PRIVACY STATEMENT
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MY BENEFITS
ANNUAL HEALTH ASSESSMENT
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Des Moines
Available Services
Allergies • Asthma • Congestion, Cough or Sore Throat Cold, Flu or Fever • Diabetes/Weight Management • High Blood Pressure • High Cholesterol • Lab work/Tests • Minor Burns • Minor Pain • Nausea or Abdominal Pain • Tobacco Cessation • Wellness Exams/Physicals • Sleep Studies • Sprains or Minor Fractures • Specialist Referral
Primary Care Partner – Exemplar Care
QuikTrip HMO health plan members located in Des Moines will receive free primary care and urgent care services through Exemplar Care. Contact the clinic directly at (515)650-4370 to schedule an appointment. Please be sure to inform them that you are with QuikTrip at the time of scheduling. Provide your ID and insurance card at the time of your appointment.
Exemplar Care Member Benefits and Services
Exemplar Care provides completely free primary care and urgent care services to covered members on the QT HMO health plan. Any services received outside of Exemplar Care would be subject to the member’s deductible and applicable co-pays.
98point6® is now available to all employees and dependents ages 1+ enrolled in a QuikTrip HMO health plan.
Our physicians deliver on-demand, text-based primary care—diagnosis and treatment, prescriptions and labs—via secure, in-app messaging.
$0/Visit($5 per visit for visits in excess of 36 visits per member, per year)
Download the app today.
Learn more at98point6.com/quiktrip
Referrals are not required to see an in-network OB/GYN and your QT out-of-pocket expenses apply including your deductible and applicable co-pays.
Preventative care will be covered at 100% if provided by an in-network provider.
See in-network provider list and maternity benefits
For more information, click on the links below:
Maternity Benefits
In-network providers are listed below and are subject to change.
Referrals are not required to see an in-network Pediatrician and your QT out-of-pocket expenses apply including your deductible and applicable co-pays.
Preventative care will be covered at 100% if provided by an in-network provider.
See in-network provider list
In-network providers are listed below and are subject to change.
For more information, click on the links below:
MercyOne Ankeny Pediatrics Care Clinic
MercyOne Clive Pediatrics Care Clinic
MercyOne Des Moines Pediatrics Care
MercyOne Grimes Pediatric Care Clinic
MercyOne Indianola Pediatrics Care Clinic
MercyOne Johnston Pediatrics Care Clinic
MercyOne Norwalk Pediatrics Care Clinic
MercyOne Pleasant Hill Pediatrics Care Clinic
Available Services
Allergies • Asthma • Congestion or Cough • Cold, Flu or Fever • Covid • Headaches • High Blood Pressure • Minor Burns • Minor Pain • Nausea or Abdominal Pain • Sore Throat • Sprains or Minor Fractures • Stitches • X-Rays
Referrals are not required for urgent care services. All urgent care is considered in-network and QT out-of-pocket expenses apply including your deductible and applicable co-pays.
Preferred facilities are listed below.
Urgent Care Locations
(available at no cost)
For additional in-network Urgent Care locations contact 800-226-5116or visitFirst Health Complementary.
Available Services
Angina • High Fever or Fever in Newborns • Severe Burns • Change in Mental Status • Ingestion of Poisons or Objects • Shock • Chest Pain • Major Head Injury • Stroke • Compound Fractures (bone visible) • Seizures • Snake Bites • Dizziness • Severe Abdominal Pain • Unconscious or Catatonic State • Heart Attack • Severe Asthma Attack • Uncontrolled Bleeding • Any Urgent or Life-threatening Conditions
Referrals are not required for emergency services. All emergency care is considered in-network and QT out-of-pocket expenses apply including your deductible and applicable co-pays.
Preferred facilitiesare listed below.
ER Locations
See details
Out-of-area coverage is available if you or a covered dependent need medical care while outside of your market area. This includes situations like travel, business trips, vacations, or a dependent who lives or attends college in out of market area.
