Health Insurance Plans for South Dakota from Dakotacare

What Should I Get?

DAKOTACAREONE is a different kind of individual plan. It’s designed to provide high quality health coverage with flexible options.

With DAKOTACAREONE you get…
• …a great Prescription Drug Benefit with no deductible and no additional premium
• …no one-size-fits-all coverage. You pay for only the benefits you need
• …access to the extensive DAKOTACARE provider network which includes 98% of the physicians and pharmacies and 100% of the hospitals in South Dakota
• …hassle free claims processing
• …access to disease management and wellness programs to help you live a healthier life
• …South Dakota’s Own standing behind its name. DAKOTACAREONE is individual coverage from DAKOTACARE, a South Dakota company created by South Dakota Physicians

Four Unique Plans
DAKOTACAREONE has four unique plans you can choose from. Each one allows you to choose the benefits that you need to fit your life.

DAKOTACAREONE is so flexible you can even purchase an individual plan for each member of your family. Dad can have the basics, mom’s got maternity and the kids can enroll in a plan where going to the doctor doesn’t bust the budget.

What’s Right For Me?
The DAKOTACAREONE Red Plan is ideal for the single person. You’re generally healthy, rarely need to go to the doctor for treatment, and you don’t expect any hospitalizations. Deductibles range from $1,000 to $5,000.

The DAKOTACAREONE Blue Plan is ideal for someone who is generally healthy but tends to go to the doctor’s office for common injuries and illnesses. The Blue Plan has a maternity copay and your choice of deductible from $1,000 to $3,000.

The DAKOTACAREONE Green Plan is the most comprehensive of all the plans. It offers a choice of deductibles from $500-$5,000 and a full maternity benefit. This is an ideal plan for someone of child bearing age to ensure coverage for both planned and unplanned pregnancies.

The DAKOTACAREONE Black Plan is a high deductible health plan that allows you to contribute money to a Health Savings Account (HSA) to pay for current health expenses and save for future expenses on a tax-free basis. In order to participate in an HSA, you must be part of a high deductible plan like the DAKOTACAREONE Black plan.



FEATURES RED BLUE GREEN BLACK
Prescription
Drug Benefit		 Generic drugs:
$10 copay

Brand-name
formulary drugs:
$35 copay

Brand-name-
non-formulary
drugs: 100% copays		 Generic drugs:
$10 copay

Brand-name
formulary drugs:
$35 copay

Brand-name-
non-formulary
drugs: 100% copays		 Generic drugs:
$10 copay

Brand-name
formulary drugs:
$35 copay

Brand-name-
non-formulary
drugs: 100% copays		 Rx covered as part of the Medical.
Deductible and coinsurance apply
Deductibles $1,000 - $5,000 $1,000 - $5,000 $500 - $5,000 $1,050 - $5,250
Coinsurance 80/20 or 70/30 80/20 or 70/30 90/10, 80/20 or 70/30 80/20, 70/30
100/0*
Out Of Pocket
(excludes deductibles)		 $1,000 - $5,000 $1,000 - $3,000 $1,000 - $2,000 $0 - $5,000
Physician
Office Visit
Deductible and
coinsurance apply		 $30 copay; then 100% (office visit component) $15 universal copay -
$30 universal copay 		Deductible and coinsurance apply
Maternity Excluded $3,600 copay - normal delivery

$7,200 copay - cesarean section delivery		 Covered Excluded
Preventative
Care		 Deductible waived $30 copay; then 100% $15 copay - primary care physician

$30 copay - specialist		 Deductible waived
Chiropractic Excluded Subject to deductible and coinsurance Subject to deductible and coinsurance Excluded
*This coinsurance option is only available with the $5,250 deductible.

This information is a summary of coverage. Please see policy for actual benefits, limitations and exclusions.

Optional DAKOTACAREONE Coverage

Value Plus – The Value Plus Discount program gives you and your family special discount pricing on vision services, travel assistance, diabetic supplies and much more.

Supplemental Accident – DAKOTACAREONE Supplemental Accident insurance provides you with additional coverage if you’re hurt in an accident. Never hurts to be prepared!


 










Lawrence & Schiller