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SUMMARY OF BENEFITS AND COVERAGE MANUAL FINDER Search for the Summary of Benefits and Coverage (SBC) and Coverage Manual for your plan. Facilities Search Physicians Search Looking for a quality care for specific procedures? 1Number of medical plan options varies by location and eligibility. Heres how you can make the most of your plan all year long. Whenever and wherever. Its easy to create an account all you need is your insurance card. We are motivated by the well-being of our friends, family, and neighborsour members. Iowa City, IA Find your plan by prefix - use "XQW" for UIChoice or UISelect Visit Wellmark.com/Blue365 for a full list of deals and discounts available to you. Select Employer and Individual Plans, followed by Choice Plus.. In the event that you or a covered family member are diagnosed with a health condition that requires complex care, or requires follow-up care after a recent hospital stay, you and your family will receive support from a dedicated team of nurses, clinicians and other specialized professionals to help you improve your health. The Blue Distinction Specialty In addition, you will be billed a $100 copay,which will be waived if you are admitted. Click the checkbox next to the jobs that you are interested in. Provider Finder Search for doctors, dentists, hospitals and other health care providers. Not all plans cover out-of-network care. The online Doctor On Demand and many of the same providers (about 98%) are part of the Narrow Network; the biggest differences are you can't receive care out of state (except for emergencies, pre-approved referrals, and dependents that live out of state); you must designate a Primary Care Physician; and the number of chiropractic care providers is substantially less. If you are in a state other than Iowa and require medical care, you may call Wellmark Blue Cross and Blue Shield of Iowa at (800) 810-BLUE (2583) for assistance in locating the closest participating provider in that state. Payment is made to you from Wellmark, and you are responsible for paying the provider. The Kaiser California $1,850 Deductible Plan has, as required by state law, a three tier deductible consisting of a $1,850 individual deductible for Self Only coverage, a $2,800 individual-within-family deductible for employees electing dependent coverage and a $3,700 overall family deductible Opioids are a highly effective treatment for pain when taken correctly, but they can also be addictive. With Doctor On Demand, you and your family members can connect face-to-face with a board-certified doctor on your schedule. The cost of prescription drugs is rising faster than many other health care services and supplies. About you: You are a skilled critical thinker, detail-oriented and analytical to your core. There are times with specific populations where it could be more likely that Doctor on Demand would advise the person to seek in-person care due to potential complications, for example, a newborn or an older adult with multiple health issues. BCBS recognizes doctors and hospitals for their expertise and exceptional quality in delivering care. Visit your providers website for more information. Company Description Why Wellmark : We are a mutual insurance company owned by our policy holders across Iowa and South D Company Description Internal Job Title : Network Innovation Analyst Why Wellmark : We are a mutual insurance company own Do you want to receive a free, professional resume evaluation from TopResume? Do More Find a Doctor They will be listed when you use the XQW when performing a search on Wellmark. Please select your plan type Need help? 3With the $900, $3,000 and $4,500 Deductible Plans, the plan will begin to pay 100% of the cost of a covered family members covered expenses if that family member's individual out-of-pocket maximum is met; the plan begins to pay 100% of covered expenses for all covered family members once the family out-of-pocket maximum has been met. Give members an intuitive, personalized experience to search and compare medical, dental, and vision providers, and guide them to the best options based on their benefits using proven, expert user design that's continuously tested by our team. BDC and BDC+ are displayed on www.bcbs.com. are in the local Plan's BlueCard PPO network. a. However, only the amount you pay towards your specialty prescriptions will be applied to your deductible and out-of-pocket maximum. If you qualify, you will receive an invitation via email to this free, confidential program, and your health coach will help you develop and implement a personal wellness plan to address any high-risk areas, with help from a licensed Health Solutions clinical pharmacist. Each providers cost of 1With the $900, $3,000 and $4,500 Deductible Plans, coinsurance will begin for a covered