Wellmark Blue Cross and Blue Shield
South Dakota/Iowa • HMO, Traditional Indemnity, High-Deductible Health Plan (HDHP)
Under this HMO prefix, the member's coverage is limited to the plan's provider network. Care is coordinated through a primary care physician. Specialist visits require a referral from the PCP. When billing, confirm that the referring provider and the referral authorization number are included on the claim.
Traditional indemnity coverage means the member has fee-for-service insurance with no network limitations. Any licensed provider can be seen without referrals. Claims are reimbursed based on usual, customary, and reasonable (UCR) charges. The member typically pays a deductible and a percentage of allowed charges.
HDHP (High-Deductible Health Plan) coverage means the member has a higher deductible than traditional plans, often paired with a Health Savings Account (HSA). Most services require the member to pay out-of-pocket until the deductible is met. Preventive care is typically covered before the deductible. Submit claims normally to the payer listed above.
Health insurance company serving Iowa and South Dakota with commercial and other plans.