Wellmark plan comparison guide for South Dakota small groups | traditional plans
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Traditional plan options

Wellmark's traditional health plans with predictable copays help your employees plan for many common health care expenses, like in-network office visits. For other expenses, like hospitalizations, outpatient surgery and maternity care, deductible and coinsurance may apply.

Amounts in the table reflect covered in-network services only. All plans use Blue Rx Essentials℠ pharmacy benefits.

Plan Details SimplyBlueSM 6000 (Bronze) CompleteBlueSM 3500 (Silver) CompleteBlueSM 5000 (Silver) EnhancedBlueSM 1500 (Gold) EnhancedBlueSM 3500 (Gold)
Annual Benefit — Deductible in-network1
Single deductible $6,000 $3,500 $5,000 $1,500 $3,500
Family2 deductible $12,000 $7,000 $10,000 $3,000 $7,000
Coinsurance — member pays 50% 30% 30% 20% 20%
Annual Benefit — Out-of-Pocket Maximum (opm) In-network
Single out-of-pocket maximum $8,150 $8,000 $8,150 $5,500 $7,500
Family3 out-of-pocket maximum $16,300 $16,000 $16,300 $11,000 $15,000
Preventive care4 screenings, immunizations Free Free Free Free Free
Virtual Visit5 $60 $40 $50 $30 $20
Primary care office Services6 $60 $40 $50 $30 $20
Non-primary care office services Deductible/coinsurance apply $90 $100 $60 $40
Emergency room Deductible/coinsurance apply $500 $500 $500 $300
Prescription drugs - Blue Rx EssentialsSM
Tier 1  For all tiers, deductible/coinsurance apply. $30 $35 $15 $15
Tier 2 $60 $70 $50 $45
Tier 3 $125 $140 $100 $100
Specialty preferred $150 $200 $200 $200
Non-preferred $500 $500 $400 $400
Medicare Part D Creditable Coverage7 No Yes Yes Yes Yes
1 Both in-network and out of-network services apply toward a single deductible. However, out-of-pocket costs for in-network services only apply to the in-network out-of-pocket maximum. Only out-of-pocket costs for out-of-network services apply to the out-of-network out-of-pocket maximum.
2 The family deductible 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 The family out-of-pocket maximum (OPM) can be met through any combination of family members. No one member will be required to meet more than the single OPM amount to receive benefits for covered services during a benefit period.
4 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.)
5 Wellmark’s preferred virtual visit partner is Doctor On Demand.
6 The primary care office copay applies to family practitioners, general practitioners, obstetricians/gynecologists, pediatricians, physicians’ 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.
7 Medicare Part D creditable coverage status applies for 2020 plan year only.