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Silver plan details

All of our members in South Dakota use the Wellmark Blue PPOSM Network which gives them access to more than 1.7 million unique, in-network health care providers throughout the United States1. Amounts in the table reflect covered, in-network services only. 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 CompleteBlueSM 3500 Blue SimplicitySM Silver CompleteBlueSM 5000 CompleteBlueSM Primary
Medical deductible annual amount you pay before Wellmark pays
Single $4,500 $7,800 $3.500 $0 $5,000 $5,500
Family $9,000 $15,600 $7,000 $0 $10,000 $11,000
Coinsurance portion of medical cost you pay after your deductible is met 0% 0% 30% 0% 30% 30%
Out-of-pocket maximum (OPM)  the most you'll spend in a year
Single $6,900 $7,800 $8,100 $8,200 $8,300 $8,700
Family $13,800 $15,600 $16,200 $16,400 $16,600 $17,400
Medical benefits
Preventive care screenings Free Free Free Free Free Free
Virtual visits Deductible $20 $20 $20 $20 $10
Primary care office services $50 $40 $60 $50 $10
Non-primary care office services Deductible; $60 after deductible $150 $90 $110 $100 $150
Emergency room visit Deductible; $250 after deductible $500 $500 $600 $500 Deductible plus 30% coinsurance
Outpatient Deductible Deductible Deductible plus 30% coinsurance $5,000 Deductible plus 30% coinsurance
Hospitalization $8,200
Pharmacy benefits — Blue Rx EssentialsSM
Preventive Free Free Free Free Free Free
Tier 1 $20 after deductible $30 $30 $30 $35 $5
Tier 2 $60 after deductible $80  $60  $100  $70 Deductible plus 30% coinsurance
Tier 3 $125 after deductible $175  $125 $200  $140
Biosimilar and generic specialty $135 after deductible $235  $135 $250 $170
Specialty preferred $150 after deductible $300 $150 $300 $200
Specialty non-preferred $200 after deductible $500 $500 $500 $500
Other benefits
Qualifies for health savings account (HSA) Yes No No No No No
Medicare Part D Creditable Coverage Yes Yes Yes Yes Yes No

1 Provider Data Repository (PDR), January 2021. From national BlueCard PPO portion of the network reporting services (NRS) extract of PDR data. The data is limited to records in Plans' licensed service.

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.