2021 aca plan comparison guide
Small Group Plans
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?
Amazing state coverage(up to a 15% savings)
100% of hospitals and 98% of physicians plus emergency out-of-network coverage1
Wellmark Blue HMOSMIowa-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 POSSMI 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 PPOSMNational 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|
|Preventive & Diagnostic - member pays||20%||0%|
Including cavity repair, tooth extractions, restoration of decayed or fractured teeth, oral surgery and anesthesia
Including root canals, gum and bone disease, crowns, inlays, bridges and dentures
|Orthodontic lifetime maximum
(per child, up to age 19)
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|
|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||
|BONUS: Free hearing screening and reduced pricing on hearing devices through Amplifon Hearing Health CareTM|
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
Wellmark® Blue Cross® and Blue Shield® has partnered with HealthEquity® to offer FREE administrative services to our small groups. These services would include:
- Notice fulfillment and return mail processing
- Premium billing, collection and reimbursement
- Eligibility reporting and termination processing
- Real-time case management
- A dedicated implementation manager
Virtual visits, available through Doctor on Demand®, are included in all our plans at a lower cost than an office visit. Virtual visits allow employees to connect face-to-face with a board-certified doctor from virtually anywhere, increasing employee convenience and satisfaction.
- Shown a reduction in absenteeism
- Lower costs than an office visit
- An average wait time for 10 minutes
- More than 28,500 customers with over 1 million visits — and a 4.9 star rating out of 5
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.
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.
Step 4 of 4: Now for the plan details. Let's break it down.
Decide what's important to you.
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.
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.
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|
|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!
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.