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Consent to electronic delivery of important plan information

By signing this application, agreeing to these terms, or providing my email address, and confirming electronically, I provide my consent to Wellmark to deliver important notices and information about my health plan and coverage electronically. My consent applies to notices and documents relating to my health coverage administered by Wellmark, including but not limited to:

  • Explanation of benefits;
  • Disclosures and notices;
  • Summary of Benefits and Coverage;
  • Notices of cancellation, non-renewal or termination (which will also be provided by mail);
  • Benefits policy documents, amendments, riders or endorsements;
  • Responses to communications from you;
  • Appeals correspondence;
  • Billing and payment notices;
  • Other important information;

I understand I have a right to have a notice or document provided to me in paper form at no cost. I understand I have a right to withdraw consent for electronic delivery of plan information. Such consent will be deemed withdrawn upon receipt by Wellmark of the request to withdraw consent. Any withdrawal of consent shall not affect the legal effectiveness, validity or enforceability of a notice or document delivered by electronic means before the withdrawal of consent is effective. To obtain a paper copy of a notice or document delivered by electronic means, please contact Wellmark using the phone number on the back of your ID card. To withdraw consent, click unsubscribe in the email message.

In order to access, view, and retain documents electronically, I understand I must have access to a computer or other device capable of accessing the internet with an internet web browser, email or web service capabilities, the ability to receive and review attachments to emails, and software which permits me to receive and access Portable Document Format (PDF) files. Free software to view PDF files is available from: http://get.adobe.com/reader/ External Site. By providing this consent, I confirm that I have or have access to the hardware and software identified above necessary to receive and review electronic records, and that I have an active email account with the ability to receive and access emails and email attachments in the formats described.

Wellmark is not responsible for any unauthorized access by third parties to information provided electronically, including, without limitation, any direct, indirect, special, incidental or consequential damages resulting from such unauthorized access. Wellmark also is not responsible for delays in transmission of notices and documents.