Silver health plan options
2024 ACA Plan Comparison Guide | Iowa Small Group Plans
With a silver tier, overall Wellmark pays about 70 percent and your employees will pay about 30 percent of the plan's cost-sharing requirements, which can include the deductible, coinsurance and copays. Consider a silver plan if you want to balance monthly premium costs vs. out-of-pocket expenses for your employees when they receive care.
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Silver 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, cost shares will apply to out-of-network services. HMO and POS plans may have a variation in benefit costs when employees establish and visit a designated primary care provider (PCP). Steering employees to their designated PCP results in stronger patient-provider relationships and a higher quality of care through patient management.
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.
HMO/POS network
CompleteBlueSM 4000
Deductible
- Single: $4,000
- Family: $8,000
Coinsurance: 30%
Out-of-pocket max
- Single: $9,000
- Family: $18,000
Medical benefits
Preventive: Free
Virtual visit with Doctor On Demand®: $0
Office services
- Designated PCP : $35
- Other PCP: $50
- Non-PCP: $100
Office-administered specialty medical drug: $150
Hospital services
- Emergency room: $700
- Outpatient / Inpatient: 30% after deductible
Blue Rx EssentialsSM
- Preventive: Free
- Tier 1: $30
- Tier 2: $60
- Tier 3: $150
Specialty
- Biosimilar / generic: $135
- Preferred: $150
- Non-preferred: $500
Medicare Part D Creditable: Yes
CompleteBlueSM 5000
Deductible
- Single: $5,000
- Family: $10,000
Coinsurance: 30%
Out-of-pocket max
- Single: $9,000
- Family: $18,000
Medical benefits
Preventive: Free
Virtual visit with Doctor On Demand®: $0
Office services
- Designated PCP: $45
- Other PCP: $60
- Non-PCP: $100
Office-administered specialty medical drug: $200
Hospital services
- Emergency room: $600
- Outpatient / Inpatient: 30% after deductible
Blue Rx EssentialsSM
- Preventive: Free
- Tier 1: $35
- Tier 2: $70
- Tier 3: $140
Specialty
- Biosimilar / generic: $170
- Preferred: $200
- Non-preferred: $500
Medicare Part D Creditable: Yes
CompleteBlueSM Primary
Deductible
- Single: $5,750
- Family: $11,500
Coinsurance: 30%
Out-of-pocket max
- Single: $8,900
- Family: $17,800
Medical benefits
Preventive: Free
Virtual visit with Doctor On Demand®: $0
Office services
- Designated PCP: $10
- Other PCP: $25
- Non-PCP: $100
Office-administered specialty medical drug: 30% after deductible
Hospital services
- Emergency room: 30% after deductible
- Outpatient / Inpatient: 30% after deductible
Blue Rx EssentialsSM
- Preventive: Free
- Tier 1: $15
- Tier 2: 30% after deductible
- Tier 3: 30% after deductible
Specialty
- Biosimilar / generic: 30% after deductible
- Preferred: 30% after deductible
- Non-preferred: 30% after deductible
Medicare Part D Creditable: No
myBlue HDHPSM 5500
Deductible
- Single: $5,500
- Family: $11,000
Coinsurance: 0%
Out-of-pocket max
- Single: $5,500
- Family: $11,000
Medical benefits
Preventive: Free
Virtual visit with Doctor On Demand®: Deductible applies
Office services: Deductible applies
Office-administered specialty medical drug: Deductible applies
Hospital services: Deductible applies
Emergency room: Deductible applies
Blue Rx Essentials
- All tiers: Deductible applies
Medicare Part D Creditable: Yes
PPO network
CompleteBlueSM 4000
Deductible
- Single: $4,000
- Family: $8,000
Coinsurance: 30%
Out-of-pocket max
- Single: $9,000
- Family: $18,000
Medical benefits
Preventive: Free
Virtual visit with Doctor On Demand®: $0
Office services
- PCP: $40
- Non-PCP: $100
Office-administered specialty medical drug: $150
Hospital services
- Emergency room: $700
- Outpatient / Inpatient: 30% after deductible
Blue Rx Essentials
- Preventive: Free
- Tier 1: $30
- Tier 2: $60
- Tier 3: $150
Specialty
- Biosimilar / generic: $135
- Preferred: $150
- Non-preferred: $500
Medicare Part D Creditable: Yes
CompleteBlueSM 5000
Deductible
- Single: $5,000
- Family: $10,000
Coinsurance: 30%
Out-of-pocket max
- Single: $9,000
- Family: $18,000
Medical benefits
Preventive: Free
Virtual visit with Doctor On Demand®: $0
Office services
- PCP: $50
- Non-PCP: $100
Office-administered specialty medical drug: $200
Hospital services
- Emergency room: $600
- Outpatient / Inpatient: 30% after deductible
Blue Rx Essentials
- Preventive: Free
- Tier 1: $35
- Tier 2: $70
- Tier 3: $140
Specialty
- Biosimilar / generic: $170
- Preferred: $200
- Non-preferred: $500
Medicare Part D Creditable: Yes
CompleteBlueSM Primary
Deductible
- Single: $5,750
- Family: $11,500
Coinsurance: 30%
Out-of-pocket max
- Single: $8,900
- Family: $17,800
Medical benefits
Preventive: Free
Virtual visit with Doctor On Demand®: $0
Office services
- PCP: $15
- Non-PCP: $100
Office-administered specialty medical drug: 30% after deductible
Hospital services
- Emergency room: 30% after deductible
- Outpatient / Inpatient: 30% after deductible
Blue Rx Essentials
- Preventive: Free
- Tier 1: $15
- Tier 2: 30% after deductible
- Tier 3: 30% after deductible
Specialty
- Biosimilar / generic: 30% after deductible
- Preferred: 30% after deductible
- Non-preferred: 30% after deductible
Medicare Part D Creditable: No
myBlue HDHPSM 5500
Deductible
- Single: $5,500
- Family: $11,000
Coinsurance: 0%
Out-of-pocket max
- Single: $5,500
- Family: $11,000
Medical benefits
Preventive: Free
Virtual visit with Doctor On Demand®: Deductible applies
Office services: Deductible applies
Office-administered specialty medical drug: Deductible applies
Hospital services: Deductible applies
Emergency room: Deductible applies
Blue Rx Essentials
- All tiers: Deductible applies
Medicare Part D Creditable: 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.
