DakotaBlue | Trinity

The tiered-network plan is available in 11 counties served by Trinity 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:

Preferred Network: Trinity Health System and a Preferred network of providers.
Enhanced Network: North Dakota providers who accept BCBS network coverage.
Standard Network: Any provider outside of North Dakota who accept BCBS coverage.
Non-Participating Provider: All other providers without BCBS service agreements.

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.

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Platinum Plan

Gold Plan

Silver Plan

DakotaBlue | Trinity 90 500

DakotaBlue | Trinity 80 1000

DakotaBlue | Trinity 60 3000

Trinity is an independent healthcare organization partnering with BCBSND to provide the lowest out-of-pocket costs to members through the DakotaBlue | Trinity preferred network.
All cost sharing amounts apply to covered services you receive within the DakotaBlue | Trinity 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

Available to Businesses Based in

Bottineau, Burke, Divide, McHenry, McLean, Mountrail, Pierce, Renville, Rolette, Ward and Williams counties

Deductible
(Preferred Network)

$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
(Preferred Network)

$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
(Preferred Network)

10% of total cost*

20% of total cost*

40% of total cost*

Enhanced

Standard

Non-Participating

30% of total cost*

50% of total cost*

40% of total cost*

50% of total cost*

Preventive Visits
(Preferred Network)

Covered at 100%

Enhanced

Standard

Non-Participating

Covered at 100%

No Coverage

Covered at 100%

No Coverage

Covered at 100%

No Coverage

HealthyBlue Online Wellness

Doctor Visits, Chiropractic Care, Physical, Speech and Occupational Therapy
(Preferred Network)

$10

$20

Enhanced

Standard

Non-Participating

30% of total cost*

50% of total cost*

40% of total cost*

50% of total cost*

Prescription Drugs
(Preferred Network)

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
(Preferred Network)

$20

$60

$80

Enhanced

Standard

Non-Participating

30% of total cost*

50% of total cost*

40% of total cost*

50% of total cost*

Emergency Room Visit
(Preferred Network)

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
(Preferred Network)

10% of total cost*

20% of total cost*

40% of total cost*

Enhanced

Standard

Non-Participating

30% of total cost*

50% of total cost*

40% of total cost*

50% of total cost*

Telehealth
(Preferred Network)

Enhanced

Standard

Non-Participating

30% of total cost*

50% of total cost*

40% of total cost*

50% of total cost*

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