High Deductible Health Plan

Looking for Health Savings Account (HSA) qualified plan? South Dakota Farm Bureau Health Plans (SDFBHP) offers a range of High Deductible Health Plans (HDHP) which meet all federal requirements necessary to open a HSA.

SDFBHP uses UnitedHealthcare ChoicePlus Network. Please keep in mind that in-network payments are based on negotiated fees. If an out-of-network provider is used, the member’s liability will increase significantly.

Not everyone is eligible for an HSA. For more information about HSA’s contact Health Equity at 866-346-5800.

About the Plan

As long as you make premium payments on time and do not file claims with false or misleading information you’ll have the security of SDFBHP Medicare Supplement plan.

Resources

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High-Deductible Health Plan Overview

Deductible

$5,000

Out-of-Pocket Max

$7,500

for

$5,000

Deductible

Individual

$10,000

Family

$20,000

Lifetime Benefit Max

Unlimited

High-Deductible Health Plan Details

Note: The benefits and costs shown are for plans effective on or after January 1, 2022. 

 In-NetworkOut-of-Network

Calendar Year Deductible1 (CYD)

+Unless otherwise indicated, all benefits are subject to CYD.
$1,500 Individual
$2,500 Individual
$3,000 Family
$5,000 2-Person/3-Person/Family
$1,500 Individual
$2,500 Individual
$3,000 Family
$5,000 2-Person/3-Person/Family
Out-of-Pocket Maximum2 (OOP)

$3,000 for $1,500 Deductible

$3,750 for $2,500 Deductible

$6,000 for $3,000 Deductible

$7,500 for $5,000 Deductible

Unlimited

Footnotes


1 Deductible – the dollar amount of covered services that must be incurred and paid first by a member each calendar year before plan benefits begin.

2 Once the OOP maximum is met, benefits are provided at 100% for a member(s) for the remainder of the calendar year. This applies to in-network provider services only. There is no Out of Pocket Maximum when out of network providers are used.

 In-NetworkOut-Of-Network
TelaDocYour responsibility: $45 consultation fee until CYD deductible is met. No charge after deductible is met.Your responsibility: $45 consultation fee until CYD deductible is met. No charge after deductible is met.

Coinsurance

+Based on the maximum allowable charges for eligible benefits.
Plan pays 80%, you pay 20%Plan pays 60%, you pay 40%

Preventive Care Benefits

 In-NetworkOut-Of-Network
Well Child Services 3Plan pays 80%, you pay 20%Not Covered
Routine Colonoscopy 4Plan pays 80%, you pay 20%Plan pays 60%, you pay 40%
Annual Routine PSA 5Plan pays 80%, you pay 20%Plan pays 60%, you pay 40%
Annual Routine OB/GYN Exam 6Plan pays 80%, you pay 20%Not Covered
Annual Routine Pap Smear 7Plan pays 80%, you pay 20%Plan pays 60%, you pay 40%
Mammogram 8Plan pays 80%, you pay 20%Plan pays 60%, you pay 40%

Prescription Drug Coverage

Unlimited Calendar Year Maximum Per Member. Home delivery service is available.

 In-NetworkOut-Of-Network
GenericPlan pays 80%, you pay 20%  
BrandPlan pays 80%, you pay 20% 

Footnotes


3 Benefits are available, subject to deductible and coinsurance, for a member under the age of seven (on plan deductibles $3,000 and $5,000) for physical examinations and appropriate immunizations/vaccinations when services are rendered by an in-network provider. Exams not used during the time periods below do not carry over to the next time period.

AgeNumber of Exams
Under age onefour exams from birth to the child's first birthday
Age onetwo exams from the child's first birthday to the child's second birthday
Age two through sixone exam per year (determined by the child's birthday)

4 Benefits will be provided for one routine colonoscopy every four years for members age 50 and over when provided by an in-network or out-of-network provider, subject to the deductible and coinsurance. 

5 Benefits will be provided, subject to deductible and coinsurance, for one routine PSA per calendar year when services are rendered by an independent laboratory or other outpatient setting.

6 Benefits will be available for one routine OB/GYN exam per calendar year, subject to deductible and coinsurance. Services must be rendered by an in-network physician’s office and billed by the in-network provider. Related pathology, including pap smear, which is provided as a part of the routine OB/GYN exam, will be covered when the services are rendered by an in-network physician’s office and billed by the in-network provider. Related pathology that the physician sends to an independent laboratory will be subject to deductible and coinsurance. No benefit is available for routine OB/GYN exams provided by an out-of-network provider.

