August 6, 2024
The Wellmark EOB has a fresh, new look
Beginning in August, employees, retirees and students covered under the University of Iowa health plans will begin receiving a redesigned version of Wellmark’s Explanation of Benefits (EOB), which is provided whenever you or your health care provider files a claim for health care services.
The new design makes it easier for members to identify their financial responsibilities and understand next steps as they navigate their health care journey.
Please note: Wellmark has only updated the EOB’s visual design. Your actual plan details — benefits, premiums, cost-sharing, etc. — have not changed.
Here is what the new EOB will look like:
Find the information you need, faster and easier:
- Your cost-sharing responsibility is now clearly displayed on the first page for all claims.
- A new summary page layout makes it easier to find services, notes, and costs associated with each claim. Non-covered costs are also clearly listed, so you understand your financial responsibility for services NOT covered by your plan.
- The updated glossary includes straightforward definitions for health insurance terms and phrases you’ll see when managing and paying for health care services.
- New language highlights your right to an appeal and other protections
Wellmark would love to know what you think about the new look. You may be asked to fill out an online survey. This survey will be sent to the email you’ve shared with Wellmark.
If you do not receive a survey but would like to give feedback, select the button below to be directed to the survey site.
All feedback is anonymous and will only be used to improve the EOB experience.
The University of Iowa and Wellmark thank you for your partnership and participation in this pilot.
March 22, 2024
New Level 1 providers for UI health plans
With UI Health Care's acquisition of Mercy Iowa City hospital and community clinics, university-employed providers are now Level 1 health care providers for UIChoice and UISelect plan members.
- University-employed providers at UI Health Care Medical Center Downtown are now Level 1 providers.
- At this time, independent providers (non-UI employees) of anesthesia, pathology, and radiology services at the UI Health Care Medical Center Downtown are considered Level 2
- Providers at clinics in Iowa City, Coralville, Solon, Kalona, West Liberty, Tipton, Muscatine, and West Branch are also now Level 1.
- Most providers in Williamsburg are Level 1, however, there are independent providers currently practicing in this clinic who are Level 2.
- In emergencies, you can see a Level 1 or Level 2 (independent) emergency medicine provider at UI Health Care Medical Center Downtown.
To determine whether a provider is Level 1 or 2, refer to MyWellmark.com or call the Wellmark Customer Service number on your insurance card. It may take several more weeks for the MyWellmark portal to be completely updated.
Additional information on Level 1 providers can be found on our Level 1 providers for UIChoice and UISelect.
Archived Updates
December 5, 2023 | A new UI health plan requirement
Dec. 05, 2023
A new UI health plan requirement
The 2024 Wellmark Health Plan of Iowa (WHPI) plan updates will reinforce the importance of the relationship between members and their Primary Care Provider (PCP) in their overall health and well-being. As such, a PCP designation will now be required on all WHPI plans, including some that historically have not had a PCP requirement.
Beginning Jan. 1, 2024, Wellmark will require all health plan members enrolled in UIChoice, UISelect, and UIGRADCare to choose a primary care provider (PCP) to designate for primary care visits. This designation can quickly be made in the myWellmark portal or by calling Wellmark Customer Service at 1-800-211-6771.
Below, you will find frequently asked questions.
Primary Care Provider (PCP) Designation Frequently Asked Questions
Instructions: How to select your primary care provider on myWellmark
Create your myWellmark account if you don't have one.
- Go to mywellmark.com and choose "Register now." Enter your email address and select a password. It is recommended you use a non-employer email address. Follow the prompts to complete your registration.
Confirm or edit your PCP
Log in to your myWellmark account. Depending on your PCP selection status, you may see the following prompts:
- If you need to select a PCP:
- A pop-up screen will remind you that a PCP needs to be selected for you or other members on your plan. To do this at a later date, choose "Remind me later." To search for and select a PCP, choose "Find & select PCP."
- If a PCP has been auto-assigned:
- A pop-up screen will display the members on your plan and their PCP assignments. If you need to make updates, click "Find new PCP." If you don't need to make changes, choose "Confirm PCP selection."
Search providers to edit your PCP
- Alternatively, you can navigate to "My Plans" and then "My Providers." There, you can choose the pencil icon to search for or edit your PCP.
- On the "Find Care" page, you'll be able to search for eligible in-network providers by name or by type. Ensure this provider is accepting new patients.
