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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.

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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.