Understanding your health insurance benefits
For an in-depth, complete guide to everything your health plan includes or excludes, your Coverage Manual will have that information. It describes your plan’s specific coverage details and how your health plan works. If you have a question about a specific procedure or service, your Coverage Manual will explain how your health plan may cover it. Coverage Manuals also include information about your prescription drug benefits.
Medicare Supplement members: Use your Outline of Coverage (Iowa or South Dakota) for an overview of your benefits — what’s covered, your potential cost-share and more.
Both documents can be found one of the following ways:
- Logging in to myWellmark®.
- Searching our public SBC and Coverage Manual Finder using your Wellmark ID number.
- Calling the number on your Wellmark member ID card for assistance.
Common health insurance benefits
Each health plan’s coverage is a little different. For a complete list of your coverage and benefits, log in to myWellmark or search for your coverage manual using your Wellmark ID.
Some benefits are covered across all plans. Here are some common services members have questions about:
There are certain supplies and equipment that are necessary after surgery, pregnancy, or required for everyday use. Common types of durable medical equipment (DME) include:
- Wheelchairs
- Walkers
- Breast pumps
- Oxygen equipment
- Insulin pumps
These are covered by insurance when you get a prescription from your doctor. Once you have a prescription, check your coverage in myWellmark to confirm the equipment meets coverage requirements and see if there might be a copay or coinsurance. To find coverage for DME, look under “H” for Home/Durable Medical Equipment or check your coverage manual, which can be found in the Resources box.
Once you have that information, you can find an in-network DME provider by searching for 'durable medical equipment' under facility type. Using an in-network DME provider is the simplest way to avoid unexpected costs and make sure you get the most from your benefits.
Like other pieces of durable medical equipment (DME), a breast pump is a covered benefit when you get a prescription from your OB or midwife. During a prenatal appointment, ask your health care provider for a prescription.
Before you place your order, check your coverage documents in myWellmark to make sure the breast pump meets your plan’s DME requirements. Then find an in-network DME provider by searching for 'durable medical equipment' under facility type to get your breast pump.
Depending on your health plan, you can receive all annual preventive visits for you and your dependents at no cost. The Affordable Care Act (ACA) mandates that all non-grandfathered group and non-grandfathered individual health plans must provide preventive services at no member cost-share, when delivered by an in-network health care provider.
Preventive services include: annual wellness exams, cancer screenings, well-child visits and immunizations, adult vaccinations and prenatal wellness checks. This is not an exhaustive list, so visit myWellmark to view your coverage and benefits.
Part of a healthy body is a healthy mind. Mental health care aims to improve our emotional, psychological and social well-being. Mental health not only influences our emotions, but also our relationships, decisions and habits that impact our physical health.
Wellmark Blue Cross and Blue Shield recognizes the need to treat mental health just as equally as physical health, and strives to support our members’ whole health by connecting our members to quality care and mental health resources.
You can access solutions and resources to address mental health challenges with your Wellmark health insurance plan. Connect with your primary care provider (PCP) to identify what will work best or access other options that may be available to you through your Wellmark health plan, like:
- In-person therapy or psychiatry office visits
- Virtual therapy, psychiatry visits and behavioral health coaching through Doctor On Demand® by Included Health®
- meQuilibriumTM (meQ), which is a well-being training tool that helps you build resilience
*Check your benefits document or log in to myWellmark to see what is available in your health plan
Disclosures
Doctor On Demand by Included Health is a separate company providing an online telehealth solution for Wellmark members. Doctor On Demand® is a registered mark of Included Health, Inc.
For plans that include benefits for mental health treatment, Doctor On Demand benefits may include treatment for certain psychological conditions, emotional issues and substance use disorder. Services performed by Doctor On Demand clinicians are covered. For more information, call Wellmark at the number on your ID card or call Wellmark Customer Service.
Doctor On Demand physicians do not prescribe Drug Enforcement Administration-controlled substances, and may elect not to treat conditions or prescribe other medications based on what is clinically appropriate.
meQuilibriumTM is a trademark of New Life Solution, Inc. meQuilibrium is a proactive app to build a resilient workforce. meQuilibrium is an independent company that does not provide Wellmark Blue Cross and Blue Shield products or services.