- When you find the PCP you're looking for, choose "Select PCP." You'll be prompted to confirm which member will see this PCP.
- You will receive a confirmation message when your selection is successful.
When will myWellmark allow a person to select the PCP?
You may currently log in to myWellmark or call Wellmark Customer Service at 1-800-211-6771 to designate a PCP.
If a member doesn't designate their PCP in myWellmark, what happens?
When a member has not designated a PCP, Wellmark will assign one. They will first look at the prior 24 months of claims data to identify if the member has received care with a credentialed PCP. If the member has visited a credentialed PCP within the prior 24 months, that provider will be assigned as the member’s PCP. If the member has not received care from a PCP within the past 24 months, and has not designated a PCP within 90 days of being notified by Wellmark, a PCP will be assigned based on:
- Specialist claims history,
- Claim history of spouses or dependents, or
- Geographic location logic
Members may select a different PCP anytime by accessing myWellmark or by calling Wellmark Customer Service at 1-800-211-6771.
If a PCP is assigned by Wellmark, how is the member notified?
A letter will be mailed to the member letting them know a PCP has been auto-assigned. The letter will also include the PCP assignments of all family members, if applicable. Members can find additional information on Wellmark.com, and those who have a myWellmark account will receive a notification in the portal.
When will letters be mailed out? Who all receives the letters?
The first round of letters will be generated starting 1/1/24. These will be for members that have not provided a designation and Wellmark has primary PCP claims data to assign a PCP. The second round of letters will go out 90 days after the effective date.
What if the member lives out of state?
Members living out of state and only accessing out-of-network benefits on UIChoice will not be auto-assigned a PCP. The standard attribution steps will happen with these members. Still, if Wellmark gets to the point of geographic location logic (the very last option), then Wellmark will not auto-assign a PCP for these specific members.
Does a patient have to utilize their identified PCP before they can visit other providers?
No, our plans allow members to see any provider they wish. Wellmark does not require a referral for members to see in-network specialists. Please note that some specialists may require a referral before they will see a new patient, but our plan does not require it.
Will PCP selections be shared with providers?
Providers will not be notified by Wellmark when they are selected as a member’s designated PCP.
How will a member know if a PCP is available to accept new patients?
Members who need to designate a PCP may access the Find a Provider or Facility tool on myWellmark to determine if a provider is accepting new patients. Members should contact the provider to determine if new patients are being accepted. Members already in the care of a provider who is not taking new patients will be allowed to designate that provider as their PCP if they are an existing patient.
How will this change my health plan coverage?
Your coverage is not impacted. The plan design has not changed. Your ability to see any provider you wish has not changed.
I don't have a myWellmark account, how do I set one up?
To create an account, visit myWellmark. Select ‘Register now’ and enter:
- Your Wellmark ID number, date of birth, and last four digits of your Social Security number; OR
- Your date of birth and full Social Security number, if you don't have your Wellmark ID number on hand.
I don't want to create an account at myWellmark. How do I designate a PCP?
You can call Wellmark Customer Service at 1-800-211-6771, and they will assist you.
How soon after I add a new dependent to my insurance will I need to designate a PCP?
New members will receive a letter if they have not self-selected a PCP within 90 days of their coverage effective date. If they have claims data, Wellmark will assign the PCP based on the claims data. If they have not had a claim during that time, then a PCP will be assigned based on:
- Specialist claims history,
- Claim history of spouses or dependents, or
- Geographic location logic
I don't know who to list. I see two different providers consistently for PCP related care. Who should I pick?
Either one. The designation will not impact your ability to see either provider.
What are the immediate and long-term goals for the requirement to identify a PCP in the myWellmark portal?
These enhancements support Wellmark’s efforts to maintain health care affordability, improve the member experience, and encourage members to take an active role in improving their overall health and well-being. A member may choose to select their PCP designation using myWellmark or by calling Wellmark Customer Service; the change is immediate through the use of either option.
We were asked to make this designation several years ago by your office. Why do we have to do this again?
The designation of a PCP may have been a requirement under one of our past insurance plans that is no longer in place.
This is a new Wellmark Blue Cross and Blue Shield requirement for our UIChoice, UISelect, and UIGRADCare plans. It will not impact the ability to visit providers without a referral or impact the cost of visits.
I have already designated my PCP in MyChart. Why are you asking us to do this again?
Coming Soon
I have a PCP and have not been able to find them in Wellmark's list. What should I do?
