Your FY23 Health Plans

FY23 Open Enrollment is Closed.

Your next change to make changes to your benefits elections will be during FY24 Open Enrollment, unless you experience a qualified life event.

Click here for a comparison of all four health plans.

The Health Plans

Click here for the Washington Plan Design Matrix - a complete breakdown of medical, pharmacy, and premium costs.

The Washington Plan is one of two High Deductible Health Plans being offered for Fiscal Year 2023. This plan offers zero premium for employee coverage. The Washington Plan has a $5,500 deductible for single coverage and $11,000 deductible for two or more members.

Your out-of-pocket maximums are the same as your deductibles. This means that if you have single coverage, and you meet your deductible of $5,500, the plan will then pay 100% of your healthcare and prescription costs for the remainder of the plan year.

An important new feature in this plan is the way the deductible is met when more than two individuals are covered. For example, if you have family coverage, and one of your family members reaches the $5,500 deductible, the plan will then begin to pay 100% of covered healthcare and prescription costs for the remainder of the plan year for that family member. Then, if you and a different family member reaches the additional $5,500 remaining deductible of $11,000, the plan will pay 100% of covered healthcare and prescription costs for all of your covered family members for the remainder of the plan year.

Because there is no coinsurance with the Washington plan, you can expect to pay the reduced network costs of prescriptions, office visits, or other medical services until you have met your deductible. The exception to this is certain generic preventive prescriptions, which are not subject to the deductible, and may be covered at 100% depending on the type of the prescription.

Preventive services will still be covered at 100%, and not subject to co-insurance.

Since the Washington Plan is a High Deductible Health Plan, it is compatible with a Health Savings Account, assuming you are eligible to participate in a Health Savings Account. If you and your covered spouse (if applicable), complete the biometric screening and the online health assessment qualifications before April 1, 2022, you can earn $500 contribution to your Health Savings Account at the beginning of the new plan year in July 2022. You as the primary policy holder can also complete a variety of activities by April 1, 2022, to earn up to an additional $400 to your HSA. More details on the activities can be found on the beneFIT Well-being portal.

The state will continue to offer this premium-free option.

Click here for the Lincoln Plan Design Matrix - a complete breakdown of medical, pharmacy, and premium costs.

The Lincoln Plan is one of two High Deductible Health Plans being offered for the Fiscal Year 2023 and offers a $3,000 deductible for single coverage or a $6,000 deductible for coverage for two or more family members.

The Lincoln Plan is similar to other High Deductible Health Plans, in that you have to satisfy your deductible before the plan begins to pay benefits. Once you have reached your deductible, the Plan pays 75% of billed services, and you then pay the remaining 25% of the costs.

For example, if you go in for an urgent care visit before you meet your deductible, you will pay the reduced network cost of the visit as you would any other medical cost. If you go after meeting after meeting your deductible, you will pay just 25% of the cost. Once you meet your out-of-pocket maximum, the visit will be covered at 100%.

All co-payments and co-insurance count towards your annual out-of-pocket maximum, which is $6,000 for single coverage, or $12,000 for family coverage. Once you meet that out-of-pocket maximum, services will be covered at 100% for the remainder of the plan year. Preventive services will still be covered at 100%, and not subject to co-insurance.

One of the new features of the Lincoln Plan is that you will no longer have to meet the family coverage deductible before the plan begins to pay. In our previous High Deductible Health Plan, if you covered yourself and any family members, the full deductible had to be met before the plan began paying any benefits. Now, if one member of your family meets the single deductible, the plan will begin to pay allowable charges for that family member.

As an enhanced High Deductible Health Plan, you buy up through a small premium to enroll in this plan.

Because the Lincoln Plan is a High Deductible Health Plan, it is compatible with a Health Savings Account, assuming you are eligible to participate in a Health Savings Account. If you and your covered spouse (if applicable), complete the biometric screening and the online health assessment qualifications before April 1, 2022, you can earn $500 contribution to your Health Savings Account at the beginning of the new plan year in July 2022. You as the primary policy holder can also complete a variety of online activities on the beneFIT Well-being Portal by April 1, 2022, will also give you the opportunity to earn up to an additional $400 to your HSA.

Click here for the Jefferson Plan Design Matrix - a complete breakdown of medical, pharmacy, and premium costs.

The Jefferson Plan is one of two Low Deductible Health Plans being offered in Fiscal Year 2023 and has a $1,750 deductible for single coverage or a $3,500 deductible for coverage for two or more members.

