Health Plan Options for Peace of Mind
2021 ACA Plan Comparison Guide | South Dakota Small Group Plans
HDHPs encourage employee engagement in their health care by involving them in the full cost of care until they reach their deductible — and offers the lowest monthly premiums.
High-Deductible plan options
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Amounts reflect covered, in-network services only.
| Health Care Services | myBlue HDHPSM Bronze | myBlue HDHPSM Silver |
|---|---|---|
| Annual Benefit — Deductible 1 | ||
| Single deductible | $6,900 | $4,500 |
| Family2 deductible | $13,800 | $9,000 |
| Coinsurance — member pays | 0% | 0% |
| Annual benefit — Out-of-Pocket Maximum (opm) In-network | ||
| Single out-of-pocket maximum | $6,900 | $6,750 |
| Family3 out-of-pocket maximum | $13,800 | $13,500 |
| Preventive care4 screenings, immunizations | Free | Free |
| Virtual Visit5 | Deductible applies | $0 after deductible |
| Primary care office services6 | Deductible applies | $0 after deductible |
| Non-primary care office services | Deductible applies | $60 after deductible |
| Emergency room | Deductible applies | $250 after deductible |
| Prescription drugs - Blue Rx EssentialsSM | ||
| Tier 1: Most generics and select branded drugs | Deductible applies | $20 after deductible |
| Tier 2: Preferred drugs based on effectiveness | $60 after deductible | |
| Tier 3: Non-preferred drugs that have cost-effective alternatives | $125 after deductible | |
| Specialty preferred: Proven to treat complex and rare conditions | $150 after deductible | |
| Non-preferred: More beneficial than preferred alternative | $200 after deductible | |
| Medicare Part D Creditable Coverage7 | No | Yes |
1 Both in-network and out of-network services apply toward a single deductible. However, out-of-pocket costs for in-network services only apply to the in-network out-of-pocket maximum. Only out-of-pocket costs for out-of-network services apply to the out-of-network out-of-pocket maximum.
2 The family deductible can be met through any combination of family members for all plans. No one member will be required to meet more than the single deductible amount to receive benefits for covered services during a benefit period.
3 The family out-of-pocket maximum (OPM) can be met through any combination of family members. No one member will be required to meet more than the single OPM amount to receive benefits for covered services during a benefit period.
4 All costs waived when using an in-network or participating provider. One preventive exam with a separate gynecological exam per member per benefit period. Preventive care includes gynecological exam, preventive exam, screening mammography, well-child and newborn visits. One preventive exam with separate gynecological exam per member per benefit period. Well-child visits up to age 7 (includes normal newborn visits, physical examinations, assessments and immunizations.)
5 This applies to Wellmark's preferred virtual visit partner, Doctor On Demand.
6 The primary care office copay applies to family practitioners, general practitioners, obstetricians/gynecologists, pediatricians, physicians' assistants and advanced registered nurse practitioners. This lower office copay also applies to in-network chiropractors, physical therapists, occupational therapists, and in some cases, mental health or chemical dependency visits. All other in-network practitioners are subject to the non-primary care office copay. The copay applies per practitioner, per visit.
7 Medicare Part D creditable coverage status applies for 2021 plan year only.
