SimplyBlue Health Insurance Plan

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

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 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

	Simply Blue
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.
Preventive Visits	$0
HealthyBlue Online Wellness	$0
Doctor Visits	$40
Chiropractic Care, Physical, Speech and Occupational Therapy	Deductible and coinsurance apply
Prescription Drugs	Value Drug: $5 Generics: $40 Preferred Brand: Deductible and coinsurance applies Non-Preferred Brand: Deductible and coinsurance applies Specialty: Deductible and coinsurance applies
Emergency Room Visit	Deductible and coinsurance apply
Hospitalization	40%
Deductible	Individual: $6,800 Family: $13,600
Coinsurance	40% of total cost
Out-of-Pocket Maximums	Individual: $8,150 Family: $16,300