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Health Insurance 101 - Teamwork

Your dollars support the pool.


You’ll have the peace of mind knowing that if you have a health problem, we’ve got you covered. Your premiums not only support the health care needs of you and your family, they also support others in your pool. It’s our job to make sure there is enough money in the pool to cover potential health car e expenses for everyone.


Nearly one quarter (23 percent) of our members did not file any claims in a year’s time. In other words, they paid their premiums, but did not use any health care services.


The vast majority of dollars spent (81 percent) came from 11 percent of members who had major claims. Often these major claims are unexpected. For example, these could be due to a heart attack, surgery, accident or sudden illness.

Haven’t filed any claims?

Your premiums can increase even if no services are used because your premiums are used to support others in the pool.


Impact of Claims


 Claims incurred for all Individual Under 65 Market for period 4/1/2010-3/31/2011.
Common claims: Claims less than $2,500  
Major claims: Claims exceeding $2,500 


Some Uses of Premiums


Did you know ...


About 400 people paid their premiums and sought no services to have dollars available to take care of one prematurely born baby.

What else impacts premiums?

Three main reasons why health care costs change


At Wellmark Blue Cross and Blue Shield, changing premiums is not a process we take lightly. We genuinely care about you, as well as all of our members. In many cases, you are our friends and family. Catastrophic health situations aren’t the only type of claims that impact the cost of care.

  1. Members are using more services. Overall, the number of times members of a pool go to the doctor, have tests run or prescriptions filled is increasing.
  2. Cost per service is increasing. For example, the price of medical treatment and certain prescription drugs means increased spending.
  3. The type of services received is more expensive. For example, a trip to the emergency room is far more expensive than an office visit. An MRI is far more expensive than an X-ray.

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