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New ACA-Compliant Products Launch

What you need to know

On October. 1, 2013, Wellmark launched a new set of ACA-compliant products. Along with the introduction of these new plans, there are some key changes you should be aware of:

  • EFFECTIVE JAN. 1, 2014, the amount some patients will pay out-of-pocket (OPM) for health care services will change. This will have a big impact on when and how much you bill patients. Also, all amounts patients pay out of their own pocket, including copayments, will apply toward the OPM. This means patients will likely reach their OPM sooner. Once a patient's OPM is reached, you can no longer collect any deductible, coinsurance or copayment amounts from that patient.
  • TWO NEW TYPES OF PLANS
    • MAX PLAN - the concept is simple: there are just two numbers to compare. When a patient reaches his or her annual deductible, his or her out-of-pocket maximum (OPM) is also met.
    • 50/50 PLANS - the name says it all. It's a "split the bill," no-deductible approach to payment of allowed (insurer-provided contracted) charges for medical services.
  • YOU MAY RECEIVE AN ADDITIONAL PCR/ERA if your patient has a new Wellmark ACA-compliant product. The new products will be housed on a new Wellmark system.

 

In 2014, all amounts some patients will pay out of their own pocket, including copayments, will apply toward the OPM.

 


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