Agent Resources

Your connection to the most up to date application forms, rate sheets and training resources!

Newsletters & Updates

May 2017 Newsletter: REQUIRED – Wellmark Agent Certification, June Medicare Compliance Audit

2017 Medicare Costs at a Glance

Special Alert – REVISED Individual ACA Renewal Process

Special Alert: Individual ACA Renewal Process

Individual Open Enrollment is here!

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Individual Over 65

Applications & Forms

download-icon-circle-redRequired Federal Notice for Meaningful Access & Nondiscrimination: This notice must be included in all digital and print communications beginning AUGUST 26, 2016. Failure to provide this notice with ALL these communications will result in fines. Please contact your assigned Account Rep for any questions regarding this notice.

Medicare Supplement Ancillary

Medicare Supplement Ancillary Coverage Flyer – IA – Includes information on Dental, Vision and Hearing.

Application for Blue Dental and Avesis Vision and Hearing ( M-5318891 11/17 AN-T) – Application to add or remove optional ancillary coverage.  Available ONLY for MedicareBlue Supplement Members.

Medicare Supplement

download icon-circle22018 Medicare Cost Shares (a CMS document) – 2018 Part A/B deductible amounts, includes IRMAA amounts for both Part B & Part D

download icon-circle22018 MedicareBlue Supplement Enrollment Kit – IA (M-50374) – You will need to order on the Marketing Toolkit or contact your account team to order.

download icon-circle2Application for MedicareBlue Supplement Plans (M-53314 AN-T) 

download icon-circle22018 Outline of Coverage – Medicare Supplement

Medicarebluerx – Drug Plan

2018 MedicareBlueRx Enrollment Kit – IA/SD RAS1001R10 09/17 – Order kits by contacting your Account Manager with Partners Health Insurance or on the Market Toolkit on your Producer Connection page.

download icon-circle22018 MedicareBlue Rx (PDP) Sell Sheet – IA/SD RAS1014R08

download icon-circle22018 MedicareBlueRx Enrollment Form – application for 2016 MedicareBlueRx

2018 MedicareBlueRx EFT form

download icon-circle2Scope of Appointment Form – required document to use when discussing MedicareBlueRx products with customers

Individual Under 65

Applications & Forms

download-icon-circle-redRequired Federal Notice for Meaningful Access & Nondiscrimination: This notice must be included in all digital and print communications beginning AUGUST 26, 2016. Failure to provide this notice with ALL these communications will result in fines. Please contact your assigned Account Rep for any questions regarding this notice.

download icon-circle2Pre-ACA Contract Change Form N-5428 AN-T (9/17) – For pre-ACA Individual health plans – grandfathered & grandmothered plans.

download icon-circle2Automatic Authorization Form M-5779 (8/16) AN-T – Includes Standard Notice and Taglines for MA/ND

download icon-circle2SEP Chart (12/2017) – This chart outlines SEP information for Individual policies including effective dates, requirement application & contract change form, and additional documentation that is required

Small Group

Applications & Forms

download-icon-circle-redRequired Federal Notice for Meaningful Access & Nondiscrimination: This notice must be included in all digital and print communications beginning AUGUST 26, 2016. Failure to provide this notice with ALL these communications will result in fines. Please contact your assigned Account Rep for any questions regarding this notice.

download icon-circle2Group Application for ACA Small Business (N-5431 04/17 AN-T) – To be used only by employees of new non-grandfathered small groups size 1-50 applying for a plan from the small group ACA portfolio.  This is an application for small business health, dental, and vision insurance for coverage effective 1/1/16 and after. Includes Standard Notice and Taglines for MA/ND.

download icon-circle2Group Application for Health & Dental Insurance (N-5411 08/17  AN-T) – To be used by employees of Grandfathered and Non-Grandfathered Small Business Plans (2-50), Mid-Size Plans (51-100) or Large Group Fully Insured Plans (101+) with new hires, late enrollees, special enrollees, and changes. This application should also be used by Self-Funded Groups who offer coverage to domestic partners.  Includes Standard Notice and Taglines for MA/ND.

download icon-circle2Group Application for Health Insurance (N-5408 08/17  AN-T) To be used only by employees of groups 51+ or by current 2-50 grandfathered and non-grandfathered groups with new hires, late enrollees, special enrollees and changes. This is an application for Group Health Insurance for Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Health Plan of Iowa. Use this form for groups no longer applying pre-existing waiting periods in accordance with the Affordable Care Act (ACA). Includes Standard Notice and Taglines for MA/ND.

download icon-circle2MSP Compliance Form N-2305 (05/14  AN-T) – Includes Standard Notice and Taglines for MA/ND

download icon-circle2Group Employer Application for ACA Small Business (N-53292 09/17 AN-T) – Producers will use this application for groups enrolling in coverage effective 1/1/16 and after.

download icon-circle22018 Renewal Alternatives Form (M-4334) – (anytime a group is transitioning to an ACA plan beginning after 11-15-15)

download icon-circle2Group Membership Change Form – (N53143 10/14 AN-T) – Includes Standard Notice and Taglines for MA/ND

download icon-circle251 – 100 New Account Enrollment Form – M-53281 7/17

download icon-circle251 – 100 New Account Quote Request Form – M-53280 8/16

download icon-circle2Group Membership Change Forms for Small Business ACA Plans(N-4314 10/16) – Used only to notify Wellmark of membership or contract changes for Small Business ACA Plans effective 1/1/16 or after.

Large Group

download-icon-circle-redRequired Federal Notice for Meaningful Access & Nondiscrimination: This notice must be included in all digital and print communications beginning AUGUST 26, 2016. Failure to provide this notice with ALL these communications will result in fines. Please contact your assigned Account Rep for any questions regarding this notice.

Please contact Jaci Van Wechel for additional Large Group Forms

Training Resources

Wellmark Agent Certification – Annual. 2016 Certification is closed. Watch for 2017 Certification details which will be released Spring of 2017. Certification is located at the Blue Learning Center: wellmark.csod.com/

2018 MedicareBlueRx Certification – Training must be completed prior to marketing 2017 products.  Click this link to access the MedicareBlue Online Training Center

Please review these helpful guides:

*2018 MedicareBlueRx Online Training Center User Guide
*2018 Training and Certification FAQ
*MedicareBasics Resources

FFM Certification (required annually to sell on the Federal Marketplace) – For agents that are going to sell on the Federal Marketplace. Click the below resources for more information on the training:

*Quick Reference Guide for Plan Year 2017
*Resources for Agents & Brokers in the Health Insurance Marketplace

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