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Large Group 101+


Small Group 51-100


Small Group 2-50

Iowa Heritage Product Spec Sheet

2016 Benefit Summaries

2015 Benefit Summaries

2014 Benefit Summaries

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

Flat Copay 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)

Flat Copay 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 - Arkansas
Employer Application (Groups 1-50, #262-6491)
Employee Enrollment Form (Groups 1-50, #262-6492)

Large Group - Arkansas
Employer Application (Groups 51+, #262-6493)
Employee Enrollment Form (Groups 51+, #262-6494)
Employee (New Hire) Enrollment Form with Medical Question (Groups 51-100, #262-6495)


Large Group - Georgia
Employer Application (Groups 51+, #200-8287)
Employee Enrollment Form (Groups 51+, #200-8288)
Employee Enrollment Form with Medical Question (Groups 51-100, #200-8289)

Small Group - Georgia
Employer Application (Groups 1-50, #200-8285)
Employee Enrollment Form (Groups 1-50, #200-8286)


Small Group - Illinois
Employer Application for groups 1-50 (230-11119)
Employee Enrollment Form for groups 1-50 (230-11120)

Large Group - Illinois
Employer Application for groups 51+ (230-11121)
Employee Enrollment Form for groups 51-100 (230-11123)
Employee Enrollment Form for groups 51+ (230-11122)


Small Group - Iowa
Employer Application (Groups 1-50, #250-6988)
Small Group Member Universal Enrollment Application (Groups 1-50)

Large Group - Iowa
Employer Application (Groups 51+, #250-6990)
Employee Enrollment Form (Groups 51+, #250-6991)
Employee Enrollment Form with Medical Question (Groups 51-100, #250-6992)


Small Group - Ohio
Employer Application (Groups 1-50, #290-7611)
Employee Enrollment Form (Groups 1-50, #262-7612)

Large Group - Ohio
Employer Application (Groups 51+, #262-7613)
Employee Enrollment Form (Groups 51+, #262-7614)
Employee Enrollment 1-Question Form (Groups 51+, #262-7615)


Small Group - Tennessee
Employer Application for SG (Groups 1-50, #261-6693)
Employee Enrollment Form for SG (Groups 1-50, #261-6694)

Large Group - Tennessee
Employer Application for LG (Groups 51+, #261-6695)
Employee Enrollment Form for LG (Groups 51+, #261-6696)


 



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