Attachment C Benefit Guide.pdf

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Benefits Guide & R E F E R E N C E M A N U A L

What's New for FY26?

OPEN ENROLLMENT IS

May 1–15, 2025

Mental Health Resources

The Employee Health Office

Get Connected Having access to your benefits and well-being information is essential in today's world. That's why we have partnered with vendors that make it easier than ever for you to access information and resources.

�WEX Benefits: Access your benefits on the go 24/7 with the WEX benefits mobile app. This free app gives you convenient, real-time access to all your benefits accounts in one spot. This makes it easier than ever to use your hard-earned dollars and view recent account activity without ever needing to call in.

�myWellmark: Enjoy instant access to your health care information with the myWellmark app. See what services and medications are covered, estimate costs, track your deductibles, access your mobile health ID card, and more.

�Doctor on Demand: Use this app to connect face to face with a doctor, psychologist, or psychiatrist through your mobile device 24 hours a day, 7 days a week.

�EyeMed: Vision plan information at your fingertips. View your benefits and eligibility, find in-network providers, check on the status of a claim, set reminders, or get your ID card with a quick (and literal) shake of your hand.

Delta Dental: Access your dental plan information anyplace, anytime. The Delta Dental Mobile App lets you find providers, view your personalized benefits information and claims, and estimate costs. You can also call up your mobile ID card at the touch of a button.

FOLLOW BENEFITS ON SOCIAL MEDIA

facebook.com/sdbenefits instagram.com/sdbenefits x.com/benefitssd

All apps are available on both iOS and Android devices.

Use your Wellmark ID for the myWellmark app.

COMPLIANCE

This guide contains basic information to help members of the South Dakota State Employee Benefits Program prepare for FY26 Open Enrollment. Complete plan information can be found at bhr.sd.gov/benefits. The health plan summary plan description (SPD) or the insurance carrier’s plan certificates should be consulted for coverage, benefits information, exclusions, and other important information. The benefit information provided in this guide is not all inclusive. If there is a discrepancy between the benefits guide and the SPD or plan certificates, the SPD or plan certificates prevail.

Additional compliance documents are available at https://bhr.sd.gov/benefits/forms-documents/compliance/

WHAT'S NEW?

YOUR HEALTH PLANS

FLEXIBLE BENEFITSTHE EMPLOYEE HEALTH

OFFICE

HOW TO ENROLL

What’s Inside What’s New?

Frequently Used Terms Dependent Verification/Opting Out The ALEX Tool Wellmark BC BS of South Dakota Washington Plan Lincoln Plan Jefferson Plan Roosevelt Plan Pharmacy Benefits Compare the Plans The Wellmark Care Team Hinge Health Options for Afforable Care The LiveWellSD Program Additional Well-Being Resources The EAP Program Dental Plans Vision Plans Health Savings Accounts Flexible Spending Accounts Health Reimbursement Accounts Combination FSAs Basic Life Insurance Supplemental Life, AD&D, Long Term Care Short-Term Disability Accident Insurance Hospital Indemnity Plan Critical Illness How to Enroll Contacts

What’s New for FY26?

An Exciting Enhancement to LiveWellSD

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!

Well-Being Champion Update

Over the past year, our Well-Being Champions Program has shown incredible progress. What started with a pilot project of three state agencies and two Board of Regents sites has now expanded to 20 agencies and all six universities.

With 32 new Well-Being Champions added in FY25, there are now a total of 48 Champions statewide. We’re excited for you to learn more about the Well-Being Champion Network through the new LiveWellSDplatform coming in July 2025!

Learn more about the Well-Being Champions on page 21.

Wondr Health is Going State Wide!

After a successful beginning, we are pleased to announce Wondr Health is now available to all state employees!

Details for Wondr Health can be found on page 21!

Teledentistry by Delta Dental

Now you can access your dental benefits from the comfort of your own home! With Teledentistry, you can use a Delta Dental virtual visit when you are having a dental emergency, need a dentist after hours, or need to consult with a dentist without leaving home.

This service is available 24/7! See more on page 25 or scan the QR code below.

Mental Health Resources

Are you masking your mental health? The BHR Website is home to a wealth of mental health resources. Visit https://bhr.sd.gov/benefits/mental-health/ for a comprehensive list of articles, contact information, and resources for you and your family.

IMPORTANT!

FY26 Open Enrollment will be an Active Enrollment, which means that you must log in to Employee Space between May 1–May 15, 2025 to elect your benefits for the plan year beginning July 1, 2025.

If you do not log in and participate, you will be enrolled in the Washington High Deductible Health plan with employee-only coverage.

Any flexible benefits coverage you currently enjoy will be discontinued.

Covered dependents will also lose coverage.

Please note that if you are married to a State employee and you choose to cover your spouse on the health plan, your spouse will need to opt out of the health plan.

Important Benefit Information

HEALTH

�The State offers a plan with no premium for employee-only coverage: the Washington Plan. The Lincoln, Jefferson, and Roosevelt Plans are offered so you can buy up coverage that best fits you and your family's needs.

�Employees may enroll in any of the four health plans they wish.

�Married State employees are not required to carry separate health care plans; they can be on the same health plan.

Additionally, eligible dependent children who are covered on a parent’s plan and who then become employed by the State are not required to carry a separate health plan. This means dependent children can stay on the parent’s plan as long as they continue to meet the eligibility requirements.

�On all health plans, employees will receive one eye exam per year for each covered member of their family. This is in addition to the exam that's included if you elect vision insurance.