family member if that family members individual deductible is met; coinsurance begins for all covered family members once the family deductible has been met. For more efficient service, please have your member ID number handy - it can be found on the front of your card. providers recognized for their expertise and efficiency in delivering By agreeing to submit your resume, you consent (in accordance with our Terms of Use and Privacy Policy) to: Should you have any questions or wish have your information removed from our service, please contact us here. Chat with a Doctor is on demand, real-time messaging with a doctor to receive medical advice and triage. Member Discounts Take advantage of member-only discounts on health-related products and services. With complex healthcare benefits and so many online and in-person healthcare options, finding the right provider or facility can be a challenge. Find a Provider; Member Forms; Prescription Drug Info; Important Things to Know; Get Adobe Reader; Company. Well predict member intent to give them the most relevant care optionseven when they misspell names or medical terms. We're here for you. Review health screening results and understand areas of risks; Receive education specific to your conditions and risks; Develop goals and action plans to reduce risk; Get support in overcoming obstacles, tracking progress and celebrating success. Washington County Hospitals & Clinics and The Iowa Clinic, PC, Des Moines, A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat specific symptoms and conditions. The $4,500 Deductible Plan is a high deductible health plan, or HDHP. Choose the doctor, specialist or dentist whos right for you. For the National network" plans: Select Wellmark Blue PPO," and then click Confirm selection. Before you can move to the next steps . You will only be offered Kaiser as a medical option if it is available for your home ZIP code. Iowa City, Iowa 52240, Benefits:319-335-2676Payroll:319-335-2381Administrative Services:319-335-3558, Accessibility notice and website disclaimers. Find a trusted health provider. When you sign up, you get exclusive discounts for wellness products and services you use every day, such as fitness trackers, eyeglasses and athletic shoes. Apply qualitative and quantitative techniques to interpret provider data and provide pricing recommendations as appropriate. Most people are looking to their health plans for help. The Blue Distinction Specialty Care program recognizes healthcare providers for their quality care and patient results. However, in general, there are no specific age restrictions. Get a Quote Individual & Family Plans Find Medicare Insurance Plans Shop Individual & Family Plans Member Resources Compare Group Insurance Plans Producer Resources Bettendorf, Grundy Center, Hiawatha receive 2023 Healthy Hometown Powered by Wellmark Community Award 1 of 6 You are skilled at thinking conceptually, anticipating long-term outcomes, and identifying and implementing continuous improvement opportunities around provider reimbursement. Enter your ZIP code. Call 911 or go to the nearest hospital emergency room. Employees can earn up to $500, and a covered spouse has the opportunity to earn an additional $300. Find a Doctor Help How would you like to search? surgery. HealthSparq turns your latest provider directory data into printable directories and FHIR APIs to support plan compliance needs and reduce your administrative costs. Employees in Iowa who enroll in the Wellmark Narrow Network Plan must assign a Primary Care Physician during the enrollment process for you and your dependents. To get the most out of your dental plan, make sure your dentist is in the Delta Dental Medicare Advantage network. Blue Distinction Centers+ are healthcare facilities and Once your account reaches a certain balance, there are investment options to help your money grow. Non-participating providers do not have contracts with Blue Cross and Blue Shield. Articulates complex technical information effectively. Provides copay assistance toward the purchase of certain specialty medications. The $900 Deductible Plan offers the lowest out-of-pocket costs when you need care, but has the highest premiums of all your plan options. The $3,000 Deductible Plan is a high deductible health plan, or HDHP. Any balance billing beyond coinsurance is NOT applied to OPMs. If your clinic is closed, you can call the 24/7 HealthPartners CareLine service at 612-339-3663 or 800-551-0859. Health and Wellness. Tips to get care, answers and advice faster: To learn more about COVID-19 and how Teladoc can help, explore the frequently asked questions For your convenience, facility designations Note to large groups or self-funded plans: To find your SBC or coverage manual, search using your Wellmark ID Number. Claims are settled directly with these providers. 