Know what your Wellmark plan covers
Besides protecting you from hefty medical bills, your health plan connects you to a network of experienced, reliable health care providers and delivers benefits focused on improving your whole health. One way to get to know your health insurance benefits is understanding the different terms you’ll see when reviewing your plan.
Each month you’ll pay what’s called a premium. This is the amount you pay monthly to your health insurance provider to maintain your health coverage.
When you receive care, you’ll likely have to pay a copayment (copay) or coinsurance. A copay is a fixed amount you pay for a covered health care service, usually when you receive the service. Coinsurance means you share the costs of a covered health care service and pay a percentage of that cost.
Before your plan begins to pay for your care, you’ll likely need to meet your deductible. Your deductible is the amount of money you must pay for covered health services before your health plan starts to pay. A deductible may not apply to all services. Most health plans also have an out-of-pocket limit, which sets a limit to how much of your care you pay in copayments, coinsurance or deductibles before your health plan pays for 100 percent of covered services.
myWellmark® makes getting to know your health plan easier
Many of the questions you have about your health plan can be found easily online. Your personalized member portal, myWellmark, makes it easy to understand what your health plan covers, track your claims, find an in-network provider and more. Log in to learn more today.
Understand the benefits included in your plan
Most health plans have the same basic benefits. These typically include preventive care, laboratory services, emergency care, ambulatory services and hospitalization.
In addition to keeping medical costs affordable, Wellmark members also have many benefits and services automatically included with your health plan, at no extra cost. This makes it easier to stay on top of your health and use your plan to live a healthier life.
Your benefits as a Wellmark member
To get the most out of your health plan, you need to know what benefits you have and how you can use them. While these benefits are common for most Wellmark plans, it’s always important to log in to myWellmark to check your benefits before seeking care.
Prescription drug coverage
One way your health plan helps you save is through prescription drug coverage. As long as you have prescription drug coverage included with your Wellmark health plan, you can refer to your Wellmark drug list, also known as a formulary, to see all the drugs covered by your plan. Your plan’s drug list also shows generic drug options, which can help you save even more.
Virtual care
Get the care you need without leaving work or home with virtual care from Doctor On Demand®. With Doctor On Demand, you can see a board-certified physician for a variety of common illnesses. Virtual visits through Doctor On Demand are a standard benefit for most Wellmark members.
Mental health care
Treating mental health is just as important as treating your physical health. Support your whole health with services that may be included with your health plan, like in-person therapy or psychiatry office visits. Depending on your health plan benefits, you may also get care virtually through Doctor On Demand’s mental health therapy and coaching. Doctor On Demand gives you 24/7 access to doctors, psychiatrists, psychologists, therapists and other medical experts. You can even select and see your favorite mental health providers again and again.
Maternity care
Maternity care is covered by most health insurance plans. In addition, Wellmark members can get trusted and helpful resources for a healthy, stress-free pregnancy with the Pregnancy Support Program. This free program offers expecting parents 24/7 support and advice. As long as it’s available under your plan, you can access the Pregnancy Support Program in myWellmark. Members may also have one-on-one support available from an Advanced Care nurse, if needed.
Case management programs
If you are diagnosed with a complex condition, Wellmark’s case management programs are available to coordinate your care. Our case management nurses not only offer advice and education about your condition but may also assist in navigating your claims and health coverage. This program is available to Wellmark members at no cost and is completely confidential. Just make sure your information is updated in myWellmark so we can help you, if needed. Review and update your contact information in myWellmark and navigate to your profile.
Durable medical equipment
Durable medical equipment — items like wheelchairs, walkers, breast pumps, oxygen equipment and more — are the supplies and equipment ordered by a provider to be used for everyday or extended use. Once you have a prescription for your equipment, Wellmark customer service can help you understand how much you’ll pay for your equipment and what your health plan will cover. You can also check your coverage manual on myWellmark.
Not every Wellmark plan will include all these benefits. You can see what covered benefits your plan offers in myWellmark. If you haven't already, register for myWellmark. For questions about the benefits included with your health insurance premium, you can call the phone number listed on the back of your Wellmark ID card.
Access your benefits with myWellmark
Log in to myWellmark for easy access to your health plan, no matter your location. With your secure member portal, you can locate in-network doctors, hospitals and facilities, view and email your mobile ID card, plus much more. Log in to myWellmark today to get more from your health plan and start using your benefits.