�Those who choose to opt out of the health plan will not be able to elect a full medical FSA. However, you can elect a combination FSA. Learn more on page 29.

PHARMACY

�Along with health insurance, Wellmark Blue Cross and Blue Shield administers the State's pharmacy benefits in partnership with CVS. That means you can access national networks and comprehensive coverage, along with the tools, resources, specialty pharmacy and savings opportunites that come with being a Wellmark member.

�Prudent RX is available for plan members who utilize specialty prescriptions and are enrolled in the Jefferson and Roosevelt plans who utilize specialty prescriptions. Learn more on pages 15.

WELL-BEING REWARDS

�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 bhr.sd.gov/livewellsd/ to check your rewards earned, which will be added to WEX accounts by September 2025.

Frequently Used Terms The language of health insurance can be confusing. Keep this list of common terms handy as you explore your open enrollment materials; it will help you understand and choose the plan that’s right for you. For more terms and definitions, visit https://bhr.sd.gov/fy26plans/.

�Coinsurance: The percentage you pay for care or prescriptions after you’ve reached your deductible. Your plan pays the remaining percentage until you reach your out-of-pocket maximum, or OPM. Then your plan takes over and pays 100% of your costs for the rest of the plan year.

�Copayment/copay: A fixed dollar amount you pay for care or prescriptions, usually at the time of service.

�Deductible: The amount of money you pay out of pocket for care and prescriptions before your plan begins to pay benefits.

���Dependent: An eligible spouse or child you elect to cover on your health plan or flexible benefits.

��Eligible employee: A permanent full-time employee, permanent part-time employee, or an employee of a participating unit who has worked an average of 30 hours or more per week during a 12-month period, as defined by the Patient Protection and Affordable Care Act of 2010.

��Health reimbursement account (HRA): An employer-funded account that members can use to be reimbursed for certain medical, pharmacy, dental, and vision expenses. See page 26.

��Health savings account (HSA): For those who elect a high-deductible health plan, a triple tax-advantaged account that lets you and your employer set aside funds for eligible healthcare costs. See page 24.

�In-network: Healthcare providers who have agreed to accept discounted rates for products and services from the insurance plan. You will pay much less at in-network doctors, hospitals, and pharmacies.

��Network: The doctors, hospitals, pharmacies, and other providers and suppliers your health plan contracts with to provide care and services.

Out-of-network: Out-of-network healthcare providers have not contracted with our insurance company to accept discounted rates. You will pay much less at in-network doctors, hospitals, and pharmacies.

�Out-of-pocket maximum: The most you have to pay out of pocket in a plan year. After you spend this amount on deductibles, copays, and coinsurance, the plan pays 100% of your covered medical and prescription costs.

�Preauthorization: A decision by your health plan that a service, treatment plan, prescription drug, or durable medical equipment is medically necessary.

Preauthorization is sometimes required before care will be covered. It can also be called prior authorization, prior approval, or precertification.

��Preventive care/services: Care received to prevent disease rather than treat it. Examples include routine screenings, well-child care, and immunizations.

Embedded deductibles bring you more value and make your deductible easier to manage. The Washington, Lincoln, and Jefferson Plans all have embedded deductibles. (The Roosevelt Plan does not have a deductible to meet) Let’s look at how an embedded deductible works with the Washington Plan:

Kelly is single and has two children, Jason and Mandy.

Kelly experiences acute appendicitis, resulting in an emergency room visit, an overnight stay in the hospital, and surgery that adds up to $7,500.

With this payment, Kelly has met her individual embedded deductible — she pays $5,750, and the plan pays the remaining $1,750, along with the rest of her covered medical and prescription costs for the plan year.

The remaining unmet family deductible is $5,750. Jason incurs $1,000 in doctor visits, and Mandy incurs another $4,750 in emergency room visits and prescription costs.

The family has met the remaining $5,750 of the $11,500 family deductible and OPM, and the entire family’s eligible healthcare and prescription expenses are covered at 100% for the rest of the plan year.

Learn more at bhr.sd.gov/fy26plans/.

Qualifying Life Events and Dependent Verification Requirements If you request to add a spouse or dependent(s) to your health or flexible benefits during open enrollment or because of a qualifying event — and they were not previously covered under your benefits — you must submit acceptable proof of dependent eligibility to the State of South Dakota Benefits Program.

�If you experience a qualifying event and wish to update your benefits, you must complete and submit a Life Event Change request through Employee Space, within 30 days of the event date.

You may also be required to submit acceptable proof of dependent eligibility and supporting documentation that a qualifying life event has occurred. For more information on Qualifying Life Events, visit https://bhr.sd.gov/benefits/lifeevents/

��Newly hired employees are required to submit dependent eligibility verification within 30 days of their hire date.

��If you fail to submit the required proof of dependent eligibility and/ or supporting documentation within the 30-day window, your spouse and/or dependent(s) will not be enrolled and your change request will not occur. If this happens, your next opportunity to make changes to your benefits is during the next open enrollment period or if you experience another qualfying life event.

�After the Open Enrollment period is closed and finalized, you will be asked to submit proof of dependent eligibility for any newly added dependent(s). Please watch for important communications in August 2025.

Opting Out You can opt out of the South Dakota State Employee Health Plan if you provide proof of other creditable group health coverage.

��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 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, or coverage obtained through the Marketplace Exchange.

If this is your first time opting out, the deadline to submit your proof of creditable coverage is May 22, 2025. Email it to benefitswebsite@state.sd.us.

