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Compare Individual & Family health plans

2023 coverage in Iowa

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Traditional health plans

Traditional health plans provide predictable copays for many common health care expenses, like in-network office visits. Plus, your copays all go toward your out-of-pocket maximum. For other expenses like hospitalizations, outpatient surgery and maternity care, deductible and coinsurance may apply.


With a bronze tier, Wellmark pays about 60 percent and you'll pay about 40 percent of the plan's cost-sharing requirements, which can include the deductible, coinsurance and copays. Consider a bronze plan if you want lower monthly premiums compared to gold and silver plans.

 

Plan Details Wellmark Bronze Traditional HMO
Preventive care1 from an in-network provider Free
Deductible

Single: $7,200
Family2: $14,400

Coinsurancemember pays 50%
Out-of-pocket maximum Single: $9,000
Family2: $18,000
Virtual visit through Doctor On Demand3: Includes new behavioral health coaching services $0 — Includes NEW virtual primary care services
Included in $0 copay (no additional cost)
Primary care office services4 $80
Non-primary care office services $150
Emergency room care5 $1,200
Prescription drugs
Blue Rx Essentials Drug List/CVS Specialty Program External Site

Tier 1: $35
All other tiers: deductible/coinsurance applies (medical/drug deductible combine)


Wellmark Bronze Traditional HMO
Preventive care from an in-network provider Free
Deductible Single: $7,200
Family2: $14,400
Coinsurance — member pays 50%
Out-of-pocket maximum (OPM) Single: $9,000
Family2: $18,000
Virtual visit through Doctor On Demand3: Includes new behavioral health coaching services $0 — Includes new virtual primary care services
Included in $0 copay (no additional cost)
Primary care office services 4 $80
Non-primary care office servicesospitalization $150
Emergency room care 5 $1,200
Prescription drugs
Blue Rx Essentials Drug List/CVS Specialty Program External Site
Tier 1: $35
All other tiers: Deductible/coinsurance applies (medical/drug deductible combine)

1 Preventive care exams (such as annual physical, annual gynecological, and well-child exams), screenings and immunizations must be provided by an in-network doctor.

2 The family deductible and out-of-pocket maximum can be met through any combination of family members. No one member will be required to meet more than the single deductible or out-of-pocket maximum amount to receive benefits for covered services during the benefit period.

3 The $0 virtual visit copay only applies to Doctor On Demand. All other virtual visits apply the plan’s PCP or non-PCP copay.

4 The primary care office copay applies to certified nurse midwives, 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.

5 Emergency room copay includes physician, facility, labs and X-rays. Copays are waived if admitted as inpatient.

With a silver tier, overall Wellmark pays about 70 percent and you'll pay about 30 percent of the plan's cost-sharing requirements, which can include the deductible, coinsurance and copays. If you're eligible for cost sharing reduction (CSR), you may pay less for services. Consider a silver plan if you qualify for a CSR, which can help lower your out-of-pocket expenses throughout the year.

 

Plan Details Wellmark Silver Traditional HMO
Preventive care1 from an in-network provider Free
Deductible Single: $5,000
Family2: $10,000
Coinsurance — member pays 30%
Out-of-pocket maximum (OPM) Single: $8,700
Family2: $17,400
Virtual visit through Doctor On Demand3
Includes new Behavioral Health Coaching services at $0 copay
$0
Included in $0 copay (no additional cost)
Primary care office services4 $50
Non-primary care office services $75
Emergency room care $1,000
Prescription drugs
Blue Rx Essentials Drug List/CVS Specialty Program External Site
Tier 1: $30
Tier 2: $60
Tier 3: $140
Biosimilars: $220
Preferred specialty: $300
Non-preferred specialty: $500
Wellmark Silver Traditional HMO
Preventive care1 from an in-network provider Free
Deductible Single: $5,000
Family2: $10,000
Coinsurance — member pays 30%
Out-of-pocket maximum (OPM) Single: $8,700
Family2: $17,400
Virtual visit through Doctor On Demand3
Includes new Behavioral Health Coaching services at $0 copay
$0
Included in $0 copay (no additional cost)
Primary care office services4 $50
Non-primary care office services $75
Emergency room care $1,000
Prescription drugs
Blue Rx Essentials Drug List/CVS Specialty Program External Site
Tier 1: $30
Tier 2: $60
Tier 3: $140
Biosimilars: $220
Preferred specialty: $300
Non-preferred specialty: $500

1 Preventive care exams (such as annual physical, annual gynecological, and well-child exams), screenings and immunizations must be provided by an in-network doctor.

