Silver health plan options
2022 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.
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.
