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No matter which plans you choose, your employees will have these common coverage benefits.

  • Preventive & wellness services1
  • Physician services
  • Facility services
  • Prescription drugs
  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Chronic disease management
  • Maternity, newborn and pediatric care
  • Mental health and substance use disorder services
  • Rehabilitative and habilitative services and devices
  • Organ and tissue transplants
  • Diabetes outpatient self-management training
  • Physical, occupation or speech therapy services
  • Spinal manipulations2
  • Durable medical equipment
  • Pediatric vision services3

Once your employees enroll in a Wellmark health plan, they'll receive a complete coverage list with their coverage manual. They can also find detailed cost information in their Summary of Benefits and Coverage document.

What's not covered?

The following services typically won't be covered by your health plan4:

  • Elective abortions
  • Massage therapy
  • Certain types of counseling such as marital and family
  • Wigs
  • Acupuncture
  • Routine foot care
  • Weight reduction programs
  • Services that aren't medically necessary
  • Investigational or experimental treatment
  • Routine vision services, except services covered for children under age 19
  • Artificial insemination, in-vitro fertilization or any related fertility or infertility transfer procedure
  • Cosmetic services, except for surgery that restores function lost or impaired as a result of injury, illness or birth defect, and breast reconstruction after a mastectomy
1Plans on the Wellmark ValueSM Health Plan HMO Network require members to designate a personal doctor and/or OB-GYN for annual wellness and preventative exams.
2Limits may apply.
3Coverage includes annual routine vision exams at no cost, plus frames and lenses or contact lenses for children under age 19. Avēsis covers up to $130 for one frame per benefit year (80% coinsurance for covered charges exceeding $130) and up to $130 for non-medically necessary contact lenses per benefit year (85% coinsurance for covered charges exceeding $130). Deductible is waived for all plans except myBlueSM HDHP. This plan will waive the deductible for routine vision exams only. For myBlueSM HDHP plans where the deductible and out-of-pocket maximum (OP) are equal, there's no additional cost once the deductible and OPM are reached.
4This policy does not include pediatric dental services as described under the federal Patient Protection and Affordable Care Act (ACA). This coverage is available in the insurance market and can be purchased as a stand-alone product. Contact your insurance carrier, producer or Iowa's Partnership Marketplace Exchange if you wish to purchase pediatric dental coverage or a stand-alone dental product.