Health Plan Options for Peace of Mind
2021 ACA Plan Comparison Guide | Iowa Small Group Plans
With a BlueSimplicity plan, your employees will know the absolute maximum amount a service or procedure will cost before they seek care.
BlueSimplicity plan options
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Amounts reflect covered, in-network services only. For plans within a PPO and POS network, additional cost-shares will apply to out-of-network services.
|Health Care Services||BlueSimplicitySM Silver||BlueSimplicitySM Gold|
|Annual benefit — out-of-pocket maximum (opm)1|
|Level 1: Preventive care4||Free||Free|
|Level 2: Primary care provider (PCP) office visit5, facility lab/X-ray||$60||$35|
|Level 3: Non- office visit, outpatient PT/OT/ST, home health care, durable medical equipment (DME)||$110||$70|
|Level 4: Emergency room, ground ambulance, diagnostic imaging/studies6 and radiation therapy||$600||$500|
|Level 5: Outpatient practitioner and facility||$5,000||$2,500|
|Level 6: Hospitalization, air ambulance and skilled nursing facility||$8,100||$4,000|
|Prescription drugs - Blue Rx EssentialsSM|
|Tier 1: most generics and select branded drugs||$30||$25|
|Tier 2: Preferred drugs based on effectiveness||$100||$85|
|Tier 3: Non-preferred drugs that have cost-effective alternatives||$200||$150|
|Specialty preferred: Proven to treat complex and rare conditions||$300||$300|
|Non-preferred: more beneficial than preferred alternative||$500||$500|
|Medicare Part D Creditable Coverage7||Yes||Yes|
Your employees will be required to use Blue Distinction® Centers for bariatric surgery and transplants. There are many Blue Distinction Centers across the state. Find the closest one to you.