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work for you

Simplify your health care experience with myWellmark. Once you register, you’ll have all your health and benefits information at your fingertips:


No more guessing. Easily check your out-of-pocket maximums, copayments, deductibles and more.


No more lost information. myWellmark will track and organize your medical claims for you.


No more paper shuffling. Sign up to receive your Explanation of Benefits statements online.


No more digging. Your Wellmark ID card is available on your mobile device.


Registration is easy. Just create a myWellmark account at Wellmark.com, using your Wellmark member ID.


myWellmark is ready for your mobile device. Using myWellmark from your smartphone is easy and convenient. Download the FREE app at Wellmark.com/GoMobile


Learn more about health care reform. Visit Wellmark.com/WhatMatters.

 


 

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.

 

 

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What’s the outlook for health care reform in 2014?

Consider three ways the Affordable Care Act (ACA) may change
your health care experience in the coming year.

 

 

1 Removal of pre-existing condition exclusion periods

Excluding coverage for pre-existing conditions is a thing of the past. Prior to 2014, the ACA prohibited group health plans and health insurance carriers from offering coverage that imposed pre-existing condition exclusion periods on children under the age of 19. Now, this extends to everyone.


Wellmark has chosen to remove pre-existing limitations on Jan. 1, 2014, for all its health plans1. This means you have coverage for pre-existing conditions that may have previously been excluded.

 

 

2You may pay less out-of-pocket

Out-of-Pocket Maximum (OPM) is the total you pay within a calendar year toward out-of-pocket medical services covered by your plan. This has typically included coinsurance and deductibles.


As of plan years on or after Jan. 1, 2014, copayments will also count toward your OPM. This means you could reach your OPM sooner.


The ACA set a limit on the maximum amount you can spend out of pocket on in-network services. In 2014, OPM cost-sharing amounts for non-grandfathered plans cannot exceed $6,350 for an individual and $12,700 for a family. You can rest assured that your existing Wellmark plan has been updated to be compliant with these new limits.

 

 

3 No dollar limits on non-grandfathered plans

If you have a non-grandfathered plan, your plan may cover Essential Health Benefits. Listed below are 10 categories of required coverage. No annual or lifetime dollar limits will be applied to these items or services. There can, however, be limits placed on these services, such as the number of visits per year.


Essential Health Benefits include:

 

Essential Health Benefits include:

Employer groups with 50 or more employees are not required to cover Essential Health Benefits in their plans. However, if employers wish to cover Essential Health Benefits, the plan can’t have an annual or lifetime dollar limit imposed on these benefits. If your health plan coverage is purchased through your employer, check with your human resources department to see if Essential Health Benefits are covered within your plan.

 

1 As of Jan. 1, 2014, pre-existing condition exclusion periods will be removed for individual and fully insured group plans in Iowa and South Dakota. Large, self-funded groups may also use Jan. 1, 2014, as their effective date, or choose a different date if they do not have a Jan. 1 plan year, as long as the exclusion is removed by the beginning of the group’s plan year in 2014.

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