Wellmark Blue Cross Blue Shield

Last updated
Wellmark Blue Cross Blue Shield
Type Mutual
Industry Health Insurance
Founded1939
Headquarters1331 Grand Avenue
Des Moines, Iowa United States
Key people
Cory Harris, CEO
Products Insurance
Number of employees
1,878 [1]
Website wellmark.com

Wellmark Blue Cross Blue Shield is a mutual insurance in the United States with more than two million members in Iowa and South Dakota. It is the dominant health insurance in Iowa. It is an independent licensee of the Blue Cross Blue Shield Association. Founded in 1939, Wellmark offers dental and health insurance as well as life insurance. It began participating in the health care exchange for 2017. [2]

Contents

History

In 1939, 'Hospital Service Incorporated of Iowa' (later known as Blue Cross of Iowa) began business in Des Moines, Iowa. That same year, 'Associated Hospital Services Incorporated' (later known as Blue Cross of Western Iowa and South Dakota) was established in Sioux City, Iowa. [3] In 1945, Iowa Medical Service (later known as Blue Shield of Iowa) was formed. In 1948, Associated Hospital Services began doing business in South Dakota and marketing activities as Blue Cross. In 1956 'South Dakota Medical Service' began doing business in South Dakota as South Dakota Blue Shield. [3] In 1986, Blue Cross and Blue Shield of Iowa purchased Benefit Administrators of America, Inc., a third-party administrator, which was the plans' first for-profit venture. Benefit Administrators of America was renamed Wellmark Administrators, Inc. in 1997. [3]

In 1989, Blue Cross of Iowa, Blue Shield of Iowa and Blue Cross of Western Iowa and South Dakota merged to form 'IASD Health Services Corporation'. In 1991, IASD Health Services Corporation became a mutual insurance. In 1994, Blue Cross Blue Shield (BCBS) allowed its licensees to be for-profit corporations, [4] and the joint service agreement of Blue Cross of South Dakota and South Dakota Blue Shield expired, putting the two plans in competition with one another. [3]

In 1996, Blue Shield of South Dakota merged into IASD to form a single company. Blue Cross of South Dakota and South Dakota Blue Shield merged into 'South Dakota Health Services Company' doing business as Blue Cross Blue Shield of South Dakota. In 1997, the companies were branded as Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota. [3]

Companies

Wellmark is headquartered in downtown Des Moines and Sioux Falls. It has 1707 employees in Iowa and 171 in South Dakota. [5] It consists of Wellmark Blue Cross and Blue Shield of Iowa, Wellmark of South Dakota, Inc. (doing business as Wellmark Blue Cross and Blue Shield of South Dakota) and Wellmark Health Plan of Iowa, Inc. [5] The Wellmark Foundation is a private foundation to support health improvement initiatives in Iowa and South Dakota.

Wellmark insures almost 1.8 million Iowans and more than 300,000 South Dakotans. [5] It is Iowa's largest and dominant insurer but has not participated in the government's health care exchange for two years in a row. [6] During its open enrollment period from October 1, 2013 to March 31, 2014 more than 41,000 people in Iowa and South Dakota enrolled in 24,000 "Affordable Care Act-compliant health plans" by Wellmark. [7] Cliff Gold, former Wellmark employee, then chief operating officer of Iowa's CoOportunity, said that "they have denied consistently, that they [...] push bad risk into the exchanges." [6]

Organization

As of 2016 the Board of Directors consists of 11 members, namely Thomas M. Cink, Melanie C. Dreher, John D. Forsyth, Daryl K. Henze, William C. (Curt) Hunter, Paul E. Larson, Angeline M. Lavin, Terrence J. Mulligan, Dave Neil, Timothy J. Theriault, Terri M. Vaughan. The CEO is Cory Harris. [3]

Economic aspects

Wellmark's credit rating from Standard and Poor's was "A+" (Strong).

According to Wellmark's 2013 balance sheet its assets were $2,357,637, its liabilities $1,003,329 and its reserves were $1,354,308. [5] As of 2014, Wellmark explains that premiums are spent as follows: 86.6% on payment for health care services, 7.6% for administrative services, 3.9% on commissions, 1.3% for earnings on premiums, and 0.4% on premium tax. [5]

As of 2014 Wellmark Health Plan of Iowa had to refund $651,895 to customers, because it did not meet specifications of the 80/20 rule in the Affordable Care Act, which requires insurers to spend at least 80 percent of premium dollars on patient care and quality improvement activities. [8] Most rebates in Iowa ($1.1 million) were owed by Coventry Healthcare of Iowa Inc. [8]

Rate increases

Wellmark raised premiums on individual policy holders by between 12 and 13 percent in 2013, 9.4 percent in 2012, 8.5 percent in 2011 and 18 percent in 2010. [9] As of June 2014 Wellmark is seeking to increase rates again, apparently by less than 5.9 percent for the majority of insured, and by 11.9 percent and 14.5 percent for people enrolled after the Affordable Care Act went into effect. [9]

