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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, 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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myBlue HDHPSM Silver CompleteBlueSM Modified BlueSimplicitySM Silver CompleteBlueSM 4000 CompleteBlueSM Primary
Medical deductible annual amount you pay before Wellmark pays
Single $4,500 $7,800 $0 $4,000 $5,500
Family $9,000 $15,600 $0 $8,000 $11,000
Coinsurance portion of medical cost you pay after your deductible is met 0% 0% 0% 30% 30%
Out-of-pocket maximum (OPM)  the most you'll spend in a year
Single $6,900 $7,800 $8,200 $8,300 $8,700
Family $13,800 $15,600 $16,400 $16,600 $17,400
Medical benefits
Preventive care screenings Free Free Free Free Free
Virtual visits Deductible $20 $20 $20 $10
Primary care office services $50 $60 $40 $10
Non-primary care office services Deductible; $60 after deductible $150 $110 $90 $150
Emergency room visit Deductible; $250 after deductible $500 $600 $500 Deductible plus 30% coinsurance
Outpatient Deductible Deductible $5,000 Deductible plus 30% coinsurance
Hospitalization $8,200
Pharmacy benefits — Blue Rx EssentialsSM
Preventive Free Free Free Free Free
Tier 1 $20 after deductible $30 $30 $30  $5
Tier 2 $60 after deductible $80  $100  $60 Deductible plus 30% coinsurance
Tier 3 $125 after deductible $175  $200  $125
Biosimilar and generic specialty $135 after deductible $235  $250 $135
Specialty preferred $150 after deductible $300 $300 $150
Specialty non-preferred $200 after deductible $500 $500 $500
Other benefits
Qualifies for health savings account (HSA) Yes No No No No
Medicare Part D Creditable Coverage Yes Yes Yes Yes No

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.