For in-network out-of-area benefits* the member is responsible for verifying if the provider participates with First Health Complementary. To locate an in-network provider or facility contact 800-226-5116 or visit First Health Complementary. Please verify your network affiliation as First Health Complementary when calling to receive medical attention or when scheduling an appointment.
*The deductible and coinsurance for all out-of-area benefits are collected by the provider.
Referrals are not required to see an in-network Chiropractor.
QT out-of-pocket expenses apply including your deductible and applicable co-pays.
Limited benefit: 6 visit Fiscal Year maximum for chiropractic care. Visit maximum does not apply to initial office visit and x-rays.
See in-network provider list
Preferred in-network providers are listed below and are subject to change.
For more information, click on the links below:
Back Care Clinic (515)277-3716
Chiropractic Health & Wellness Clinic
Sandberg Chiropractic & Health Assoicates, PLC
For additional in-network providers contact 800-226-5116 or visit First Health Complementary.
Imaging services include x-rays, diagnostic ultrasounds, MRIs, PET scans, and CT scans.
QT out-of-pocket expenses apply including your deductible and applicable co-pays.
See in-network imaging facilities
A referral is not required for imaging related to preventative care or screening mammograms at an in-network facility. All other imaging requires a referral from Exemplar Care or your in-network treating provider.
All employees and members of their family have access to 5 free EAP visits per year, per episode of care. This runs on a rolling calendar. If additional visits are needed, the EAP counselor can coordinate with QT Benefits to have a referral initiated for coordination. Continued treatment and/or referral to community resources may be recommended, and these may result in costs for which the employee is responsible. Health insurance, if in effect, will cover these fees (deductible and co-payments apply).
If you have questions or need more information about your local EAP providers, please call Employee Assistance Associates and Consultants at 1800-477-2990. When calling identify yourself as a QuikTrip employee and ask for the Employee Assistance Office.
See provider list
New Beginnings Counseling – (515)401-6886
Green Counseling Services – (319)800-5564
The Prescription Benefit is not subject to the medical deductible. The in-network out-of-pocket limit for the prescription plan is $2,000 for an individual.
Below is a summary of the prescription benefit. For further information on specific drug coverage participants must contact Sav-Rx or reference the health plan document.
See how to save on your prescriptions
Sav-Rx
Sav-Rx has a network of over 72,000 pharmacies nationwide. You can choose to pick up your medications at a local pharmacy or receive your medications via the Sav-Rx mail order pharmacy. New in 2019 – Sav-Rx allows pick up of generic medications at participating retail locations. Pharmacy plan benefits apply to medications received through Sav-Rx mail orders or retail pharmacy pick ups. Contact Sav-Rx at 1-800-228-3108 or atwww.savrx.com.
30-day supply:
• $10 Copayment for generic prescriptions
• 40% up to a maximum $80 for preferred brand name prescriptions
• 50% up to a maximum $180 for non-preferred brand name prescriptions
90-day supply through mail order:
• Generic prescriptions have a $20 Copayment
• Preferred Brand name prescriptions (Formulary) have a $165 Copayment
• Non-Preferred brand name prescriptions (Non-Formulary) have a $265 Copayment
• Brand with Generic have a $265 copayment plus difference in cost.
90-day supply through any retail pharmacy participating with Sav-Rx:
• Generic prescriptions have a $30 Copayment
• Preferred Brand name prescriptions have a 40% coinsurance up to a maximum $240.
• Non-Preferred brand name prescriptions have a 50% coinsurance up to a maximum $540
Some medications require prior authorization. If prior authorization is required and not received the medication may cost more or the Plan may not cover it. Other medications may have a quantity limit or require step therapy.
QT out-of-pocket expenses apply including your deductible and applicable co-pays
See available national benefits
Durable Medical Equipment (DME) – ConnectDME
ConnectDME can ship nationally in 1 – 2 business days. Deductible applies to all DME. ConnectDME can provide the full range of DME, including CPAP equipment and supplies, crutches, walker, slings andmore!
connectdme.com
Quest Diagnostics
Quest Diagnostics offers clinical testing services through a national network of laboratories. If your specialist requests to run labs you may save money if you visit a Quest Diagnostics location.