Rate increases above average per CSA require a public hearing in front of the Iowa Commissioner of Insurance; in 2013 the Commission received a total of 300 comments, 240 of which expressed rate increase weariness, and that some increases reached nearly 50 percent since 2010. [10] The second most common comment had to do with affordability, and the third highest reoccurring comment was Wellmark's discretionary spending. Individual comments criticized the chairman's salary of $3.1 million [10] :28 The Insurance Division's actuary and an independent actuary reviewed Wellmark's data and both found the rate request was not discriminatory, but was supported by the data. [10]

Criticism

In 2010, Wellmark opened its $250 million headquarters, and at the same time raising premiums by double-digit percentages annually. [11] The CEO justified the reserves, or found them possibly even a bit too low, considering that Wellmark pays out more than $5 billion per year in claims. [11]

Related Research Articles

Health insurance or medical insurance is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance is risk among many individuals. By estimating the overall risk of health risk and health system expenses over the risk pool, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to provide the money to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization, such as a government agency, private business, or not-for-profit entity.

Highmark

Highmark is a non-profit healthcare company and Integrated Delivery Network based in Pittsburgh, Pennsylvania, United States. It is a large individual not-for-profit health insurer in the United States, which operates several for-profit subsidiaries.

Blue Cross Blue Shield Association Federation of 36 separate United States health insurance organizations and companies

Blue Cross Blue Shield Association (BCBSA) is a federation of 35 separate United States health insurance companies that provide health insurance in the United States to more than 106 million people. It was formed in 1982 from the merger of its two namesake organizations: Blue Cross was founded in 1929 and became the Blue Cross Association in 1960, while Blue Shield emerged in 1939 and the Blue Shield Association was created in 1948.

The Massachusetts health care reform, commonly referred to as Romneycare, was a healthcare reform law passed in 2006 and signed into law by Governor Mitt Romney with the aim of providing health insurance to nearly all of the residents of the Commonwealth of Massachusetts.

Health Care Service Corporation major American multistate health insurer and health maintenance organization

Health Care Service Corporation (HCSC) is a member-owned health insurance company in the United States. HCSC was formerly known as Hospital Service Corporation and changed its name to Health Care Service Corporation in 1975. The company was founded in 1936 and is based in Chicago, Illinois with a network of offices in the United States. Health Care Service Corporation is the licensee of the Blue Cross and Blue Shield Association for five states. It concentrates its operations in Illinois, Montana, New Mexico, Oklahoma, and Texas.

Health insurance in the United States is any program that helps pay for medical expenses, whether through privately purchased insurance, social insurance, or a social welfare program funded by the government. Synonyms for this usage include "health coverage", "health care coverage", and "health benefits". In a more technical sense, the term "health insurance" is used to describe any form of insurance providing protection against the costs of medical services. This usage includes both private insurance programs and social insurance programs such as Medicare, which pools resources and spreads the financial risk associated with major medical expenses across the entire population to protect everyone, as well as social welfare programs like Medicaid and the Children's Health Insurance Program, which both provide assistance to people who cannot afford health coverage.

Independence Blue Cross (Independence) is a health insurer based in Philadelphia, Pennsylvania, in the United States. Independence is the largest health insurer in the Philadelphia area, serving more than two million people in the region and seven million nationwide.

Council for Affordable Quality Healthcare

Council for Affordable Quality Healthcare, Inc. is a non-profit organization incorporated in California as a mutual benefit corporation. It was first incorporated under the name Coalition for Affordable, Quality Healthcare, Inc., and then was renamed the Council for Affordable Quality Healthcare, Inc. on August 8, 2002. It is based in Washington, D.C.. Previously a 501(c)6 tax-exempt organization, CAQH changed its tax status in 2016, although it remains a non-profit.

In the United States, health insurance marketplaces, also called health exchanges, are organizations in each state through which people can purchase health insurance. People can purchase health insurance that complies with the Patient Protection and Affordable Care Act at ACA health exchanges, where they can choose from a range of government-regulated and standardized health care plans offered by the insurers participating in the exchange.

Mary Kramer American politician and diplomat

Mary E. Kramer is a former Republican Iowa State Senator who served from 1990 to 2003. She was elected President of the Senate in 1997, becoming the first independently elected woman to fill the post. In 2003 Kramer was nominated by President George W. Bush to serve as U.S. Ambassador to Barbados and the Eastern Caribbean; she was confirmed by the United States Senate and served from 2004 to 2006.

Affordable Care Act Obamacare, ACA - U.S. federal statute

The Affordable Care Act (ACA), formally known as the Patient Protection and Affordable Care Act, and colloquially known as Obamacare, is a United States federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act of 2010 amendment, it represents the U.S. healthcare system's most significant regulatory overhaul and expansion of coverage since the enactment of Medicare and Medicaid in 1965.