Picking the right health plan can be challenging. How do you know which one is right for you? To answer your questions and simplify the process, State employees can access an easy-to-use online tool called ALEX. All information you discuss with ALEX is completely confidential.

Just log on and respond to ALEX’s questions. ALEX will...

�Prompt you for some basic information.

�Ask a few questions about how you and your family use health benefits.

�Help you figure out which plan to choose during open enrollment based on your responses.

With simple language that avoids insurance jargon, talking with ALEX feels like having a conversation with a real person. And, ALEX is available anywhere that’s convenient for you. Log on from your work computer, your smart phone, or your home computer with an internet connection.

Learn more at https://start.myalex.com/benefitssd/

Alex Homepage with chat: https://www.myalex.com/benefitssd/home

NOTE: ALEX does NOT enroll you in benefits.

ALEX makes suggestions based on your answers so that, during open enrollment, you can make the decision that feels right for you. To successfully enroll, you must log in and elect benefits. See instructions for logging in on page 38.

STRONGER COVERAGE, BETTER BENEFITS

Wellmark Members enjoy:

• Network discounts.

• �Coverage at 95% of physicians and 100% of hospitals in South Dakota.

• �Access to the nationwide Blue Cross and Blue Shield network.

• Care Management to help navigate health conditions.

You have access to free tools and resources, including:

• �myWellmark®, your secure member portal for access to all your health benefits information at home or on the go.

• �Livongo® Diabetes Management, a free program for management of type 1 and type 2 diabetes.

• �Wellmark’s Blue365® program for discounts and deals on healthy purchases.

• �BeWell 24/7®, a free phone line to answer your health questions and help you navigate the healthcare system 24/7.

• �IDX Identity® for identity theft protection.

• Pregnancy Care Management, a free program to support expectant mothers.

For more information, please visit the Health and Pharmacy Guide: bhr.sd.gov/benefits/ HealthPharmacyGuide.pdf

Wellmark We are pleased to continue our partnership with Wellmark® to deliver our health benefits. While our plan is self-insured — meaning the State assumes all financial responsibility — we need a partner to administer claims payments and negotiate network discounts. That partner is Wellmark Blue Cross® and Blue Shield® of South Dakota.

Based in Sioux Falls, Wellmark of South Dakota offers the largest health care provider network in the state. Approximately 386,000 South Dakotans have healthcare coverage through Wellmark, and they’re in good company: One in every three Americans is covered by a Blue Cross and Blue Shield plan.

As a Wellmark member, you’ll enjoy access to a broad range of doctors, hospitals, and telehealth benefits.

To learn more about our health insurance administrator, visit Wellmark.com.

Not all employees will get new ID cards at open enrollment.

Only members who change plans, enroll for the first time, or go from single to family coverage at open enrollment will receive new ID cards.

The Washington Plan

H I G H - D E D U C T I B L E H E A LT H P L A N

PREMIUMS 24 PAY

PERIODS

12 PAY

PERIODS

Employee $0 $0

Employee + spouse $59.91 $119.82

Employee + child(ren) $23.74 $47.48

Family $70.59 $141.18

Administered by Wellmark Blue Cross and Blue Shield

YOUR COST SHARE

Deductible Medical $5,750 single

$11,500 family

Pharmacy Combined with medical deductible

Coinsurance No coinsurance

Out-of-pocket max (OPM)

Medical & pharmacy combined

$5,750 single $11,500 family

Medical care

Office visits

Deductible

Urgent care

ER

Diagnostic tests (X-ray, blood work)

Outpatient

Inpatient

The Washington Plan is a true high-deductible health plan. It has no medical coinsurance or copays, and the deductible is the same amount as the out-of-pocket maximum (OPM). Once you reach your deductible, the plan will pay 100% of your costs for covered healthcare and prescriptions for the remainder of the plan year.

Here are some additional important things to know about the Washington Plan:

�This plan offers a $0 premium for employee-only coverage.

�Preventive services are 100% covered. Certain preventive prescriptions are also 100% covered.

�For those with family coverage, the plan includes an embedded deductible. If a family member meets $5,750 of their deductible

— half of the family deductible — the plan will then begin to pay 100% of their covered healthcare and prescription costs for the remainder of that plan year. Then, if a different family member (or combination of family members) reaches the additional $5,750 remaining deductible of $11,500, the plan will pay 100% of covered healthcare and prescription costs for all covered family members for the remainder of the plan year.

��This plan qualifies eligible employees for a Health Savings Account (HSA). Primary policyholders who complete well-being qualifications may receive reward dollar contribution towards their Health Savings Account. See page 28 for details.

See page 14 for pharmacy information.

�Covered services that are not considered preventive are still provided at discounted rates when an in-network provider is utilized.

Health Plans

The Lincoln Plan

H I G H - D E D U C T I B L E H E A LT H P L A N

PREMIUMS 24 PAY

PERIODS

12 PAY

PERIODS

Employee $14.45 $28.90

Employee + spouse $93.80 $187.60

Employee + child(ren) $45.57 $91.14

Family $110.55 $221.10

See page 14 for pharmacy information.

