Wellmark Gold Traditional EPO
Wellmark of South Dakota, Inc. · 2026 plan year
Gold
- Ind. deductible
- $1,750
- Family deductible
- $3,500
- Ind. OOP max
- $7,500
- Family OOP max
- $15,000
Compare with other Gold plans in SD
Side by side: deductibles, out-of-pocket limits and copays.
Other cost-sharing reduction variants for this plan:
More Wellmark of South Dakota, Inc. plans in SD
Monthly premiums by age
Rating Area 1
| Age | Individual | Individual + tobacco |
|---|---|---|
| Under 15 | $443 | $443 |
| 21 | $579 | $666 |
| 30 | $658 | $756 |
| 40 | $740 | $852 |
| 50 | $1,035 | $1,190 |
| 60 | $1,572 | $1,808 |
| 64 and over | $1,738 | $1,999 |
Live premium estimate
Benefits & cost sharing
Primary Care
| Benefit | In-network |
|---|---|
| Preventive Care/Screening/Immunization | No charge |
| Primary Care Visit to Treat an Injury or Illness | $20.00 |
Specialist
| Benefit | In-network |
|---|---|
| Specialist Visit | $45.00 |
Hospital
| Benefit | In-network |
|---|---|
| Inpatient Hospital Services (e.g., Hospital Stay) | 25.00% Coinsurance after deductible |
| Emergency Room Services | 25.00% Coinsurance after deductible |
| Outpatient Surgery Physician/Surgical Services | 25.00% Coinsurance after deductible |
| Urgent Care Centers or Facilities | $20.00 |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | $20.00 |
| Non-Preferred Brand Drugs | $125.00 |
| Preferred Brand Drugs | $60.00 |
| Specialty Drugs | $300.00 |
Mental Health
| Benefit | In-network |
|---|---|
| Mental/Behavioral Health Inpatient Services | 25.00% Coinsurance after deductible |
| Mental/Behavioral Health Outpatient Services | $20.00 |
Other
| Benefit | In-network |
|---|---|
| Infusion Therapy | 25.00% Coinsurance after deductible |
| Abortion for Which Public Funding is Prohibited | Not covered |
| Accidental Dental | $45.00 |
| Acupuncture | Not covered |
| Allergy Testing | $45.00 |
| Bariatric Surgery | 25.00% Coinsurance after deductible |
| Basic Dental Care - Adult | Not covered |
| Basic Dental Care - Child | 40.00% |
| Chemotherapy | 25.00% Coinsurance after deductible |
| Chiropractic Care | $20.00 |
| Cosmetic Surgery | Not covered |
| Delivery and All Inpatient Services for Maternity Care | 25.00% Coinsurance after deductible |
| Dental Check-Up for Children | No charge |
| Diabetes Education | $20.00 |
| Dialysis | 25.00% Coinsurance after deductible |
| Durable Medical Equipment | 25.00% Coinsurance after deductible |
| Emergency Transportation/Ambulance | 25.00% Coinsurance after deductible |
| Eye Glasses for Children | 80.00% |
| Habilitation Services | 25.00% Coinsurance after deductible |
| Hearing Aids | Not covered |
| Home Health Care Services | 25.00% Coinsurance after deductible |
| Hospice Services | 25.00% Coinsurance after deductible |
| Imaging (CT/PET Scans, MRIs) | 25.00% Coinsurance after deductible |
| Infertility Treatment | $20.00 |
| Inpatient Physician and Surgical Services | 25.00% Coinsurance after deductible |
| Laboratory Outpatient and Professional Services | 25.00% Coinsurance after deductible |
| Long-Term/Custodial Nursing Home Care | Not covered |
| Major Dental Care - Adult | Not covered |
| Major Dental Care - Child | 60.00% |
| Nutritional Counseling | Not covered |
| Orthodontia - Adult | Not covered |
| Orthodontia - Child | 60.00% |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $20.00 |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | 25.00% Coinsurance after deductible |
| Outpatient Rehabilitation Services | 25.00% Coinsurance after deductible |
| Prenatal and Postnatal Care | 25.00% Coinsurance after deductible |
| Private-Duty Nursing | 25.00% Coinsurance after deductible |
| Prosthetic Devices | 25.00% |
| Radiation | 25.00% Coinsurance after deductible |
| Reconstructive Surgery | 25.00% Coinsurance after deductible |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | 25.00% Coinsurance after deductible |
| Rehabilitative Speech Therapy | $20.00 |
| Routine Dental Services (Adult) | Not covered |
| Routine Eye Exam (Adult) | Not covered |
| Routine Eye Exam for Children | No charge |
| Routine Foot Care | Not covered |
| Skilled Nursing Facility | 25.00% Coinsurance after deductible |
| Substance Abuse Disorder Inpatient Services | 25.00% Coinsurance after deductible |
| Substance Abuse Disorder Outpatient Services | 25.00% Coinsurance after deductible |
| Transplant | 25.00% Coinsurance after deductible |
| Treatment for Temporomandibular Joint Disorders | 25.00% Coinsurance after deductible |
| Weight Loss Programs | Not covered |
| Well Baby Visits and Care | No charge |
| X-rays and Diagnostic Imaging | 25.00% Coinsurance after deductible |
Plan rules
Service area
This plan covers 16 geographic areas.
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