2 The family deductible and out-of-pocket maximum can be met through any combination of family members. No one member will be required to meet more than the single deductible or out-of-pocket maximum amount to receive benefits for covered services during the benefit period.

3 The $0 virtual visit copay only applies to Doctor On Demand. All other virtual visits apply the plan’s PCP or non-PCP copay.

4 The primary care office copay applies to certified nurse midwives, 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.

5 Emergency room copay includes physician, facility, labs and X-rays. Copays are waived if admitted as inpatient.

With a gold tier, overall Wellmark pays about 80 percent and you'll pay about 20 percent of the plan's cost-sharing requirements, which can include the deductible, coinsurance and copays. Consider a gold plan for lower out-of-pocket costs.

 

Plan Details Wellmark Gold Traditional HMO
Preventive care1 from an in-network provider Free
Deductible Single: $1,500
Family2: $3,000
Coinsurance — member pays 30%
Out-of-pocket maximum (OPM) Single: $8,700
Family2: $17,400
Virtual visit through Doctor On Demand3
Includes new Behavioral Health Coaching services at $0 copay
$0
Included in $0 copay (no additional cost)
Primary care office services4 $20
Non-primary care office services $60
Emergency room care $400
Prescription drugs
Blue Rx Essentials Drug List/CVS Specialty Program External Site
Tier 1: $20
Tier 2: $60
Tier 3: $125
Biosimilars: $215
Specialty preferred: $300
Non-preferred: $400
Wellmark Gold Traditional HMO
Preventive care1 from an in-network provider Free
Deductible Single: $1,500
Family2: $3,000
Coinsurance — member pays 30%
Out-of-pocket maximum (OPM) Single: $8,700
Family2: $17,400
Virtual visit through Doctor On Demand3
Includes new Behavioral Health Coaching services at $0 copay
$0
Included in $0 copay (no additional cost)
Primary care office services4 $20
Non-primary care office services $60
Emergency room care $400
Prescription drugs
Blue Rx Essentials Drug List/CVS Specialty Program External Site
Tier 1: $20
Tier 2: $60
Tier 3: $125
Biosimilars: $215
Specialty preferred: $300
Non-preferred: $400

1 Preventive care exams (such as annual physical, annual gynecological, and well-child exams), screenings and immunizations must be provided by an in-network doctor.

2 The family deductible and out-of-pocket maximum can be met through any combination of family members. No one member will be required to meet more than the single deductible or out-of-pocket maximum amount to receive benefits for covered services during the benefit period.

3 The $0 virtual visit copay only applies to Doctor On Demand. All other virtual visits apply the plan’s PCP or non-PCP copay.

4 The primary care office copay applies to certified nurse midwives, 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.

5 Emergency room copay includes physician, facility, labs and X-rays. Copays are waived if admitted as inpatient.


High-Deductible Health Plan*

Because you are responsible for 100 percent of the cost of care until your deductible is met (excluding preventive care), this plan encourages members to have meaningful conversations with health care providers to determine care options and cost-savings’ opportunities. If you understand your future medical needs or plan to use a health savings account (HSA), this plan could be a good fit.


With a bronze tier, Wellmark pays about 60 percent and you'll pay about 40 percent of the plan's cost-sharing requirements, which can include the deductible, coinsurance and copays. Consider a bronze plan if you want lower monthly premiums compared to gold and silver plans.

