The Student Health Insurance Plan (SHIP) is an Alliance Select plan, which provides coverage for hospitalization, surgery, maternity, well-baby/well-child care (to age seven), emergency care for accidents or illness, medically necessary physician care, prescription drugs and mental health. There is a lifetime benefit maximum of $250,000 per person covered under this plan.
How an Individual Uses SHIP
Health care under this plan is provided by various groups of health care practitioners, suppliers, agencies, programs, and facilities called Select Providers who have agreed to join with Blue Cross and Blue Shield of Iowa to offer each student affordable health care. One hundred percent of the hospitals and more than 4,000 physicians in Iowa participate with the Alliance Select plan.
Students may also purchase coverage for their spouse or domestic partner and/or dependent children.
Students are urged to take advantage of The University of Iowa Student Health Service when they need health care. Unlimited office visits for General Medicine Services, Surgery, Allergy Treatment, Sexually Transmitted Diseases, Mental Health Services, and the Health Iowa education program are included in a mandatory health service fee which is included in tuition charges if a student is enrolled for five (5) or more semester hours of classes. Students who are enrolled for less than five (5) semester hours may choose to pay the health fee and obtain these same benefits.
The Student Health Fee does not cover lab tests, supplies, physicals (incuding annual gynecological exams), immunizations, procedures (such as wart removal) and other costs.
Many Services that are not covered by the Student Health Fee are available at Student Health Service-such as laboratory and x-ray services, physicals, annual gynecological exams, etc. Any charges incurred for such services are the responsibility of the student. SHIP may be used to pay for some of these services up to the payment limits of the plan.
Family members are not eligible to use The University of Iowa Student Health Service. To receive the greatest benefits from SHIP, dependents are advised to use the physicians from the Alliance Select Provider list.
How Much an Individual Pays for Health Care Services
Insureds are limited to a total of $1,500 per covered person per calendar year for:
* office services and outpatient care not related to emergency, accident, surgery, or maternity services.
* ambulance services, home infusion therapy, home medical equipment, and prosthetic appliances.
Insureds are limited to $1,500 per covered person per calendar year for:
* services for diagnostic x-ray and lab as a hospital outpatient.
Insureds are limited to $500 for individuals or $750 for family status for prescription drugs.
When using an Alliance Select Provider the insured will pay a $10 copayment per covered visit for office services; a $10 copayment per covered visit as an outpatient for diagnostic x-ray and lab services at physician’s office; and a $50 copayment for hospital outpatient services for surgery, emergency room, and ambulatory surgery centers. Whenever an insured is admitted to a Select Provider hospital, the individual will pay a $300 deductible per covered admission plus 10% coinsurance up to a total of $1,000 out-of-pocket maximum per admission.
The copayments for health care services provided by Non-Select Providers are $30 per covered visit for office services, $150 per covered visit for outpatient surgery, and a $600 deductible per covered admission and 20% coinsurance for hospital inpatient treatment.
Out-of-Pocket Maximum (OPM) Expenses for Individuals
SHIP provides a $1,000 out-of-pocket maximum per hospital inpatient admission.
The out-of-pocket maximum equals the per-service deductible plus the coinsurance amounts paid during each inpatient hospital stay.
When the amount paid by the insured equals the OPM, the plan pays 100% of the covered charges incurred for that admission.
Coverage for Prescription Drugs
Prescription drugs are covered under a 3-tier plan.
1. Generic drugs- you pay 25%
2. Name brand formulary drugs- you pay 30%
3. Name brand non-formulary drugs- you pay 50%
Formulary drugs are drugs that are on Wellmark’s preferred list. The maximum benefit payable is $500 for single and $750 for all other contracts.
If you purchase a brand name drug when an FDA-approved “A”-rated generic equivalent is available, you are responsible for your co-payment or coinsurance, plus any difference between the billed charge for the brand name drug and the billed charge for the generic. This can result in you paying substantially higher costs than if you had chosen the generic drug.
If your physician feels it is important for you to have the brand name drug, they can write the prescription for the brand name drug with the direction, “Dispense as Written” on the prescription. In this situation you will not be responsible for the difference between the billed charge for the brand name drug and the billed charge for the generic drug.
Limitations and Exclusions
Certain services are limited, excluded, or not considered medically necessary under SHIP. Routine physicals, immunizations (except for children under 7 years of age), dental check ups, and eye exams are not covered. Dental Services are limited to accidental injuries treated within seven days of the injury and limited surgical corrections to the jaw, mouth, and accessory sinus. Injuries to the eye have limited coverage.
Alliance Select Care Providers in Iowa
Covered individuals may use any provider they choose for physician and other office and outpatient services. However, your financial responsibility is greater if you use Non-Select Providers. All hospitals in Iowa are Select Providers.
Health Care for Individuals Who Are Away from Iowa
SHIP provides coverage world wide. For covered services received in other states or outside of the USA, the provider category may be Select or Non-Select when determining payment amounts. Choosing a Select provider can be an advantage when receiving treatment.
The insured is responsible for telephoning the Blue Cross and Blue Shield of Iowa toll-free number before being admitted to a hospital for non-emergency care and within 24 hours of emergency and maternity admissions.
Medical Evacuation Benefit
The University of Iowa SHIP will cover medical evacuation services in the event of illness or injury to students if necessary and adequate medical care cannot be provided at the location when the illness or injury occurs.
Medical evacuation expenses to the nearest appropriate medical facility are limited to a lifetime maximum of $10,000 per person. Precertification of medical evacuation services is required.
Repatriation Benefit
A $7,500 repatriation benefit applies to the insured under SHIP. This must be applied toward those expenses incurred in returning the body to the person’s place of residence in his or her home country including, but not limited to, the cost of embalming, the coffin, and transportation of the body.
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