Exhibit A - FY27BenefitsGuideFINAL.pdf

What's New for FY27?

OPEN ENROLLMENT IS

May 1–15, 2026

Marquee Health

Dually Covered Dependents

Benefits Guide

2026 – 2027 EMPLOYEE

and Reference Manual

LYRA HEALTH HOW TO ENROLL

What’s Inside What’s New?

Frequently Used Terms Dependent Verification/Opting Out Wellmark BC BS of South Dakota Upwise Chose Washington Plan Lincoln Plan Jefferson Plan Roosevelt Plan Pharmacy Benefits Compare the Plans The Wellmark Care Team Hinge Health No Cost/Convenient Options 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 Short-Term Disability Accident Insurance Hospital Indemnity Plan Critical Illness Dually Covered Dependents Incentive Rewards for FY27 How to Enroll Contacts

UPWISE CHOOSE

YOUR HEALTH PLANS

COMPLIANCE

This guide contains basic information to help members of the South Dakota State Employee Benefits Program prepare for FY27 Open Enrollment. Complete plan information can be found at sd.gov/bhra. 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 sd.gov/bhra.

What’s Inside What's New for FY27?

Upwise Choose Upwise is a personalized guidance tool that helps you pick the benefits that best fit your needs. After just a few simple questions, Upwise will deliver a clear, data-driven confidential recommendation based on your health, finances, and preferences. We have implemented this improved tool to help you make selections and get the most out of your benefits!

Lyra Health The State is partnering with Lyra Health to offer additional options for care through the state health plan. As of January 1, 2026, you and your dependents, including children and teens enrolled in one of the State health plans, have access to continued care with your Lyra therapist beyond your 6 free sessions. You and your dependents will also have access to Medication Management Support, which allows participants to consult with a specialized prescriber on mental health medication.

Short Term Disability The Short Term Disability coverage through MetLife is changing effective July 1, 2026. At that time, MetLife will be the primary payer, with any state pay for PFL and PFLMA paying secondary. Be sure to watch for upcoming important communications.

Long-Term Care Long-Term Care coverage, which was available to employees enrolled in Supplemental Life Insurance, will end on June 30, 2026.

As of February 1, 2026, UNUM is no longer accepting new enrollments. If you currently have Long-Term Care coverage, you should have received information from UNUM about the option to port (continue) your coverage as an individual policy directly with them. For questions or more information about continuing your coverage, please contact UNUM at 800.227.4165.

Important Information You must log in to Employee Space between May 1–May 15, 2026, to elect your benefits for the plan year beginning July 1, 2026. 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. If you are married to a State employee and you choose to cover them on the health plan, your spouse will need to opt out of the health plan.

HEALTH

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. Dependent children can stay on the parent’s plan as long as they 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.

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.

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://sd.gov/bhra/.

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.

Embedded Deductible: A threshold that prevents one single family member from having to pay the full out of pocket maximum of a health plan.

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 28.

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 26.

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.

Qualifying Life Event: A significant change in your circumstances, such as marriage, birth of a child, or loss of other health coverage, that makes you eligible for a Special Enrollment Period.

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 life event — and they were not previously covered under your benefits — you will need to submit acceptable proof of dependent eligibility to the South Dakota State Employee Benefits Program.

• 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 2026.

• If you experience a qualifying event and wish to update your benefits, you need to complete and submit a Qualifying 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://sd.gov/bhra/.

• If you are a newly hired employee and choose to cover dependents, you will need to submit dependent verification within 30 days of your 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.

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.

Even if you opt out of the health plan, you can still elect other benefits, such as dental, vision, short-term disability, and so on.

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, 2026. Email it to benefitswebsite@state.sd.us.

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.

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.

For more information, visit https://sd.gov/bhra and click on Benefits.

Choosing the right benefits can be overwhelming. With four health plans and even more flexible benefits options, it's difficult to know what will work well for you and your family. You want to get the most value without paying for coverage you don’t need—but it’s not always clear which options best fit your health, finances, and priorities.

That’s why we're pleased to provide you access to Upwise Choose.

With a quick, easy survey, Upwise Choose helps you identify the best plans for you and your family - so you can enroll with confidence. This new benefits selection tool will guide you through the benefits and options for each health plan, clearly laying out how each would work for you.

Whether you're young and healthy, planning for surgery, or expecting a baby, you're going to have questions.

Do you want to see examples of how a Health Savings Account or Flexible Spending Account could help you with medical expenses? Are you curious about the base vs the enhanced dental plans? Each possibility affects how the health plans work for you. The more information you have, the better prepared you will be!

This convenient, simple tool will be ready Mid-April to help you make the best choice for Open Enrollment.

Visit Upwise Choose when it's launched at: https://upwise.app.nayya.com/users/sign_up

The Washington Plan

HIGH-DEDUCTIBLE HEALTH PLAN

The Washington Plan is a high-deductible health plan in its simplest form.

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.

