Health Plan Options for Peace of Mind
2021 ACA Plan Comparison Guide | South Dakota Small Group Plans
With traditional and modified health plans, your employees will have predictable copays for many common health care expenses, like in-network office visits.
Traditional and Modified plan options
- Traditional health plans — no deductible and coinsurance except for expenses like hospitalizations, outpatient surgery and maternity care.
- Modified health plans — eliminates coinsurance altogether.
Bronze and Silver plans
(Best if viewed on tablet size or larger.)
Amounts reflect covered, in-network services only.
| Health Care Services | SimplyBlueSM 6000 (Bronze) | SimplyBlueSM Modified (Bronze) | CompleteBlueSM 3500 (Silver) | CompleteBlueSM 5000 (Silver) | CompleteBlueSM Modified (Silver) |
|---|---|---|---|---|---|
 Most Popular |
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| Annual benefit — deductible1 | |||||
| Single | $6,000 | $8,400 | $3,500 | $5,000 | $7,700 |
| Family2 | $12,000 | $16,800 | $7,000 | $10,000 | $15,400 |
| Coinsurance — member pays | 50% | 0% | 30% | 30% | 0% |
| Annual benefit — out-of-pocket maximum (opm)1 | |||||
| Single out-of-pocket maximum | $8,550 | $8,400 | $8,00 | $8,150 | $7,700 |
| Family out-of-pocket maximum3 | $17,100 | $16,800 | $16,000 | $16,300 | $15,400 |
| Preventive care4 | Free | Free | Free | Free | Free |
| Virtual visit5 | $30 | $30 | $20 | $20 | $20 |
| Primary care office services6 | $70 | $80 | $40 | $50 | $50 |
| Non-primary care office services | Deductible/coinsurance apply | $160 | $90 | $100 | $150 |
| Emergency room | Deductible/coinsurance apply | $1,000 | $500 | $500 | $500 |
| Prescription drugs - Blue Rx EssentialsSM | |||||
| Tier 1: Most generics and select branded drugs | $30 | $30 | $30 | $35 | $30 |
| Tier 2: Preferred drugs based on effectiveness | All other tiers: deductible/coinsurance applies | All other tiers: annual benefit applies | $60 | $70 | $80 |
| Tier 3: Non-preferred drugs that have cost-effective alternatives | $125 | $140 | $175 | ||
| Specialty preferred: Proven to treat complex and rare conditions | $150 | $200 | $300 | ||
| Non-preferred: More beneficial than preferred alternative | $500 | $500 | $500 | ||
| Medicare Part D Creditable Coverage7 | No | No | Yes | Yes | Yes |
Gold plans
(Best if viewed on tablet size or larger.)
Amounts reflect covered, in-network services only.
| Health Care Services | EnhancedBlueSM 1500 (Gold) | EnhancedBlueSM 3000 (Gold) | EnhancedBlueSM Modified (Gold) | |
|---|---|---|---|---|
| Annual benefit — deductible1 | ||||
| Single | $1,500 | $3,000 | $4,600 | |
| Family2 | $3,000 | $6,000 | $9,200 | |
| Coinsurance — member pays | 20% | 30% | 0% | |
| Annual benefit — out-of-pocket maximum (opm)1 | ||||
| Single out-of-pocket maximum | $5,500 | $7,000 | $4,600 | |
| Family out-of-pocket maximum3 | $11,000 | $14,000 | $9,200 | |
| Preventive care4 | Free | Free | Free | |
| Virtual visit5 | $10 | $10 | $10 | |
| Primary care office services6 | $30 | $30 | $35 | |
| Non-primary care office services | $60 | $60 | $70 | |
| Emergency room | $500 | $400 | $600 | |
| Prescription drugs - Blue Rx EssentialsSM | ||||
| Tier 1: Most generics and select branded drugs | $15 | $20 | $30 | |
| Tier 2: Preferred drugs based on effectiveness | $50 | $50 | $60 | |
| Tier 3: Non-preferred drugs that have cost-effective alternatives | $100 | $125 | $150 | |
| Specialty preferred: Proven to treat complex and rare conditions | $200 | $200 | $200 | |
| Non-preferred: More beneficial than preferred alternative | $400 | $400 | $500 | |
| Medicare Part D Creditable Coverage7 | No | 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. 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. 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 copay 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.
