CurrentBlue Cross Blue Shield - IowaPolicy H5900-006

SilverSneakers fitness benefit

Defines the SilverSneakers fitness membership benefit available to eligible Blue Medicare Advantage Valor PPO members in Iowa and South Dakota, including covered services, vendor requirements, member cost-sharing, and enrollment options.

Policy Summary

PayerBlue Cross Blue Shield - Iowa

PolicySilverSneakers fitness benefit

Policy CodePolicy H5900-006

Change TypeNo material change

Effective DateJan 1, 2022

Next Review Date

Key ActionEnroll members only at plan-authorized SilverSneakers vendors to ensure benefit coverage.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

IA & SDGeographic scope

Participating centersBenefit availability

1-888-338-0345Member contact

Eff 01/01/2022Policy dates

Covered Benefits and Limitations

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Program eligibility and vendor: Member must be enrolled in Blue Medicare Advantage Valor PPO (Wellmark Advantage Health Plan) and must use a plan-authorized SilverSneakers vendor to receive the benefit.

Applies because Original Medicare does not cover fitness services; benefit scope determined by WMAHP.

Covered services: SilverSneakers membership at participating locations; customized classes, seminars, and other social educational events; a trained senior adviser to assist members at the fitness center; conditioning classes, exercise equipment and possible amenities (e.g., pool, sauna); online support and programs, SilverSneakers GO app, and SilverSneakers Steps at‑home kit for members not near a contracted center.

Eligible members receive a SilverSneakers membership card and may enroll at participating centers; members must show their WMAHP identification card when enrolling.

Provider / Vendor and Member Operational Requirements

Note

Enrollment with plan-authorized vendor

Enrollment with a plan-authorized vendor — No prior authorization is required for membership. Members must enroll with a plan-authorized SilverSneakers vendor or participating fitness center to receive the benefit. The SilverSneakers benefit does not include gym or health club memberships other than those facilities that participate in the program.

Members not in close proximity to a contracted fitness center may request SilverSneakers Steps (at-home kit) or use the SilverSneakers GO app.
Members will receive a SilverSneakers membership card and must show their WMAHP identification card when enrolling at a participating fitness center.

Denial Risk

Vendor participation required

Vendor participation required — Members must use a plan-authorized vendor or participating SilverSneakers fitness center to access the benefit. Use of non–plan-authorized vendors or non-participating gyms is not covered and may lead to denial of the benefit.

The SilverSneakers benefit covers membership payments only at participating facilities.

Billing Rule

Member liability for elective non-covered services

Member liability for elective non-covered services — Some centers offer services that require added costs (for example, court sports, massage therapy, or other fee-based activities). If a member elects to receive a non-covered or add-on service, the member is fully responsible for the entire charge associated with that service.

To verify member eligibility, benefits, and applicable cost share, visit the WMAHP secure website or call Provider Inquiry 1-855-716-2556 (TTY:711).

Key Definitions

SilverSneakers — definition and summary of program components

Program definitionSilverSneakers is a basic fitness benefit offering classes, seminars, trained senior advisers, conditioning classes, exercise equipment, and online support tailored to older adults to improve strength, endurance, flexibility, agility, and balance.

Included servicesMembership at participating SilverSneakers locations nationwide; customized classes and seminars; trained senior adviser assistance; conditioning classes and exercise equipment; online resources including SilverSneakers GO and at‑home kits.

Enrollment requirementMember must be enrolled in the Blue Medicare Advantage Valor PPO (Wellmark Advantage Health Plan) and enroll with a plan‑authorized SilverSneakers vendor to receive the benefit.

Member verificationMembers must show their WMAHP identification card when enrolling at participating centers; providers may verify eligibility via the WMAHP secure website or Provider Inquiry phone number.

Excluded/optional paid servicesServices that require added costs (e.g., court sports, massage therapy) are not covered and are the member's financial responsibility if elected.

Background

SilverSneakers is a specialized fitness program for older adults offered through Wellmark Advantage Health Plan. The program provides membership at participating facilities and program-specific services such as classes, trained staff assistance, and online resources. To receive the benefit, members must enroll with and use a plan-authorized vendor; memberships at facilities that do not participate in the SilverSneakers program are excluded. Additionally, certain on-site offerings that carry extra fees (e.g., court sports, massage therapy) are outside the benefit scope and are the financial responsibility of the member if elected.

Policy Dates & Revision History

2026-01-01policy updateLatest

Policy updated (document lists 'Updated: 01/01/2026').

2022-01-01effective date

Policy became effective (Effective: 01/01/2022).

2021-09-13creation

Policy created (Created: 9/13/2021).