Health Insurance in Iowa

Health insurance is an important precaution when it comes to insuring your financial future. Protecting your family against the occurrence of illness or injury is rather difficult; however a suitable health policy can relieve your financial burden caused by these events. When it comes to purchasing health coverage, you should evaluate all potential risks and its effect on your finances. In the U.S., approximately 47 million people are uninsured, majority of whom are working families. These families, especially children, end up bearing the consequences of not having proper health coverage. For those families who are not covered by their employers’ group plan, there are low-cost state sponsored health insurance programs that provide insurance to these individuals.

Iowa is the 15th healthiest state to live in and obtain health coverage, according to the America’s Health 2008 Rankings. The state has not shown much improvement in its healthcare system since last two years; it was on 14th and 11th position in 2007 and 2006 respectively. The main cause for the stagnant healthcare is the low public health funding. The state of Iowa, with more than two million people, offers both private-market and public health insurance alternatives. The private-market health insurance consists of various types of health plans including family, Medicare supplemental, short-term, student, group and dental. Additionally, the state and federal government sponsored programs provide low-priced coverage to the uninsurable residents of Iowa who meet specific eligibility requirements of age and income.

The Iowa Insurance Division manages and supervises all kinds of insurance sold through private-market health insurers as well as public health coverage programs. Despite the state’s strong health features, approximately 9.9% of the state population is still uninsured. According to the Censor Bureau’s 2007 and 2008 Current Population Survey, roughly 39.1% of Iowa’s uninsured residents come under the above 200% FPL category.

Buying health coverage is not easy; however, with the help of a licensed health insurance agent/broker, you can choose a proper health insurance plan with benefits that are ideal for your family.

Individual/Family Health Insurance

Below is the guidelines for applying for and obtaining individual health insurance in the state of Iowa. These regulations apply to all insurance companies offering individual or c:

Medical Underwriting
Yes
Pre-Existing Condition Exclusion Period
24 months
Look Back Period
60 months
Look Back Standard
Prudent person
Mandatory Benefits
Cancer screening for women including breast cancer screening, OB/GYNs are Primary Care Providers
Market Rate Restrictions
Yes
Guaranteed Issue Options
None
Small Group Health Insurance

Below is the guidelines for small group health insurance in the state of Iowa. These regulations apply to all insurance companies offering small group health insurance in Iowa.

Small Group Size
2-50
Employee Qualifications
Two employees must be present for half of the preceding calendar quarter and work 20 hrs/week
Guaranteed Issue
Yes
Premium Rating Factors
Rate Bands
Rate Adjustment Factors
25%
Look-Back Period
6 months
Pre-existing condition exclusionary period
12 months
Mandatory Benefits
Same as individual
State Cobra Variations for Small Groups

Below are the COBRA guidelines for small groups in the state of Iowa. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:

Mini-Cobra Option
Yes
Eligible Group Sizes
2-19
Extension of Benefits Period – Standard
9 months
Extension of Benefits Period – Disabled
9 months
Maximum Premium Increase
100%
State Legislation Reference
Iowa Insurance Code 509 B.3, Section
Additional Notes
The election period is 30 days following the termination date of employment and any individual that is eligible for coverage under a different group health insur­ance policy is not eligible.
State Sponsored Health Insurance Programs

There are several state sponsored health insurance programs in the State of Iowa to assist those without insurance in obtaining adequate coverage.

High-Risk Pools

Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. The guidelines for enrollment in these programs vary by state. The high-risk pool in the State of Iowa is summarized in the chart below:

Plan Name
Health Insurance Plan of IOWA (5HIPIOWA)
Website
https://www.hipiowa.com/
Phone Number
877- 793-6880
HIPPA Eligibility Required?
Yes
Available Carriers
Midlands Choice Provider Network
Pre-Existing Condition Waiting Period
6 months
Enrollment Periods
Open to new enrollment
Premium Limits
No more than I50% of standard rates
Lifetime Maximum Benefit
$3 million
Special Notes
HIPIOWA Plans also cover ‘HIPAA eligible individuals’ who have left group health coverage and fully exhausted all COBRA or state continuation coverage for which they are eligible.
Children’s Health Insurance Program

Through shared funding from the federal government, the State of Iowa provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:

Program Name
Healthy and Well Kids in Iowa (5HAWK-I)
Website
http://www.hawk-i.org/en_US/index.html
Phone Number
800-257-8563
Apply Online
Yes
Age Limits
Under 19
Insurance Carrier
Wellmark Classic Blue Health and Dental, AmeriChoice, a plan from UnitedHealthcare Plan, Wellmark Health Plan of Iowa Blue Access and Blue Dental and Delta Dental.
Length of Coverage
12 months
Residency Requirements
Iowa resident and U.S. citizen, qualified alien
Other Eligibility Requirements
Children that are dependents of a state of Iowa employee or children that are eligible for Medicaid are not eligible for coverage under the hawk-i program.
Pre-Existing Condition Exclusions
None
Cost
No cost or minimal share of cost. Family pays no more than $20.
Medicaid

Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of Iowa:

Governing Agency
Iowa Department of Human Services
Website
https://www.benefitcheckaccess.com/lin/faces/LinLogin.jsp?themeProfile=iowa
Phone Number
800-338-8366
Residency Requirements
Iowa resident and U.S. citizen
Federal Poverty Line Income Limits
Children (5ages 1-19): 133% FPL
Pregnant Women and Infants (5ages 0-1): 200% FPL
Working Parents: 82% FPL
Non-Working Parents: 33% FPL
Supplemental Security Income Recipients: 74% FPL
Medically Needy Individual: 67% FPL
Medically Needy Couple: 50% FPL
Additional Resources

Iowa Health Care Options Matrix™ Guide
Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines Iowa’s public and private health care choices for individuals and groups with various demographic profiles.
Family Health Insurance Guide by HealthInsuranceFinders.com
The guide created by HealthInsuranceFinders.com provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.
Iowa: At-A-Glance
Provides exclusive health data of Iowa. Statehealthfacts.org is a project of the Henry J. Kaiser Family Foundation and is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.