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Health care can be expensive. That's why there's health insurance to help you pay for care and help protect your savings. To be insured, you make regular payments called premiums. This money goes into a pool that pays for your medical expenses and those of other people in the same pool. Their premiums also help pay your medical bills.

To lower your premiums, you share some costs with your insurance provider through:

  • Deductible: The amount you pay before your plan starts to pay.
  • Coinsurance: The amount you pay, calculated as a percent of the total amount for the service.
  • Copay: The fixed dollar amount you pay at the time of getting care.

You’ll be protected by an out-of-pocket maximum, which caps the amount of money you can spend on health care over a year.

Knowing these terms and principles can help you learn more about the plans we offer. If you run across terms you don’t know, visit our glossary.

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In-network vs. out-of-network care

It pays to stay in-network for your doctors, hospitals, service providers and pharmacies. That's because we've reached agreements with these providers to give you the best prices possible. If you go out-of-network, you'll pay higher prices and, depending on your plan, may be responsible for the full cost. In- or out-of-network, you are always covered in the case of an emergency.
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Staying in-network for prescription drugs, doctors, and hospitals is lower cost.

Going out-of-network is higher cost.

About the Affordable Care Act (ACA)

Signed into law on March 23, 2010, the ACA made health insurance available to all Americans. When you purchase a Wellmark individual and family health insurance plan through the Health Insurance Marketplace, the plan includes a number of important benefits and protections External Site. For example, dependents can be covered on family plans up to age 26, and no one can deny you coverage based on pre-existing conditions. All Wellmark plans through the Marketplace meet or exceed these requirements.

Are you looking for an individual and family health plan? Shop Wellmark plans and enroll during open enrollment or with a qualifying life event.

Learn more about the ACA

How health savings accounts (HSAs) work

A health savings account is an individual savings account that may be combined with high-deductible health plans to help pay for qualified medical expenses, like doctor visits and prescription drugs. The dollars grow and can be withdrawn tax-free.

HSA contribution limits may change year-to-year for individuals and families, so check with your employer or agent. If you're 55 or older, you may be able to make a higher contribution.

If you don't use all the money in your HSA, don’t worry — the funds automatically roll over to the next year and continue to accumulate. The account stays with you even if you change plans, and its interest is tax-free.

What is a flexible spending account (FSA)?

An FSA is another account that can be used to pay for qualified expenses, tax-free. It's available only through an employer group plan and is typically funded by pre-tax payroll deductions. This means an FSA can reduce your taxable income and save you money.

Talk to your employer about your FSA options.

Summary of Benefits and Coverage (SBC) and Coverage Manuals

A Summary of Benefits and Coverage (SBC) is required by the Affordable Care Act and outlines your plan’s benefits and coverage, plus other unique features like cost-sharing information and coverage limits or exceptions.

A Coverage Manual contains information about your specific medical and prescription benefits. This includes health benefits, costs, limitations and exceptions and network provider information.

Learn more about your plan today.

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