Blue Cross Blue Shield of North Dakota offers this marketplace health insurance plan (Plan ID 37160ND2410021) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.
Marketplace enrollment for 2026 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in North Dakota). Submit changes before the deadline to avoid a coverage gap.
Enroll by Dec 15 for Jan 1 starts.
Finalize plan switches before the window closes.
Special Enrollment Periods
You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).
Report the event within 60 days.
Keep documentation handy for Healthcare.gov or your state exchange.
CSR & subsidy reminders
Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.
Enter accurate income to maximize Advanced Premium Tax Credits.
Standard Catastrophic Off Exchange Plan plans like this one keep deductibles and copays lower if you qualify.
Thinking about switching?
Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.
Match provider networks so ongoing care isn’t disrupted.
Confirm prescriptions stay on-formulary or budget for tier changes.
Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.
Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).
Variant 37160ND2410021-00 (Standard Off Exchange Plan) currently displayed.
Advertisement
Benefits
Covered services & limitations
Everyday care
Office visits, preventive care, labs, imaging, and home health.
Chiropractic Care
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network20.00% Coinsurance after deductible
Limit: 20.0 Visit(s) per Benefit Period
Chiropractic services provided on an inpatient or outpatient basis when Medically Appropriate and Necessary as determined by BCBSND and within the scope of licensure and practice of a Chiropractor, to the extent services would be covered if provided by a Physician.
Exclusions: Maintenance care that is typically long-term. This includes care provided after maximum therapeutic improvement, without a trial of withdrawal of treatment, to prevent symptomatic deterioration or it may be initiated with patients without symptoms in order to promote health and to prevent further problems. All forms of thermography for all uses and indications. Clinical ecology, orthomolecular therapy, vitamins or dietary nutritional supplements, or related testing.
Diabetes Education
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network100.00%
Diabetes Prevention Program
Home Health Care Services
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network20.00% Coinsurance after deductible
Limit: 40.0 Visit(s) per Benefit Period
Covered Services include: 1. The professional services of an R.N., Licensed Vocational Nurse or L.P.N.; 2. Physical, Occupational or Speech Therapy; 3. Medical and surgical supplies; 4. Administration of prescribed drugs; 5. Oxygen and the administration of oxygen; and 6. Health aide services for a Member who is receiving covered Skilled Nursing Services or Therapy Services. A visit is considered up to 4 continuous hours. Psychiatric and substance use services are excluded from the Maximum Benefit Allowance.
Laboratory Outpatient and Professional Services
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network20.00% Coinsurance after deductible
Exclusions: Genetic testing when performed in the absence of symptoms or high risk factors for a heritable disease; genetic testing when knowledge of genetic status will not affect treatment decisions, frequency of screening for the disease, or reproductive choices; genetic testing that has been performed in response to direct to consumer marketing and not under the direction of the members physician.
Other Practitioner Office Visit (Nurse, Physician Assistant)
$50.00
Tier 1 in-network$50.00
Out-of-network20.00% Coinsurance after deductible
Exclusions: Services provided and billed by a registered nurse (other than an advanced practice registered nurse), intern (professionals in training), licensed athletic trainer or other paramedical personnel.
Preventive Care/Screening/Immunization
No Charge
Tier 1 in-networkNo Charge
Out-of-network100.00%
Preventive screening services for Members age 6 and older according to A or B Recommendations of the U.S. Preventive Services Task Force and issued by the Health Resources and Services Administration.
Exclusions: Immunizations for Foreign Travel. Contraceptive products that do not require a prescription order or dispensing by a healthcare provider. Evaluations and related procedures to evaluate sterilization reversal procedures and the sterilzation reversal procedure.
Primary Care Visit to Treat an Injury or Illness
$50.00
Tier 1 in-network$50.00
Out-of-network20.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network20.00% Coinsurance after deductible
Limit: 30.0 Visit(s) per Year
Rehabilitative Services: therapies that are designed to restore function following a surgery or medical procedure, injury or illness. 30-visit limit is for each of PT, OT, and ST. Psychiatric and substance use services are excluded from the Maximum Benefit Allowance. Benefits are not available for Maintenance Care.
