Wellmark plan comparison guide for South Dakota small groups | Modified health plans
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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
$4,500
Family2 out-of-pocket maximum $16,300 $15,000 $9,000
Coinsurance — member pays 0% 0% 0%
Preventive care3 Free Free Free
Virtual visit4 $75 $50 $30
Primary care office services5 $75 $50 $30
Non-primary care office services $150 $100 $60
Emergency room $1,000 $500 $500
Prescription drugs - Blue Rx Essentials
Tier 1 $20 $30 $20
Tier 2 All other tiers: annual benefit applies $80 $50
Tier 3 $175 $125
Specialty preferred $300 $200
Non-preferred $500 $500
Medicare Part D Creditable Coverage6 No Yes Yes
1 Both in-network and out-of-network services apply to a single deductible/OPM. However, out-of-pocket costs for in-network services only apply to the in-network deductible/OPM. Only out-of-network pocket costs for out-of-network services apply to the out-of-network deductible/OPM.
2 The family deductible/OPM 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 All costs waived when using an in-network or participating provider. Preventive care includes gynecological exam, preventive exam, screening mammography, well-child care and newborn care. One preventive exam with separate gynecological exam per member per benefit period. Well-child care up to age 7 (includes normal newborn care, physical examinations, assessments and immunizations.)
4 Wellmark’s preferred virtual visit partner is Doctor On Demand.
5The primary care office copay applies to family practitioners, general practitioners, obstetricians/gynecologists, pediatricians, physician’ 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.
Medicare Part D creditable coverage status applies for 2020 plan year only.