In 1948, Associated Hospital Services began doing business in South Dakota and marketing activities as Blue Cross.

[3] In 1996, Blue Shield of South Dakota merged into IASD to form a single company.

[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.

[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] As of 2016[update] 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.

[5] As of 2014[update] 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.

[10] 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.