If your provider is still a resident, you may not be able to find them in Wellmark's system. For now, while your PCP is still a resident, you may need to list the resident's attending physician.
I updated my address several months/years ago and myWellmark still shows my old address. How do I update the myWellmark portal to reflect the correct address?
The incorrect address on the MyWellmark member portal has been an ongoing issue that Wellmark has been unable to resolve. The mainframe system is not properly transferring addresses to the myWellmark portal. Any mailings that Wellmark sends to members, pull addresses from the mainframe, so you should still be receiving mailings without issue.
Archived Updates
June 15, 2023 | Free virtual mental health visits through Doc on Demand
June 15, 2023
Free virtual mental health visits through Doc on Demand
Effective July 1, 2023, all UIChoice and UISelect health plan participants and their covered dependents can receive free virtual mental health visits through Doc on Demand. Choose from various licensed therapists or psychiatrists (for more complex issues) who can be available day or night. Get the help you need in days, not months.
Virtual visits can be used for:
- Depression
- Workplace stress
- Relationship issues
- Trauma and loss
- Social or general anxiety
- Addictions
To get started, visit the Wellmark Doc on Demand flyer (pdf) to scan the QR code or the website DoctoronDemand.com/Wellmark.
April 25, 2023 | Important COVID-19 Update
End of Public Health Emergency
Recently, the Biden administration announced it intends to end the COVID-19 public health emergency (PHE) declared by the U.S. Department of Health and Human Services on May 11, 2023.
During the COVID-19 PHE, Wellmark enhanced your benefits coverage to ensure you had access to COVID-related services. With the end of PHE, you will see the changes to your benefits below.
If you have questions about these changes, don't hesitate to contact the Wellmark Blue Cross and Blue Shield customer service number on the back of your ID card.
| Benefit | Update | What this means for you |
|---|---|---|
| COVID-19 testing and testing-related services | Cost-share waiver stops the day after the end of PHE (5/12/23)
| You’ll pay the cost-share for testing services outlined in your benefits.
|
| Over-the-counter COVID-19 tests | Coverage stops the day after the end of PHE (5/12/23)
| You’ll be responsible for paying out-of-pocket costs for over-the-counter tests.
|
| COVID-19 vaccines | The COVID-19 vaccine will continue to be covered under your benefits plan.
| There will be zero cost to you for COVID-19 vaccines.
|
June 30, 2022 | Transparency in Coverage Rule
Transparency in Coverage Rule
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 to improve health plan transparency in the cost of health 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.
Review the public files effective July 1, 2022.
Downloading files
The files are a specific file type, JavaScript Object Notation (.json.gz file format), as the law prescribes. Wellmark cannot make the files available in other formats.
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 determine how much a visit will cost you before receiving services. The machine-readable files do not provide information on a member’s out-of-pocket charges.
June 8, 2022 | Wellmark's Legal Notice
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 not in our health plan network related 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:
January 18, 2022 (revised January 21, 2022) | Over-the-counter COVID-19 Test Kits
Over-the-Counter (OTC) COVID-19 Test Kit Coverage
(Plan members with UIChoice, UISelect, SHIP, and UIGRADCare)
Effective Jan. 15, 2022, all self-funded health plans will cover OTC COVID-19 Tests during the national public health emergency. Wellmark Blue Cross & Blue Shield of Iowa has shared how CVS/Caremark will administer the mandate for our plan members (Employees, Students, and Retirees).
Coverage of OTC COVID-19 Tests through the Pharmacy Benefit
Who is eligible?
- All University of Iowa health plan members and their eligible covered dependents can receive OTC at-home COVID-19 test kits at no-cost or reimbursed to the plan member by CVS/Caremark.
- Wellmark also reminds plan members that they are reimbursed OTC COVID-19 tests for personal use and should only be used by the policyholder and their eligible covered dependents on the same health plan that paid for those tests.
What is covered?
- Only qualifying tests purchased on or after Jan. 15, 2022, will be covered.
- To be covered, OTC COVID-19 tests need to have received an Emergency Use Authorization from (or are approved by) the Food and Drug Administration (FDA), subject to certain limitations.
What tests will Wellmark cover?
- Community-based testing. Iowa's program, Test Iowa, has drive-up locations throughout the state. It includes an online assessment developed in coordination with the Iowa Department of Public Health. These programs do not submit health insurance claims and are free of charge.
- Health care provider testing. COVID-19 tests provided through the member's doctor or hospital will be processed through insurance and covered in full.
