June 30, 2022
Transparency in Coverage Rule
To improve health plan transparency in the cost of health services, the Transparency in Coverage Rule (TCR) requires self-funded health plans and insurers to disclose rates and other price information for all covered billable services. Wellmark has provided two machine-readable files publicly available beginning July 1, 2022, including:
- In-network allowed amount
- Out-of-network allowed amount, if applicable, based on threshold requirement
Please note, as machine-readable files, they are not readily interpretable by consumers. As such, members are encouraged to use the more member-friendly Find Costs tool available through myWellmark.com. The tool can help you find providers and even determine how much a visit will cost you before you receive services. The machine-readable files do not provide information on a member’s out-of-pocket charges.
June 8, 2022
Wellmark's Legal Notice for all Health Plan Members
This notice explains member rights as it applies to surprise medical billing when you see a provider or visit a healthcare facility that is not in our health plan network as it relates to Emergency Services or certain services at an In-Network Hospital or Ambulatory Surgical Center.
To read the complete notice from Wellmark, please select the pdf link listed below:
Dec. 16, 2021
Wellmark 2022 Updates
(Plan members with UIChoice, UISelect, UI GRADCare, and SHIP)
The Transparency in Coverage Rule (TCR) and Consolidated Appropriations Act (CAA), signed into law in 2020, ensure consumers can make informed health care decisions and protect patients from surprise medical bills, transparency in costs, and more. Wellmark is prioritizing what must be done and is making a good-faith effort to comply with the new laws. As a result, effective Jan. 1, 2022, Wellmark will be implementing the following:
- Transparency in ID Cards: ID cards will include both in-network and out-of-network deductibles, OPMs, and how to find a network provider.
- Provider Directory: The online directory will be updated every 90 days.
- Continuity in Care: The opportunity to continue care for certain patients if their provider is no longer considered an in-network provider.
- No Surprise Billings: Establish new claim payment requirements for patient liability and balance billing if ER services are obtained from an out-of-network provider.
For further details and questions regarding Wellmark’s efforts with the TCR and ACC laws, please reach out to the customer service number 1-800-643-9724.
Have a Question?
The information presented on our website describes only the highlights of the plans and does not constitute official plan documents. Additional terms and conditions may apply. If there are any discrepancies between the information contained herein and the official plan documents, the plan documents will govern. For more detailed information you may contact Wellmark Blue Cross/Blue Shield at toll-free number 800-524-9242 (TTY: 888-781-4262), Monday through Friday from 7:30 a.m. to 5:00 p.m. (Central Time). For more efficient service, please have your member ID number handy - it can be found on the front of your card.