Exclusions: Therapy Maintenance Care, work hardening programs, prevocational evaluation and functional capacity evaluations. Health and athletic club membership or facility use, and all services provided by the facility, including physical therapy, sports medicine therapy and physical exercise.
Rehabilitative Speech Therapy
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network20.00% Coinsurance after deductible
Limit: 30.0 Visit(s) per Year
Rehabilitative Services: therapies that are designed to restore function following a surgery or medical procedure, injury or illness.
Exclusions: Speech Therapy Maintenance Care and group speech therapy services.
Specialist Visit
$50.00
Tier 1 in-network$50.00
Out-of-network20.00% Coinsurance after deductible
Urgent Care Centers or Facilities
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network20.00% Coinsurance after deductible
X-rays and Diagnostic Imaging
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network20.00% Coinsurance after deductible
Hospital & urgent
Emergency room, inpatient stays, ambulance, and surgeries.
Chemotherapy
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network20.00% Coinsurance after deductible
Delivery and All Inpatient Services for Maternity Care
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network20.00% Coinsurance after deductible
Exclusions: Collection and storage of umbilical cord blood. Abortion except for those necessary to prevent the death of the woman.
Dialysis
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network20.00% Coinsurance after deductible
Durable Medical Equipment
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network20.00% Coinsurance after deductible
Out of state non-participating health care provider waiver may be required.
Exclusions: Benefits are not available for prosthetic limbs or components required for work-related tasks, leisure or recreational activities or to allow a member to participate in sport activities.
Emergency Room Services
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-networkNo Charge after deductible
Emergency Transportation/Ambulance
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-networkNo Charge after deductible
Medically Appropriate and Necessary Ambulance Services to the nearest facility equipped to provide the required level of care, including transportation: from the home or site of an Emergency Medical Condition; between hospitals; and between a Hospital and Skilled Nursing Facility. Benefits for air transportation are available only when ground transportation is not Medically Appropriate and Necessary as determined by BCBSND.
Hospice Services
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network20.00% Coinsurance after deductible
Hospice benefits are provided only for the treatment of Members diagnosed with a condition where there is a life expectancy of 6 months or less. Precertification is required.
Inpatient Hospital Services (e.g., Hospital Stay)
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network20.00% Coinsurance after deductible
Exclusions: Inpatient services performed primarily for diagnostic examinations, physical therapy, rest cure, convalescent care, custodial care, maintenance care or sanitaria care.
Inpatient Physician and Surgical Services
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network20.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network20.00% Coinsurance after deductible
Benefits are available for the inpatient treatment of psychiatric illness, including management of medical problems related to an eating disorder diagnosis, when provided by an appropriately licensed and credentialed Hospital or Psychiatric Care Facility. Precertification may be required for Inpatient Hospital Admissions.
Mental/Behavioral Health Outpatient Services
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network20.00% Coinsurance after deductible
Home and Office Visits Including assessment, counseling, case management services, Behavioral Modification Intervention for Autism Spectrum Disorder (Including Applied Behavioral Analysis (ABA), treatment planning, coordination of care, psychotherapy and group therapy; precertification may be required. Precertification is required for residential treatment. Out of state non-participating health care provider waiver may be required.
Exclusions: Special education, Including lessons in sign language to instruct a Member whose ability to speak has been lost or impaired to function without that ability. Counseling or therapy services, Including bereavement, codependency, marital dysfunction, family dysfunction, sex or interpersonal relationship.
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network20.00% Coinsurance after deductible
Includes dental anesthesia and hospitalization for dental care to members under age 9 who have a medical condition that requires hospitalization.
Outpatient Rehabilitation Services
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network20.00% Coinsurance after deductible
Limit: 30.0 Visit(s) per Benefit Period
Rehabilitative Services: therapies that are designed to restore function following a surgery or medical procedure, injury or illness. 30-visit limit is for each of PT, OT, and ST. Psychiatric and substance use services are excluded from the Maximum Benefit Allowance. Benefits are not available for Maintenance Care.
