Wellmark Bronze HDHP HMO | Farm Bureau

25896IA0370007
Expanded Bronze
HMO

Wellmark Bronze HDHP HMO | Farm Bureau is an Expanded Bronze HMO plan by Wellmark Health Plan of Iowa, Inc..

IMPORTANT: You are viewing the 2024 version of Wellmark Bronze HDHP HMO | Farm Bureau 25896IA0370007. You can enroll in this plan during open enrollment 2024, which starts November 1st and ends January 15th, 2023, in most states.

Locations

Wellmark Bronze HDHP HMO | Farm Bureau is offered in the following counties.

Plan Overview

This is a plan overview for 2024 version of Wellmark Bronze HDHP HMO | Farm Bureau 25896IA0370007.
Insurer: Wellmark Health Plan of Iowa, Inc.
Network Type: HMO
Metal Type: Expanded Bronze
HSA Eligible?: Yes
Plan ID: 25896IA0370007

Cost-Sharing Overview

Wellmark Bronze HDHP HMO | Farm Bureau offers the following cost-sharing.

Notes:

  • Some plans have separate cost-sharing for medical and drugs, while other plans offer combined cost-sharing. The cost-sharing amounts above are combined medical and drug costs unless otherwise noted.
  • You are viewing the standard version of this plan. Your costs may be lower depending on your income. Use the “get a quote” button below to see your estimated premium and out-of-pocket costs after assistance.
Ready to sign up for Wellmark Bronze HDHP HMO | Farm Bureau?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

Plan Features

Wellmark Bronze HDHP HMO | Farm Bureau offers the following features and referral requirements.

Wellness Program: Yes
Disease Program: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
Notice Pregnancy: No
Referral Specialist: No
Specialist Requiring Referral:
Plan Exclusions:
Child Only Option?: Allows Adult and Child-Only

Network Details

The following network details will help you understand what Wellmark Bronze HDHP HMO | Farm Bureau covers when you are out of the service area or out of the country.

Out of Country Coverage: Yes
Out of Country Coverage Description: Accidental injury and emergency services only
Out of Service Area Coverage: Yes
Out of Service Area Coverage Description: Accidental injury and emergency services only
National Network: No

Additional Benefits and Cost-Sharing

Wellmark Bronze HDHP HMO | Farm Bureau includes the following benefits at the cost sharing rates listed below.

Service In-Network
Copay / Coinsurance
Out-of-Network
Copay / Coinsurance
Limits and Explanation
Primary Care Visit to Treat an Injury or Illness
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Specialist Visit
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Other Practitioner Office Visit (Nurse, Physician Assistant)
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Outpatient Surgery Physician/Surgical Services
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Hospice Services
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00% Quantitative limits apply, see EHB benchmark.
Routine Dental Services (Adult)
Infertility Treatment
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Routine Eye Exam (Adult)
Urgent Care Centers or Facilities
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Home Health Care Services
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Emergency Room Services
Covered
Not Applicable No Charge after deductibleNot Applicable No Charge after deductible
Emergency Transportation/Ambulance
Covered
Not Applicable No Charge after deductibleNot Applicable No Charge after deductible
Inpatient Hospital Services (e.g., Hospital Stay)
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Inpatient Physician and Surgical Services
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Bariatric Surgery
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Cosmetic Surgery
Skilled Nursing Facility
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00% No limit on covered benefit
Prenatal and Postnatal Care
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Delivery and All Inpatient Services for Maternity Care
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Mental/Behavioral Health Outpatient Services
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Mental/Behavioral Health Inpatient Services
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Substance Abuse Disorder Outpatient Services
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Substance Abuse Disorder Inpatient Services
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Generic Drugs
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Preferred Brand Drugs
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Non-Preferred Brand Drugs
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Specialty Drugs
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Outpatient Rehabilitation Services
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Habilitation Services
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Chiropractic Care
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Durable Medical Equipment
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Hearing Aids
Imaging (CT/PET Scans, MRIs)
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Preventive Care/Screening/Immunization
Covered
No Charge Not ApplicableNot Applicable 100.00% Quantitative limits apply, see EHB benchmark.
Routine Foot Care
Acupuncture
Weight Loss Programs
Routine Eye Exam for Children
Covered
No Charge Not ApplicableNot Applicable 100.00%1.0 Visit(s) per Year
Eye Glasses for Children
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%1.0 Item(s) per Year
Dental Check-Up for Children
Not Covered
Pediatric dental not embedded
Rehabilitative Speech Therapy
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Rehabilitative Occupational and Rehabilitative Physical Therapy
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Well Baby Visits and Care
Covered
No Charge Not ApplicableNot Applicable 100.00% Covered for child through age 7.
Laboratory Outpatient and Professional Services
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
X-rays and Diagnostic Imaging
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Basic Dental Care – Child
Not Covered
Pediatric dental not embedded
Orthodontia – Child
Not Covered
Pediatric dental not embedded
Major Dental Care – Child
Not Covered
Pediatric dental not embedded
Basic Dental Care – Adult
Orthodontia – Adult
Major Dental Care – Adult
Abortion for Which Public Funding is Prohibited
Transplant
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Accidental Dental
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00% Care must be completed within 12 months
Dialysis
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Allergy Testing
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00% Allergy testing is a covered benefit
Chemotherapy
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Radiation
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Diabetes Education
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Prosthetic Devices
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00% Prosthetic devices are covered
Infusion Therapy
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Treatment for Temporomandibular Joint Disorders
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Nutritional Counseling
Reconstructive Surgery
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Gender Affirming Care

Free Preventive Services

There is no copayment or coinsurance for any of the following Wellmark Bronze HDHP HMO | Farm Bureau preventive services. This is true even if you haven’t met your yearly deductible.

Please note, these services are free only when delivered by a doctor or other provider in your plan’s network.

Additional Resources

Below are additional resources for Wellmark Bronze HDHP HMO | Farm Bureau including the Summary of Benefits & Coverage (SBC), plan brochure, formulary link, and a link to the website to pay your monthly premium after you enroll.

Summary of Benefits: Summary of Benefits Link
Plan Brochure: Plan Brochure Link
Formulary: Formulary Link
Premium Payment Website: Premium Payment Link
Ready to sign up for Wellmark Bronze HDHP HMO | Farm Bureau?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

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