Silver health plan options
2022 ACA Plan Comparison Guide | South Dakota 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
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.
(Best if viewed on tablet size or larger.)
| 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.