This plan introduces a mix of co-payments and co-insurance. What this means is that some services are paid at a flat dollar amount without having to satisfy your deductible, while other services may be covered with a co-payment and co-insurance, and others with a simple co-insurance amount.

If you go for an office visit or urgent care, it will cost you $50. A visit to the emergency room will cost you $250 plus 30% of the remaining bill. For example, if the emergency room visit costs $1,000 dollars, you will pay a total of $475 if you have not yet reached your out-of-pocket maximum.

Prescription drug costs will also be co-payments, depending on the type of prescription you have filled. All co-payments and co-insurance count toward your annual out-of-pocket maximum, which is $4,000 for single coverage, or $8,000 for family coverage. Once you have met that out-of-pocket maximum, services will be covered at 100% for the remainder of the plan year.

As a participant in the Jefferson Plan, you will know your out-of-pocket costs for the most common medical and prescription expenses, allowing you to budget for you and your family’s expenses more easily.

Preventive services will still be covered at 100%, and not subject to co-payments. With this plan, you buy a higher value with your monthly premium.

Like all Low Deductible Health Plans, the Jefferson Plan is not compatible with a Health Savings Account. However, you can elect to participate and set aside pre-tax money in a Medical Flexible Savings Account to help budget for costs. Additionally, if you and your covered spouse (if applicable), complete the biometric screening and the online health assessment qualifications before April 1, 2022, you can earn $500 contribution to your Health Reimbursement Account at the beginning of the new plan year in July 2022. You as the primary policy holder can also complete a variety of online activities on the beneFIT Well-being Portal by April 1, 2022, will also give you the opportunity to earn up to an additional $400 to your HRA.

Click here for the Roosevelt Plan Design Matrix - a complete breakdown of medical, pharmacy, and premium costs.

The Roosevelt Plan is one of two Low Deductible Health Plans being offered in Fiscal Year 23, and offers a zero-dollar deductible, whether you have single or family coverage; you will not have to meet a deductible before the plan starts paying benefits. This plan also introduces a new feature not previously available with our prior Health Plan, a set of co-payments for all for all covered services.

The Roosevelt Plan is ideal for people who want to know exactly what medical services will cost with no surprises. It also provides an opportunity to budget medical expenses because you are paying these in a more predictable way – a combination of your monthly premium and these established co-pays.

If you or a covered family member have a visit with your primary care physician, need to go to an urgent care facility, or have an x-ray, you will pay a flat $30 to your provider. An emergency room visit will cost you $500, while an inpatient or outpatient service will cost you $3,500 or $2,500 respectively.

Prescription drug costs will also be co-payments, depending on the type of prescription you have filled. All co-payments do count towards your annual out-of-pocket maximum, which is $4,500 for single coverage, or $9,000 for family coverage. Once you meet that out-of-pocket maximum, services will be covered at 100% for the remainder of the plan year.

So, what does this mean for you? As a participant in the Roosevelt Plan, you will know what your out-of-pocket costs will be for medical and prescription coverages, allowing you to budget for you and your family’s expenses for the plan year.

Preventive services will still be covered at 100%, and not subject to co-payments.

With this robust plan, you buy up to the higher value through premium.

Like all Low Deductible Health Plans, the Roosevelt Plan is not compatible with a Health Savings Account. However, you can elect to participate and set aside pre-tax money in a Medical Flexible Savings Account to help budget for costs. Additionally, if you and your covered spouse (if applicable), complete the biometric screening and the online health assessment qualifications before April 1, 2022, you can earn $500 contribution to your Health Reimbursement Account at the beginning of the new plan year in July 2022. You as the primary policy holder can also complete a variety of online activities on the beneFIT Well-being Portal by April 1, 2022, will also give you the opportunity to earn up to an additional $400 to your HRA.

Flexible Benefits

Dental insurance options include low- or no-cost preventive care, as well as coverage for routine and restorative services, major services, and orthodontics.

The State will continue subsidizing a cost share of $16.20 per month, regardless of which plan or coverage level you choose. Premiums include the subsidized cost share.

You can visit any dentist you choose, but you may pay less when you go to an in-network provider. There is no waiting period for services. Orthodontic cases may be paid for over two years based on the treatment plan.

Employees enrolled in the Enhanced Plan for dental coverage and their dependents are eligible for Maximum Bonus Account (MBA) benefits. With MBA benefits, each covered person who qualifies will receive $250 per plan year to pay for dental care, up to the $2,000 maximum.

Learn more about your dental benefits on our dental plans page or at deltadentalsd.com.

