The tiered-network plan is available in 11 counties served by Altru Health System and a Preferred network of providers. The provider network is split into four tiers, depending on where you get care.
Tiered networks are designed to help employees make informed decisions about where they get care. With this approach, out-of-pocket costs are determined by which network a provider is in:
NOTE: Occasionally, Preferred Network providers refer patients to doctors in the Enhanced or Standard networks. If the referral is approved, the services may be covered at the Preferred Network level.
Learn more about tiered-network plans: Tiered Networks: How They Work.
Amounts indicated are your share of the medical expenses.
Platinum Plan | Gold Plan | Silver Plan | |
---|---|---|---|
DakotaBlue | Altru 90 500 | DakotaBlue | Altru 80 1000 | DakotaBlue | Altru 60 3000 | |
Altru is an independent healthcare organization partnering with BCBSND to provide the lowest out-of-pocket costs to members through the DakotaBlue | Altru preferred network. All cost sharing amounts apply to covered services you receive within the DakotaBlue | Altru network. Covered services received from a non-participating provider are paid at a lesser benefit or no benefit amount. For a family plan, an individual on the plan must meet the individual deductible before coinsurance begins. *After deductible is met |
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Available to Businesses Based in |
Grand Forks, Ramsey, Walsh, Pembina, Benson, Nelson, Cavalier, Towner, Eddy, Griggs and Steele counties | Grand Forks, Ramsey, Walsh, Pembina, Benson, Nelson, Cavalier, Towner, Eddy, Griggs and Steele counties | Grand Forks, Ramsey, Walsh, Pembina, Benson, Nelson, Cavalier, Towner, Eddy, Griggs and Steele counties |
Deductible
|
$500 (Individual)
$1,000 (Family) |
$1,000 (Individual)
$2,000 (Family) |
$3,000 (Individual)
$6,000 (Family) |
Enhanced Standard Non-Participating |
$3,500 $4,500 $6,750 $7,000 $9,000 $13,500 |
$2,000 $2,500 $3,750 $4,000 $5,000 $7,500 |
$6,000 $7,000 $10,000 $12,000 $14,000 $20,000 |
Out-of-pocket Maximums
|
$1,800 (Individual)
$3,600 (Family) |
$8,250 (Individual)
$16,500 (Family) |
$9,400 (Individual)
$18,800 (Family) |
Enhanced Standard Non-Participating |
$9,100 $15,000 $22,500 $18,200 $30,000 $45,000 |
$9,250 $20,375 $30,500 $18,500 $40,750 $61,000 |
$9,400 $22,750 $34,125 $18,800 $45,500 $68,250 |
Coinsurance
|
10% of total cost* | 20% of total cost* | 40% of total cost* |
Enhanced Standard Non-Participating |
30% of total cost* 50% of total cost* 50% of total cost* |
40% of total cost* 50% of total cost* 50% of total cost* |
50% of total cost* 50% of total cost* 50% of total cost* |
Preventive Visits
|
Covered at 100% | Covered at 100% | Covered at 100% |
Enhanced Standard Non-Participating |
Covered at 100% Covered at 100% No Coverage |
Covered at 100% Covered at 100% No Coverage |
Covered at 100% Covered at 100% No Coverage |
HealthyBlue Online Wellness |
$0 | $0 | $0 |
Doctor Visits, Chiropractic Care, Physical, Speech and Occupational Therapy
|
$5 | $10 | $20 |
Enhanced Standard Non-Participating |
30% of total cost* 50% of total cost* 50% of total cost* |
40% of total cost* 50% of total cost* 50% of total cost* |
50% of total cost* 50% of total cost* 50% of total cost* |
Prescription Drugs
|
Value drugs: $5 Preferred Generic: $5 Non-Preferred Generic: $5 Preferred Brand: $20 Non-Preferred Brand: $40 Preferred Specialty: 20%* Non-Preferred Specialty: 50%* |
Value drugs: $5 Preferred Generic: $5 Non-Preferred Generic: $5 Preferred Brand: $50 Non-Preferred Brand: $150 Preferred Specialty: 30%* Non-Preferred Specialty: 50%* |
Value drugs: $5 Preferred Generic: $20 Non-Preferred Generic: $20 Preferred Brand: $150 Non-Preferred Brand: $200 Preferred Specialty: 50%* Non-Preferred Specialty: 50%* |
Specialist Visit
|
$20 | $60 | $80 |
Enhanced Standard Non-Participating |
30% of total cost* 50% of total cost* 50% of total cost* |
40% of total cost* 50% of total cost* 50% of total cost* |
50% of total cost* 50% of total cost* 50% of total cost* |
Emergency Room Visit
|
10% of total cost* | 20% of total cost* | 40% of total cost* |
Enhanced Standard Non-Participating |
10% of total cost* |
20% of total cost* |
40% of total cost* |
Hospitalization
|
10% of total cost* | 20% of total cost* | 40% of total cost* |
Enhanced Standard Non-Participating |
30% of total cost* 50% of total cost* 50% of total cost* |
40% of total cost* 50% of total cost* 50% of total cost* |
50% of total cost* 50% of total cost* 50% of total cost* |
Telehealth
|
$0 | $0 | $0 |
Enhanced Standard Non-Participating |
30% of total cost* 50% of total cost* 50% of total cost* |
40% of total cost* 50% of total cost* 50% of total cost* |
50% of total cost* 50% of total cost* 50% of total cost* |
Blue Cross Blue Shield of North Dakota is an independent licensee of the Blue Cross Blue Shield Association, serving residents and businesses in North Dakota. All rights reserved.
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