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
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.
You may currently log in to myWellmark or call Wellmark Customer Service at 1-800-211-6771 to designate a PCP.
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.
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.
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.
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.
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.
Providers will not be notified by Wellmark when they are selected as a member’s designated PCP.
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.
Your coverage is not impacted. The plan design has not changed. Your ability to see any provider you wish has not changed.
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.
You can call Wellmark Customer Service at 1-800-211-6771, and they will assist you.
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
Either one. The designation will not impact your ability to see either provider.
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.
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) that can be available day or night. Get the help you need in days, not months.
Virtual visits can be used for:
- Depression
- Workplace stress
- LGBTQ+
- 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.
June 30, 2022
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 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 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:
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.