Simplot Medical Program

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What you need to know

Medical benefits are covered through the Simplot Medical Program, administered by Blue Cross of Idaho. The Medical Program covers age- and gender-appropriate in-network preventive care with no deductible or cost sharing. You’ll get access to in-network and out-of-network care — but you’ll pay more for services if you decide to see an out-of-network provider.

Who’s eligible

Most employees are eligible to participate in the Simplot Medical Program. If you’re eligible, you can also enroll certain family members.

Eligible family members

• Legal spouse
• Children under age 26, including:
– Biological and step children
– Adopted children or children placed for adoption
– Foster children or children of whom you have legal guardianship
– Adult children, until they reach the end of the month of their 26th birthday
• Your or your spouse’s child of any age who becomes disabled while the child is enrolled in the plan and is dependent on you

You will need to provide supporting documentation, such as a marriage or birth certificate, for your spouse and/or any family members you enroll within 75 days from the date of your event.

What you pay — annual deductible

	In-Network		Out-of-Network
Deductible	Individual $1,800	Family $3,400	Individual $3,300	Family $6,400

What you pay — after deductible

	In-Network		Out-of-Network
Preventive Care	$0 No deductible		40%¹ After deductible
Cost Sharing	20% After deductible		40% After deductible
Out-of-Pocket Maximum³	Individual $4,300	Family $8,400⁴	Individual $8,300	Family $16,400

Footnotes

¹Preventive care received from an out-of-network provider is subject to deductible and coinsurance.
²Out-of-network for ER for a true emergency is covered the same as in-network.
³In-network services don’t apply to the out-of-network out-of-pocket maximum. But, if you use an out-of-network provider, it will count toward the in-network out-of-pocket maximum.
⁴Once the in-network out-of-pocket costs for an individual reach $6,850, additional covered services for that individual are paid 100 percent.

Prescription drug coverage

The Simplot Medical Program includes prescription drug coverage. Prescription drugs can be an important part of medical care, whether you need to treat a sinus infection or manage a chronic condition like high blood pressure or diabetes. You will pay the full cost of many prescription drugs until your deductible is met. The prescription drug costs are applied to the individual or family Medical Program deductible and out-of-pocket maximum to help you reach them faster.

If you take a maintenance medication, you may consider the mail order program. Through mail order, you can purchase a 90-day supply of your prescription and enjoy the convenience of direct home delivery.

What you pay — prescription drugs

	In-Network	Out-of-Network
Preventive Contraceptives, smoking cessation medications, medications for chronic conditions (including insulin and medications for high blood pressure or high cholesterol) and others as required by the Affordable Care Act	$0 No deductible	No coverage
TIER 1 Generic & TIER 2 Preferred Brand	20% After deductible	No coverage
TIER 3 Non-Preferred Brand	30% After deductible	No coverage

Learn the lingo

See your 2025 contributions

See what you’ll pay each pay period for your coverage based on the level you choose.

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Get started

You can take advantage of all the Simplot Medical Program has to offer once you register on the Blue Cross of Idaho website. You can view in-network providers and more. How to register:

Visit members.bcidaho.com.
Select Register from the menu at the top of the page.
You will need to:
- Enter your first and last name
- Enter your email address
- Create a username and password
- Create three security questions with answers only you know to help identify you if you lose your password

After you register, you can use the website to learn about your coverage, find an in-network provider, view your ID card and view information about pharmacy benefits. By clicking on Pharmacy from the top menu, you can find an in-network pharmacy and view covered drugs.