A few reminders about 2024 changes to your health plan

The new calendar year means changes to the university's health care plans announced last fall have arrived. And while employees should expect to pay more attention to their health care and pay a greater share of the (nonpreventive) medical services they receive in 2024, in many cases their office visit experience will be similar. On the day you see your doctor or therapist, you're responsible for a copay, $15 for BlueHMO participants and $25 for BluePPO participants. That copay will cover other services received.

If your appointment is for a preventive service, you won't even have a co-pay. Under the national Affordable Care Act, the federal government maintains an expanding list of preventive services that, by law, carry no cost-sharing. Benefits director Ed Holland, university human resources, said it's important to keep scheduling these covered services -- including annual wellness exam, colonoscopy, 2D and 3D mammogram, skin or lung cancer screening, mental health screenings, among others -- to stay ahead of any health issues.

One change with office visit payments in 2024 is that ongoing or short-series appointments, for example, for allergy shots, mental health sessions or physical therapy, require the copay at each visit, not just the first one.

Besides a copay, the other pieces of the medical cost-sharing structure are a deductible and coinsurance. If one of these applies (typically when a copay is not taken), it will be paid later to your medical provider -- for example, McFarland Clinic -- after the provider has sent the claim to Wellmark and Wellmark has processed it. That usually takes three to four weeks, after which you'll receive a bill from your provider.

Explanation of Benefits: Not a bill

The Explanation of Benefits (EOB), which you'll receive from ISU Plan administrator Wellmark after you receive service, is a recap of what your insurance has paid. It's not a bill, it's simply a summary of the services provided, along with a detailed breakdown of who is responsible for which portion of the costs, as detailed in the linked sample. Review your EOB when it arrives.

These tips could help reduce the amount you pay out-of-pocket:

• Select an in-network provider. Use the Find a Doctor or Hospital tool on Wellmark.com to find an in-network provider so you can get the best savings from your health plan.
• Compare charges. If you receive a bill from your provider, compare charges on your EOB to charges listed on the provider bill to confirm that services and charges listed on the two align and are correct.
• Register for myWellmark. This website becomes your personalized site to make the most of your coverage.

More about myWellmark

The myWellmark member portal can help you stay on top of your ISU plan benefits and usage. The site helps you manage your health, your health plan and your health care costs, all in one place. This secure member website is available 24/7 and lets you track your expenses and use tools to help you reach your health goals. On the site, you can do tasks such as check your claims, find providers, see if a procedure is covered and check the prices of your prescriptions. Plus, you get access to Wellmark's secure message center and digital notification preferences for information about your health plan. And you'll find answers to common questions, including:

• Where do I find my claims information?
• Where do I find how much of my deductible I have met for the year?
• How do I print my health plan ID card or request a replacement card?

If you haven't registered for the portal, visit the myWellmark registration site. You also can download the myWellmark app on the App Store or Google Play.

Curious about costs?

ISU employees have several options for finding out what -- or if -- a service will cost them.

Also in myWellmark, you have access to a cost estimator -- but keep in mind it's an estimator, not a quote for services. To use it, at the bottom of your myWellmark homepage, locate the section called "what are you searching for today?" Select "find costs" and the link below to be taken to the provider finder tool. Once there, select the "estimate your costs" box and enter a procedure.

Customer service specialists at Wellmark also can help with medical plan questions, for example, comparing how a medical service was paid in 2023 and how the same service will be processed in 2024. Wellmark staff also can answer questions about the list of preventive services. Call the number on the back of your Wellmark member ID card for help.

Or, you can request information locally. The business office staff for most providers, including Ames-based McFarland Clinic and Ames' Mary Greeley Medical Center (MGMC), will provide, at no charge, a cost estimate of a procedure before it's scheduled and reflecting the patient's insurance coverage.

Payment plans for even small balances

If you've received nonpreventive medical services and are concerned about covering those expenses in your monthly cash flow, payment plans are common among medical providers. ALEX, the virtual benefits counselor, offers a video and FAQ about using payment plans. Closer to home, MGMC and McFarland Clinic both offer interest-free payment plans for anyone and financial assistance or adjustments for qualifying individuals and families. Here are a few details shared by the providers:

• MGMC, billing services office, 515-239-2111. Payment plan of up to 24 months (minimum balance to request a payment plan is $25). MGMC suggests monthly payments of 10% of the balance, if possible.
• McFarland Clinic, business services office, 515-239-4598. The minimum balance to request a payment plan is $50. The maximum length and minimum monthly payment vary according to the size of the balance (the larger the balance, the longer the terms). McFarland's financial advisor team works with the patient on a payment arrangement.

Related stories

• Q&A: Oct. 4 benefits town hall, Oct. 5, 2023
• Begin to plan for health care changes in January, Sept. 28, 2023