COVID-19 Employer Resources | Wellmark
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COVID-19

Frequently Asked Questions for Employer Groups

Wellmark members were notified about our response via email and social media on March 17, 2020. To learn more, they can also visit Wellmark.com/coronavirus.

All Wellmark members will have no cost-share for appropriate diagnostic testing as well as the accompanying office, urgent care or emergency room visit to establish the diagnosis of COVID-19. This applies to fully-insured, Medicare and self-funded groups per the Families First Coronavirus Response Act signed into law on March 18, 2020.

Fully-insured and Medicare supplement members will have no cost-share for treatment of COVID-19 when seeking care from an in-network provider, effective Feb. 4 through at least June 16, 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 member cost-share. The cost-share for such visits, including those for mental health reasons, are waived for the next 90 days. At that time, we will reassess.

This applies to all fully-insured and self-funded plans.

View $0 cost share flyer (English) PDF File

View $0 cost share flyer (Spanish) PDF File

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 with you individually 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 who is unable to pay administrative fees 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 unable to pay administrative fees 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 in workforce hours through June 16, 2020. This date will continue to be evaluated through the COVID-19 pandemic.

Fully-insured groups

Yes. Wellmark's requirement for employees to be actively working in order to be eligible for coverage will be relaxed through June 16, 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

If stop loss eligibility is impacted by COVID-19 due to a reduction in workforce, through June 16, 2020, the employer can still be covered under Wellmark's 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 June 16, 2020, date 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

Yes. Wellmark's requirement for employees to be actively working in order to be eligible for coverage will be relaxed through June 16, 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 are 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

If stop loss eligibility is impacted by COVID-19 due to a reduction in workforce, through June 16, 2020, the employer can still be covered under Wellmark's 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 June 16, 2020, date 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

Through June 16, 2020, the employee may be reinstated the first of the month following the re-hire date without fulfilling an eligibility waiting period. The June 16, 2020, date will continue to be evaluated through the COVID-19 pandemic.

Wellmark stop loss coverage

If stop loss eligibility is impacted by COVID-19 due to a reduction in workforce, through June 16, 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 June 16, 2020, date 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.