YOUR COST SHARE

Deductible Medical $3,500 single

$7,000 family

Pharmacy Combined with medical deductible

Coinsurance 25%

Out-of-pocket max (OPM)

Medical & pharmacy combined

$6,500 single $13,000 family

Medical care

Office visits

Deductible then coinsurance

Urgent care

ER

Diagnostic tests (X-ray, blood work)

Outpatient

Inpatient

The Lincoln Plan is another high-deductible health plan with affordable premiums. But unlike the Washington Plan, it includes coinsurance to allow for a more moderate deductible. Once you reach your deductible, the plan pays 75% of your costs for covered care and prescriptions, and you pay the remaining 25%. Once you reach your out-of-pocket maximum (OPM), the plan pays 100% of your covered costs. Here are some more important things to know about the Lincoln Plan:

�Preventive services are 100% covered. Certain preventive prescriptions are also 100% covered.

�For those with family coverage, the plan includes an embedded deductible. If a family member meets $3,500 of their deductible

— half of the family deductible — the plan will then begin to pay 75% of covered charges for that family member.

�This plan qualifies eligible employees for a Health Savings Account (HSA). Primary policyholders who complete well-being qualifications may receive reward dollar contribution towards their Health Savings Account. See page 28 for details.

“If I am paying 100% for care with an High Deductible Health Plan (HDHP), why should I even have insurance?”

Our insurance administrator negotiates discounts with doctors and hospitals on behalf of the State. Even though you pay for your healthcare costs up to your deductible, you still get those discounts — meaning you pay considerably less than if you weren’t covered by the plan at all.

Administered by Wellmark Blue Cross and Blue Shield

�Covered services that are not considered preventive are still provided at discounted rates when an in-network provider is utilized.

The Jefferson Plan

L O W - D E D U C T I B L E H E A LT H P L A N

The Jefferson Plan is a low-deductible health plan that includes a mix of copays and coinsurance. That means you’ll pay more in premiums than on an high deductible health plan, but have more predictable out-of-pocket costs. This plan may be a good option if you prefer the peace of mind of knowing you don’t have to save up for large or surprise healthcare expenses. Here are some more details about the Jefferson Plan:

�Preventive services are 100% covered.

�Office visits with primary care providers and specialists have a flat copay. Primary care refers to any non-specialty provider, including your primary care provider, OB/GYNs, physician's assistants, and nurse practitioners. Non-primary care refers to specialists, like dermatologists, oncologists, and cardiologists.

�All copays and coinsurance costs count towards your out-of-pocket maximum (OPM). Copays do not count towards your deductible. Once you meet your OPM, all covered care and prescriptions will be 100% paid for by the plan.

�For those with family coverage, the plan includes an embedded deductible. If a family member meets $2,000 of their deductible — half of the family deductible — the plan will then begin to pay 70% of covered charges for that family member.

�Like all low-deductible health plans, the Jefferson Plan does not qualify you for a health savings account (HSA). However, you can elect a medical flexible spending account (FSA) to set aside pre-tax money to pay for medical, prescription, dental, and vision care expenses. Primary policyholders who complete well-being qualifications may receive reward dollar contribution towards their Health Reimbursement Account (HRA) to offset costs during the plan year. See page 30 for details.

PREMIUMS 24 PAY

PERIODS

12 PAY

PERIODS

Employee $54.46 $108.92

Employee + spouse $201.13 $402.26

Employee + child(ren) $109.50 $219.00

Family $235.82 $471.64

YOUR COST SHARE

Deductible Medical $2,000 single

$4,000 family

Pharmacy No deductible

Coinsurance 30%

Out-of-pocket max (OPM)

Medical & pharmacy combined

$4,500 single $9,000 family

Medical care

Office visits $50 primary care $100 non-primary care

Urgent care $50

ER $250 +

30% coinsurance

Diagnostic tests (X-ray, blood work) Deductible then coinsuranceOutpatient

Inpatient

Administered by Wellmark Blue Cross and Blue Shield

See page 14 for pharmacy information.

The Roosevelt Plan is robust and uniquely easy to use. It has no deductible and no coinsurance; you only pay copays up to your out-of-pocket maximum. Because you will always know your costs for care and prescriptions, the plan makes it easy to maintain a budget and keep track of spending. Here is additional information about the Roosevelt Plan:

�Preventive services are 100% covered.

�The copay for office visits can vary depending on whether you receive primary care or non-primary care. Primary care refers to any non-specialty provider, including your primary care provider, OB/GYNs, physician's assistants, and nurse practitioners. Non-primary care refers to specialists, like dermatologists, oncologists, and cardiologists.

�All copays count towards your out-of-pocket maximum (OPM).

Once you meet your OPM, all covered care and prescriptions will be 100% paid for by the plan.

�Like all low-deductible health plans, the Roosevelt Plan does not qualify you for a health savings account (HSA). However, you can elect a medical flexible spending account (FSA) to set aside pre-tax money to pay for medical, prescription, dental, and vision care expenses. Primary policyholders who complete well-being qualifications may receive reward dollar contribution towards their Health Reimbursement Account (HRA) to offset costs during the plan year. See page 30 for details.

The Roosevelt Plan

N O D E D U C T I B L E H E A LT H P L A N

PREMIUMS 24 PAY

PERIODS

12 PAY

PERIODS

Employee $70.56 $141.12

Employee + spouse $242.16 $484.32

Employee + child(ren) $134.83 $269.66

Family $284.01 $568.02

YOUR COST SHARE

Deductible Medical No deductible

Pharmacy No deductible

Coinsurance No coinsurance

Out-of-pocket max (OPM)

Medical & pharmacy combined

$6,000 single $12,000 family

Medical care

Office visits $40 primary care $75 non-primary care

Urgent care $40

ER $500

Diagnostic tests (X-ray, blood work)

$40 in an office setting

Outpatient $2,500

Inpatient $3,500

Administered by Wellmark Blue Cross and Blue Shield

See page 14 for pharmacy information.

