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Large Group 101+


Small Group 51-100


Small Group 2-50

Iowa Heritage Product Spec Sheet

Deductible with $0 Kid Copay (2013/2014)

Deductible with POS with $0 Kid Copay (2013/2014)

Health Reimbursement Arrangement (2013/2014)

Health Reimbursement Arrangement with POS (2013/2014)

Qualified HDHP (2013/2014)

Qualified HDHP with POS (2013/2014)

SelectAdvantage (2013/2014)

Split Copay Deductible with $0 Kid Copay (2013/2014)

Split Copay Deductible with POS with $0 Kid Copay (2013/2014)

Riders

Deductible (2013)

Deductible with POS (2013)

Split Copay Deductible (2013)

Split Copay Deductible with POS (2013)

Deductible with POS and $0 Kid Copay

Changes are made frequently to commercial benefit plan summaries. Check back regularly for updates.

These plans are for effective dates January 1, 2014 and later.

O0-1 (20/250/90%)
O0-2 (20/500/90%)
O0-3 (20/750/80%)
O0-4 (30/1000/80%)

These plans are for effective dates prior to January 1, 2014.

From now until Aug. 1, 2012, health plans will have both a "G" series designation as well as a "W" plan designation. This change to the benefit plan name is to accommodate the expanded women's preventive services coverage effective for plans beginning on or renewing Aug. 1, 2012. The benefit summaries remain the same.

As of May 1, 2012, you must use the "W" plan for quotes for Aug. 1, 2012 new or renewing groups. For quotes with effective dates prior to Aug. 1, continue using the "G" series. The "G" plans will be termed Aug. 1, 2012, and only the "W" plans will remain. Our health plans comply with the Patient Protection and Affordable Care Act.

The letter "K" indicates $0 PCP kid copay for enrollees under age 19.

IAKDPC15-10-1000-250 POS70 / IAXDPC15-10-1000-250 POS70
IAKDPC15-10-1000-500 POS70 / IAXDPC15-10-1000-500 POS70
IAKDPC15-10-1500-750 POS70 / IAXDPC15-10-1500-750 POS70
IAKDPC15-10-2000-1000 POS70 / IAXDPC15-10-2000-1000 POS70
IAKDPC15-10-3000-1500 POS70 / IAXDPC15-10-3000-1500 POS70
IAKDPC15-10-4000-2000 POS70 / IAXDPC15-10-4000-2000 POS70
IAKDPC20-20-1000-500 POS60 / IAXDPC20-20-1000-500 POS60
IAKDPC20-20-1500-250 POS60 / IAXDPC20-20-1500-250 POS60
IAKDPC20-20-2000-1000 POS60 / IAXDPC20-20-2000-1000 POS60
IAKDPC20-20-3000-1500 POS60 / IAXDPC20-20-3000-1500 POS60
IAKDPC20-20-4000-2000 POS60 / IAXDPC20-20-4000-2000 POS60
IAKDPC25-20-5000-2500 POS60 / IAXDPC25-20-5000-2500 POS60
IAKDPC25-20-6000-3000 POS60 / IAXDPC25-20-6000-3000 POS60
IAKDPC25-20-8000-4000 POS60 / IAXDPC25-20-8000-4000 POS60
IAKDPC25-20-10000-5000 POS60 / IAXDPC25-20-10000-5000 POS60
IAKDPC25-30-1500-500 POS50 / IAXDPC25-30-1500-500 POS50
IAKDPC25-30-2250-750 POS50 / IAXDPC25-30-2250-750 POS50
IAKDPC25-30-3000-1000 POS50 / IAXDPC25-30-3000-1000 POS50
IAKDPC25-30-4500-1500 POS50 / IAXDPC25-30-4500-1500 POS50
IAKDPC25-30-6000-2000 POS50 / IAXDPC25-30-6000-2000 POS50
IAKDPC30-30-7500-2500 POS50 / IAXDPC30-30-7500-2500 POS50
IAKDPC30-30-9000-3000 POS50 / IAXDPC30-30-9000-3000 POS50
IAKDPC30-30-12000-4000 POS50 / IAXDPC30-30-12000-4000 POS50
IAKDPC30-30-15000-5000 POS50 / IAXDPC30-30-15000-5000 POS50

How to interpret the benefit plan naming system (for example, IAKDPC15-10-1000-250 POS70):

IA = The state the benefit applies to
K = $0 PCP kid copay for enrollees under age 19
DPC = Type of benefit plan
15 = $15 (network) physician services copayment (does not necessarily apply to all physician services)
10 = 10 percent (network) coinsurance expressing member responsibility in a percentage amount
1000 = $1,000 (network) out-of-pocket maximum per individual per calendar year
250 = $250 (network) deductible per individual per calendar year
POS70 = 70 percent point of service option expressing plan responsibility in a percentage amount

Note: Please reference individual benefit summaries for specific benefit information.





Enrollment Forms

Click on a state to reveal downloadable enrollment forms.


Small Group - Illinois
Small Employer Application (Groups 2-99)
Standard Employee Application (Groups 2-50)
Employee Enrollment Form (Groups 51-99)
Employee Enrollment Form for Additions or Changes to Existing Groups (Groups 2-99)

Large Group - Illinois
Employee Enrollment Form (Groups 100+)

Large Group - Virginia
Large Group Insured Member Enrollment Application (PPO & HMO)

Small Group - Virginia
Employee Enrollment Form (Groups 2-24)
Employee Enrollment Form (Groups 25-99 and Self-Funded or Groups with no prior coverage 51-99)
Employee Enrollment Form (Groups 25-99)
Employer Enrollment Form (Groups 2-99)
Employer Health Addendum (Groups 25-99)

 



Find a Physician or Facility


Find a Physician

Search our online directory to Find a Physician or Facility. For a paper provider directory or assistance finding a provider, please call the Customer Care number on the back of your health plan ID card.


 
Popular Links
- Lab Corp (use to find laboratory services out of your local service area)
- National Committee for Quality Assurance (NCQA)
- NCQA HealthChoices
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