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BlueSimplicitySM


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Why BlueSimplicity? Maybe you should ask "Why not?"

  1. There’s no waiting!
    With no deductible, your benefits start day one. So go ahead, schedule your preventive exam! We dare you. 
  2. There’s no surprises!
    Ever wonder why you got multiple bills from multiple doctors for ONE hospital stay? Well, with no coinsurance and only a single copay, you’ll know your costs up front. 
  3. The essentials are covered.
    You can count on all of the essential health benefits being covered under your plan – services like:
    • Preventive Care 
    • Prescription Drugs 
    • Emergency Services 
    • Hospitalization 
    • Mental Health and more…
  4. You’ll never pay full price.
    Who doesn’t like discounts? Wellmark members get discounted rates for medical services from in-network providers. So, if the discounted service is less than your copay, you’ll only pay the cost of the service. You can keep that money in your pocket – nice!
  5. You’ll like this limit.
    Nobody likes limits – unless it’s a limit on how much you owe! Every dollar you spend on a covered benefit adds up to your out-of-pocket maximum (OPM). That means every copay on a trip to the doctor or pharmacy helps you reach the point where you don’t have to pay anymore.
  6. We’re in all 99 counties!
    That’s right, you can seek and receive in network benefits across Iowa. That means BlueSimplicity is welcomed in 100% of the hospitals and 97% of providers state-wide. And don’t worry, you’re still covered in case of an emergency out of state too!
  7. We’ve got 65,000 pharmacies.
    Whether you’re at home or on vacation, you can use your pharmacy benefits at more than 65,000 pharmacies nationwide. And your specialty drugs can be picked up at any Hy-Vee or CVS. 
  8. It makes you smarter.
    This plan is so simple, you’ll have the highest health care IQ on the block. You’ll have the tools, and know the questions to ask your doctor to know your costs up front.

Wellmark Simple Copay Plans

Contact your agent for details about BlueSimplicity plans for small groups.
BlueSimplicity Plan Options
Metallic Tier BlueSimplicitySM Bronze HMO BlueSimplicitySM Silver HMO
Level 1 — You Pay
Preventive services1
Examples: mammogram, well-child visit, annual exam
Free Free
Level 2 — You Pay
Primary care physician (PCP)2 office visit
Facility lab/X-ray
Urgent care
$75 $35
Level 3 — You Pay
Non-primary care physician (Non-PCP) office visit
Outpatient physical therapist/occupational therapist/speech therapist
Home health care
$200 $70
Level 4 — You Pay
Outpatient practitioner services
Emergency room
Ground ambulance
$1,500 $500
Level 5 — You Pay
Outpatient facility services
Ambulatory
High-cost imaging (CT scan, MRI, PET scan, EKG)
$1,500 $1,000
Level 6 — You Pay
Air ambulance
Skilled nursing facility
Inpatient hospitalization
$7,150 $5,250
Prescription Drugs — BlueSimplicitySM RX
Level 1 Free Free
Level 2 $50 $30
Level 3 $150 $125
Level 4 $250 $225
Level 5 $400 $350
Out-of-pocket maximum — Single $7,150 $7,150
Out-of-pocket maximum — Family3 $14,300 $14,300
1 Designated personal doctor must be seen for preventive care/screenings and immunizations. 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).
2 The primary care office copay applies to family practitioners, general practitioners, internal medicine 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, speech pathologists, 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 date of service.
3 The family 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 out-of-pocket maximum amount.