Sears Insurance has constantly stayed ahead of the curve when it comes to the health and financial responsibilities that you have entrusted us with. This year has brought about more change as we transition from one year to the next and understand the provisions of the Affordable Care Act (ACA). Most of the folks that I visit with do not consider their options “affordable” and they may or may not be able to “keep their own doctor,” but we can help.
Wellmark has worked diligently to provide innovative new products, forge relationships with providers and contain costs for their clients. If you received letters telling you your plan will not be available in 2017 or if you received a huge increase in your premium for 2017, you may have other options that you have not explored. We are here to help.
Choosing the right health insurance starts with choosing the right network. In previous years you may have been advised not to participate in an HMO. Health Maintenance Organizations were typically a network of providers that was very limited. Wellmark has unveiled new HMO products that are not like what your grandfather had. The Wellmark Blue HMO network covers 100 percent of hospitals and 97 percent of doctors — and provides out-of-state-coverage in an emergency.
Wellmark Value Health Plans and Wellmark Synergy Health Plans
These plan options are brought to you by local companies dedicated to improving the health and well-being of Iowans. Available in select Iowa counties, Wellmark Value Health Plans work within the Mercy Health Network and its affiliated providers, while Wellmark Synergy Health Plans give you access to the network of providers who work within the University of Iowa Health Alliance. It is important to know that these are narrow networks and you may not have coverage or will have greater out-of-pocket costs when you go out-of-network.
With all our HMO plans, you choose a health care coordinator. That’s your personal or "family doctor." He or she knows your whole medical history and can recommend health care solutions to meet your unique needs.
You see your personal doctor for routine health issues like treating the flu or preventive care like an annual physical. If you need to see a specialist, he or she may need to provide a referral.
In an HMO network, premiums are generally lower. There is a little less flexibility — for instance, if your current family doctor is not in the network you may have to pay more out-of-pocket. You may consider choosing a new in-network doctor to keep costs lower. But thanks to our extensive network of providers, your doctor is probably in our network, along with the best specialists in the state.
I will explain the differences between the “metallic tiers”. You will have an SBC – a Summary of Benefits and Coverage – this is a concise document that clearly explains the plan’s benefits and coverage options. This will be very beneficial in helping you choose the right plan.
When it comes to the pharmacy benefit, we want to assist you with how your prescriptions will be paid. We use the Wellmark Drug list. You will know how the prescription will be paid before you commit to the order. There are pharmacy mail order services, specialty drugs, prior authorization, quantity limits and formulary exceptions. I can explain that process.
myWellmark is a fantastic tool. Here are just a few of its benefits:
- Check claims. Find out the status of a claim.
- Track health care costs. Run reports to see how much you’ve spent out of pocket.
- Find out what’s covered. See how much your plan will pick up for certain services.
- Compare prescription prices. See what you’ll save with generics.
- Ask questions. Speak to a Wellmark associate safely and securely.
- Go green. Receive your Explanation of Benefits (EOB) digitally.
Resources are right at your fingertips:
Be Well 24/7, download the free mobile app, utilize the Blue 365 Rewards for discounts on items you may use every day and don’t forget the Blue Magazine. These are just a few of the ways we can make your life easier.
Consultations are FREE – 515.285.6766
Thank you for your business and referrals throughout 2016 and years past. It is you that make us what we are! Have a Merry Christmas and a safe and healthy New Year!
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Debra Sears
Sears Insurance, Inc.
515-285-6766
Email: searsdebra@aol.com
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