5Deductible does not apply. criteria for providers located in its own service area; for details, contact Select A high deductible health plan (HDHP) that offers lower premiums and high deductibles, along with a tax-advantaged Health Savings Account (HSA) to put you in charge of your spending. Check your benefits to see whats covered for you. Proactive self-starter with strong organizational, prioritization and time management skills, as well as excellent attention to detail. program, only. An emergency is considered to be a medical condition that a prudent layperson (with an average knowledge of health and medicine) could reasonably expect to result in serious jeopardy to a persons health in the absence of immediate medical attention. Money in your HSA can be carried forward from year to year and is always yours to keep. Keep in mind: If you choose a Kaiser plan in California, Colorado, the District of Columbia, Georgia, Maryland or Virginia, you are required to select a Primary Care Provider (PCP), who will manage your care. Try to contribute enough to your HSA to cover your expected out-of-pocket costs, such as your annual deductible and coinsurance. Substance Use Treatment & ResourcesLearn more about substance use disorders and find a treatment provider that meets your needs. c. Develop and maintain positive professional relationships with Network Engagement and Health Network to provide proactive communication of changes. If your share of medical expenses reaches $6,550/$13,100 (individual/family), the plans, You pay for your initial medical and prescription costs until you meet your annual, If your share of medical expenses reaches $5,500/$11,000 (individual/family), the plans, Once you meet the deductible, youll pay 20% of your covered medical expenses; this amount is called your, If your share of medical expenses reaches $3,500/$6,500 (individual/family), the plans, You pay your medical costs in full until you meet the plans annual, Once you meet the deductible, youll pay 20%of your covered medical expenses; this amount is called your, If your share of medical expenses reaches $3,000/$6,000 (individual/family), the plan's, Under the Menu, click on Find a provider or facility" under Quick Links.". Take care of them with a health plan that offers the coverage they need. Learn more about our Total Care and Blue Distinction Specialty Care designation programs and find a designated doctor or hospital that meets your needs. Are there any age restrictions when using Doctor on Demand? HealthPartners insurance plans cover more than 1,000,000 doctors. Medical residents and medical students are an integral part of the team thatsupports treatment by the faculty and physicians on staff. Even add accurate, flexible, and augmented provider profiles and data to boost satisfaction and go beyond provider data mandate requirements. Effectively builds relationships, influences, and solicits cooperation from others. You can also access Mango Health, which offers a mobile app with games and rewards for healthy habits, such as taking medication on time. If you live in Iowa, you have an additional option for medical coverage: the Narrow Network (Iowa only). Providers in CA, ID, NY, Click on "Choose a location and plan" when the "Hi there, let's get started!" box appears. Register or sign in to myWellmark at myWellmark.com to get started. Users are 3x more likely to select preferred providers with HealthSparqs guidance-based experience. To live free of worry, free of fear, because you have the strength of Blue Cross Blue Shield companies behind you. input from the medical community. You pay lower premiums in exchange for assuming more financial responsibility when you receive care, so its smart to plan ahead. Benefits are provided by Express Scripts for Wellmark Blue Cross Blue Shield and United Healthcare plans, and by Kaiser Pharmacy for Kaiser plans. (scheduled) procedures related to this Blue Distinction Specialty Care program Adjust your contributions as necessary during the year to make sure you have money available when you need it. The member should follow up with Wellmark regarding any additional questions. You can ensure your members find cost-effective, quality care that best meets their specific needs and your network preferences with HealthSparq One. To find providers designated as Blue Distinction Centers and Blue Distinction Centers+, please note: *Blue Distinction Center designation only. Strong verbal/written communications skills. Find a Doctor; Member Forms; Prescription Drug Info; Important Things to Know; Get Adobe Reader; Company. If you have diabetes, this program helps you monitor and control your glucose levels. Care program recognizes healthcare providers for their quality care and patient results. 