Coverage & Benefits
By law, every health insurance plan has to cover some important basics — comprehensive preventive care, prescription drug benefits, emergency services, maternity care and much more.
Essential Health Benefits (EHB)Essential Health Benefits are a comprehensive package of services that all individual and small group health plans must offer. The basic idea is that health insurance should be about making, or keeping, people healthier. As a result, every plan covers the essentials, like an annual physical, prescriptions or an emergency ambulance ride.
Your Essential Health Benefits fall into these 10 categories:
Ambulatory patient services
Preventive and wellness services and chronic disease management
Wellmark's Affordable Care Act (ACA) Preventive Services List PDF File outlines what services are considered preventive for non-grandfathered, under 65 members.
Maternity and newborn care
Mental health and substance-use disorder services, including behavioral health
Rehabilitative and habilitative services and devices
Pediatric services, including dental and vision care
Wellmark does not deny coverage — or charge more — based on health status. Period. Pre-existing conditions are not a factor in your ability to purchase a policy, nor will they affect the quality of care. You’ll know you can get the care you need when you need it.
Summary of Benefits and Coverage
Understanding your health plan should be easy. And Wellmark is here to help. A Summary of Benefits and Coverage (SBC) helps you better understand and compare your coverage options. The summaries use a standard format, so it’s easier to make those comparisons. The SBC outlines the medical care and prescription benefits health plans cover, including health benefits, costs, limitations and exceptions, and network provider information.
A Uniform Glossary of Benefits is also included, because most people don’t use words like "coinsurance" and "in-network" in their everyday lives. With simple, concise definitions, the glossary makes it easier to understand common health insurance terms.