Exclusions: Therapy Maintenance Care, work hardening programs, prevocational evaluation, functional capacity evaluations or group speech therapy services. Health and athletic club membership or facility use, and all services provided by the facility, including physical therapy, sports medicine therapy and physical exercise.
Outpatient Surgery Physician/Surgical Services
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network20.00% Coinsurance after deductible
Radiation
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network20.00% Coinsurance after deductible
Skilled Nursing Facility
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network20.00% Coinsurance after deductible
Limit: 30.0 Days per Benefit Period
Precertification is required. Psychiatric and substance use services are excluded from the Maximum Benefit Allowance.
Substance Abuse Disorder Inpatient Services
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network20.00% Coinsurance after deductible
Benefits are available for the inpatient treatment of substance use, including medically managed inpatient detoxification, medically monitored inpatient detoxification, medically managed intensive inpatient treatment or medically monitored intensive inpatient treatment, when provided at an appropriately licensed and credentialed Substance Use Facility. Benefits available for residential treatment. Benefits available for partial hospitalization. Precertification is required. For SUD, Precertification is required for inpatient and residential.
Exclusions: Services by a vocational residential rehab center, a community reentry program, halfway house or group home.
Substance Abuse Disorder Outpatient Services
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network20.00% Coinsurance after deductible
Home and Office Visits: Benefits Including assessment, counseling, case management services, treatment planning, coordination of care, psychotherapy, group therapy and Opioid Treatment Program provided by a licensed and/or credentialed independent provider in accordance with the Health Care Provider's scope of licensure as provided by law. Precertification may be required. Out of state non-participating health care provider waiver may be required. Outpatient benefits include diagnostic, evaluation and treatment services provided by a licensed and credentialed indepedent provider in accordance with the health care provider's scope of licensure as provided by law.
Transplant
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network100.00%
Limit: 1.0 Exam(s) per Transplant
One evaluation is allowed per transplant procedure. Services must be performed at a qualified transplant center. Pre-transplant review or second opinion prior to the member's evaluation at the transplant center, are covered under the professional office visit benefit or the second surgical opinion benefit. Similarly, the post-transplant evaluation would be covered under the professional office visit benefit.
Exclusions: Benefits are not available for transportation services for the member. Benefits are not available for artificial organs, donor search services or organ procurement if the organ or tissue is not donated. Benefits are not available if the member is the donor for transplant services.
Pregnancy & family
Maternity, newborn, pediatric dental and vision extras.
Basic Dental Care - Child
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network50.00% Coinsurance after deductible
Hearing Aids
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network20.00% Coinsurance after deductible
Limit: 1.0 Visit(s) per 3 Years
Subject to a Maximum Benefit Allowance per Member of 1 hearing aid per ear every 3 years.
Exclusions: No benefits are available for a tinnitus masker.
Major Dental Care - Child
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network50.00% Coinsurance after deductible
Prenatal and Postnatal Care
No Charge
Tier 1 in-networkNo Charge
Out-of-network20.00% Coinsurance after deductible
Office visits for pre and post-natal care waive all cost sharing amounts.
Routine Eye Exam for Children
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network100.00%
Limit: 1.0 Exam(s) per Benefit Period
Well Baby Visits and Care
No Charge
Tier 1 in-networkNo Charge
Out-of-network100.00%
Limit: 11.0 Visit(s) per 3 Years
Well Child Care through age 6, 100% of Allowed Charge. Deductible Amount is waived.
Pharmacy & drugs
Generic, brand, specialty, and mail order tiers.
Generic Drugs
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network100.00%
Prescription Medications or Drugs and nonprescription diabetic supplies are subject to a dispensing limit of a 90-day supply. Prescription Medication listed on the Value Drug list will apply a $5 copayment amount, then 100% of allowed charge. Preventive medications required under PPACA and the USPSTF are covered at 100%. An additional drug list is being added to address higher out-of-pocket costs on a sub-set of medications for individuals diagnosed with diabetes, hypertension, high cholesterol, asthma, etc.; i.e. chronic conditions.