6If you take a long-term or maintenance medication to manage a health condition like high blood pressure, diabetes or high cholesterol, the Smart90 program gives you the option to pick up a three-month supply of your medication at a CVS or Walgreens, or have your medication shipped to your home using Express Scripts mail-order pharmacy. 1 HealthSparq One supports your complex benefit designs and quality scores to help drive down costs for both you and your members, while improving healthcare outcomes. Tip: If you want extra protection from large or unexpected medical expenses, you may also choose to enroll in one of the supplemental health insurance plans. Perform data modeling to assist providers understanding of methodology changes/updates. You have access to TouchCare. These providers file claims for you. If you live in Hawaii, you are only eligible for the Platinum Be Fit Plan offered by Kaiser-Hawaii. Enter your ZIP code to continue your search. Understanding of Wellmark products, policies and processes to ensure consistency in the compensation strategies designed and implemented. Find an In-Network Provider in Iowa and SD | Wellmark Find an in-network health care Provider Notice Regarding Your Rights and Protections Against Surprise Medical Bills Find a health care provider or facility 2023 Blue Cross Blue Shield Association. (Examples: allergist, cardiologist, dermatologist, neurologist, ophthalmologist, orthopedics, etc. When you are sick and need care quickly, a Virtual Visit is a convenient way to start feeling better faster. Providers at the University of Iowa Hospitals &Clinics When searching on the Wellmark website for providers, you will use the prefix "XQW.". See note on Facilities Search homepage. Keep in mind: With an HSA, you can only spend up to the amount thats actually been deposited into your account. Level 1 providers under UIChoice include the University of Iowa Hospital and affiliated clinics, UI Urgent Care, UI QuickCare, Washington County Hospitals and Clinics, and The Iowa Clinic in Des Moines. With IDX Identity, you can monitor your credit record, keep track of your online ** If the providersare non-participating with BCBS, even within the state of Iowa, any coinsurance if the claim is payable will be applied to the Level 3 out-of-network OPMs of $2,000 individual and $4,000 family. These services are available 8 a.m. - 10 p.m., seven days a week. Most HealthPartners plans offer both in-network and out-of-network coverage. Once you meet the deductible, youll pay 30% of your covered medical expenses; this amount is called your. Never signed in? You can see a therapist, get a chemical dependency evaluation or receive other outpatient care from any clinic in your network. C) Salary.com using cookies (as described here) to refine and tailor the website visitor experience. included with each medical plan. View and download online provider claim remittances (PCRs) Log in to Provider Portal. Neither Blue Cross and Blue Shield Association nor Additional terms and conditions may apply. **Blue Distinction designations (BDC and BDC+) are given to facilities; but are specialty care. Find a Doctor; Member Forms; Prescription Drug Info; Important Things to Know; Get Adobe Reader; Company. With Virtual Visits, you have access to United Healthcares network of virtual doctors who can provide care using live audio and video technology. Click on Choose a location and plan" when the Hi there, let's get started!" Non-participating providers may charge more for health care than participating providers. To find a doctor or hospital within your health plan network: 1. Make an appointment online instantly with Chiropractors that accept Wellmark Blue Cross Blue Shield insurance. Select Blue Cross Blue Shield Globalor GeoBlue if you have international coverage and need to find care outside the United States. Get help from a variety of health care services. A CareLine nurse can help you find nearby care including urgent care clinics and retail clinics, which are open evenings and weekends. Bachelor's Degree or direct and applicable work experience. Kaisers specialty pharmacy will vary by location. through annual out-of-pocket maximums that limit the amount youll pay each year. Excellent critical thinking and creative problem solving skills. local BCBS Plan, or visit If your plan doesnt require a referral, just call the specialist to make an appointment. Find a provider or facility for a Wellmark health plan available on Healthcare.gov To find a provider or facility, select the link that matches your plan network and state where you live. If youre passionate about joining an organization working hard to put its members first, to provide best-in-class service, and one that is committed to sustainability and innovation, consider applying today! Watch for more information in 2023. Your pre-tax HSA contributions and any earned Reward Dollars from Transamerica can help you pay your