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.

2018 Plans

Compare 2017 Plans

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-$7350

$500-$7350

$500-$7350

$1350-$6650

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 - $6350
70%/30% to $1500 - $6350
50%/50% to $2500 - $6350

100%/0%*
80%/20% to $500 - $6350
70%/30% to $1500 - $6350
50%/50% to $2500 - $6350

100%/0%*
80%/20% to $500 - $6350
70%/30% to $1500 - $6350
50%/50% to $2500 - $6350

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 $1000 to $7350 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 Co-Pay. A complete list of available Preventive Health Services is located here.

Lab and X-Ray

Coinsurance % after deductible

Coinsurance % after deductible

$30 universal co-pay+ /
100% (deductible waived)

Coinsurance % after deductible

Maternity Care

Coinsurance % after deductible

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Hospital ServicesInpatient or Outpatient

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Anesthesia

Coinsurance % after deductible

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Coinsurance % after deductible

Outpatient Surgery

Coinsurance % after deductible

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Emergency Room

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Ambulance Transport

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

Coinsurance % after deductible

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Durable Medical Equipment and Prosthetics

Coinsurance % after deductible

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Hospice

Coinsurance % after deductible

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Prescription Drugs(Subject to DAKOTACARE Formulary)

Refer to Pharmacy Rider options.

Refer to Pharmacy Rider options.

Refer to Pharmacy Rider options.

Coinsurance % after deductible

Chiropractic(Visit Limits Apply per Benefit Year)

$25 co-pay (office visit & manipulation components) /
100% (deductible waived)

Coinsurance % after deductible

$30 co-pay /
100% (deductible waived)

Coinsurance % after deductible

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