Gold health plan options
2022 ACA Plan Comparison Guide | Iowa Small Group Plans
With a gold tier, overall Wellmark pays about 80 percent and your employees will pay about 20 percent of the plan's cost-sharing requirements, which can include the deductible, coinsurance and copays. Consider a gold plan for lower out-of-pocket expenses for your employees when they receive care.
Gold plan details
Regardless of the network you choose, all plans 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 include easy-to-navigate pharmacy benefits with Blue Rx EssentialsSM. Blue Rx Essentials prescription tiers are designated based on factors like cost and effectiveness when compared to similar drugs.
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| EnhancedBlueSM Modified | BlueSimplicitySM Gold | EnhancedBlueSM 2000 | EnhancedBlueSM Primary | EnhancedBlueSM 3000 | |
|---|---|---|---|---|---|
| Medical deductible — annual amount you pay before Wellmark pays | |||||
| Single | $4,700 | $0 | $2,000 | $2,500 | $3,000 |
| Family | $9,400 | $0 | $4,000 | $5,000 | $6,000 |
| Coinsurance — portion of medical cost you pay after your deductible is met | 0% | 0% | 20% | 20% | 30% |
| Out-of-pocket maximum (OPM) — the most you'll spend in a year | |||||
| Single | $4,700 | $4,800 | $5,100 | $6,900 | $7,000 |
| Family | $9,400 | $9,600 | $10,200 | $13,800 | $14,000 |
| Medical benefits | |||||
| Preventive screenings | Free | Free | Free | Free | Free |
| Virtual visits | $10 | $10 | $10 | $10 | $10 |
| Primary care office services | $35 | $35 | $25 | $10 | $30 |
| Non-primary care office services | $70 | $70 | $50 | $150 | $60 |
| Emergency room visits | $600 | $500 | $400 | Deductible plus 20% coinsurance | $400 |
| Outpatient | Deductible | $2,500 | Deductible plus 20% coinsurance | Deductible plus 30% coinsurance | |
| Hospitalization | $4,800 | ||||
| Pharmacy benefits — Blue Rx EssentialsSM | |||||
| Preventive | Free | Free | Free | Free | Free |
| Tier 1 | $30 | $25 | $15 | $5 | $20 |
| Tier 2 | $60 | $85 | $50 | Deductible plus 20% coinsurance | $50 |
| Tier 3 | $150 | $150 | $125 | $125 | |
| Biosimilar and generic specialty | $175 | $225 | $135 | $160 | |
| Specialty preferred | $200 | $300 | $150 | $200 | |
| Specialty non-preferred | $500 | $500 | $300 | $400 | |
| Other benefits | |||||
| Qualifies for health savings account (HSA) | No | No | No | No | No |
| Medicare Part D Creditable Coverage | Yes | Yes | Yes | Yes | Yes |
Virtual Visits with Doctor On Demand®
Reduce absenteeism and costs while increasing employee satisfaction with virtual visits, included in all our plans. Offered at a lower cost than an office visit, Doctor On Demand allows employees to connect face-to-face with a board-certified doctor or mental health professional from virtually anywhere.
