Traditional Health Plans
2020 ACA Plan Comparison Guide for Small Groups | Iowa
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|
|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|
|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|
|Medicare Part D Creditable Coverage7||No||Yes||Yes|
Your employees will be required to use Blue Distinction® Centers for knee and hip replacements, bariatric surgery and transplants in 2020.