Classic Choice

Classic Choice is for those who are looking for a health plan with preventative health, dental and vision benefits. Get the trifecta—health, dental and vision—under one health plan. Available for individuals only.

South Dakota Farm Bureau Health Plans uses UnitedHealthcare Choice Plus 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.

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.

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Classic Choice Plan Overview

Deductible

Option 1

$3,000

Option 2

$6,000

Out-of-Pocket Max

Option 1

$10,000

Option 2

$20,000

Lifetime Benefit Max

Unlimited

Classic Choice Plan Details

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

 In-NetworkOut-Of-Network

Office Visit

+Not subject to CYD or OOP
$40 copayment* per visitCYD/Coinsurance
TelaDoc$0 copayment* per visitNo coverage

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

No Waiting Period

 In-NetworkOut-Of-Network
Preventative Health Exam 1Plan pays 100%Plan pays 60%, you pay 40%
Annual Well Woman Exam 2Plan pays 100%Plan pays 60%, you pay 40%
Routine Colonoscopy 3Plan pays 100%Plan pays 60%, you pay 40%
Annual Routine PSA 4Plan pays 100%Plan pays 60%, you pay 40%

Emergency Room

+Not resulting in admission

$75 deductible per visit

+In addition to CYD and Coinsurance
$75 deductible per visit

Prescription Drug Coverage

Unlimited Calendar Year Maximum Per Member

 In-NetworkOut-Of-Network
Generic 30 Day SupplyPlan pays all but copayment, you pay $4 copayment 5Plan pays 60%, you pay 40%
BrandPlan pays 80%, you pay 20%Plan pays 60%, you pay 40%

Dental

No waiting periods

Pediatric (Under Age 19)
  • Preventative services paid at 100%
  • Other eligible dental services subject to CYD and coinsurance
  • Limited orthodontic care
Age 19 and Over
  • $40 copay for preventative and restorative services
  • Maximum benefit per calendar year is $500

Vision

No Waiting Periods

Pediatric (Under Age 19)
  • Eye exams are covered at 100% once every calendar year, no dollar limit
  • Eyeglass frames, eyeglass lenses or contact lenses are covered once every Calendar Year at 100% up to a maximum of $100 per Member, not subject to Deductible and Coinsurance.
Age 19 and Over
  • Eye exams are covered once every calendar year with a $40 limit per member
  • Eyeglass frames, eyeglass lenses or contact lenses are covered once every Calendar Year at 100% up to a maximum of $100 per Member, not subject to Deductible and Coinsurance.

Footnotes


1 Preventative health exam for adults and children and related services as outlined below and performed by the physician during the preventative health exam or referred by the physician as appropriate, including:

2 Annual Well Woman Exam

  • Routine well woman preventative exam office visit
  • Cervical cancer screening
  • Screening mammography at age 40 and older, with one baseline mammogram between the ages of 35-39
  • Other USPSTF screenings with an A or B rating
    • Pap smears
    • Bone density measurement screening

3 Colorectal cancer screening for members age 50 and older

4 Prostate cancer screening for men age 50 and older

5 Prescription copayment does not apply toward deductibles or out-of-pocket maximums.

Benefits will not be provided for any pre-existing condition until a member has completed a waiting period of at least 6 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."

A copayment will be applied to each office visit for the covered services performed in the office and provided and billed by a physician who is an in-network provider. The remaining charges for covered services rendered during the office visit will be paid at 100% of the maximum allowable charge. If a physician who is an out-of-network provider is utilized for covered services, benefits will be determined on the basis of a out-of-network coinsurance percentage after deductible is met.

Copayments do not apply to the following services: advanced radiological imaging, allergy testing and injections, biopsy interpretation, bone density testing, cardiac diagnostic testing, chemotherapy services, chiropractic services, complex diagnostic services, dental services except preventative and restorative for all Members age nineteen (19) and over, diagnostic services sent out, durable medical equipment, growth hormone injections, IV therapy, Lupron injections, mammography, maternity services, nerve conduction studies, neuropsychological or neurological tests, nuclear cardiology, nuclear medicine, orthotics, preventative services as indicated in contract, prosthetics, provider administered specialty pharmacy products, sleep studies, surgery performed in a physician’s office and related surgical supplies, Synagis injections, therapeutic/ rehabilitative/ habilitative services, ultrasounds and vision services. These services are subject to the terms and conditions of the contract and deductibles and coinsurance will apply except where otherwise indicated. Copayments will not be applied to the deductibles or out-of-pocket maximums.

Maternity benefits will be eligible after a member’s 6 month pre-existing waiting period is exhausted.

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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.

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