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2021 aca plan comparison guide

Small Group Plans

Shop plans as an employer of 1-50 employees:

Iowa Business Plans South Dakota Business Plans

Looking for mid-size or large group plans?

8 in 10 small businesses in Iowa and South Dakota are covered by Wellmark.

Why Camp Courageous Choose Wellmark

"Our goal is to provide the best benefits we can for our employees and that goes to our long-term goal of retaining our talent and keeping our staff here." – Tim Raine, chief financial officer

Step 1 of 4: Understanding network options could help you save $$$.

First, let's make sure you know some important facts before making any decision.

Which network best meets your needs?

State-Based Network

Amazing state coverage(up to a 15% savings)

=

100% of hospitals and 98% of physicians plus emergency out-of-network coverage1

Wellmark Blue HMOSM

Iowa-based is perfect

1Wellmark Blue Cross and Blue Shield network numbers as of May 2020.

State + Select National

Amazing state coverage(state-based HMO network)

+

Choose to see any BlueCard® provider2 nationwide at a higher cost-share

Wellmark Blue POSSM

I need the flexibility

2BlueCard providers can be found at bcbs.com or by calling 800-810-2583.

State + National Network

Amazing state coverage(broadest access)

+

Access to more than 96% of hospitals and 95% of physicians throughout the country3

Wellmark Blue PPOSM

National is necessary

3 Consortium Network Compare Findings as of June 2020.

Step 2 of 4: Did someone say free? 

In a competitive market, offering specialty benefits improves your ability to attract top talent.

Click the plans to explore the options available at no additional cost.

Wow. Blue Dental offers checkups, cleanings, routine diagnostics and restorative services — at little or no out-of-pocket costs to your employees!

Plan Details1 Option A Option B
Benefit Year Maximum - Plan Pays $1,500 $2,000
Benefit year Deductible2
Single $25 $25
Family $75 $75
Preventive & Diagnostic - member pays 20% 0%
Basic Restorative

Including cavity repair, tooth extractions, restoration of decayed or fractured teeth, oral surgery and anesthesia

50% 20%
Major Restorative

Including root canals, gum and bone disease, crowns, inlays, bridges and dentures

50% 50%
Add Orthodontia
Orthodontics 50% 50%
Orthodontic lifetime maximum

(per child, up to age 19)

$1,000 $2,000
1 Benefits and general provisions described are subject to plan selected, and terms of the actual policy and coverage manual.
2 Deductible waived for preventive and diagnostic services.

Score! Avēsis1 has one of the most comprehensive vision plans in the industry, plus a bonus: free hearing screening and reduced pricing on hearing devices with Amplifon Hearing Health CareTM2.

Plan Details3 Avēsis 80 Avēsis 150
Eye Exam Covered in full after $10 copay, every 12 months Covered in full after $10 copay, every 12 months
Eyewear products
Frames Covered once every 24 months, after $25 materials copay; $80 retail allowance Covered once every 24 months, after $10 materials copay; $150 retail allowance
Standard plastic lenses One pair covered in full after materials copay, every 12 months One pair covered in full after materials copay for adult polycaronate, scratch-resistant coating, UV screening, standard tint, anti-reflective coating, every 12 months
Contact lenses Covered up to allowance, every 12 months, in lieu of eyeglasses Covered up to allowance, every 12 months, in lieu of eyeglasses
Lens Options Up to 20 percent off polycarbonate, scratch-resistant coating, tint and UV protective coating
  • Covered in full: polycarbonate, scratch-resistant coating, tint and UV protective coating
  • Copay applies: progressives, transitions, polarized, PGX/PBX
  • Up to 20% discount: other lens options
BONUS: Free hearing screening and reduced pricing on hearing devices through Amplifon Hearing Health CareTM
Avēsis Vision is an independent vision insurance company that does not provide Blue Cross and Blue Shield products and services. Avēsis Vision is underwritten by Fidelity Life Insurance Company.
Hearing Discount Savings Plan provided by Amplifon Hearing Health Care. Amplifon Hearing Health Care is an independent company that does not provide Wellmark Blue Cross and Blue Shield products or services.
3 Applies to in-network benefits. Out-of-network services are covered and include higher copays. Coverage is available for members age 19 or older.