Along with our health plans, Wellmark is administering the State’s pharmacy benefits. That means you get comprehensive prescription drug coverage. And, it means all your medical and pharmacy benefits are in one place, making it easier for you to access resources that help you use your benefits and save money.

Note: You do not need to elect a pharmacy plan, as it is included with your health coverage. There is no additional premium or deductible.

Pharmacy Benefits

Administered by Wellmark Blue Cross and Blue Shield

Washington Plan Lincoln Plan Jefferson Plan Roosevelt Plan

Deductible Combined with medical deductible

Combined with medical deductible No deductible No deductible

Coinsurance No coinsurance 25% 30% No coinsurance

Out-of-pocket max (OPM) Medical & pharmacy combined

$5,750 single $11,500 family

$6,500 single $13,000 family

$4,500 single $9,000 family

$6,000 single $12,000 family

Prescription drugs

Tier 1 Deductible Deductible then 25% coinsurance $25 (30-day supply)

$62.50 (90-day supply)

$25 (30-day supply) $62.50 (90-day supply)Tier 1 preventive $0 $0

Tier 2 Deductible Deductible then 25% coinsurance

$65 (30-day supply) $162.50 (90-day supply)

$65 (30-day supply) $162.50 (90-day supply)Tier 2 preventive

$55 (30-day supply) $137.50 (90-day supply)

$55 (30-day supply) $137.50 (90-day supply)

Tier 3 Deductible Deductible then 37.5% coinsurance

$150 (30-day supply) $375 (90-day supply)

$150 (30-day supply) $375 (90-day supply)Tier 3 preventive

$75 (30-day supply) $187.50 (90-day supply)

$75 (30-day supply) $187.50 (90-day supply)

Preferred specialty

Preventive list: $85 All other drugs: Deductible

Preventive list: $85 All other drugs: Deductible then coinsurance

$300 (Managed by Prudent RX)

$300 (Managed by Prudent RX)

Non-preferred specialty

Preventive list: $110 All other drugs: Deductible

Preventive list: $110 All other drugs: Deductible then coinsurance $450 $450

THE BLUE RX VALUE PLUSSM FORMULARY

Your plan is called Blue Rx Value Plus, and it’s based around a formulary: a list of covered drugs. The formulary helps guide you, your doctor and your pharmacist to the lowest cost drug options that effectively treat your condition. Understanding the formulary could help you save money.

PRESCRIPTION DRUG TIERS

Your plan has three levels of coverage called “tiers.” Your drug’s tier determines how much you’ll pay at the pharmacy. The lower the tier, the more affordable your prescription. If you choose to take a drug that’s not covered, you will pay the full cost for the medication.

USE YOUR FORMULARY TO SAVE

Follow these steps to use your formulary to research more affordable treatment options.

1. When you get a new prescription, go to Wellmark.com.

2. �Scroll down to the bottom of the page and select Prescription Drug Information and then Drug List. Then, scroll down and choose Blue Rx Value Plus from the Formulary Drug Lists.

3. �Finally, search for your drug by name.

• If your drug is considered preventive, it will be listed as PV.

• �If your drug is on a higher tier, you can ask your doctor if a lower-cost equivalent is appropriate.

• �If your drug is listed as non-formulary or NF, your drug is not covered. Ask your doctor for a medication that is covered by your plan.

SPECIALTY DRUGS

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 assistance in enrolling in manufacturers' assistance for your specialty medications. Participating members will have $0 out-of-pocket costs on eligible specialty medications.

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.

PRESCRIPTION DRUG TIERS

CVS CAREMARK MEMBER PORTAL & APP

With the CVS Caremark member portal and app, you can access savings and manage pharmacy benefits anytime, anywhere.

• �Know your coverage and costs:

See if a medication is covered, find lowest-cost drug alternatives, and more.

• �Fill or refill prescriptions: Use the app to take a photo of the front and back of your new paper prescription, or scan the barcode on your existing Rx label to place a refill order.

• �Find a pharmacy: Locate in-network retail pharmacies near you.

• �Manage your profile: Set your notifications, update shipping and billing, and more.

Register and link to the free mobile app at Caremark.com/mobile.

TIER 1:

Most affordable drugs Includes most generics and select branded drugs.

TIER 2:

Preferred drugs Drugs that have been proven to be effective and favorably priced compared to other drugs that treat the same condition

TIER 3:

Non-preferred drugs Drugs that are not as cost-effective as available generics or preferred brands.

Low out-of-pocket costs

Middle-value out-of-pocket costs

Higher out-of-pocket costs

YOUR IN-NETWORK COST SHARE

Deductible Medical

$5,750 single $11,500 family

$3,500 single $7,000 family

$2,000 single $4,000 family

No deductible

Pharmacy Combined with medical deductible

Combined with medical deductible No deductible No deductible

Coinsurance No coinsurance 25% 30% No coinsurance

Out-of-pocket max (OPM)

Medical & pharmacy combined

$5,750 single $11,500 family

$6,500 single $13,000 family

$4,500 single $9,000 family

$6,000 single $12,000 family

Medical care

Office visits

Deductible Deductible then coinsurance

$50 primary care $100 non-primary care

$40 primary care $75 non-primary care

Urgent care $50 $40

ER $250 + 30% coinsurance $500

Diagnostic tests (X-ray, blood work)

