A few things to know
To help you make the best decision for you and your family, this information explains your rights as a member, and the protection you expect from Wellmark.
As a member, it’s important that you know your rights and responsibilities. This can help you make informed health care decisions and have more control over your well-being.
Your information is secure
At Wellmark, we have strong policies and systems regarding the use and disclosure of your personal and medical information. And they’re all designed to protect you.
To find out how your medical information may be used and disclosed, review Wellmark's Privacy Practice Notice PDF File.
View transparency in coverage information.
Know the differences between health care plans, and you'll feel good about the choices you're making for you and your family. Get the facts (available in more than 20 languages).
Know the differences between health care plans, and you'll feel good about the choices you're making for you and your family. Get the facts (available in more than 20 languages).
See the in-network and out-of-network Machine-Readable Files for Wellmark health plans and the South Dakota prescription drug Machine-Readable File.
If for some reason, a claim is denied, partially-denied or covered by a reduced payment, you can request a review through our Claims Appeal and External Review Process.
The right to appeal and the external review information is also available when reviewing a claim in myWellmark®.
Our prescription drug coverage can help you reduce out-of-pocket drug costs. For details about your benefits, including which drugs may require authorization, review the Wellmark Drug Information page.
No one plans to get injured or become sick. But if you or a family member has a medical issue serious enough to need quick attention, urgent care may be the answer.
In a medical emergency, get qualified help immediately.
With your Wellmark health plan, you’re covered 24 hours a day, anywhere you go for emergency medical services.
As a member, you also have coverage wherever you travel through the BlueCard® program.
To ensure that our members have access to the best possible care, we regularly review the latest procedures, drugs, devices and methods.
After enrolling in a Wellmark health plan, you'll receive your coverage manual, which outlines your plan benefits, and provides information on:
- Covered and non-covered benefits, which are located in the "Details - covered and not covered" section of the manual.
- Copayments and other charges you're responsible for paying, which are located in the "Factors affecting what you pay" section of the manual.
- How to file a claim, which is located in the "Claims" section of the manual.
- How to submit a complaint, which is located in the "General provisions" section of the manual.
To view your coverage manual, log in to log in to myWellmark. If you have questions, please contact Customer Service.
Quality at Wellmark is part of everything we do. We are committed to quality by working with providers to keep you healthy, creating healthy communities and providing tools, resources and programs to help you manage your health and spending. Wellmark is also Accredited by National Committee for Quality Assurance (NCQA), a non-profit organization dedicated to improving health care quality.
You can rest assured knowing coverage decisions are based on the medical appropriateness of care, services, and your benefit plan. To make sure you receive the highest quality and safest care:
- Wellmark does not reward providers for denying services
- Wellmark does not reward coverage decisionmakers for decisions that result in a denial of coverage or service
Case management programs help support members by managing chronic medical conditions and diseases, ongoing health maintenance and preventive services. These programs also provide care coordination, which includes the use of health care services, continuity of care and care coordination across health settings.
Wellmark's Case Management Program
When faced with a serious diagnosis, multiple conditions or complex conditions, you and your family have many tough choices to make. Wellmark's Case Management Program can help you navigate the health care system and provide support during your time of need. Case management services are available to you by calling 800-552-3993.
To learn more about Wellmark's Case Management Program, log in to myWellmark® or call BeWell 24/7 at Eight, Four, Four, Eight, Four, Be Well.