7 Benefits will be provided for the interpretation of one routine pap smear per calendar year when services are rendered by an independent laboratory or other outpatient setting, subject to deductible and coinsurance.

8 Benefits will be provided, subject to deductible and coinsurance, for routine mammography screening provided such examinations are conducted upon the recommendation of the member’s physician. One baseline routine mammogram will be allowed for members between the ages of 35-39. One routine mammogram will be allowed annually for members age 40 and above. All routine mammography screens are subject to deductible and coinsurance.

Benefits will not be provided for any pre-existing condition until a member has completed a waiting period of at least 12 months. A pre-existing condition is defined in the contract as “An illness, injury, pregnancy or any other medical condition which existed at any time preceding the effective date of coverage under this contract for which: Medical advice or treatment was recommended by, or received from, a provider of health care services; or symptoms existed which would cause an ordinarily prudent person to seek diagnosis, care or treatment.” The pre-existing condition waiting period does not apply to members under the age of 19.

Maternity Benefits will be available after a member’s coverage on a 2-person, 3-person or family contract has been in effect for nine consecutive months. Individual coverage has NO maternity benefits.

Enroll today!

If you already know what coverage you need, and you’re ready to sign-up for affordable and quality coverage, we’re ready to help.

In-Network Out-Of-Network
TelaDoc Your responsibility: $45 consultation fee until CYD deductible is met. No charge after deductible is met. Your responsibility: $45 consultation fee until CYD deductible is met. No charge after deductible is met.
Coinsurance
+Based on the maximum allowable charges for eligible benefits.
Plan pays 80%, you pay 20% Plan pays 60%, you pay 40%

Preventive Care Benefits

In-Network Out-Of-Network
Well Child Services 3 Plan pays 80%, you pay 20% Not Covered
Routine Colonoscopy 4 Plan pays 80%, you pay 20% Plan pays 60%, you pay 40%
Annual Routine PSA 5 Plan pays 80%, you pay 20% Plan pays 60%, you pay 40%
Annual Routine OB/GYN Exam 6 Plan pays 80%, you pay 20% Not Covered
Annual Routine Pap Smear 7 Plan pays 80%, you pay 20% Plan pays 60%, you pay 40%
Mammogram 8 Plan pays 80%, you pay 20% Plan pays 60%, you pay 40%

Prescription Drug Coverage

Unlimited Calendar Year Maximum Per Member
In-Network Out-Of-Network
Generic 30 Day Supply Plan pays all but copayment, you pay $4 copayment 9 Plan pays 60%, you pay 40%
Brand Plan pays 80%, you pay 20% Plan pays 60%, you pay 40%

Footnotes


3 Benefits are available, subject to deductible and coinsurance, for a member under the age of seven for physical examinations and appropriate immunizations/vaccinations when services are rendered by an in-network provider. Exams not used during the time periods below do not carry over to the next time period.

Age Number of Exams
Under age one four exams from birth to the child’s first birthday
Age one two exams from the child’s first birthday to the child’s second birthday
Age two through six one exam per year (determined by the child’s birthday)

4 Benefits will be provided for one routine colonoscopy every four years for members age 50 and over when provided by an in-network or out-of-network provider, subject to the deductible and coinsurance.

5 Benefits will be provided, subject to deductible and coinsurance, for one routine PSA per calendar year when services are rendered by an independent laboratory or other outpatient setting.

6 Benefits will be available for one routine OB/GYN exam per calendar year, subject to deductible and coinsurance. Services must be rendered by an in-network physician’s office and billed by the in-network provider. Related pathology, including pap smear, which is provided as a part of the routine OB/GYN exam, will be covered when the services are rendered by an in-network physician’s office and billed by the in-network provider. Related pathology that the physician sends to an independent laboratory will be subject to deductible and coinsurance. No benefit is available for routine OB/GYN exams provided by an out-of-network provider.

7 Benefits will be provided for the interpretation of one routine pap smear per calendar year when services are rendered by an independent laboratory or other outpatient setting, subject to deductible and coinsurance.

8 Benefits will be provided, subject to deductible and coinsurance, for routine mammography screening provided such examinations are conducted upon the recommendation of the member’s physician. One baseline routine mammogram will be allowed for members between the ages of 35-39. One routine mammogram will be allowed annually for members age 40 and above. All routine mammography screens are subject to deductible and coinsurance.

9 Prescription copayment does not apply toward deductible or out-of-pocket maximum.

Enroll today!

If you already know what coverage you need, and you’re ready to sign-up for affordable and quality coverage, we’re ready to help.

Find an Agent

Farm Bureau Financial Services agents are equipped and ready to provide you a variety of health care coverage options.

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