Health Plan Options for Peace of Mind
2021 ACA Plan Comparison Guide | South Dakota Small Group Plans
Make it easy for your employees to know how much a service or procedure will cost before they go for care. BlueSimplicity is an innovative health plan that assigns copays based on the type of service received.
BlueSimplicity plan options
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Amounts reflect covered, in-network services only.
Health Care Services | BlueSimplicitySM Silver | BlueSimplicitySM Gold |
---|---|---|
Annual benefit — out-of-pocket maximum (opm)1 | ||
Single OPM | $8,100 | $4,750 |
Family2 OPM | $16,200 | $9,500 |
Virtual visit3 | $20 | $10 |
Level 1: Preventive care4 | Free | Free |
Level 2: Primary care provider (PCP) office visit5, facility lab/X-ray | $60 | $35 |
Level 3: Non- office visit, outpatient PT/OT/ST, home health care, durable medical equipment (DME) | $110 | $70 |
Level 4: Emergency room, ground ambulance, diagnostic imaging/studies6 and radiation therapy | $600 | $500 |
Level 5: Outpatient practitioner and facility | $5,000 | $2,500 |
Level 6: Hospitalization, air ambulance and skilled nursing facility | $8,100 | $4,000 |
Prescription drugs - Blue Rx EssentialsSM | ||
Tier 1: Most generics and select branded drugs | $30 | $25 |
Tier 2: Preferred drugs based on effectiveness | $100 | $85 |
Tier 3: Non-preferred drugs that have cost-effective alternatives | $200 | $150 |
Specialty preferred: Proven to treat complex and rare conditions | $300 | $300 |
Non-preferred: More beneficial than preferred alternative | $500 | $500 |
Medicare Part D Creditable Coverage7 | Yes | Yes |