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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.

EnhancedBlueSM 1500 EnhancedBlueSM 3000 EnhancedBlueSM Primary
Medical deductible annual amount you pay before Wellmark pays
Single $1,500 $3,000 $2,500
Family $3,000 $6,000 $5,000
Coinsurance portion of medical cost you pay after your deductible is met 20% 30% 25%
Out-of-pocket maximum (OPM)  the most you'll spend in a year
Single $6,500 $6,000 $5,650
Family $13,000 $12,000 $11,300
Medical benefits
Preventive screenings Free Free Free
Virtual visits $0 $0 $0
Primary care office services $30 $30 $10
Non-primary care office services $60 $60 $100
Emergency room visits $500 $400Deductible plus 25% coinsurance
Outpatient Deductible plus 20% coinsurance Deductible plus 30% coinsurance
Hospitalization
Pharmacy benefits — Blue Rx EssentialsSM
Preventive Free Free Free
Tier 1 $15 $15 $10
Tier 2 $50 $40Deductible plus 25% coinsurance
Tier 3 $100 $100
Biosimilar and generic specialty $150 $160
Specialty preferred $200 $200
Specialty non-preferred $500 $400
Other benefits
Qualifies for health savings account (HSA) No No No
Medicare Part D Creditable Coverage Yes Yes Yes
EnhancedBlueSM 1500
Medical deductible annual amount you pay before Wellmark pays
Single $1,500
Family $3,000
Coinsurance portion of medical cost you pay after your deductible is met 20%
Out-of-pocket maximum (OPM)  the most you'll spend in a year
Single $6,500
Family $13,000
Medical benefits
Preventive screenings Free
Virtual visits $0
Primary care office services $30
Non-primary care office services $60
Emergency room visits $500
Outpatient Deductible plus 20% coinsurance
Hospitalization
Pharmacy benefits — Blue Rx EssentialsSM
Preventive Free
Tier 1 $15
Tier 2 $50
Tier 3 $100
Biosimilar and generic specialty $150
Specialty preferred $200
Specialty non-preferred $500
Other benefits
Qualifies for health savings account (HSA)
Medicare Part D Creditable Coverage Yes
EnhancedBlueSM 3000
Medical deductible annual amount you pay before Wellmark pays
Single $3,000
Family $6,000
Coinsurance portion of medical cost you pay after your deductible is met 30%
Out-of-pocket maximum (OPM)  the most you'll spend in a year
Single $6,000
Family $12,000
Medical benefits
Preventive screenings Free
Virtual visits $0
Primary care office services $30
Non-primary care office services $60
Emergency room visits $400
Outpatient Deductible plus 30% coinsurance
Hospitalization
Pharmacy benefits — Blue Rx EssentialsSM
Preventive Free
Tier 1 $15
Tier 2 $40
Tier 3 $100
Biosimilar and generic specialty $160
Specialty preferred $200
Specialty non-preferred $400
Other benefits
Qualifies for health savings account (HSA) No
Medicare Part D Creditable Coverage Yes
EnhancedBlueSM Primary
Medical deductible annual amount you pay before Wellmark pays
Single $2,500
Family $5,000
Coinsurance portion of medical cost you pay after your deductible is met 25%
Out-of-pocket maximum (OPM)  the most you'll spend in a year
Single $5,650
Family $11,300
Medical benefits
Preventive screenings Free
Virtual visits $0
Primary care office services $10
Non-primary care office services $100
Emergency room visits Deductible plus 25% coinsurance
Outpatient
Hospitalization
Pharmacy benefits — Blue Rx EssentialsSM
Preventive Free
Tier 1 $10
Tier 2 Deductible plus 25% coinsurance
Tier 3
Biosimilar and generic specialty
Specialty preferred
Specialty non-preferred
Other benefits
Qualifies for health savings account (HSA) No
Medicare Part D Creditable Coverage 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.

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