 

Plan Details Wellmark Bronze HDHP HMO
Deductible and out-of-pocket maximum Single: $7,000
Family1: $14,000
Preventive care2 from an in-network provider
Behavioral Health Coaching is free on this plan
Free
Lowest cost
Virtual visit through Doctor On Demand, which includes NEW Behavioral Health Coaching services
$
Low cost
Primary care provider office visit3
Facility lab/X-ray
Urgent care
$
Medium cost
Specialist office visit
Outpatient physical therapist
Home health care
$$
High cost
Emergency room
Ambulatory
Inpatient hospitalization
$$$
Prescription drugs
Blue Rx Essentials Drug List/CVS Specialty Program External Site
All tiers: Deductible applies (medical/drug deductible)

Wellmark Bronze HDHP HMO
Deductible and out-of-pocket maximum Single: $7,000
Family1: $14,000
Preventive care2 from an in-network provider
Behavioral Health Coaching is free on this plan
Free
Lowest cost
Virtual visit through Doctor On Demand, which includes NEW Behavioral Health Coaching services
$
Low cost
Primary care provider office visit3
Facility lab/X-ray
Urgent care
$
Medium cost
Specialist office visit
Outpatient physical therapist
Home health care
$$
High cost
Emergency room
Ambulatory
Inpatient hospitalization
$$$
Prescription drugs
Blue Rx Essentials Drug List/CVS Specialty Program External Site
All tiers: Deductible applies (medical/drug deductible)

* The deductible applies for all services under the Wellmark Bronze HDHP Plan except in the case of preventive services. This chart is illustrative in nature and is intended to demonstrate the cost levels of typical health care services. For example, your out-of-pocket cost to visit a non-primary care provider will be significantly lower than the cost of an emergency room visit. For an exhaustive list of covered and non-covered services, please refer to the plan’s coverage manual.

1The family deductible and out-of-pocket maximum can be met through any combination of family members. No one member will be required to meet more than the single deductible or out-of-pocket maximum amount to receive benefits for covered services during the benefit period.

2Preventive care exams (such as annual physical, annual gynecological, and well-child) must be received from an in‑network doctor.

3The cost associated to primary care provider office visits applies to certified nurse midwives, family practitioners, general practitioners, obstetricians/gynecologists, pediatricians, physician assistants, advanced registered nurse practitioners. This cost also applies to in-network chiropractors, physical therapists, occupational therapists, speech pathologists and in some cases, mental health or chemical dependency visits. All other in-network practitioners are subject to the non-primary care provider office cost.


Standard health plans

Similar to Traditional plans, Standard plans were designed by CMS to make it easier to compare Marketplace plans by requiring plans to have specific cost-share amounts like deductible, copays, coinsurance and out-of-pocket maximums across all insurers, like Wellmark, offering plans through the Marketplace.

With a bronze tier, Wellmark pays about 60 percent and you'll pay about 40 percent of the plan's cost-sharing requirements, which can include the deductible, coinsurance and copays. Consider a bronze plan if you want lower monthly premiums compared to gold and silver plans.

 

Plan Details Wellmark Standard Bronze HMO
Preventive care1 from an in-network provider Free
Deductible Single: $7,500
Family2: $15,000
Coinsurance — member pays 50%
Out-of-pocket maximum (OPM) Single: $9,000
Family2: $18,000
Virtual visit through Doctor On Demand3
Includes new Behavioral Health Coaching services at $0 copay
$50
Primary care office services4 $50
Non-primary care office services $100
Emergency room care 50% coinsurance after deductible
Prescription drugs
Blue Rx Essentials Drug List/CVS Specialty Program External Site
Tier 1: $25
Tier 2: $50 copay after deductible
Tier 3: $100 copay after deductible
Biosimilars & specialty: $500 copay after deductible
Wellmark Standard Bronze HMO
Preventive care1 from an in-network provider Free
Deductible Single: $7,500
Family2: $15,000
Coinsurance — member pays 50%
Out-of-pocket maximum (OPM) Single: $9,000
Family2: $18,000
Virtual visit through Doctor On Demand3
Includes new Behavioral Health Coaching services at $0 copay
$50
Primary care office services4 $50
Non-primary care office services $100
Emergency room care 50% coinsurance after deductible
Prescription drugs
Blue Rx Essentials Drug List/CVS Specialty Program External Site
Tier 1: $25
Tier 2: $50 copay after deductible
Tier 3: $100 copay after deductible
Biosimilars & specialty: $500 copay after deductible

1Preventive care exams (such as annual physical, annual gynecological, and well-child exams), screenings and immunizations must be provided by an in-network doctor.

