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Frequently Asked Questions for Employer Groups

Changes to cost-share for virtual visits, per the March 17 announcement, are effective as of March 16. The March 17 Sales Bulletin instructed sales team members to share with their groups. Members were notified via email, social media and on Wellmark.com/Coronavirus.

Standard benefits for virtual visits will resume effective Sept. 1, 2020. This information was shared with Groups and Producers on Aug. 5 & 6, and the general public on Aug. 17 via a press release and updates made to Wellmark.com/Coronavirus.

All Wellmark members, as well as members of self-funded plans, have no cost-share for appropriate testing and related services to diagnose or detect COVID-19. This is required by the Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief, and Economic Security (CARES) Act and remains in place as long as we are in a public health emergency, as declared by the federal government.

Fully-insured and Medicare supplement members also have no cost-share for in-patient treatment of COVID-19 when seeking care from an in-network provider through Dec. 31, 2020. Wellmark will work with self-funded groups that want to implement similar benefits for their members.

Effective March 16, 2020, all Wellmark members will have access to virtual health care visits with no cost-share. To avoid the spread of COVID-19, we encourage our members to take advantage of virtual visits with their current primary care physician, if they have this capability. For those who don’t currently have a primary care physician, please use an in-network provider. The member cost-share for such visits, including those for mental health reasons, are waived through Aug. 31, 2020. Standard benefits will resume effective Sept. 1, 2020.

Covered Wellmark members may request an early refill through the pharmacy. The pharmacy has their own process to call the CVS help desk if there are issues. If a member continues to have issues, the member should call Customer Service.

Yes, our DME vendors have been instructed to proceed with filling the order. As soon as the social distancing practices have ended, the vendor will contact the physician to get updated documentation.

Fully-insured groups

Yes. We will work on a group-by-group basis if you have problems paying. Any group who is unable to pay premiums due to COVID-19 should send an email to FullyInsuredBilling@wellmark.com Send Email. Please include your group ID, subgroup ID, and group name. Please state you are unable to pay premiums due to COVID-19. A billing representative will reach out to collect further information and work to ensure benefits remain active.

Self-funded groups

Yes. We will work with you individually if you have problems paying. Any group needing to discuss payment options due to COVID-19 should send an email to SelfFundedBilling@wellmark.com Send Email. Please include your group ID, subgroup ID, and group name. Please state you are needing to discuss payment options due to COVID-19. A billing representative will reach out to collect further information and work to ensure benefits remain active.

Wellmark will initially extend the 31-day grace period to a 60-day grace period upon request for any small group or individual policy, understanding that if circumstances change, we may need to revisit the extensions offered. For large groups and self-funded payments, a review will be done on a case-by-case basis to ensure payments are made as timely as possible while allowing flexibility when possible.

No. Wellmark will not require customers to notify Wellmark in writing of a layoff or reduction of workforce hours for the remainder of 2020.

Fully-insured groups

Yes. Wellmark's requirement for employees to be actively working in order to be eligible for coverage will be relaxed through the remainder of 2020. Payment of premium is required to continue coverage for laid-off employees who are not actively at work and employees actively working.

Coverage must be offered on a uniform, non-discriminatory basis to all employees and employee premium contributions must be the same or less prior to the layoffs.

Self-funded groups

Yes. Payment of administrative fees, claims cost and stop loss premium is required to continue coverage for laid-off employees who are not actively at work. Coverage must be offered on a uniform, non-discriminatory basis to all employees and employee premium contributions must be the same or less prior to the layoffs.

Groups with Wellmark stop loss coverage

For employers who have stop loss coverage through Wellmark - if their stop loss eligibility is impacted by COVID-19 due to a reduction in workforce until Wellmark communicates otherwise, the employer can still be covered under the stop loss policy during the current Policy Year as long as the PCPM premium for laid-off employees who are not actively at work and employees actively working continues to be paid as outlined within the eligibility guidelines and exceptions above. We will not require that an amended plan document permitting such continued coverage be sent to us for approval. However, in order to process claims accurately, we need to be made aware of any such plan changes as soon as possible.

If Wellmark is not a customer's stop loss carrier, Wellmark recommends that the customer verify this coverage with its stop loss carrier.

Fully-insured groups

Yes. Wellmark's requirement for employees to be actively working in order to be eligible for coverage will be relaxed through the remainder of 2020. Payment of premium is required to continue coverage for laid-off employees who are not actively at work and employees actively working. This date will continue to be evaluated through the COVID-19 pandemic.

Coverage must be offered on a uniform, non-discriminatory basis to all employees and employee premium contributions must be the same or less prior to the layoffs.

Self-funded groups

Yes. Payment of administrative fees, claims cost and stop loss premium is required to continue coverage for laid-off employees who are not actively at work. Coverage must be offered on a uniform, non-discriminatory basis to all employees and employee premium contributions must be the same or less prior to the layoffs.

Groups with Wellmark stop loss coverage

For employers who have stop loss coverage through Wellmark - if their stop loss eligibility is impacted by COVID-19 due to a reduction in workforce, through the remainder of 2020, the employer can still be covered under the stop loss policy during the current Policy Year as long as the PCPM premium for laid-off employees who are not actively at work and employees actively working continues to be paid as outlined within the eligibility guidelines and exceptions above. We will not require that an amended plan document permitting such continued coverage be sent to us for approval. However, in order to process claims accurately, we need to be made aware of any such plan changes as soon as possible. The timeframe for this will continue to be evaluated through the COVID-19 pandemic.

If Wellmark is not a customer's stop loss carrier, Wellmark recommends that the customer verify this coverage with its stop loss carrier.

Fully-insured groups

If one person remains actively employed, employees who have been laid off may elect to continue coverage at their expense under state continuation requirements by following the normal notice and election procedures. [Iowa Code Chapter 509B; South Dakota – SDCL 58-18-7.5 – 7.14]

If there are no active employees, the plan is terminated:

  • In Iowa, state continuation is not an option.
  • In South Dakota, state continuation may be available at the employee's expense for up to 12 months. [SDCL 58-18C-1]

Fully-insured and self-funded groups

For employers with 20 or more employees, if one person remains actively employed, employees may elect COBRA at their expense by following the normal notice and elections procedures.

If there are no active employees, the plan is terminated and COBRA is not an option.

Groups with Wellmark stop loss coverage

For employers who purchase Wellmark stop loss, standard contract provisions apply.

Fully-insured and self-funded groups

The employee may be reinstated the first of the month following the re-hire date without fulfilling an eligibility waiting period through the remainder of 2020. The timeframe for this will continue to be evaluated through the COVID-19 pandemic.

Wellmark stop loss coverage

For employers who have Stop-Loss coverage through Wellmark - if their employee stop-loss eligibility is impacted by COVID-19 due to a reduction in workforce, through the remainder of 2020, laid off employees may be reinstated without fulfilling an eligibility waiting period. We will not require that an amended plan document permitting such rehire eligibility be sent to us for approval. However, in order to process claims accurately, we need to be made aware of any such plan changes as soon as possible. The timeframe for this will continue to be evaluated through the COVID-19 pandemic.

If Wellmark is not a customer's stop loss carrier, Wellmark recommends that the customer verify coverage with its stop loss carrier.