BlueSimplicitySM Health Plans
2020 ACA Plan Comparison Guide for Small Groups | South Dakota
Make it easy for your employees to know how much a service or procedure will cost before they go for care. BlueSimplicity is an innovative health plan that assigns copays based on the type of service received.
BlueSimplicity plan options
With BlueSimplicity, services are grouped into six levels, making it easy for your employees to know their cost share even before receiving services.
- Level 1 services are free and include preventive services.
- Level 6 services require higher member copays and cover more serious health needs, such as air ambulance services and hospitalizations.
Amounts in the table reflect covered in-network services only. All plans use Blue Rx Essentials℠ pharmacy benefits.
|Plan Details||BlueSimplicitySM Silver||BlueSimplicitySM Gold|
|Annual benefit — out-of-pocket maximum (opm) In-network1|
|Single out-of-pocket maximum||$7,900||$4,500|
|Family2 out-of-pocket maximum||$15,800||$9,000|
|Level 1: Preventive care3||Free||Free|
|Level 2: Primary care provider (PCP) office visit4, facility lab/X-ray, virtual visit5||$50||$30|
|Level 3: Non-PCP office visit, outpatient PT/OT/ST, home health care, durable medical equipment (DME)||$100||$60|
|Level 4: Emergency room, ground ambulance, diagnostic imaging/studies6 and radiation therapy||$600||$500|
|Level 5: Outpatient practitioner and facility||$5,000||$2,500|
|Level 6: Hospitalization, air ambulance and skilled nursing facility||$7,900||$3,500|
|Prescription drugs - Blue Rx Essentials|
|Medicare Part D Creditable Coverage7||Yes||Yes|