Wellmark plan comparison guide for Iowa small groups | traditional plans
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Traditional plan options

Wellmark's traditional health plans with predictable copays help your employees plan for many common health care expenses, like in-network office visits. For other expenses, like hospitalizations, outpatient surgery and maternity care, deductible and coinsurance may apply.

Regardless of the network you choose, all the products below are available. Amounts in the table reflect covered in-network services only. For PPO and POS plans, additional cost-shares will apply to out-of-network services.

All plans use Blue Rx EssentialsSM pharmacy benefits.

Plan Details SimplyBlueSM 6000 (Bronze) CompleteBlueSM 4000 (Silver) EnhancedBlueSM 2000 (Gold)
Annual Benefit — Deductible in-network1
Single deductible $6,000 $4,000 $2,000
Family2 deductible $12,000 $8,000 $4,000
Coinsurance — member pays 50% 30% 20%
Annual Benefit — Out-of-Pocket Maximum (opm) In-network
Single out-of-pocket maximum $8,150 $8,150 $5,000
Family3 out-of-pocket maximum $16,300 $16,300 $10,000
Preventive care4 screenings, immunizations Free Free Free
Virtual Visit5 $60 $40 $25
Primary care office Services6 $60 $40 $25
Non-primary care office services Deductible/coinsurance apply $90 $50
Emergency room Deductible/coinsurance apply $500 $400
Prescription drugs - Blue Rx EssentialsSM
Tier 1  For all tiers, deductible/coinsurance apply. $30 $15
Tier 2 $60 $50
Tier 3 $125 $125
Specialty preferred $150 $150
Non-preferred $500 $300
Medicare Part D Creditable Coverage7 No Yes Yes

Your employees will be required to use Blue Distinction® Centers for bariatric surgery and transplants in 2020.

1Both in-network and out-of-network services apply toward a single deductible. However, out-of-pocket costs for in-network services only apply to the in-network out-of-pocket maximum. Only out-of-pocket costs for out-of-network services apply to the out-of-network out-of-pocket maximum.
2The family deductible can be met through any combination of family members. No one member will be required to meet more than the single deductible amount to receive benefits for covered services during a benefit period.
3The family out-of-pocket maximum (OPM) can be met through any combination of family members. No one member will be required to meet more than the single OPM amount to receive benefits for covered services during a benefit period.
4All costs waived when using an in-network or participating provider on PPO plans. On all other available networks, costs are waived when using an in-network provider. Preventive care includes gynecological exam, preventive exam, screening mammography, well-child care and newborn care. For plans on the Wellmark ValueSM Health Plan HMO Network, a designated personal doctor must be seen for preventive care/screenings and immunizations. One preventive exam with separate gynecological exam per member per benefit period. Well-child care up to age 7 (includes normal newborn care, physical examinations, assessments and immunizations.)
5The virtual visit copay applies to Doctor On DemandTM.
6The primary care office copay applies to family practitioners, general practitioners, internal medicine practitioners, obstetricians/gynecologists, pediatricians, physicians' assistants and advanced registered nurse practitioners. This lower office copay also applies to in-network chiropractors, physical therapists, occupational therapists, speech pathologists, and in some cases, mental health or chemical dependency visits. All other in-network practitioners are subject to the non-primary care office copay. The copay applies per practitioner, per visit.