Comprehensive Health Insurance Plans for Employers

DAKOTACARE is different from any other South Dakota health insurance agency. We care about improving your health...not just providing insurance to cover it. That’s why all of our plans offer comprehensive coverage, preventative care programs and flexible deductible options.

We’re health insurance experts...so you don’t have to be. DAKOTACARE Flex helps our members save money by allowing them to pay group health care premiums, unreimbursed medical expenses and dependent care expenses with pre-tax dollars.

DAKOTACARE COBRA delivers employers complete administration and management services for benefits mandated under COBRA (the Consolidated Omnibus Budget Reconciliation Act) and state continuation laws.

DAKOTACARE does just what our name says it does. We care about South Dakota. That’s why we’ve created four group plans that let you be in control of your health care costs while helping your employees live happier, healthier lives.

 

Employers should take into consideration all full-time, part-time, and seasonal employees when determining the number of employees for this.

Employers should take into consideration all full-time, part-time, and seasonal employees when determining the number of employees for this.

Choice Plan
Select Plan
Ultra Plan
Reserve Plan
Plan Options
Choice Plan
Select Plan
Ultra Plan
Reserve Plan
Deductible (Benefit Year)Deductibles are shown as individual for Select, Choice and Ultra Plans and as single for Reserve Plan. Family Deductibles of 2x or 3x are available in Select, Choice and Ultra Plans.** Reserve Plan family Deductible is 2x aggregate (non-embedded).

$500-$7150

$500-$7150

$500-$7150

$1300-$6550

Coinsurance Maximum (Benefit Year)Coinsurance Maximums are shown as individual for Select, Choice and Ultra Plans and as single for Reserve Plan. Family Coinsurance maximum of 2x or 3x will mirror selected Deductible option for Select, Choice and Ultra Plans. Reserve Plan family Coinsurance Maximum is 2x aggregate (non-embedded).

100%/0%*
80%/20% to $500 - $5650
70%/30% to $1500 - $5650
50%/50% to $2500 - $5650 

100%/0%*
80%/20% to $500 - $5650
70%/30% to $1500 - $5650
50%/50% to $2500 - $5650 

100%/0%*
80%/20% to $500 - $5650
70%/30% to $1500 - $5650
50%/50% to $2500 - $5650 

100%/0%*
80%/20% to $500 - $3950
70%/30% to $500 - $3950 

Out-of-pocket MaximumApplicable medical copays apply to a Maximum Out-of-Pocket accumulation.

The portion of payments for health services which is the responsibility of the Member, which shall include Deductible and Coinsurance. Annual Out-of-Pocket Maximum can range from $700 to $6600 depending on the deductible and coinsurance options selected.

Annual Maximum Benefit (per Benefit Year)

Unlimited

Unlimited

Unlimited

Unlimited

Physician Office Visits

$25 copay (office visit component) / 100% (deductible waived)

Coinsurance % after deductible

Ultra: $30 Universal copay / 100% (deductible waived)

Coinsurance % after deductible

Preventive Health Services

Covered preventive health services provided by a Participating Provider are not subject to Deductible, Coinsurance or Copayment. A complete list of available Preventive Health Services is located here.

Lab and X-Ray

Coinsurance % after deductible

Coinsurance % after deductible

Ultra: $30 copay / 100% (deductible waived)

Coinsurance % after deductible

Maternity Care

Coinsurance % after deductible

Coinsurance % after deductible

Coinsurance % after deductible

Coinsurance % after deductible

Hospital ServicesInpatient or Outpatient

Coinsurance % after deductible

Coinsurance % after deductible

Coinsurance % after deductible

Coinsurance % after deductible

Anesthesia

Coinsurance % after deductible

Coinsurance % after deductible

Coinsurance % after deductible

Coinsurance % after deductible

Outpatient Surgery

Coinsurance % after deductible

Coinsurance % after deductible

Coinsurance % after deductible

Coinsurance % after deductible

Emergency Room

Coinsurance % after deductible

Coinsurance % after deductible

Coinsurance % after deductible

Coinsurance % after deductible

Ambulance Transport

Coinsurance % after deductible

Coinsurance % after deductible

Coinsurance % after deductible

Coinsurance % after deductible

Mental Health and Substance Use DisordersInpatient, Outpatient or Partial Hospital Care

Coinsurance % after deductible

Coinsurance % after deductible

Coinsurance % after deductible

Coinsurance % after deductible

Durable Medical Equipment and Prosthetics

Coinsurance % after deductible

Coinsurance % after deductible

Coinsurance % after deductible

Coinsurance % after deductible

Hospice

Coinsurance % after deductible

Coinsurance % after deductible

Coinsurance % after deductible

Coinsurance % after deductible

Prescription Drugs(Subject to DAKOTACARE Formulary)

Rider may be purchased

Rider may be purchased

Rider may be purchased

Coinsurance % after deductible

Chiropractic(Visit Limits Apply per Benefit Year)

$25 copay (office visit & manipulation components) / 100% (deductible waived)

Coinsurance % after deductible

$30 copay / 100% (deductible waived)

Coinsurance % after deductible

Choice Plan
Select Plan
Ultra Plan
Reserve Plan
Choice Plan
Select Plan
Ultra Plan
Reserve Plan