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

• 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 the well-being qualifications and earn the incentive dollars may receive a contribution towards their Health Savings Account. See page 26 for details.

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

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

See page 12 for pharmacy information.See page 12 for pharmacy information.

The Lincoln Plan

HIGH-DEDUCTIBLE HEALTH PLAN

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

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.

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

• 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 the well-being qualifications and earn the incentive dollars may receive a contribution towards their Health Savings Account. See page 26 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.

See page 12 for pharmacy information.See page 12 for pharmacy information.

Hinge Health

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

The Jefferson Plan

LOW-DEDUCTIBLE HEALTH PLAN

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 the well-being qualifications and earn the incentive dollars may receive a contribution towards their Health Reimbursement Account (HRA) of offset costs during the plan year.

See page 28 for details.See page 12 for pharmacy information.See page 12 for pharmacy information.

The Roosevelt Plan

NO DEDUCTIBLE HEALTH PLAN

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

See page 12 for pharmacy information.See page 12 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 the well-being qualifications and earn the incentive dollars may receive a contribution towards their Health Reimbursement Account (HRA) to offset costs during the plan year.

See page 28 for details.

Pharmacy Benefits Administered by Wellmark Blue Cross and Blue Shield

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.

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

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

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.

PrudentRX 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.

See page 14 for pharmacy information.

Compare Your Health Plan Options 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

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

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

*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.

See page 14 for pharmacy information.

The Wellmark Care Team

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:

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.

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

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.

Struggling with joint or muscle pain?

Hinge Health is 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 combines digital programs and 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 contact the Hinge Health support team, call 1.855.902.2777 or email help@hingehealth.com. Hinge Health is committed to protecting the privacy and personal information of all customers.

Hinge Health

"I'm amazed at the number of troubles they can help with. I've noticed a difference in various areas, including balance - something I've long struggled with. I'm confident that whatever problems arise, I can turn to my Hinge Health Care Team to help!"

– Participant Testimonial

No Cost Care/ Convenient Options

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

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://sd.gov/bhra and click on Benefits 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.

The 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 provides you the ability to personalize your experience. There is no app required to access the LiveWellSD Portal and it is available 24/7 for you to live your best life at home and at work to make every day count.

• Connect your smart device

• Meditation and Meaningful Tools

• Access and download healthy Recipes

• Join our fun statewide challenges

• Support and tools to complete self-paced programs

• Marquee Health Coaching

• Guided workout videos

• And so much more!

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

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://sd.gov/bhra and click on LiveWellSD. Take the first step towards better well-being and rewards by scheduling your annual wellness exam and completing the biometric screening form.

You will also need to complete the online health assessment.

Additional Well-Being Resources 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 each month. Be on the lookout for resources, tips, tools, and reminders!

Wonder Health 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.

Health and well-being shouldn't be complicated. Whether you are seeking to manage stress, enhance fitness, improve nutrition, or achieve a new holistic balance, Marquee Health has a total of 17 comprehensive health coaching programs designed to suit your needs.

This free, confidential program is easy to access. Get started today by calling 1.800.822.2019 or email coaching@ marqueehealth.com. All you will need to provide to get started is your name, date of birth, and area of well-being you would like to focus on:

• UFit Advanced Physical Activity

• URest Sleep Hygiene

• UBeat Heart Health

• UCents Financial Fitness

• UFuel Personalized Nutrition

• UCentered Menopause Coaching

• UBalance Stress Management

• UPrevent Cancer Resistance

• UBreathe Tobacco Cessation

• UBody Weight Management

• UMove Physical Activity

• UFlourish Personal Development

• U&Yours Family Health

• UThrive Diabetes Education

• UControl General Health

• UAgeWell Longevity Coaching

• UMind Brain Health

Your Employee Assistance Program (EAP) When someone you care about is struggling, the Employee Assistance Program (EAP) is here to help. The State is partnering with Lyra Health to bring enhanced support and resources to the whole family. Lyra Health is available to benefit-eligible employees and their household members including children and teens.

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, seven 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.

Lyra provides high quality confidential mental health care, with additional support and resources, that can be utilized in your daily life at home and at work. The Lyra app makes it easily accessible for on-the-go wellness.

To access the Lyra Health portal log into sd.lyrahealth.com or download the Lyra app.

What You Get with Lyra Heath

Lyra provides a whole host of resources for support through your well-being journey:

• Care Navigator Team: The Care Navigator Team is comprised of Master’s Level Clinicians that are available 365/24/7.

They are there to help you when you need it. Lyra’s Care Navigator Team: (833) 872.0201.

• Mental Health Coaching or Therapy: Six (6) free sessions per fiscal year with top therapists and mental health coaches. Sessions are virtual or in-person.

• Library of self-guided tools and resources: meditations, articles and videos you can access at your own pace.

• Resource Coordination – Assistance with finding free or reduced-cost resources like food, housing, financial assistance, healthcare and more.

• Work-Life Services: Support for Legal, Identity, Financial and more: Call 833.872.0201 or visit sd.lyrahealth.com.