Deductible then coinsurance

$40 in an office setting

Outpatient $2,500

Inpatient $3,500

Prescription drugs

Tier 1 Deductible Deductible then 25% coinsurance $25 (30-day supply)

$62.50 (90-day supply) $25 (30-day supply)

$62.50 (90-day supply)Tier 1 preventive $0 $0

Tier 2 Deductible Deductible then 25% coinsurance $65 (30-day supply)

$162.50 (90-day supply) $65 (30-day supply)

$162.50 (90-day supply)Tier 2 preventive $55 (30-day supply)

$137.50 (90-day supply) $55 (30-day supply)

$137.50 (90-day supply)

Tier 3 Deductible Deductible then 37.5% coinsurance

$150 (30-day supply) $375 (90-day supply)

$150 (30-day supply) $375 (90-day supply)Tier 3 preventive

$75 (30-day supply) $187.50 (90-day supply)

$75 (30-day supply) $187.50 (90-day supply)

Preferred specialty

Preventive list: $85 All other drugs: Deductible

Preventive list: $85 All other drugs: Deductible then coinsurance

$300 (Managed by Prudent RX)

$300 (Managed by Prudent RX)

Non-preferred specialty

Preventive list: $110 All other drugs: Deductible

Preventive list: $110 All other drugs: Deductible then coinsurance $450 $450

Washington Plan Lincoln Plan Jefferson Plan Roosevelt Plan 24 PAY PERIODS 12 PAY PERIODS 24 PAY PERIODS 12 PAY PERIODS 24 PAY PERIODS 12 PAY PERIODS 24 PAY PERIODS 12 PAY PERIODS

Employee* $0 $0 $14.45 $28.90 $54.46 $108.92 $70.56 $141.12

Employee + spouse* $59.91 $119.82 $93.80 $187.60 $201.13 $402.26 $242.16 $484.32

Employee + child(ren)* $23.74 $47.48 $45.57 $91.14 $109.50 $219.00 $134.83 $269.66

Family* $70.59 $141.18 $110.55 $221.10 $235.82 $471.64 $284.01 $568.02

Compare Your Health Plan Options

*Tobacco surcharge: If you and/or your spouse use tobacco products, a surcharge will be added to your premiums. If you receive your paychecks in 24 pay periods, $30 will be added per person per pay period. If you receive your paychecks in 12 pay periods, $60 will be added per person per pay period.

For more information including out-of-network costs, see your plan summary documents on the BHR website.

SUPPORTING HEALTHY

PREGNANCIES

State employees and any covered spouses and/or dependents can access additional resources for a healthy pregnancy. The Pregnancy Support Program is free, and it’s here for you now and after your baby is born.

HOW IT WORKS

Call the number on your Wellmark ID, and a Pregnancy Support advocate will connect you with tools and resources, including:

Pregnancy assessment: Complete this online assessment within the first 12 weeks of your pregnancy to receive a $250 wellness incentive.

After your baby arrives, you can qualify for another $250 incentive by taking a postpartum assessment.

WebMD® Pregnancy Assistant:

Provides information about your pregnancy and the stages of your baby’s growth.

Count the Kicks® app: Helps you keep track of your baby’s normal movement patterns.

Text4BabySM: A texting tool that delivers appointment reminders, safety information, and updates on your baby’s milestones.

BeWell 24/7: A phone line that connects you with a nurse for one-on-one support day and night.

Note: You must register within the first 12 weeks of pregnancy to be eligible for the initial incentive.

In addition to helpful tools and Care Team support, when you participate in the Pregnancy Support Program, the cost share for your first and second trimester ultrasound is waived.

CARE CAN BE COMPLICATED. SUPPORT IS JUST ONE CALL AWAY

Major illnesses, injuries, and chronic conditions can be overwhelming. From the complexities of the healthcare system to the challenges of staying on track with your treatment plan, navigating your care can feel like a full-time job.

YOUR HEALTH BENEFITS CAN HELP

You need advocates who will work on your behalf, ensuring you’re getting the care you need so you can focus on getting or staying healthy. And, you need to be able to find them all in one place. That’s why your health benefits include the Wellmark Care Team.

ONE CALL FOR EVERY CONDITION

With the Wellmark Care Team, you will have a dedicated case manager and an integrated team of specialists including nurses, pharmacists, behavioral health specialists, and care advocates who are here to help — and they’re accessible any time by calling the number on the back of your Wellmark ID.

With just one call to Wellmark’s State of South Dakota Care Team line, anyone can get support, including members who experience:

The Wellmark Care Team

�1 blood glucose meter 150 testing strips 150 lancets 1 lancing device

�1 USB charger 1 carrying case Instructions 2 bottles of control solution

Serious illnesses High-risk pregnancies Premature babies Complex chronic conditions including heart disease, asthma, and others

Transplants Traumatic injuries Major surgeries Cancer Behavioral health conditions, and more

HOW TO PARTICIPATE

If you have a health condition, you can call the Wellmark Care Team at any time to request support. Wellmark will also reach out to members who are identified for program participation through hospital admission notifications, health and pharmacy claims information, and through provider referral.

This program is free, voluntary, and confidential. To learn more or to enroll, call 800.846.9183.

RARE CONDITION MANAGEMENT

This new no-cost program is available to any member with one of nine conditions. The goal of this program is to provide you with another level of help for your condition and to compliment what you already have through Wellmark.