out-of-pocket costs. Looking for a quality care for specific procedures? Prescription benefits are provided by Express Scripts if you enroll in a Wellmark Blue Cross Blue Shield or United Healthcare plan, and by Kaiser Pharmacy if you enroll in a Kaiser plan. That means you can go to any doctor, clinic or hospital. Therefore, the emergency services must be provided to the member in an emergency room setting (not an urgent care center or physicians office). For example, Mercy of Iowa City is considered a Level 2 provider. GET STARTED The care you need. The Blue Cross Blue Shield System is made up of 34 independent and locally operated companies. The lower the provider level you visit, thelower out-of-pocket costs for the UISelect member. If you choose a coverage tier other than Self Only, there is an embedded individual deductible, which means that coinsurance will begin for a covered family member if that persons individual deductible is met; coinsurance begins for all covered family members once the family deductible has been met. Learn more about your rights and protections. Health Solutions offers an invitation-only coaching program which provides tools and guidance to empower you to effectively manage your health and to ultimately achieve a better quality of life. Contact Us Y0020_WCM_100876E Last Updated On: 10/1/2022 To get started, visit www.touchcare.com or call 866-486-8242. University Services Building (USB) TouchCare also offers a 30-minute consultation during open enrollment. General Medical Primary360 Mental Health Specialists & Expert Opinion Wellness Care Services may vary based on health plan or employer. b. If there are any discrepancies between the information contained herein and the official plan documents, the plan documents will govern. ( Note: See Medicaid page for BCCHP and MMAI Provider Finder links.) They do not agree to accept payment arrangements and are not responsible for filing claims for you. You will work with your Health Solutions Care Team to: Order or refill prescriptions, sign up for mail order and more on your prescription websites: Manage your Health Savings Account and Health Care Flexible Spending Account online with Transamerica at Transamerica.com/portal. If you take a long-term or maintenance medication to manage a health condition like high blood pressure, diabetes or high cholesterol, the Smart90 program gives you the option to pick up a three-month supply of your medication at a CVS or Walgreens, or have your medication shipped to your home using Express Scripts mail-order pharmacy. By selecting continue you will be leaving Wellmark's website and going to Healthsparq.com operated by HealthSparq. Why Wellmark: We are a mutual insurance company owned by our policy holders across Iowa and South Dakota, and weve built our reputation on over 80 years worth of trust. An individual may choose to have all primary health care provided by faculty members and staff physicians. Wellmark Blue Cross Blue Shield or United Healthcare, based on the state where you live. It should be back shortly, but if you keep getting this message, please call technical assistance at 800-407-0267. Likewise, keep tabs on your HSA by logging in to Transamericas website at transamerica.com/portal to view your balance, manage claims, etc. With a three-month supply of your medicine on hand, you're less likely to miss a dose, which can keep you healthier and save money. When participating in the wellness program, you and your covered spouse (if applicable) can earn Reward Dollars that will be deposited automatically into your HSA within six weeks of reaching certain point levels. All agents represented by Wellmark on this website are authorized independent agents for Wellmark Blue Cross and Blue Shield and are licensed to sell insurance in their respective states. Blue Magazine; . The Blue Cross Blue Shield Association is an association of independent, locally operated Blue Cross and Blue Shield companies. These providers participate with a Blue Cross and Blue Shield Plan but are not in Level 1 or Level 2. To access your member services, please visit your BCBS company. You can also find providers in other states through the Wellmark website. They can also provide advice on home treatment options and help you decide what kind of care you need. MedicareBlue Supplement. In addition to our NCQA-certified provider directory, we can help your plan with other business and compliance-related provider data needs. Using in-network providers saves you money. Search for Doctors, Hospitals and Dentists Blue Cross Blue Shield members can search for doctors, hospitals and dentists: In the United States, Puerto Rico and U.S. Virgin Islands. Find a Provider or Facility Notice Regarding Your Rights and Protections Against Surprise Medical Bills Find a provider or facility If your plan is not through Medicare