Blue Cross and Blue Shield of Alabama (BCBSAL) is a nonprofit health insurance company headquartered in Birmingham, Alabama. The company was founded in 1936, provides coverage to more than 3 million people and is a member of the Blue Cross and Blue Shield Association (BCBS). BCBSAL employs nearly 5,000 people, which includes almost 3,500 people at its corporate headquarters in Birmingham. The company also operates Cahaba Government Benefit Administrators and Cahaba Safeguard Administrators, both headquartered in Birmingham. It commands over 90 percent of the health insurance market in Alabama, a state with half a million uninsured people, one of the highest uninsured rates in the nation at 10 percent of the population.

Health insurance costs in the United States are a major factor in access to health coverage. The rising cost of health insurance leads more consumers to go without coverage and increase in insurance cost and accompanying rise in the cost of health care expenses has led health insurers to provide more policies with higher deductibles and other limitations that require the consumer to pay a greater share of the cost themselves.

Anthem (company) American healthcare company

Anthem, Inc., is a provider of health insurance in the United States. It is the largest for-profit managed health care company in the Blue Cross Blue Shield Association. As of 2018, the company had approximately 40 million members.

Covered California

Covered California is the health insurance marketplace in the U.S. state of California established under the federal Patient Protection and Affordable Care Act (ACA). The exchange enables eligible individuals and small businesses to purchase private health insurance coverage at federally subsidized rates. It is administered by an independent agency of the government of California.

The Iowa Employer Benefits Study is an annual survey of Iowa employers conducted to determine the types and amounts of employee benefits offered by organizations in Iowa. The information collected in this research allows employers to understand the value of their benefit plans compared to state and industry averages. Iowa benefits can also be compared to those offered nationally. The Iowa Employer Benefits Study is recognized to be a trustworthy and credible resource on employee benefits offered in this state.

The Affordable Care Act (ACA) is divided into 10 titles and contains provisions that became effective immediately, 90 days after enactment, and six months after enactment, as well as provisions phased in through to 2020. Below are some of the key provisions of the ACA. For simplicity, the amendments in the Health Care and Education Reconciliation Act of 2010 are integrated into this timeline.

The Affordable Care Act (ACA) established the health insurance rate review program in order to protect consumers from unreasonable rate increases. Through this program, proposed premium increases in the small group and individual markets that are above a threshold amount are reviewed by states or the federal government to determine whether the increases are reasonable.

David Young (Iowa politician) Former U.S. Representative from Iowa

David Edmund Young is an American politician who served as the U.S. Representative for Iowa's 3rd congressional district from 2015 to 2019. A member of the Republican Party, he is a native and resident of Van Meter, a western suburb of Des Moines. He was first elected in 2014 and reelected in 2016; he lost reelection in 2018 to Democrat Cindy Axne. Young unsuccessfully challenged Axne in 2020 to regain his old seat, losing by 1.3%.

The Patient Protection and Affordable Care Act, often shortened to the Affordable Care Act (ACA) or nicknamed Obamacare, is a United States federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act of 2010 amendment, it represents the U.S. healthcare system's most significant regulatory overhaul and expansion of coverage since the passage of Medicare and Medicaid in 1965. Once the law was signed, provisions began taking effect, in a process that continued for years. Some provisions never took effect, while others were deferred for various periods.

References

  1. ↑ "Company information".
  2. ↑ Tony, Leys (Oct 5, 2015). "Wellmark to sell policies on Obamacare exchange for 2017" . Retrieved 11 January 2016.
  3. 1 2 3 4 5 6 "History". Wellmark. 2014. Retrieved 24 June 2014.
  4. ↑ Coordinated Issue Paper – Blue Cross Blue Shield/Health Insurance; Life Insurance: Conversion of nonprofit corporations. 4 June 2008) Archived July 23, 2012, at the Wayback Machine
  5. 1 2 3 4 5 "Fast Facts". Wellmark. 2014. Retrieved 24 June 2014.
  6. 1 2 Patane, Matthew (20 June 2014). "Wellmark won't join health insurance exchange in 2015". Des Moines Register. Retrieved 24 June 2014.
  7. ↑ Chelsea Keenan (19 May 2014). "Wellmark enrolls 41,000 in Iowa, South Dakota". The Gazette. Retrieved 18 December 2014.
  8. 1 2 Deirdre Baker (24 July 2014). "Consumers due rebates now from health insurers". Quad City Times. Quad City Times. Retrieved 18 December 2014.
  9. 1 2 Patane, Matthew (20 June 2014). "Wellmark seeks insurance rate increases". Des Moines Register. Retrieved 24 June 2014.
  10. 1 2 3 "2013 Hearing Transcript" (PDF). Iowa Insurance Commission. 5 January 2013. p. 90. Retrieved 24 June 2014.
  11. 1 2 Leys, Tony (29 December 2013). "Forsyth responds to three criticisms of Wellmark". Des Moines Register. Retrieved 24 June 2014.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.