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Important things to know

Selecting the right health benefits can be challenging. To help you make the best decision for you and your family, here is important information to help you understand your rights as a member and the protection you can expect from Wellmark.

 

Your rights and responsibilities as a member

Informed members have greater control over their health care decisions and well-being. Know your rights and responsibilities.

 

How Wellmark protects the privacy of our members

The privacy of our member's medical information is important to us. Review Wellmark's Privacy Practice Notice  to find out how your medical information may be used and disclosed.

 

How Wellmark protects your personal health information
We understand the importance of keeping members’ medical and personal information private and protected. Learn how Wellmark is protecting your personal health information.

 

Help to understand and compare your coverage options

It's important to understand the health care coverage you are buying before you invest in the coverage. Find out where you can learn about the documents you'll receive when reviewing your coverage options.

 

Language assistance offered

In order to serve you better in your language, please call Wellmark Customer Service. Para asistencia en idiomas, llame al Servicio de Atención al Cliente.

 

Getting care when traveling

Health care needs don't surface only when you are near home. As a Wellmark member, you'll have coverage through the BlueCard® program wherever you travel.

 

Getting emergency care

If you or someone in your family has a sudden medical problem, get qualified help immediately. With your Wellmark health plan, you’re covered for emergency medical services anywhere, 24 hours a day.

 

Getting urgent care

If you or a family member have an illness, injury or condition serious enough to need care right away, but not so severe to require an emergency room, you may need to seek urgent care.

 

Requirements before you receive services
For some services or procedures, you have to get approval before you receive the care. Learn what services require pre-service review and why.

 

Guidelines on investigational and experimental procedures

You may find yourself in a position where a standard treatment or therapy has been unable to help you. Learn Wellmark's policy on investigational and experimental treatments.

 

What you can do when a claim doesn't pay as expected
It's important you understand the reasons behind any decision to deny, partially deny or reduce payment for a claim. Learn how to request a review of a claim through Wellmark's Claims Appeal and External Review Process.

 

How we pay providers

Do you ever wonder how Wellmark pays providers? Find out the process behind provider payments.

 

Network providers, facilities and professional qualifications

Before you receive services, always determine if the health care provider participates in Wellmark’s network, and if the service is covered by your plan. A list of Wellmark’s network health care providers and participating facilities can be found on the Find a Doctor or Hospital tool, or by contacting Customer Service at the phone number on your ID card.

 

Choosing an in-network provider is one of the best ways to save on health care costs. If you see an in-network provider, you won’t have to pay the difference between what Wellmark allows for covered services and what the provider charges. Also, if you see an out-of-network provider, your benefits may not apply at all.

 

Contact your provider directly for information on professional qualifications such as board certification status, medical school attended, and completion of residency.

 

How Wellmark evaluates new technology

Wellmark regularly reviews the latest procedures, drugs, devices, and methods that will improve medical outcomes. Learn how Wellmark evaluates new technology.

 

How to get prescription drug information

Wellmark's prescription drug coverage offers you ways to save on your out-of-pocket drug costs. Learn more about your drug coverage, including what drugs require prior authorization, on the Drug Information page. If you need to fill a prescription that is not on the Wellmark Drug list, follow the process to complete a Exception Request for Non-formulary Prescription Drugs #P-23282 .

 

Important information found in your coverage manual
Once you enroll in a Wellmark health plan, you’ll receive your coverage manual. This is what outlines your plan benefits. Find important information on a variety of important topics, like:

Benefit Topic Coverage Manual Section Name
Covered and non-covered benefits Details – covered and not covered
Copayments and other charges you’re responsible for paying Factors affecting what you pay
How to file a claim Claims
How to submit a complaint General provisions



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