SimplyBlue Plan

Budget-friendly plan covering ND doctors

Special Enrollment

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Consider this plan if

You’re comfortable with just the basics and don’t need to go outside of North Dakota to receive care.

Coverage available for:

Individual
Families

Plan features

Coverage for medical care within North Dakota
Preventive care, screening and immunization coverage
One doctor office visit with a low copay in addition to preventive care
Generic prescriptions have low copays and are covered even before deductible is met
Wellness rewards for actively managing your health
Covers the 10 essential health benefits

Plan highlights

Plan has a lower monthly premium in return for using the Preferred Blue PPO network
Network includes most ND doctors
Preventive visits are free if they are in network
Low copay for generic drugs
Out-of-state emergency care covered at the same rates as within the network
Includes HealthyBlue online wellness and rewards for managing your health

Bronze Plan

SimplyBlue

Cost sharing amounts apply to covered services you receive within the Preferred Blue PPO network.
The SimplyBlue plan prescription drug coverage is not considered creditable coverage.
*After deductible is met.

Deductible

Individual: $6,800
Family: $13,600

Coinsurance

50% of total cost*

Out-of-Pocket Maximums

Individual: $9,100
Family: $18,200

Preventive Visits

HealthyBlue Online Wellness

Doctor Visits

$40 for first visit. Subsequent visits subject to deductible and coinsurance

Chiropractic Care, Physical, Speech and Occupational Therapy

50% of total cost

Prescription Drugs

Value Drug: $5
Preferred Generic: $40
Non-Preferred Generic: $40
Preferred Brand: 50% of total cost*
Non-Preferred Brand: 50% of total cost*
Preferred Specialty: 50% of total cost*
Non-Preferred Specialty: 50% of total cost*

Emergency Room Visit

50% of total cost*

Hospitalization

50% of total cost*

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