Covered conditions include Crohn's disease, Cystic fibrosis, Gaucher's disease, Hemophilia, Hereditary angioedema, Multiple Sclerosis, Rheumatoid arthritis, systemic lupus erythematosus (SLE or lupus), and Ulcerative colitis.

DIABETES MANAGEMENT WITH LIVONGO

We're pleased to offer you a no-cost option for diabetes care through Livongo, a holistic program that can offer assistance to benefitted members living with or trying to prevent the onset of diabetes.

Livongo Diabetes Management is a program helps make living with diabetes easier by providing you with a connected meter, unlimited strips and lancets and coaching. In addition to 24/7 support, participants will receive:

Hinge Health

Struggling with joint or muscle pain?

The State of South Dakota is proud to partner with Hinge Health, a digital clinic for joint and muscle pain. Combining expert clinical care and advanced technology, this service will provide employees and covered family members to move beyond pain and injury, avoid unnecessary surgeries when possible, and reduce opioid use.

Hinge Health is more than exercise therapy, with digital programs that combine gentle exercise with 1-on-1 support to reduce your pain and help you move with confidence. Whether your goal is to go hiking more, work in your garden, or take the stairs (or all three), you can get on the road to pain relief with exercises that can be done in as little as 10 minutes — anytime, anywhere you’re comfortable. This new benefit, which is available at no cost to eligible members, can provide a personalized program to help you with:

• �Knees

• �Back

• Shoulders

• �Lower back and hips

• �Ankles & feet

• �Elbows, forearms, wrists, and hands

• �Women's Pelvic Health

• and more!

Ready to get started? Visit https://hingehealth.com/for/southdakota/ today!

To talk to a member of the Hinge Health support team, call 1.855.902.2777 or email help@hingehealth.com. Hinge Health is committed to protexcting the privacy and personal information of all customers.

Preventive care The earlier a serious medical condition is caught, the easier it is to treat. Preventing disease before it starts keeps your healthcare costs down and helps you live a longer, healthier life.

All State health plans pay 100% of preventive care costs for you and your covered spouse and dependents.

Based on your age and health status, this could include:

��An annual wellness exam ��A well-child exam ��A well-woman exam ��Cancer screenings ��Pregnancy care preventive screenings ��Scheduled vaccinations ��Tests and screenings for cholesterol and blood pressure levels, depression, and type 2 diabetes

Healthy living includes regular checkups with your health care provider to measure your most important health numbers, including your blood pressure, your cholesterol levels, and your body mass index. It is important to know your numbers and identify health risks early on when there’s time to help reduce or eliminate them.

To learn more about preventive care, please visit https://bhr.sd.gov/benefits/health-plans/preventive/ for a wide array of information.

Doctor On Demand®

With Doctor On Demand, you can have video visits with board-certified physicians and get treatment and prescriptions for a cold, flu, allergies, bugs your kids pick up, and more. It’s fast care anywhere — 24/7.*

And, Doctor On Demand offers mental health care, too.

Schedule talk therapy and medication management for stress, depression, anxiety, postpartum concerns, and more.

WHY SEE A DOCTOR ONLINE?

��Affordable: The app will provide you with an exact cost before you book your appointment.

��Convenient: Available at home or on the go.

Fast: Be seen in minutes.

��Always there: Available 24/7, even in the middle of the night.

TO GET THIS BENEFIT

Coverage is included when you enroll in a State health plan. Visit DoctorOnDemand.com to register, and then go to the App Store® or Google Play® to download the app for free.

*Doctor On Demand physicians do not prescribe Scheduled I-IV DEA Controlled Substances and may elect not to treat or prescribe other medications based on what is clinically appropriate. During times of high overnight call volume, patients may be directed to make an appointment with a Doctor On Demand physician for the following morning.

Options for Affordable Care

The New LiveWellSD Portal has many exciting key features, including:

Our Commitment to Your Well-Being The State of South Dakota is committed to providing support and resources to you on your well-being journey. The LiveWellSD portal is moving to a new platform effective July 1, 2025. The new platform will have a new look and feel to navigate easily. There is no app to access the new platform. The new platform has more communication options as well as support and resources for your unique well-being journey.

The new platform will enhance your ability to take care of your overall well-being, and live your best life at work and at home to make every day count.

The New, Exciting LiveWellSD Portal The new LiveWellSD Portal will provide you with the ability to personalize your experience with support and resources that meet you where you are on your well-being journey.

There is also a financial reward for participating! To learn how you can earn up to a $1,000 contribution to your HSA or HRA, visit https://bhr.sd.gov/benefits/livewellsd/.

Take the first step towards better well-being and rewards by scheduling your annual wellness exam (with blood work) and complete the biometric screening form when the new portal opens.

You will also need to complete the online health assessment.

BETTER WELL-BEING BRINGS REWARDS

• Increased energy

• Decreased stress

• More restful sleep

• Decreased risk of illness and injury

• Improved immunity

• Increased longevity

• A happier and more fulfulling life

The Employee Health Office

Watch for upcoming details on the new LiveWellSD Portal!

The Employee Health Office is a recent addition to the Bureau of Human Resources and Administration that provides support and resources for the health and well-being of employees and their family. This unique office focuses on areas that, when brought together, have proven to be a great asset to state employees:

• Safety

• Well-Being

• Workers' Compensation, Medical

Conditions, Return to Work

• Connect your smart device

• Medication and Meaningful Tools

• Access and download healthy

Recipes

• Join our fun statewide challenges

• Support and tools to complete self-paced programs

• Join and create custom challenges

• Guided workout videos

• And so much more!

