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Electronic Disclosure Notification

  1. Scope and Duration of Consent
    You have indicated that you want to receive your form 1095-B electronically. This consent will apply to each form 1095-B statement you are required to receive from Wellmark unless you revoke your consent following the steps below. Please download a copy to save with your important tax information. Form 1095-B may be required when completing your tax return.

  2. Paper Statement
    You will receive a paper statement of the form 1095-B if you do not consent to receive it electronically.

  3. Notify Policy Holder on Hardware/Software Change with Material Risk
    You will be notified of any changes to Wellmark’s software that may affect your access to your electronic form 1095-B. Please be aware that you will need hardware and software with internet capability, along with a PDF viewer to view your form 1095-B.

  4. Consent from Policy Holder for Electronic Delivery after Hardware/Software Changes
    If changes to Wellmark’s software impacts your access to your electronic form 1095-B, you may have to indicate that you want to receive your form electronically again. You can do this by logging in to myWellmark and selecting “My Web Account” under the “My Account” menu on the home page, then select “Edit”.

  5. Notify Policy Holder of Procedure for Getting a Paper Form 1095-B
    You can request a paper copy of form 1095-B at any time. To request your form 1095-B via paper, log in to myWellmark, select “My Web Account” under the “My Account” menu on the home page, and select “Edit”. You can also request your form via paper through the mail. Just send a letter to the address below:

    Wellmark Blue Cross and Blue Shield
    1331 Grand Ave.
    Des Moines, IA 50306

    If you would rather call Customer Service, you can do so at the phone number found on your Wellmark ID card.

  6. Notify Policy Holder of Procedure to Withdraw Consent for Electronic 1095-B
    To withdraw your consent to receive the 1095-B electronically, log in to myWellmark at myWellmark, select “My Web Account” under the “My Account” menu on the home page, and select “Edit”. You can also request your form via paper through the mail. Just send a letter to the address below: 

    Wellmark Blue Cross and Blue Shield
    1331 Grand Ave.
    Des Moines, IA 50306

    If you would rather call Customer Service, you can do so at the phone number found on your Wellmark ID card.

    Once you decide to revoke the electronic delivery selection for your form 1095-B, it will be effective immediately. A withdrawal of consent does not apply to a statement provided electronically before the withdrawal of consent.

  7. Notify Contact Information Update
    You will be notified if any of the information above changes.

  8. Updating Information
    If your contact information changes, please log in to myWellmark and select “My Contact Information” under the My Account tab. You may also update your contact information by calling Wellmark Customer Service at the phone number on your ID card.