Gold health plan options
2023 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.
| 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 | $400 | Deductible 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 | $40 | Deductible 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.