2The family deductible and out-of-pocket maximum can be met through any combination of family members. No one member will be required to meet more than the single deductible or out-of-pocket maximum amount to receive benefits for covered services during the benefit period.

3The lower PCP copay applies to Doctor On Demand. All other virtual visits apply the plan’s PCP or non-PCP copay.

4The primary care office copay applies to certified nurse midwives, 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. Independent labs apply deductible and coinsurance.

With a silver tier, overall Wellmark pays about 70 percent and you'll pay about 30 percent of the plan's cost-sharing requirements, which can include the deductible, coinsurance and copays. If you're eligible for cost sharing reduction (CSR), you may pay less for services. Consider a silver plan if you qualify for a CSR, which can help lower your out-of-pocket expenses throughout the year.

 

Plan Details Wellmark Standard Silver HMO
Preventive care1 from an in-network provider Free
Deductible Single: $5,800
Family2: $11,600
Coinsurance — member pays 40%
Out-of-pocket maximum (OPM) Single: $8,900
Family2: $17,800
Virtual visit through Doctor On Demand3
Includes new Behavioral Health Coaching services at $0 copay
$40
Primary care office services4 $40
Non-primary care office services $80
Emergency room care 40% coinsurance after deductible
Prescription drugs
Blue Rx Essentials Drug List/CVS Specialty Program External Site
Tier 1: $20
Tier 2: $40
Tier 3: $80 copay after deductible
Biosimilars & specialty: $350 copay after deductible
Wellmark Standard Silver HMO
Preventive care1 from an in-network provider Free
Deductible Single: $5,800
Family2: $11,600
Coinsurance — member pays 40%
Out-of-pocket maximum (OPM) Single: $8,900
Family2: $17,800
Virtual visit through Doctor On Demand3
Includes new Behavioral Health Coaching services at $0 copay
$40
Primary care office services4 $40
Non-primary care office services $80
Emergency room care 40% coinsurance after deductible
Prescription drugs
Blue Rx Essentials Drug List/CVS Specialty Program External Site
Tier 1: $20
Tier 2: $40
Tier 3: $80 copay after deductible
Biosimilars & specialty: $350 copay after deductible

1Preventive care exams (such as annual physical, annual gynecological, and well-child exams), screenings and immunizations must be provided by an in-network doctor.

2The family deductible and out-of-pocket maximum can be met through any combination of family members. No one member will be required to meet more than the single deductible or out-of-pocket maximum amount to receive benefits for covered services during the benefit period.

3The lower PCP copay applies to Doctor On Demand. All other virtual visits apply the plan’s PCP or non-PCP copay.

4The primary care office copay applies to certified nurse midwives, 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. Independent labs apply deductible and coinsurance.

With a gold tier, overall Wellmark pays about 80 percent and you'll pay about 20 percent of the plan's cost-sharing requirements, which can include the deductible, coinsurance and copays. Consider a gold plan for lower out-of-pocket costs.

 

Plan Details Wellmark Standard Gold HMO
Preventive care1 from an in-network provider Free
Deductible Single: $2,000
Family2: $4,000
Coinsurance — member pays 25%
Out-of-pocket maximum (OPM) Single: $8,700
Family2: $17,400
Virtual visit through Doctor On Demand3
Includes new Behavioral Health Coaching services at $0 copay
$30
Primary care office services4 $30
Non-primary care office services $60
Emergency room care 25% coinsurance after deductible
Prescription drugs
Blue Rx Essentials Drug List/CVS Specialty Program External Site
Tier 1: $15
Tier 2: $30
Tier 3: $60
Biosimilars & specialty: $250
Wellmark Standard Gold HMO
Preventive care1 from an in-network provider Free
Deductible Single: $2,000
Family2: $4,000
Coinsurance — member pays 25%
Out-of-pocket maximum (OPM) Single: $8,700
Family2: $17,400
Virtual visit through Doctor On Demand3
Includes new Behavioral Health Coaching services at $0 copay
$30
Primary care office services4 $30
Non-primary care office services $60
Emergency room care 25% coinsurance after deductible
Prescription drugs
Blue Rx Essentials Drug List/CVS Specialty Program External Site
Tier 1: $15
Tier 2: $30
Tier 3: $60
Biosimilars & specialty: $250