• Treatment for alcohol and substance use

• And more.

To access the Lyra Health portal log into sd.lyrahealth.com or download the Lyra app.

Dental Plans

BASE PLAN ENHANCED PLAN

24 PAY

PERIODS

12 PAY

PERIODS

24 PAY

PERIODS

12 PAY

PERIODS

Employee $9.01 $18.02 $22.03 $44.06

Employee + spouse $30.63 $61.26 $56.60 $113.20

Employee + child(ren) $34.71 $69.42 $57.95 $115.90

Family $56.33 $112.66 $92.53 $185.06

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

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 plan at deltadentalsd.com or visit https://sd.gov/bhra and click on Benefits.

�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.

TELEDENTISTRY – Access your dental benefits from the comfort of your own home.

Now the same ease of accessibility you can enjoy with Doctor on Demand is available through Dental Dental. Teledentistry from Delta Dental gives you access to video visits from the comfort of your home.

Are having a dental emergency and do not have a dentist? �Need access to a dentist after hours, or need to consult a dentist without leaving your home or otherwise traveling?

This service is available to all dental plan members twenty-four hours a day, seven days a week.

Ready to get started?

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

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. MBA benefits cannot be shared.

��MBA benefits cannot be used for orthodontic claims.

�You will lose your account balance if you move from the Enhanced Plan to the Base Plan, or if you have a break in coverage.

Questions about MBA benefits? Call Delta Dental at 1.877.841.1478, or visit https://southdakota.deltadental.com/ shop-dental-plans/features-and-options/maximum-bonus-account/.

PREVENTION PAYS

Administered by Delta Dental

The Prevention Pays feature exempts preventive care and some gum disease (periodontal) services from the calculation of the plan's annual maximum benefit. That means preventive services like exams, x-rays, and periodontal maintenance cleanings are covered even when the plan's annual maximum benefit has been reached. It also means more benefits are available to help pay for treatment procedures like cavity fillings, crowns, and root canals.

HEALTH THROUGH ORAL WELLNESS®

Administered by Delta Dental Health through Oral Wellness is a unique program that adds benefits to your dental plan based on your oral health needs. There is no need to enroll, and it is provided at no cost to you.

A Delta Dental network dentist trained in Health through Oral Wellness will assess your risk for tooth decay and periodontal disease during a regular preventive visit. Depending on your level of risk, your dentist will recommend additional benefits you are eligible for, including additional cleanings*, fluoride treatments, sealants, and oral hygiene instruction.

Also, if you have any of the following health conditions, you are eligible for additional benefits:

�Pregnancy: One additional cleaning during your pregnancy �Diabetes: Two additional cleanings �High-risk cardiac care: Two additional cleanings �Kidney failure or dialysis: Two additional cleanings �Rheumatoid arthritis: Two additional cleanings ���Stroke: Two additional cleanings �Cancer-related chemotherapy or radiation: Two additional cleanings and two applications of fluoride �Suppressed immune system: Two additional cleanings and two applications of fluoride

Learn more: https://southdakota.deltadental.com/shop-dental-plans/features-and-options/health-through-oral-wellness/.

*Cleanings may be either a general cleaning (prophylaxis) or a periodontal maintenance cleaning, depending on your dentist’s recommendation.

Ready to get started?

PREMIUMS 24 PAY

PERIODS

12 PAY

PERIODS

Employee $3.19 $6.38

Employee + spouse $6.38 $12.76

Employee + child(ren) $5.40 $10.80

Family $8.91 $17.82

Along with the one eye exam covered annually on your health plan, you have the option of electing vision coverage to help pay for an additional eye exam, as well as frames, lenses, contacts, and more.

Premiums are paid with pre-tax deductions.

• �You can see any vision care doctor you choose, but you may pay less at in-network providers. To find in-network care, visit eyemedvisioncare.com/sosd, select Provider Locator, enter your zip code, and choose the network Insight.

• If your vision care provider is out of network, you may be eligible to be partially reimbursed for care. Visit https://sd.gov/bhra/ and click on Benefits to read instructions and download an out-of-network claim form. The completed form must be mailed in or uploaded within 15 months of the date of service.

• Your eligibility for services resets on July 1 of each year.

Questions? Call EyeMed at 1.888.626.6334.

NETWORK ADEQUACY REIMBURSEMENT

No in-network provider near you? Unable to schedule an in-network appointment when you need it? In these situations, your vision benefits allow you to schedule out-of-network care and get reimbursed as if you visited an in-network provider.

You may take advantage of this benefit if:

• You are unable to locate a participating provider within a 10-mile radius in an urban/suburban area.

• You are unable to locate a participating provider within a 20-mile radius in a rural area.

• You are unable to schedule a visit within two weeks with a participating provider.

To get reimbursed, after your appointment, go to https://sd.gov/bhra/ and click on Benefits to download and complete an out-of-network claim form, including the Network Adequacy section on page 4.