Step 3 of 4: Wait, there's more? Lots more at no extra cost!

Click each section to expand and explore all the extra benefits available to Wellmark members.

Continue to Health Plans

As an employer, we know you have a lot on your plate. And, when your employees have a question, you want to answer them quickly. Wellmark's Employer Connection is your secret weapon.

If your employees have questions about eligibility or benefits, you can log into a secure portal, Employer Connection, to provide an answer right away without having to contact your Wellmark representative. You’ll also be able to order new ID cards, update member information and more.

Whether you’re on your computer, phone or tablet, Employer Connection makes it easy to find everything you need to efficiently manage benefits, plus you’ll find news alerts, free educational materials, and electronic billing and payment options. 

BeWell 24/7, exclusively available to Wellmark members, connects your employees with a real person who can help with a variety of health-related concerns and help maintain a work-life balance. With BeWell 24/7, your employees can:

  • Find a doctor.
  • Coordinate appointments.
  • Get treatment advice.
  • Seek a second opinion.
  • Manage complex health situations.

Our free Pregnancy Support program provides trusted online resources for every stage of pregnancy, plus additional, personalized support for high-risk pregnancies.

Concerned about the cost? Talk to your agent about how you can get a no-cost solution.

Health insurance is complex — myWellmark makes it easy

With myWellmark, your employees can receive their personal health insurance information at their fingertips — no matter their location — with tools, resources and insights to help them manage health care spending and live a healthier life. It’s accessible on any device — including those with facial and one-touch fingerprint recognition capabilities — in a streamlined, easy and convenient way.

As your company’s HR or benefits administrator, help educate your employees to be savvy health care consumers and make informed decisions. With myWellmark, you can be confident in your employees’ knowledge of their health insurance coverage, leaving you with fewer questions to answer about health insurance information.

Wellmark Blue Cross and Blue Shield members are automatically eligible to get personalized access to Blue365 — a free portal that gives them deals and discounts on their favorite health and wellness brands. Your employees can stay informed of the updated discounts with a weekly email sent to their inbox. With Blue365, your employees will save money while meeting their health and personal goals.

This program, meant to alleviate emotional, physical and financial burdens, offers comprehensive care for patients with complex and rare conditions that are not curable. A specialized, trained nurse serves as an advocate, providing holistic and proactive support for eligible members. 

Blue@Work

Get unique industry insights and other information you need to administer your employee benefits. Blue@Work can help move your business forward by featuring industry news, pharmacy information, employee benefits, community and health-related articles that can be accessed anytime, anywhere at Wellmark.com/Blue-at-Work.

On Blue@Work, you will also find topics specific for groups of 1–50 employees just like you!

Blue SM Magazine

Each issue, found at Wellmark.com/Blue, features health and wellness articles, consumer tips, health plan news and healthy recipes. It helps your employees get the most from their health plans — and from their lives.

With the Wellmark Wellness Center powered by WebMD®, your employees will be able to customize their wellness programs to fit their interests and needs.

  • A personalized status report with tips to improve your well-being.
  • A digital health coach in your pocket to help you set lifestyle goals and track progress.
  • A free, confidential service to help you reach your health and wellness goals.
  • Sync your data with a fitness tracker.

This program makes a meaningful difference by seizing opportunities to reduce gaps in care and coordinating services that align with member benefits. It not only impacts well-being and health outcomes for your employees but also reduces cost and use of services for you.

Virtual Visits with Doctor on Demand®

Reduce absenteeism and costs while increasing employee satisfaction with virtual visits, included in all our plans. Offered at a lower cost than an office visit, Doctor on Demand allows employees to connect face-to-face with a board-certified doctor from virtually anywhere.

Step 4 of 4: Now for the plan details.  Let's break it down.

Decide what's important to you.

BlueSimplicitySM health plans

I want my employees to have peace of mind.


  • No deductible or coinsurance; up-front costs to help members understand their coverage.
  • Service types are grouped into six levels.
  • We make it easy for your employees to know the absolute most they will pay before they seek care.

2 plans

Traditional & Modified health plans

I want my employees to have predictable copays.


