The Wellmark Health Plan of Iowa, Inc. products are:
Primary Care Physicians (PCP) Referrals
Members covered by Blue Advantage and Blue Choice must choose a PCP (internist, family practitioner, or pediatrician) to manage their care.
Referral Paperwork Requirements
Blue Advantage requires referral paperwork for the following services to be considered for benefits:
Blue Choice requires referral paperwork for the following services to be eligible for Level 2 benefits; otherwise, services will be eligible for Level 3 benefits, the highest level of member cost sharing:
Blue Access requires referral paperwork for the following services to be considered for benefits:
Out-of-Network Laboratory Services
Remember, if you use an out-of-network laboratory for Wellmark Health Plan of Iowa members, you must seek and receive preapproval from Wellmark through the referral process. As with any other nonemergency out-of-network care, the member will experience full or higher liability for the services unless the approval is received beforehand.
Preventive Care Benefits and Requirements
Members with preventive care coverage must receive the care from the following providers to be eligible for benefits.
These additional preventive benefits are available:
To determine if a member’s contract includes coverage for preventive care, check our secure website at www.wellmark.com.
Members covered by Blue Advantage and Blue Access do not have benefits for out-of-network care unless services are a medical emergency or are preapproved through the referral process by Wellmark Health Plan of Iowa, Inc.
Blue Choice provides out-of-network benefits at a higher level (Level 2) when out-of-network services are pre-approved by Wellmark through the referral process. Otherwise, benefits process at Level 3. Whenever possible, in-network laboratory services should be used to keep member costs low.
Locating an In-Network Specialist for Referrals
Access to Care Policies:
Health Management section, Wellmark Provider Guide:
Health Plan Ratings including HEDIS and NCQA information