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) |
---|---|---|---|---|---|
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 |