Iowa Health Insurance Guide
Iowa Health Insurance Information, Health Organizations and Resources and access to online health insurance quotes
If you live in Iowa, you can choose from a variety of private health insurance plans that include plans for individuals and group plans provided by an employer, as well as Iowa State-funded affordable health insurance for eligible individuals and families, and federal programs such as Medicaid and COBRA.
While health insurance policies for individuals in Iowa can by medically underwritten, if you can show proof of 12 months’ prior creditable coverage that meets specific criteria, carriers must guarantee issue of a standardized policy. They are permitted to place elimination on such a policy, and there is a 12-month exclusionary period for pre-existing medical conditions and a 12-month look-back period. All other individual health insurance policies in Iowa can be denied for reasons of health or other criteria, and are subject to a 24-month exclusionary period for pre-existing conditions and a 60-month look-back period. Note that pregnancy can be considered a pre-existing condition and genetic information collected as a result of a medical condition that has been diagnosed can be used to determine if a pre-existing condition exists.
Your individual plan premiums can be based on the type of plan you apply for, your health, age, sex and lifestyle habits including tobacco use. If you represent a higher risk, you may be offered a policy with a correspondingly higher premium, although Iowa does place limitations on how much your premiums can be increased because of your health.
Iowa is a guaranteed renewal state. Regardless of your health, your insurer must renew your individual health insurance policy as long as you’ve paid your premiums on time and haven’t defrauded the company, or in the case of some HMOs, as long as you haven’t moved out of the service area. However, your premiums can be increased to reflect your current health status.
Iowa is a guarantee issue state for group health plans issued to small businesses. If your Iowa health insurance is provided through your employer, your coverage cannot be denied because of your past or current health health. However, a 12-month exclusionary period and 6-month look-back period for pre-existing conditions can be applied if you don’t have proof of creditable coverage. Furthermore, an employer can specify a waiting period before new hires become eligible for group coverage, although it must be applied equally. Iowa allows premiums to be rated based on the health status of employees within a group, but the rates cannot vary by plus or minus 25% of the indexed rate.
Iowa Mandated Health Benefits
Iowa laws require private health insurance policies to cover several state-mandated benefits. These currently include:
- Autism
- Breast Reconstruction
- Contraceptives
- Dental Anesthesia
- Diabetes Supplies and Self Management
- Emergency Services
- HPV Vaccine
- Mammography
- Maternity Stays
- Mental Health Parity
- Well-Child Care
- Coverage for newborn and adopted children under parent's policy
- Coverage for continuation and handicapped dependents under their parent’s policy
- Coverage for domestic partners
- Coverage for continuation/employees
- Coverage for conversion to non-groups.
Types Health Insurance Plans Available in Iowa
The following major medical health insurance plans are generally available in Iowa. Major medical plans cover illness and injury, hospitalization, prescription drugs and office visits, as well as the mandated services stated above.
Indemnity plans - Typically the most flexible and therefore highest priced choice, an indemnity plan lets you select your health providers and facilities. Depending on your plan, you will have to pay a deductible or co-insurance.
Preferred provider organization plans (PPOs) - You select from a network of preferred health care providers and facilities, and receive services at an agreed-upon discounted rate. You also have the option of going outside the network, but typically at a higher cost. You do not need a referral from a primary care physician to see a specialist. Premiums may be less than an indemnity plan but more than an HMO. You will have to pay a deductible or co-insurance.
Health maintenance organizations (HMOs) - HMOs plans require you to select a primary care physician from a prescribed network of providers, who must issue a referral before you can see a specialist. Services and covered costs are typically more comprehensive than those provided by a PPO. HMOs offer the advantage of affordable premiums and low out-of-pocket costs, with an emphasis on preventive care. Non-emergency services out of network are usually not reimbursed.
Point of Service plans (POS) - Similar to a PPO in that you will receive reimbursement for out-of-network care, but with an HMO’s requirement for a primary care physician who must provide referrals to specialists. Premiums, co-pays and co-insurance are typically higher than what you’d pay with an HMO.
Alternative Health Programs in Iowa
The Health Insurance Plan of Iowa (HIPIOWA)
HIPIOWA is a high risk pool providing health insurance for eligible residents who are otherwise uninsurable. HIPIOWA also covers HIPAA-eligible individuals who have left group plans and have exhausted all COBRA and state-continuation coverage. Eligible residents can choose from five comprehensive plans from preferred providers, plus one Medicare carve-out plan. Deductibles and out-of-pocket expenses vary per plan. The lifetime maximum dollar benefit under the HIPIOWA plans is $3,000,000. There is a 6-month exclusionary period on benefits for most pre-existing conditions.
Healthy and Well Kids in Iowa (Hawk-I)
Hawk-I provides health insurance to eligible resident children under the age of 19, who have no other health insurance. Eligibility is based on family income limits. There is no waiting period. Benefits are comprehensive. Participants can choose from three health plans and one dental plan, based on the county in which the child resides. Premiums, which range from nothing to $20 a month, are based on family income. There is no co-payment or coinsurance for most services. Enrollment is for a 12-month period and can be renewed annually.
Care for Yourself
This program provides free screening through the Iowa Breast and Cervical Cancer Early Detection Program and treatment through Medicaid for women at risk of breast or cervical cancer.
Regulating Agency
The Iowa Division of Insurance, Department of Banking, Insurance, Securities and Health Care Administration is responsible for regulating Iowa’s health insurance industry.
Get access to Iowa health insurance quotes from http://www.einsurance.com/health-insurance/.
Iowa Insurance Division
330 Maple St.
Des Moines, IA 50319-0065
(515) 281-5705, (877) 955-1212
http://www.iid.state.ia.us/
HIPIOWA
(877) 793-6880
http://www.hipiowa.com/
Healthy and Well Kids in Iowa (HAWK –I)
(800) 257-8563
http://www.hawk-i.org/en_US/index.html
Iowa Department of Public Health
Care For Yourself Program
321 E 12th Street
Des Moines, IA 50319-0075
(515) 281-7689, (866) 227-9878
http://www.idph.state.ia.us/careforyourself/default.asp
(NAIC) National Association of Insurance Commissioners
The National Association of Insurance Commissioners (NAIC) is the organization of insurance regulators from the 50 states, the District of Columbia and the five U.S. territories. The NAIC provides a forum for the development of uniform policy when uniformity is appropriate. NAIC members are the elected or appointed state government officials who along with their departments and staff regulate the conduct of insurance companies and agents in their respective state or territory.
http://www.naic.org/
Insurance Information Institute (I.I.I)
The mission of the Insurance Information Institute (I.I.I.) is to improve public understanding of insurance -- what it does and how it works.
Contact info:
110 William Street
New York, NY 10038
212-346-5500
http://www.iii.org/