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The Health Plans

• Plan Design Matrix for the Washington, Lincoln, Jefferson, and Roosevelt Health Plans
• Health and Pharmacy Benefit Guide
• Health Plan Comparison
• Premiums Side-By-Side

If you currently opt out, you will need to participate in open enrollment this year or you will be enrolled in the Washington Plan with employee-only coverage. Any flexible benefits coverage you currently enjoy will be discontinued. Covered dependents will also lose coverage. Acceptable proof of credible coverage includes:
• A Certificate of Coverage from the health plan carrier that shows group coverage (a copy of your insurance ID card is insufficient).
• A letter on letterhead or an email from an employer’s HR department verifying active coverage, along with the type of coverage for the enrolled members.
• TriCare Letter from the Defense Enrollment Eligibility Reporting System (DEERS) or a TriCare identification card.
• Current Medicare identification card (including Part A and Part B).
• Social Security Award letter within the past twelve months, and which shows active Medicare coverage (including Part A and Part B).
• A current benefits enrollment statement.

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

If you are opting out of the health plan for the first time due to other creditable group coverage, you must send proof of other credible coverage to benefitswebsite@state.sd.us by May 22, 2025, so you may want to make sure you have that available by the deadline.

Flexible Benefits

If you have 12 months of continuous service within the past year, have worked at least 1,250 hours in that time period, your sick leave balance is below 80 hours, and you experience a qualified FMLA event, you may qualify for Paid Family Medical Leave, which covers 100% of your weekly salary for up to 12 weeks. However, this leave would only be available for whatever remaining FMLA leave you have at that time.

Short-Term Disability (STD) coverage does coordinate with both of these benefits in the event that you are ill or injured, on or off the job, and it continues for up to 52 weeks. According to the plan rules, you must take your Paid Family Leave and STD coverage at the same time, meaning any payments from STD will be offset by the Paid Family Leave. However, since the Paid Family Leave ends after 12 weeks, please take into consideration your finances – would you be able to cover your and your family’s expenses if you had to be off of work for more than 12 weeks? Do you meet the eligibility requirements for either of the scenarios for Paid Family Leave?

We cannot give you advice on your benefit elections, but do encourage you to carefully consider your options for STD when you make your elections for FY25.

For additional information on Short-Term Disability, please visit our plans pages at https://bhr.sd.gov/benefits/flexible-benefits/std/. For clarification on the Paid Family Medical Leave, please visit with your Human Resources Manager.

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 subsidize a cost share of $25.32 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.

• FY26 Dental Premiums
• Dental Plan Options
• Teledentistry with Delta Dental

The health plan will continue to cover 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.

• FY26 Vision Premiums

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 $1,500 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.

Critical Illness:
Critical Illness is coverage designed to protect you and your covered family members if you are diagnosed with a major illness. This type of plan provides you with extra funds to meet the demands that come with critical illness health emergencies, which often prove to be costly. Whether you need the extra money to pay for medical treatment, to help offset travel costs associated with treatment, or to just pay your everyday expenses such as groceries or your rent, Critical Illness is there to help you when you need it. Visit the Critical Illness page to for more information and rates.

Prudent RX

Medications that treat complex and chronic conditions - are also covered by your plan. You and your covered family members will be offered the opportunity to participate in a program called PrudentRX. Prudent RX offers a copay card on specialty medications, with your costs for these being as low as $0 until the copay card dollar amount expires. All covered members will be contacted if eligible for this program. Please note: This program is available to members enrolled in the Jefferson and Roosevelt low deductible health plans.

To find out if your specialty medication qualifies for this program, please refer to the PrudentRX Drug List. If you have further questions, please contact Wellmark at 800.846.9183.

Well-Being

The State of South Dakota employee well-being program, LiveWellSD, empowers employees and their families to take charge of their total well-being to live their best life at work and at home. There is a wealth of resources available including well-being challenges, daily habits programs, diabetes prevention programs, and much more.

A new customizable well-being platform, powered by Propel, goes live July 1, 2025 to replace the current LiveWellSD online resources. Propel brings over two decades of experience serving some of the world's largest employers across dozens of industries. The platform is fully customizable to bring better support and new resources to help improve the well-being of individuals and their families across the organization. The new LiveWellSD will provide you with the simplest and easiest way to get what you need to achieve your well-being goals. There is no app to access this new well-being platform, and it is available 24/7. Watch for new and exciting communications and registration details!

FY26 Reward Totals - Incentive dollars earned between April 2, 2025, and April 1, 2026, will be awarded during FY27. The award amount is based on your coverage level as of April 1, 2026, and the health plan you elect during FY27 Open Enrollment. Eligible employees who enroll in one of the high-deductible health plans will receive a contribution to an HSA, while those who enroll in one of the low deductible health plans will receive a contribution to an HRA. You must be the primary policyholder during FY26 while earning the reward and must enroll as the primary policyholder for the next year.

Visit the LiveWellSD Portal to check your rewards earned, which will be added to WEX accounts by September 2025.

For more information about resources and reward opportunities, please click here.

The Employee Assistance Program (EAP), 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.

Open Enrollment Zoom Sessions

The Benefits Team will also be offering assistance to walk you through your enrollment should you have questions. It’s important to note that you will need to make sure you can login to Employee Space prior to the enrollment sessions, as these sessions will be focused on the actual enrollment process. Please register for one of the three sessions below.

Date Time Registration Link
Check back soon for updates!

Resources: