Compare Individual & Family health plans
2023 coverage in South Dakota
You must live in South Dakota and reside in one of these counties List to enroll.
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 EPO |
|---|---|
| Preventive care1 from an in-network provider | Free |
| Deductible | Single: $7,200 |
| 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 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 EPO | |||||
|---|---|---|---|---|---|
| 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 EPO |
|---|---|
| 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 care5 | $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 Specialty preferred: $300 Non-preferred: $500 |
| Wellmark Silver Traditional EPO | |||||
|---|---|---|---|---|---|
| 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 care5 | $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 Specialty preferred: $300 Non-preferred: $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 EPO |
|---|---|
| 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 care5 | $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 EPO | |||||
|---|---|---|---|---|---|
| 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 care5 | $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 their 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 EPO |
|---|---|
| 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 EPO | |||||
|---|---|---|---|---|---|
| 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 EPO |
|---|---|
| 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 Biosimilar & specialty: $500 copay after deductible |
| Wellmark Standard Bronze EPO | |||||
|---|---|---|---|---|---|
| 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 EPO |
|---|---|
| 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 EPO | |||||
|---|---|---|---|---|---|
| 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 EPO |
|---|---|
| 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 Biosimilar & specialty: $250 |
| Wellmark Standard Gold EPO | |||||
|---|---|---|---|---|---|
| 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.
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