1 - Generics - no cost to member
Tier 2 - 25% coinsurance
up to $300.00 maximum copay / script
Tier 3 - 33% coinsurance
up to $600.00 maximum copay / script
Above applies until MOOP is reached.