- OTC COVID-19 tests approved by the Food and Drug Administration (FDA). Please visit the FDA's website, find the search box near the middle of the page, and enter "OTC" to view the qualifying tests.
What tests are NOT covered by Wellmark?
- Wellmark will not cover OTC COVID-19 tests used for employment purposes, meaning that if you're required to test for COVID-19 weekly or on another routine basis, you should not be purchasing those and submitting them to CVS Caremark for reimbursement.
- COVID-19 testing performed for travel purposes, including, but not limited to, flying internationally or boarding a cruise, is not a covered health plan benefit.
- OTC COVID-19 tests only qualify for coverage and reimbursement if the test is both self-administered and self-read at home. No laboratory or health care provider is involved.
Purchasing test kits from an IN-NETWORK pharmacy
Members can purchase tests in person at most national retail pharmacy chains like CVS and Walgreens without upfront payment.
Plan members can find in-network pharmacies by visiting CVS/Caremark online (If you do not already have a CVS/Caremark log-in, you must register your account before accessing the search portal).
- If the plan member purchased a test kit at an in-network pharmacy window or counter, the kit would be covered with no out-of-pocket costs at the time of purchase.
- If the plan member purchased a test kit at a national retail chain store (i.e., Walgreens, CVS Pharmacy) checkout (not at the pharmacy counter), the member would need to pay for that kit at the retailer's price and submit a claim to CVS/Caremark for reimbursement.
Please remember that this is still relatively new, and some pharmacies may not be ready to process point-of-sale claims.
Purchasing test kits from an OUT-OF-NETWORK pharmacy
Members who purchase OTC COVID-19 tests from out-of-network pharmacies or non-pharmacy retailers are still eligible for reimbursement. However, if the member uses an out-of-network pharmacy or non-network retailer, the member’s reimbursement may be limited to $12 per test (or $24 for a box of two tests).
How many tests can you receive reimbursement for?
CVS/Caremark is implementing a claims process that will track OTC COVID-19 test claims and apply a limit of eight OTC COVID-19 tests per member per month, consistent with the guidance released.
- For example, if a family has five members on the same health plan, CVS can reimburse the family for up to forty OTC COVID-19 tests each month. Some test kits are sold with multiple tests in a single package. The limit number is based on individual tests.
How to submit for reimbursement?
If a plan member pays out-of-pocket for qualified OTC COVID-19 tests, they must submit a claim form online to CVS to begin the reimbursement process. You will need to have a registered account before submitting a claim.
- Once logged in to your CVS account, members should visit the Plan & Benefits tab and select “Submit Prescription Claim.” Then, if you’re eligible, you will see a link on the page that reads, “Submit at-home COVID-19 test reimbursement claim.
- CVS will process and pay claims for OTC COVID-19 tests purchased on or after Jan. 15, 2022. Claims for OTC COVID-19 tests purchased before that date will not be covered or reimbursed.
Order your free tests today!
There are two ways you may order or pick up free at-home COVID-19 test kits:
- Test Iowa offers a self-administered at-home test kit that can be sent directly to your residence, or you may pick one up at a nearby pick-up site. Visit testiowa.com/en to find nearby pick-up site locations or submit a request to have one mailed to your home.
- Visit COVIDtests.gov, where every home in the U.S. is eligible to order four at-home COVID-19 test kits for free. Orders will ship out within 7-12 business days to those submitting their online request.
December 16, 2021 | Wellmark 2022 Updates
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 healthcare 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 contact the customer service number 1-800-643-9724.
May 27, 2021 | Plan Coverage Uupdate
UI Health Insurance Plans Coverage Update
With the COVID outbreak, our health plans for faculty, staff, retirees, and students provided expanded COVID-related coverage. Listed below are the services impacted and the status of ongoing COVID-19 coverages.
- COVID-19 tests and related services. Members have no cost-share for appropriate testing and related services to diagnose or detect COVID-19. This is required by the Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief, and Economic Security (CARES) Act and remains in place as long as we are in a public health emergency, as declared by the federal government.
- COVID-19 Vaccine. The federal government intends to pay for all Americans' initial vaccination doses (and providers cannot bill health plans for such doses). Once the federal government stops paying for COVID-19 vaccination doses, our health plans will cover the vaccine as an ACA preventative service without cost-share, as required by the CARES Act.
ABOUT OUR SITE:
The information 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, 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.