Wellmark will change some product coverage

Insurer to enter Affordable Care Act exchange this year

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DES MOINES — Wellmark Blue Cross and Blue Shield — the largest private provider of health insurance in Iowa — announced Tuesday it will reduce coverage for some of its products in the individual Affordable Care Act market in Iowa.

Wellmark announced in May it would enter the Iowa exchange for 2017. At that time, it said it wanted to offer “new and innovative” plans.

But for the past two years, according to the company, Wellmark customers with individual ACA plans have endured double-digit increases. In addition, Wellmark has lost about $99 million over the same time period in the individual market in Iowa and South Dakota.

“Wellmark’s mission is to create affordable health insurance for people to access quality health care ... ,” Wellmark Chairman and CEO John Forsyth said in a prepared statement. “However, it’s apparent that continuing to offer plans with broad networks, combined with the rich benefits of the ACA, is not consistent with managing continually rising costs.

“While we could seek additional premium increases to mitigate rising costs, this is not sustainable for our members’ pocketbook.”

In Iowa, Wellmark no longer will offer its gold-tier plans or promote individual under-65 plans that use its preferred provider organization (PPO) network in Iowa. Individual ACA members with a silver or bronze PPO plan today may continue on that plan for 2017, it said.

The announced changes do not affect people with grandfathered plans — those that generally purchased their individual plans before Jan. 1, 2014. The changes also do not affect customers with plans through their employer or those with Medicare supplement plans.

Wellmark also plans to debut two health insurance companies — Wellmark Value Health Plan (with Mercy Health Network) and Wellmark Synergy Health (with University of Iowa Health System).

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