or the Affordable Care Act, find a provider using the button below. d. Serve as consultant in collaboration with Network Engagement to provide compensation guidance/expertise and payment policies to providers and applicable stakeholders. BC International Provider Locator Virtual Care via Doctor on Demand | Doc on Demand (pdf) Blue Cross and Blue Shield have contracts with these providers, and they agree to accept payment arrangements. Blue Distinction Centers are healthcare facilities and providers recognized for their expertise in delivering specialty care. The medical Authorization Table is your best resource for viewing medical policies and criteria used by Wellmark. your own policys coverage, contact your Local Blue Plan and ask your provider The find a provider or facility online directory allows you to search for network providers, hospitals and dentists. Kaiser is an HMO, and all your care must be coordinated by your Primary Care Provider (PCP). NPIs, and user security for your organization for purposes of submitting provider applications and change requests in E-credentialing Central. Check member eligibility, benefits and accumulations. Leading the way in health insurance since 1929. Visit your carriers website to search for in-network providers and use the tools to compare costs for medical services. for cost of care; and their own Local Blue Plans decide whether one or both cost 2023 Mercer Belong, Inc. All rights reserved. Provide timely response to provider inquiries via Network Engagement and support data needs and inquiries. Participating vs. Non-Participating Providers. With the Wellmark Provider Portal, you can: Send Wellmark medical and drug authorization requests. See More Forms EOB Sign up to receive your health statements online. For complete details on coverage and for more information on how to enroll, visit the Mercer Marketplace 365+website. When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing. The online Doctor On Demand and many of the same providers are part of the Narrow Network (about 98%); the biggest differences are you can't receive care out of state (except for emergencies, pre-approved referrals, and dependents that live out of state); you must designate a Primary Care Physician; and the number of chiropractic care providers is substantially less. If you know about future expenses, or if you want to save for your health care costs in retirement, set aside a little extra each paycheck so your balance can grow over time. May communicate and attend provider meetings, if applicable. When you are out of state, using a participating Blue Cross and Blue Shield provider will result in lower out-of-pocket costs for you, and the out-of-pocket maximum for Level1 and Level 2 will apply to these providers. entities) with which those physicians are affiliated. Most members dont need a referral from their doctors. GreatAmerica Financial Services Corporation, Des Moines, IA, Principal Financial Group, Des Moines, IA. All of Transamericas medical plans offer: that also fulfills the requirements of the federal health care law. Want to know more? The city, state and zip code will appear, then if correct, click Yes, this is correct.". This includes supporting provider compensation initiatives by applying your thorough understanding of contracting, claims payment procedures and payment policy. REGISTER FOR OR LOG IN TO myWELLMARK AT myWELLMARK.COM. If youre already a HealthPartners member, you can sign in to your HealthPartners account to see which doctors and services your plan covers. We are not motivated by profits. If you are looking to see if the provider is participating with BCBS outside of the Blue Choice/Blue Access network (using XQW), you can use the XQQ prefix to search those providers outside of the state of Iowa. You can provide a Doctor Name or Specialty, Facility Name, Clinic Name or Medical Group Name. Whether you need help discussing care options, determining if a fever warrants a trip to the doctor or even finding elder care, you can call 24 hours a day, 7 days a week at 844-84-BeWell. This position will work a hybrid schedule of at least 3 days in a Wellmark office, with two days remote option. Your doctor might be able to help you choose the right specialist. are brand-name medications that are not on a prescription plan's preferred list (or formulary) based on drug effectiveness and cost. In fact, 75% of members say they want their health plan to help guide them through the process of finding care. may show names of affiliated physicians who participate in PPO products. your Local Blue Plan. Individual outcomes may vary. When the Find your plan by prefix" box appears, click on Browse a list of plans" at the bottom of the box. providers recognized for their expertise in delivering specialty care.

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