�Well-Being Champions

The Well-Being Champion Network has expanded enhancing the ability to bring awareness to state programs and initiatives. The Well-Being Champions within the agency partner with BHRA and the Well-Being Coordinator to increase overall awareness to health, safety and well-being.

In addition, the Well-Being Champions through partnering with BHRA provide tools and resources through the well-being platform and Employee Assistance Program that empower our employees and their families to thrive physically, mentally, and emotionally. Each month the Well-Being Champions receive a tool kit with resources, tools, tips, and reminders to improve overall well-being and quality of life.

Your Well-Being Champion will send out information throughout the month. Be on the lookout for resources, tips, tools, and reminders!

�Wondr Health

The Wondr Program is a science based program that teaches behavior skills and techniques to improve overall health. This program is available at no cost to eligible employees and covered family members enrolled in one of the state health plans.

The Wondr Program goes beyond weight loss with expert instructors teaching skills to be more physically active, stress less, sleep better, and improve overall health. This program is convenient, has a personalized approach, and available through a mobile app.

Watch for future class dates. Learn more at https://www.wondrhealth.com/southdakota.

Additional Well-Being Resources

Your Well-Being Champions

Sometimes, we all need a little extra help. The Employee Assistance Program (EAP) provides State of South Dakota employees, their dependents, and their household members with support for personal and work-related issues, including:

�Confidential Emotional Support � �Legal Guidance Work-Life Solutions �Financial Guidance

Services are strictly confidential and available 24 hours a day, 7 days a week. Whether you need short-term counseling from one of our highly trained clinicians, practical assistance for your most pressing legal and financial issues, or tools and resources to improve your work-life balance, the EAP is here to help.

To view all current information on the Employee Assistance Program, visit https://bhr.sd.gov/benefits/eap/.

Employee Assistance Program (EAP)

The Employee Health Office

Dental Plans

Flexible Benefits

Administered by Delta Dental of South Dakota

To locate in-network providers near you, visit deltadentalsd.com and click on Find a Dentist.

BASE PLAN ENHANCED PLAN

24 PAY

PERIODS

12 PAY

PERIODS

24 PAY

PERIODS

12 PAY

PERIODS

Employee $7.98 $15.96 $20.38 $40.76

Employee + spouse $28.57 $57.14 $53.30 $106.60

Employee + child(ren) $32.46 $64.92 $54.59 $109.18

Family $53.04 $106.08 $87.52 $175.04

Deductible $25 per covered person N/A

Annual maximum benefit1

$1,000 per covered person

$2,000 per covered person

Lifetime orthodontic benefit

N/A $2,000

Maximum Bonus Account (MBA) limit

N/A $2,000

1. �All services (except diagnostic, preventive and orthodontics) are subject to the annual maximum and will not be paid if your annual maximum has been reached.

Dental care is an important part of your overall health. Your benefits package includes dental insurance options with low- or no-cost preventive care, as well as coverage for basic services, major services, and orthodontics. Here are some important things to know about your coverage.

�As a value to you, the State subsidizes a cost share of $25.32 per month, regardless of which plan or coverage level you choose.

The premiums published include the subsidy, and therefore, reflect the premium you will pay.

�You can visit any dentist you choose, but you may pay less when you go to an in-network provider. Participating in-network dentists have agreed to write off charges that exceed the amounts allowable by the plan. Out-of-network dentists can bill you for the remaining amount.

�There is no waiting period for services.

�Orthodontic cases may be paid for over two years based on the treatment plan.

�Delta Dental will pay $1,000 for orthodontics in the first year on the Enhanced Plan. To receive the additional $1,000 payment in the second year, you must continue to be enrolled in the Enhanced Plan.

�Premiums are paid with pre-tax deductions.

Questions? Learn more about your dental benefits at https://bhr.sd.gov/benefits/flexible-benefits/dental/ or at deltadentalsd.com.

Administered by Delta Dental of South Dakota

To locate in-network providers near you, visit deltadentalsd.com and click on Find a Dentist.

1. �All services (except diagnostic, preventive and orthodontics) are subject to the annual maximum and will not be paid if your annual maximum has been reached.

DENTAL CARE AND SERVICES

BASE PLAN ENHANCED PLAN

Percentage your plan pays after the deductible is met

Percentage your plan pays

Preventive care Routine cleaning and examinations (two per plan year), fluoride treatments (two per plan year up to age 19), bite-wing X-rays (one per plan year), full mouth X-rays (one every five years), space maintainers (on primary back teeth, up to age 14), and dental sealants (for unrestored first and second permanent molars, up to age 16). These services do not apply to the Annual Maximum Benefit.

75% 100%

Basic services Stainless steel crowns, silver and tooth-colored fillings, non-surgical extractions, emergency treatment, periodontal maintenance cleanings, denture repair, and anesthesia in conjunction with surgical services.

60% 80%

Major services Root canals, treatment of diseases of the tissues supporting the teeth, crowns, bridges, dentures, implants, and surgical extractions.

35% 50%

Orthodontics N/A 50% For patients of any age

Additional Dental Benefits

MAXIMUM BONUS ACCOUNT (MBA) BENEFITS

Administered by Delta Dental

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. Employees can accumulate up to the $2,000 in their MBA account.

Here’s what else you need to know about MBA benefits:

��You must be enrolled in the Enhanced Plan for one plan year before you can earn MBA benefits.

�Your MBA account balance rolls over from year to year.

�You, your spouse, and your dependents will each have their own account.