Understand Health Coverage Benefits
2020 ACA Plan Comparison Guide for Small Groups | South Dakota
Blue Distinction® Centers
When your employees need specialized care, like a surgery or a transplant, choosing where to seek care can be a big decision. And, where they go can impact their results.
Blue Distinction Centers are recognized for their proven history of delivering exceptional care and results. This could mean fewer complications, lower readmissions and higher survival rates.
Providers, hospitals and facilities meet pre-determined standards to earn a Blue Distinction Center designation, and all Wellmark members have full access to the Blue Distinction network – no matter their plan.
There are many Blue Distinction Centers across the state of South Dakota, learn more about the program and find the closest facility to you External Site.
Blue Distinction Centers have shown quality results in these areas:
Bariatric surgery – 32% lower ER visit rate
Cardiac care – 12% lower inappropriate procedure rate
Fertility care – 38% higher single, live birth success rate
Knee, hip replacement – 7% lower complication rate
Maternity care – 70% lower early elective delivery rate
Spine surgery – 47% lower reoperation rate
Transplants – 15% better one-year patient survival rate
Blue Rx EssentialsSM
No matter which plans you choose, our pharmacy benefits are easy to navigate with Blue Rx Essentials.
Blue Rx Essentials prescription tiers are designated based on factors like cost and effectiveness when compared to similar drugs. Combined with our easy-to-navigate pharmacy network and tools, your employees will understand what they'll pay without any hidden costs or fees.
Drug Tier 1 has the lowest payment obligation. It includes most generics and select branded drugs that have no generic equivalent.
Drug Tier 2 has a higher payment obligation than Tier 1 and is made up of drugs that are preferred based on effectiveness when compared to similar drugs.
Drug Tier 3 also increases the payment obligation. It consists of non-preferred drugs that have reasonable, more cost-effective alternatives on Tier 1 or Tier 2. There are also some specialty preferred drugs in this tier that are used to treat complex or rare conditions.
Specialty Drugs are split into two categories — preferred and non-preferred. Preferred drugs are proven to treat complex or rare conditions. There is insufficient clinical evidence indicating non-preferred drugs are more beneficial than preferred alternatives.
In addition to these tiers, we also offer select drugs to your employees with zero cost share. This includes FDA-approved preventive drugs, such as contraceptives, tobacco cessation medications, supplements for pregnant women and more. View the full ACA preventive health and drug list PDF File.
Virtual visits with Doctor On Demand®
Reduce absenteeism and costs, while increasing employee convenience and satisfaction. Included in all of our plans is coverage with our preferred virtual visit provider, Doctor On Demand External Site. With Doctor On Demand your employees can connect face-to-face with a board-certified doctor from virtually anywhere using a smartphone, tablet or computer on their schedule.
Doctor On Demand has:
- Shown a reduction in absenteeism
- Lower costs than urgent care and emergency room visits
- An average wait time of five minutes
- More than 28,500 customers with over 1 million visits – and a 4.9 star rating out of 5
Doctor On Demand physicians can treat hundreds of the most common medical conditions, including prescribing medication if needed.1 Your employees and their family members can see a doctor for:
- Cold and flu symptoms
- Bronchitis and sinus infections
- Urinary tract infections
- Sore throats
- Pink eye
- Skin conditions
- Mental health issues2
Learn more at Doctor On Demand External Site and download the app from the App Store® or on Google PlayTM.
Your health coverage benefits
No matter which plans you choose, your employees will have these common coverage benefits.
- Preventive and wellness services
- Pediatric dental and vision services3
- Maternity, newborn and pediatric care
- Emergency and ambulatory patient services
- Physical, occupation or speech therapy services
- Rehabilitative and habilitative services and devices
- Prescription drugs
- Physician and facility services
- Chronic disease management
- Mental health and substance use disorder services
- Durable medical equipment
Once your employees enroll in a Wellmark health plan, they'll receive a complete coverage manual outlining all benefit details. They can also find detailed cost information in their Summary of Benefits and Coverage document, or by registering and logging in to myWellmark®.