  • Traditional: copay structure to incentivize care through PCP. No deductible or coinsurance (except for other expenses).
  • Modified: provides copays for the most common services and eliminates coinsurance entirely.

Contains our most popular plan.

7 plans

High-deductible health plans

I want my employees engaged in their health.


  • Employees pay the full cost of care and prescriptions until they reach their deductible.
  • Preventive care is still free.
  • These plans qualify for a health savings account (HSA).
  • Offer the lowest monthly premiums.

2 plans

Don’t forget to discuss how Flexible Spending Accounts can decrease your cost while helping your employees plan for unexpected expenses by setting aside pre-tax dollars to cover copays and out-of-pocket health expenses.

BlueSimplicity plan options

(Best if viewed on tablet size or larger.)

Amounts reflect covered, in-network services only. For plans within a PPO and POS network, additional cost-shares will apply to out-of-network services.

Health Care Services BlueSimplicitySM Silver BlueSimplicitySM Gold
Annual benefit — out-of-pocket maximum (opm)1
Single OPM $8,100 $4,750
Family2 OPM $16,200 $9,500
Virtual visit3 $20 $10
Level 1: Preventive care4 Free Free
Level 2: Primary care provider (PCP) office visit5, facility lab/X-ray $60 $35
Level 3: Non- office visit, outpatient PT/OT/ST, home health care, durable medical equipment (DME) $110 $70
Level 4: Emergency room, ground ambulance, diagnostic imaging/studies6 and radiation therapy $600 $500
Level 5: Outpatient practitioner and facility $5,000 $2,500
Level 6: Hospitalization, air ambulance and skilled nursing facility $8,100 $4,000
Prescription drugs - Blue Rx EssentialsSM
Tier 1: most generics and select branded drugs $30 $25
Tier 2: Preferred drugs based on effectiveness $100 $85
Tier 3: Non-preferred drugs that have cost-effective alternatives $200 $150
Specialty preferred: Proven to treat complex and rare conditions $300 $300
Non-preferred: more beneficial than preferred alternative $500 $500
Medicare Part D Creditable Coverage7 Yes Yes

Your employees will be required to use Blue Distinction® Centers for bariatric surgery and transplants. There are many Blue Distinction Centers across the state. Find the closest one to you.

Ready to talk pricing and select a plan?

Let your agent know you’re interested in BlueSimplicity Health Plans. And don’t forget to discuss which network works best for you:

  • Wellmark Blue HMOSM ($)
  • Wellmark Blue POSSM ($$)
  • Wellmark Blue PPOSM ($$$)

Reminder: Discuss how you can add dental and vision at no extra cost to you!

Find an Agent Discussion Guide PDF File
Back to Plans

8 in 10 small businesses in South Dakota are covered by Wellmark.

"Freedom and flexibility are important at Rise. So, when it came to choosing a health benefits provider for our employees, Wellmark Blue Cross and Blue Shield was an easy choice.“– Justin Christensen, president, Rise Structural Associates, Inc.


1 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 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.
3 Wellmark’s preferred virtual visit partner is Doctor On Demand.
4 All costs waived when using an in-network or participating provider on PPO plans. On all other available networks, costs are waived when using an in-network provider. Preventive care includes gynecological exams, preventive exams, screening mammography, well-child care and newborn care. For plans on the Wellmark Value Health Plan HMO Network, a 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.)
5 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 visit.
6 Diagnostic imaging includes CT (computerized tomography), MEG (magnetoencephalography), MRAs (magnetic resonance angiography), MRIs (magnetic resonance imaging), PET (positron emission tomography), nuclear medicine and ultrasounds.
7 Medicare Part D creditable coverage status applies for 2021 plan year only.

Helping through difficult times

Because Wellmark Blue Cross and Blue Shield cares about the health and well-being of its members, Wellmark helped small businesses keep health benefit coverage for furloughed or laid-off employees during the COVID-19 pandemic. In addition, Wellmark worked with businesses who needed their payment grace period extended during this tumultuous time.

Wellmark is here for you.

Did you know?

8 in 10 small businesses in Iowa and South Dakota are covered by Wellmark.

Trust, shared values, experience, longevity and understanding are just a few of the reasons that small groups choose — and continue to choose — Wellmark for their health coverage needs.

That's coverage you can count on.