Exclusions: Drugs for hair loss, cosmetic purposes, sexual dysfunction, infertility and medications obtained without a prescription order. Drugs and associated expenses and devices not approved by the FDA for a particular use except as required by law (unless the practitioner certifies off-label use with a letter of medical necessity).
Non-Preferred Brand Drugs
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network100.00%
Exclusions: Drugs for hair loss, cosmetic purposes, sexual dysfunction, infertility and medications obtained without a prescription order. Drugs and associated expenses and devices not approved by the FDA for a particular use except as required by law (unless the practitioner certifies off-label use with a letter of medical necessity).
Preferred Brand Drugs
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network100.00%
Prescription Medication listed on the Value Drug list will apply a $5 copayment amount, then 100% of allowed charge. Preventive medications required under PPACA and the USPSTF are covered at 100%. An additional drug list is being added to address higher out-of-pocket costs on a sub-set of medications for individuals diagnosed with diabetes, hypertension, high cholesterol, asthma, etc.; i.e. chronic conditions. Formulary insulin drugs & diabetes supplies obtainable with a Prescription Order shall not exceed a Cost Sharing Amount of $25.00 for a 30-day supply. Cost Sharing Amounts shall not exceed $25.00 for a 30-day supply of Nonformulary insulin drugs & diabetes supplies obtainable with a Prescription Order, when the Member follows the exceptions process for clinically appropriate drugs not listed on the formulary listing.
Exclusions: Drugs for hair loss, cosmetic purposes, sexual dysfunction, infertility and medications obtained without a prescription order. Drugs and associated expenses and devices not approved by the FDA for a particular use except as required by law (unless the practitioner certifies off-label use with a letter of medical necessity).
Specialty Drugs
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network100.00%
Preferred and Non-Preferred Specialty Drugs are subject to a dispensing limit of a 30-day supply. In limited circumstances Specialty Drugs may be available for a greater than 30-day supply. Non-Preferred Specialty drugs apply deductible and 50% coinsurance.
Exclusions: Drugs for hair loss, cosmetic purposes, sexual dysfunction, infertility and medications obtained without a prescription order. Drugs and associated expenses and devices not approved by the FDA for a particular use except as required by law (unless the practitioner certifies off-label use with a letter of medical necessity).
An accidental injury is defined as an injury that is the result of an external force causing a specific impairment to the jaw, sound natural teeth, dentures, mouth or face. Covered Services must be initiated within 6 months of the date of injury and completed within 24 months of the start of treatment or longer if a dental treatment plan approved by BCBSND is in place.
Basic Dental Care - Adult
Coverage details pending
Issuer did not share extra notes for this benefit beyond the summary above.
Dental Check-Up for Children
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network20.00% Coinsurance after deductible
Limit: 2.0 Exam(s) per Benefit Period
Infusion Therapy
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network20.00% Coinsurance after deductible
Covered Services include the provision of nutrients, antibiotics, and other drugs and fluids intravenously, through a feeding tube, or by inhalation; all Medically Appropriate and Necessary supplies; and therapeutic drugs or other substances. Covered Services also include Medically Appropriate and Necessary enteral feedings when such feedings are the sole source of nutrition for a Member age 1 and older.
Major Dental Care - Adult
Coverage details pending
Diagnosis and treatment of periodontal disease when recommended by a Health Care Provider based on health related impacts or further deterioration in existing acute or chronic disease state due to gum disease, including but not limited to periodontal scaling and root planing.
Nutritional Counseling
No Charge
Tier 1 in-networkNo Charge
Out-of-network100.00%
Limit: 12.0 Visit(s) per Benefit Period
12 visits each per benefit period for hyperlipedemia, gestational diabetes, diabetes mellitus, hypertension and other diabetes related diagnosis or a chronic illness or condition. Psychiatric and substance use services are excluded from the Maximum Benefit Allowance.
Orthodontia - Adult
Coverage details pending
Issuer did not share extra notes for this benefit beyond the summary above.
