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Want to know if your plan is non-grandfathered?

Ask your agent or employer or visit for more information about grandfathered and
non-grandfathered plans.

Open enrollment period begins Oct.1, 2013, for plan effective dates of Jan.1, 2014

learn moreFor more information about ACA provisions and their potential impact, visit, Wellmark’s source for health care reform news and information.

Wellmark is not providing any legal advice with regard to compliance with the requirements of the Affordable Care Act (ACA) or the Mental Health Parity Addiction Equity Act (MHPAEA). Regulations and guidance on specific provisions of the ACA and MHPAEA have been and will continue to be provided by the U.S. Department of Health and Human Services (HHS) and/or other agencies. The information provided reflects Wellmark’s understanding of the most current information and is subject to change without further notice. Please note that plan benefits, rates, renewal rate adjustments, and rating impact calculations are subject to change and may be revised during a plan’s rating period based on guidance and regulations issued by HHS or other agencies. Wellmark makes no representation as to the impact of plan changes on a plan’s grandfathered status or interpretation or implementation of any other provisions of ACA. Any questions about Wellmark’s approach to the ACA or MHPAEA may be referred to your Wellmark account representative. Wellmark will not determine whether coverage is discriminatory or otherwise in violation of Internal Revenue Code Section 105(h). Wellmark also will not provide any testing for compliance with Internal Revenue Code Section 105(h). Wellmark will not be held liable for any penalties or other losses resulting from any employer offering coverage in violation of section 105(h). Wellmark will not determine whether any change in an Employer Administered Funding Arrangement affects a health plan’s grandfathered health plan status under ACA or otherwise complies with ACA.  Wellmark will not be held liable for any penalties or other losses resulting from any Employer Administered Funding Arrangement.  For purposes of this paragraph, an “Employer Administered Funding Arrangement” is an arrangement administered by an employer in which the employer contributes toward the member’s share of benefit costs (such as the member’s deductible, coinsurance, or copayments) in the absence of which the member would be financially responsible.  An Employer Administered Funding Arrangement does not include the employer’s contribution to health insurance premiums or rates.


The information provided is accurate as of the date of publication. Items are subject to change based on additional government guidance.






























































































In just a few months, many provisions that are the centerpiece of the Affordable Care Act (ACA) will go into effect, including:

lockChanges to health plan benefits
lockhow coverage must be offered and administered
lockas well as offering a new way for coverage to be purchased


Some of these provisions, whether you receive health coverage through your employer or purchase it on your own, may not affect you directly, or immediately. For example, some Wellmark members have received notification that they may elect to remain on their current plan through 2014 or they may choose a new ACA compliant plan when open enrollment begins in October.

time iconInvesting a little time now to review key ACA provisions will make it easier for you to understand changes in the coverage you may be offered by your employer. Or, if you are purchasing coverage on your own, familiarizing yourself with ACA basics can go a long way in helping select the best plan for you and your family. As always, you can count on Wellmark to help inform and guide you through changes.


calendarImportant Changes for 2014

You may have already experienced the following benefit changes that were implemented over the past couple of years; however, come Jan. 1, 2014, they will be expanded. Here’s how:




Individual Shared Responsibility

The Supreme Court upheld the Individual Mandate requirement as part of the ACA. This means that beginning Jan. 1, 2014, virtually every legal U.S. resident will be required to have health insurance coverage (referred to as minimum essential coverage), or pay a tax penalty, known as Individual Shared Responsibility.


What qualifies as minimum essential coverage?



If you have coverage through an employer

Here are some key points for you to know:


If you purchase coverage on your own

Most Wellmark plans already meet the minimum essential coverage requirement. Your health plan may change in order to meet other requirements, but you will not face a tax penalty as a result of the individual shared responsibility as long as you keep your coverage.

Essential Health Benefits

As part of health care reform, a set of 10 categories of benefits will be put into place called essential health benefits. While a majority of Wellmark plans already cover most of these benefits, beginning in 2014, many of the plans will be required to cover the following categories:


NOTE: Only non-grandfathered plans that are purchased on your own or obtained through a small group employer with 1 to 50 employees will be required to meet metallic tier levels.

*The U.S. Department of the Treasury issued transition relief for 2014, more information coming.


What you’ll need to know when buying coverage

Starting in 2014, new individual and small group ACA plans will have four basic coverage levels:


These are known as Metallic Tiers. Each tier is defined by the portion of the claims paid by the insurer. This is known as the “actuarial value” of the plan.

For instance, for the Bronze tier, the plan typically pays 60 percent of the cost and you are responsible for the remaining 40 percent through out-of-pocket costs such as copayments, coinsurance and deductibles.

The graph below shows the actuarial value of the metallic tiers:


All the traditional places you purchase Wellmark coverage today will not change — even if you choose to purchase a new ACA compliant plan during the open enrollment period, which begins Oct. 1, 2013, for plan effective dates of Jan. 1, 2014. For instance, you can still purchase health insurance directly from Wellmark or through a broker or independent agent.

NOTE: Only non-grandfathered plans that are purchased on your own or obtained through a small group employer with 1 to 50 employees will be required to cover essential health benefits.

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