Don't leave dental benefits on the table. Click here to read about the differences between the base and enhanced dental plans.   

Medical insurance coverage will continue to include one eye exam for each covered member per plan year.

Electing vision coverage will help pay for an additional eye exam, along with frames, lenses, contacts, and more. You can see any vision care doctor you choose, but you may pay less at in-network providers. To find in-network care, visit www.eyemedvisioncare.com/sosd, select Provider Locator, enter your zip code, and choose the network Insight.

Visit the vision plans page for more information.

The State provides a $25,000 life and accidental death and dismemberment (AD&D) benefit to all benefit eligible employees.

You have the option to purchase Supplemental Life at 1-7 x your annual salary, up to a maximum of $1,000,000. If you add Supplemental Life or increase your amount, you will also need to complete an Evidence of Insurability Form.

Finally, if you purchase Supplemental Life, a $1500 Long Term Care benefit from UNUM is included. You may also select to purchase Dependent Life.

Short Term Disability Insurance:
In the event of a disability due to an illness or injury that leaves you unable to work, this benefit helps protect your income by providing 70% of your monthly salary, up to a maximum of $1,200 per week.

This plan has a six-month waiting period after your initial enrollment. After the waiting period, in the event of a disability, this plan has a seven-day elimination period. If your period of disability continues for more than 90 days, your premium is waived until you are no longer disabled and can return to work.

Short-term disability coordinates with any additional State income you may be receiving, such as worker’s compensation or paid family medical leave.

For details, see the STD Summary Plan Description on our Short-Term Disability page.

Accident Insurance:
Accident insurance provides you with a lump-sum payment to help with costs related to a covered injury. The benefit includes more than 150 covered events, and there is no limit on the number of separate accidents covered.

You can use the benefit for any out-of-pocket medical or non-medical costs, including deductibles, copays, and coinsurance, or even for childcare or travel needed as you recover.

Payments are made directly to you and there are no waiting periods for coverage.

Visit our accident insurance page for more information.

Hospital Indemnity Insurance:
Hospital indemnity insurance provides a lump-sum benefit for hospitalization and associated treatment and payments are made directly to you.

You and your covered family members receive a daily per-person benefit for each day of hospitalization due to an illness or injury — up to a total of 180 days beginning with the first day of a hospital stay.

There is no coordination with other insurance benefits, so payments are made in addition to any other insurance you may have. There is no lifetime maximum benefit and no waiting periods for coverage.

Visit our Hospital Indemnity Plans page for more information.

Well-Being

The beneFIT Well-Being Portal matches your unique needs and interests with tools and resources that are right for you. There are two well-being rewards you can earn for FY23:

Reward #1: $500 in HSA or HRA Contribution – Complete the Online Health Assessment and Biometric Screening by April 1, 2022 to earn this reward.
Reward #2: $400 additional HSA or HRA Contribution – Employees can earn points by completing well-being activities on the portal. You can complete this up to four ties to earn a maximum of $400. This reward is awarded in $100 increments.

Click here to learn more about the beneFIT Well-Being Program for FY23.

The Employee Assistance Program (EAP), is sponsored by the South Dakota State Employee Benefits Program and Administered by ComPsych® and GuidanceResources®. This service is offered at no cost to benefit-eligible employees and their spouses, dependents, and household members.

Click here to learn more about the Employee Assistance Program for FY23.

Other Important Plan Information

You can opt out of the South Dakota State Employee Health Plan if you provide proof of other creditable group health coverage. To opt out, you must log in during open enrollment. If you currently opt out, you must participate in open enrollment this year or you will be defaulted to the Washington Plan with employee-only coverage.

Acceptable proof of coverage includes:

  • A Certificate of Creditable Coverage from your other insurance carrier.
  • A TRICARE identification card showing continued coverage.
  • A Medicare identification card showing continued coverage.

Please note: Other creditable coverage does not include Medicaid, Indian Health Services, VA coverage, or coverage obtained through the Marketplace Exchange.

The deadline to submit your proof of creditable coverage is June 3, 2022. Email it to benefitswebsite@state.sd.us.

Click here to watch a recent Open Enrollment Presentation

Resources:

State of South Dakota Pharmacy Cost Compare Tool – Click for Instructions

Plan Name/Identifier Plan Member ID Link
Washington WMK8EM 1022TST0401 Click Here
Lincoln WMK8EL 1022TST0301 Click Here
Jefferson WMK8EK 1022TST0201 Click Here
Roosevelt WMK8EJ 1022TST0101 Click Here
Pharmacy Locator 1022TST0101 Click Here