1Preventive care exams (such as annual physical, annual gynecological, and well-child exams), screenings and immunizations must be provided by an in-network doctor.

2The family deductible and out-of-pocket maximum can be met through any combination of family members. No one member will be required to meet more than the single deductible or out-of-pocket maximum amount to receive benefits for covered services during the benefit period.

3The lower PCP copay applies to Doctor On Demand. All other virtual visits apply the plan’s PCP or non-PCP copay.

4The primary care office copay applies to certified nurse midwives, 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. Independent labs apply deductible and coinsurance.


Wellmark Blue HMO | UnityPoint Health plans

These are value-based health plan options that are designed to make health care simple and affordable. These plans team you up with local experts who know how to keep you healthy: the doctors, clinics and hospitals in the Wellmark HMO | UnityPoint Health network. These are providers who have proven to have measured quality and better outcomes for patients and can be a true partner in your health. You must live in Iowa and reside in one of these counties List to enroll.


If you’re looking for a health plan that’s less expensive than traditional offerings and want to work with a connected group of providers to manage your health, this plan may be your best option.

With a bronze tier, Wellmark pays about 60 percent and you'll pay about 40 percent of the plan's cost-sharing requirements, which can include the deductible, coinsurance and copays. Consider a bronze plan if you want lower monthly premiums compared to gold and silver plans.

 

Plan Details Wellmark Bronze Primary Care | UnityPoint Health Plan
Preventive care1 from an in-network provider Free
Deductible Single: $7,800
Family2: $15,600
Coinsurance — member pays 50%
Out-of-pocket maximum (OPM) Single: $9,000
Family2: $18,000
Virtual visit through in-network providers3 $0
Primary care office services4 $25 copay
Non-primary care office services $110 copay
Emergency room care5 50% coinsurance after deductible
Prescription drugs
Blue Rx Essentials Drug List/CVS Specialty Program External Site
Tier 1: $35
All other tiers: Deductible/coinsurance applies (medical/drug deductible combine)
Wellmark Bronze Primary Care | UnityPoint Health Plan
Preventive care1 from an in-network provider Free
Deductible Single: $7,800
Family2: $15,600
Coinsurance — member pays 50%
Out-of-pocket maximum (OPM) Single: $9,000
Family2: $18,000
Virtual visit through in-network providers3 $0
Primary care office services4 $25 copay
Non-primary care office services $110 copay
Emergency room care5 50% coinsurance after deductible
Prescription drugs
Blue Rx Essentials Drug List/CVS Specialty Program External Site
Tier 1: $35
All other tiers: Deductible/coinsurance applies (medical/drug deductible combine)

1 Preventive care exams (such as annual physical, annual gynecological, and well-child exams), screenings and immunizations must be provided by an in-network doctor.

2 The family deductible and out-of-pocket maximum can be met through any combination of family members. No one member will be required to meet more than the single deductible or out-of-pocket maximum amount to receive benefits for covered services during the benefit period.

3 The lower virtual visit copay only applies to in-network virtual visits. Out-of-network not covered.

4 The primary care office copay applies to certified nurse midwives, 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.

5 Emergency room copay includes physician, facility, labs and X-rays. Copays are waived if admitted as inpatient.

With a silver tier, overall Wellmark pays about 70 percent and you'll pay about 30 percent of the plan's cost-sharing requirements, which can include the deductible, coinsurance and copays. If you're eligible for cost sharing reduction (CSR), you may pay less for services. Consider a silver plan if you qualify for a CSR, which can help lower your out-of-pocket expenses throughout the year.

