Modified health plans
2020 ACA Plan Comparison Guide for Small Groups | South Dakota
Modified plans offer an easier approach to understanding cost-shares with a more traditional product design. These plans provide a simple approach by eliminating coinsurance — often cited as the most confusing aspect of health insurance.
Modified health plan options
Modified health plans offer protection from high-cost, catastrophic medical expenses like a hospital stay, while still offering simple copays for the most common services like office visits.
Amounts in the table reflect covered in-network services only. All plans use Blue Rx EssentialsSM pharmacy benefits.
|Plan Details||SimplyBlueSM Modified (Bronze)||CompleteBlueSM Modified (Silver)||EnhancedBlueSM Modified (Gold)|
|Annual benefit — deductible/out-of-pocket maximum (opm) In-network1|
|Single out-of-pocket maximum||$8,150||$7,500
|Family2 out-of-pocket maximum||$16,300||$15,000||$9,000|
|Coinsurance — member pays||0%||0%||0%|
|Primary care office services5||$75||$50||$30|
|Non-primary care office services||$150||$100||$60|
|Prescription drugs - Blue Rx Essentials|
|Tier 2||All other tiers: annual benefit applies||$80||$50|
|Medicare Part D Creditable Coverage6||No||Yes||Yes|