Orthodontia - Child
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network50.00% Coinsurance after deductible
Limit: 1.0 Treatment(s) per Lifetime
Only for 'the treatment of improper alignment of biting or chewing surfaces of upper and lower teeth through the installation of orthodontic appliances.'
Prosthetic Devices
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network20.00% Coinsurance after deductible
Precertification is required. Benefits are available for externally worn breast prostheses and surgical bras, including necessary replacements following mastectomy, subject to a Maximum Benefit Allowance of 2 external prostheses and 2 bras per Member per Benefit Period. For a double mastectomy, allow a Maximum Benefit Allowance of 4 external prostheses and 2 bras per Member per Benefit Period.
Routine Dental Services (Adult)
Coverage details pending
Issuer did not share extra notes for this benefit beyond the summary above.
Weight Loss Programs
Coverage details pending
Issuer did not share extra notes for this benefit beyond the summary above.
Additional benefits
Other plan-specific services and limitations.
Abortion for Which Public Funding is Prohibited
Coverage details pending
Not covered except for those necessary to prevent the death of the woman. No benefits are available for removal of all or part of a multiple gestation.
Acupuncture
Coverage details pending
Issuer did not share extra notes for this benefit beyond the summary above.
Allergy Testing
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network20.00% Coinsurance after deductible
Benefit includes serum, direct skin testing and patch testing when ordered by a Professional Health Care Provider and performed in accordance with medical guidelines and criteria established by BCBSND.
Bariatric Surgery
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network100.00%
Limit: 1.0 Procedure(s) per Lifetime
Bariatric surgery when Precertification is received from BCBSND. Covered Services must be received from a surgical facility approved by BCBSND. Benefits are subject to a Lifetime Maximum of 1 operative procedure per Member. Psychiatric and substance use services are excluded from the Lifetime Maximum. Guidelines and criteria are available upon request. Benefits for all proposed surgical procedures for the treatment of complications resulting from any or all types of bariatric surgery are available only when Precertification is received from BCBSND.
Cosmetic Surgery
Coverage details pending
Issuer did not share extra notes for this benefit beyond the summary above.
Eye Glasses for Children
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network100.00%
Limit: 1.0 Item(s) per Benefit Period
Frames are limited to one every other benefit period. Lenses are limited to one pair per benefit period.
Habilitation Services
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network20.00% Coinsurance after deductible
Limit: 30.0 Visit(s) per Benefit Period
Habilitative Physical Therapy, Occupational Therapy, or Speech Therapy. Therapy is care provided for conditions which have limited the normal age appropriate motor, sensory or communication development. To be considered habilitative, functional improvement and measurable progress must be made toward achieving functional goals within a predictable period of time toward a Member’s maximum potential. Functional skills are defined as essential activities of daily life common to all Members such as dressing, feeding, swallowing, mobility, transfers, fine motor skills, age appropriate activities and communication. Problems such as hearing impairment including deafness, a speech or language impairment, a visual impairment including blindness, serious emotional disturbance, an orthopedic impairment, autism spectrum disorders, traumatic brain injury, deaf-blindness, or multiple disabilities may warrant Habilitative Therapies. Measurable progress emphasizes accomplishment of functional skills and independence in the context of the Member’s potential ability as specified within a care plan or treatment goals. Benefits are subject to the Maximum Benefit Allowance listed in the Schedule of Benefits, Section 1, for each type of therapy under an individual medical plan (IMP) developed for each Member. Benefits are not available for Maintenance Care. Psychiatric and substance use services are excluded from the Maximum Benefit Allowance.
Imaging (CT/PET Scans, MRIs)
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network20.00% Coinsurance after deductible
PET Scan Benefits are available every six months per Member per Benefit Period with a Prostate Cancer Diagnosis.
Infertility Treatment
Coverage details pending
Issuer did not share extra notes for this benefit beyond the summary above.
Long-Term/Custodial Nursing Home Care
Coverage details pending
Issuer did not share extra notes for this benefit beyond the summary above.