 

Plan Details Wellmark Silver Primary Care | UnityPoint Health Plan
Preventive care1 from an in-network provider Free
Deductible Single: $5,700
Family2: $11,400
Coinsurance — member pays 30%
Out-of-pocket maximum (OPM) Single: $8,900
Family2: $17,800
Virtual visit through in-network providers3 $0
Primary care office services4 $15 copay
Non-primary care office services $95 copay
Emergency room care5 $750 copay
Prescription drugs
Blue Rx Essentials Drug List/CVS Specialty Program External Site
Tier 1: $10
All other tiers: Deductible/coinsurance applies (medical/drug deductible combine)
Wellmark Silver Primary Care | UnityPoint Health Plan
Preventive care1 from an in-network provider Free
Deductible Single: $5,700
Family2: $11,400
Coinsurance — member pays 30%
Out-of-pocket maximum (OPM) Single: $8,900
Family2: $17,800
Virtual visit through in-network providers3 $0
Primary care office services4 $15 copay
Non-primary care office services $95 copay
Emergency room care5 $750 copay
Prescription drugs
Blue Rx Essentials Drug List/CVS Specialty Program External Site
Tier 1: $10
All other tiers: Deductible/coinsurance applies (medical/drug deductible combine)

1 Preventive care exams (such as annual physical, annual gynecological, and well-child exams), screenings and immunizations must be provided by an in-network doctor.

2 The family deductible and out-of-pocket maximum can be met through any combination of family members. No one member will be required to meet more than the single deductible or out-of-pocket maximum amount to receive benefits for covered services during the benefit period.

3 The lower virtual visit copay only applies to in-network virtual visits. Out-of-network not covered.

4 The primary care office copay applies to certified nurse midwives, 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.

5 Emergency room copay includes physician, facility, labs and X-rays. Copays are waived if admitted as inpatient.

With a gold tier, overall Wellmark pays about 80 percent and you'll pay about 20 percent of the plan's cost-sharing requirements, which can include the deductible, coinsurance and copays. Consider a gold plan for lower out-of-pocket costs.

 

Plan Details Wellmark Gold Primary Care | UnityPoint Health Plan
Preventive care1 from an in-network provider Free
Deductible Single: $2,000
Family2: $4,000
Coinsurance — member pays 20%
Out-of-pocket maximum (OPM) Single: $8,700
Family2: $17,400
Virtual visit through in-network providers3 $0
Primary care office services4 $10 copay
Non-primary care office services $95 copay
Emergency room care5 $600 copay
Prescription drugs
Blue Rx Essentials Drug List/CVS Specialty Program External Site
Tier 1: $5
All other tiers: Deductible/coinsurance applies (medical/drug deductible combine)
Wellmark Gold Primary Care | UnityPoint Health Plan
Preventive care1 from an in-network provider Free
Deductible Single: $2,000
Family2: $4,000
Coinsurance — member pays 20%
Out-of-pocket maximum (OPM) Single: $8,700
Family2: $17,400
Virtual visit through in-network providers3 $0
Primary care office services4 $10 copay
Non-primary care office services $95 copay
Emergency room care5 $600 copay
Prescription drugs
Blue Rx Essentials Drug List/CVS Specialty Program External Site
Tier 1: $5
All other tiers: Deductible/coinsurance applies (medical/drug deductible combine)

1 Preventive care exams (such as annual physical, annual gynecological, and well-child exams), screenings and immunizations must be provided by an in-network doctor.

2 The family deductible and out-of-pocket maximum can be met through any combination of family members. No one member will be required to meet more than the single deductible or out-of-pocket maximum amount to receive benefits for covered services during the benefit period.

3 The lower virtual visit copay only applies to in-network virtual visits. Out-of-network not covered.

4 The primary care office copay applies to certified nurse midwives, 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.

5 Emergency room copay includes physician, facility, labs and X-rays. Copays are waived if admitted as inpatient.

Enroll online

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Our guide provides more information about our plans, benefits like vision and dental and the total value you get with Wellmark.

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