Private-Duty Nursing
Coverage details pending
Issuer did not share extra notes for this benefit beyond the summary above.
Reconstructive Surgery
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network20.00% Coinsurance after deductible
Reconstructive surgery to restore bodily function or correct deformity resulting from disease, trauma, congenital or developmental anomalies or previous therapeutic processes.
Exclusions: Services or procedures with the primary purpose to improve appearance and not primary to restore bodily function or correct deformity resulting from disease, trauma, congenital or developmental anomalies or previous therapeutic processes, or which primarily improve or alter body features which are variations of normal development.
Routine Eye Exam (Adult)
Coverage details pending
Issuer did not share extra notes for this benefit beyond the summary above.
Routine Foot Care
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network20.00% Coinsurance after deductible
Covered services include custom diabetic shoes and inserts, and the care of corns, calluses and toenails when medically appropriate and necessary for members with diabetes. Benefits are available for the care of corns, calluses and toenails when medically appropriate and necessary for members with circulatory disorders of the legs or feet.
Treatment for Temporomandibular Joint Disorders
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network20.00% Coinsurance after deductible
Exclusions: No benefits will be provided for orthodontic services or osseointegrated implant surgery.
Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.
Out of Service Area Coverage
Yes
Out of Service Area Coverage Description
Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.
Begin Primary Care Cost-Sharing After Number Of Visits
0
Child-Only Offering
Allows Adult and Child-Only
Composite Rating Offered
No
Dental Only Plan
No
Design Type
Not Applicable
Disease Management Programs Offered
Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
EHB Percent of Total Premium
1
First Tier Utilization
100%
Import Date
10/29/2025
Limited Cost Sharing Plan Variation - Estimated Advanced Payment
$0.00
HSA Eligible
Yes
New/Existing Plan
Existing
Notice Required for Pregnancy
No
Is a Referral Required for Specialist?
No
Plan Effective Date
1/1/2026
Plan Type
PPO
QHP/Non QHP
Both
Source Name
HIOS
Plan ID
37160ND2410021
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group
$63600 per group
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person
$31800 per person
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual
$31,800
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group
$21200 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person
$10600 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual
$10,600
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group
$42400 per group
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person
$21200 per person
Combined Medical and Drug EHB Deductible, Out of Network, Individual
$21,200
Unique Plan Design
No
Wellness Program Offered
Yes
Copay & coinsurance
Pharmacy cost sharing by tier
Drug tier
Pharmacy type
Copay amount
Copay option
Coinsurance rate
Coinsurance option
Mail order
Questions & answers
Frequently asked questions
How do I choose the right ACA plan in North Dakota?
BlueEssential Catastrophic 100 HSA Eligible $10600 Deductible (37160ND2410021) is a Catastrophic PPO from Blue Cross Blue Shield of North Dakota in North Dakota for the 2026 coverage year.
Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.
Does BlueEssential Catastrophic 100 HSA Eligible $10600 Deductible support telehealth or virtual urgent care?
The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.
Is BlueEssential Catastrophic 100 HSA Eligible $10600 Deductible HSA-eligible and does it include dental or vision coverage?
It is HSA-eligible, so you can pair it with a Health Savings Account to lower taxes.
Dental add-ons: Child.
Vision add-ons: Child.
Does BlueEssential Catastrophic 100 HSA Eligible $10600 Deductible support mail-order prescriptions?
Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.
Which disease management programs come with BlueEssential Catastrophic 100 HSA Eligible $10600 Deductible?
The issuer lists disease management resources for: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs.
Is there out-of-country coverage for BlueEssential Catastrophic 100 HSA Eligible $10600 Deductible?
Yes, limited out-of-country coverage is available. Review the Summary of Benefits for reimbursement steps. Details: Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.
Does BlueEssential Catastrophic 100 HSA Eligible $10600 Deductible cover care outside the service area?
Yes, you have limited out-of-area coverage. See the plan documents for referral and prior authorization rules. Details: Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.
How do I enroll in or manage payments for BlueEssential Catastrophic 100 HSA Eligible $10600 Deductible?
Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
