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2018 Dual Options

Dual options provide your employees the chance to choose a plan that best fits their lifestyles and budgets.

Group Health Coverage – Metallics and Dual Option [pdf, 387 KB]: Additional benefits available for individuals and families for these Small Group Plans.

Benefits Platinum 500-1 Gold 2500 HSA
Deductible $500 $2,500
Coinsurance 80% 100%
Out-of-Pocket $1,250 $2,500
Primary Care Physician Office Visit $20 copay N/A
Specialist Office Visit $40 copay N/A
Prescription Drugs $10 copay for generics
$30 copay for preferred brand-name
$50 copay for non-preferred brand-name
$100 copay for preferred specialty
$200 copay for specialty
N/A
Deductible Type Fulfillment True Family

Benefits Platinum 1000-1 Silver 3600 HSA
Deductible $1,000 $3,600
Coinsurance 80% 100%
Out-of-Pocket $1,250 $3,600
Primary Care Physician Office Visit $30 copay N/A
Specialist Office Visit $50 copay N/A
Prescription Drugs $10 copay for generics
$50 copay for preferred brand-name
$75 copay for non-preferred brand-name
$150 copay for preferred specialty
$300 copay for specialty
N/A
Deductible Type Fulfillment Embedded

Benefits Platinum 500-1 Silver 3000-1
Deductible $500 $3,000
Coinsurance 80% 80%
Out-of-Pocket Costs $1,250 $7,350
Primary Care Physician Office Visit $20 copay $30 copay
Specialist Office Visit $40 copay N/A
Prescription Drugs $10 copay for generics
$30 copay for preferred brand-name
$50 copay for non-preferred brand-name
$100 copay for preferred specialty
$200 copay for specialty
$20 copay for generics
$65 copay for preferred brand-name
$90 copay for non-preferred brand-name
$180 copay for preferred specialty
$360 copay for specialty
Deductible Type Fulfillment Fulfillment

Benefits Platinum 1000-1 Silver 3000-1
Deductible $1,000 $3,000
Coinsurance 80% 80%
Out-of-Pocket Costs $1,250 $7,350
Primary Care Physician Office Visit $30 copay $30 copay
Specialist Office Visit $50 copay N/A
Prescription Drugs $10 copay for generics
$50 copay for preferred brand-name
$75 copay for non-preferred brand-name
$150 copay for preferred specialty
$300 copay for specialty
$20 copay for generics
$65 copay for preferred brand-name
$90 copay for non-preferred brand-name
$180 copay for preferred specialty
$360 copay for specialty
Deductible Type Fulfillment Fulfillment

Benefits Platinum 1000-1 Silver 3000 HSA
Deductible $1,000 $3,000
Coinsurance 80% 90%
Out-of-Pocket $1,250 $6,550
Primary Care Physician Office Visit $30 copay N/A
Specialist Office Visit $50 copay N/A
Prescription Drugs $10 copay for generics
$50 copay for preferred brand-name
$75 copay for non-preferred brand-name
$150 copay for preferred specialty
$300 copay for specialty
N/A
Deductible Type Fulfillment Embedded

Benefits Gold 1000-2 Bronze 4000 HSA
Deductible $1,000 $4,000
Coinsurance 80% 50%
Out-of-Pocket $5,000 $6,550
Primary Care Physician Office Visit $20 copay N/A
Specialist Office Visit $40 copay N/A
Prescription Drugs $10 copay for generics
$30 copay for preferred brand-name
$50 copay for non-preferred brand-name
$100 copay for preferred specialty
$200 copay for specialty
N/A
Deductible Type Fulfillment Embedded

Benefits Platinum 500-3 Gold 1500-1
Deductible $500 $1,500
Coinsurance 90% 80%
Out-of-Pocket $1,000 $3,000
Primary Care Physician Office Visit $20 copay N/A
Specialist Office Visit $40 copay N/A
Prescription Drugs $10 copay for generics
$30 copay for preferred brand-name
$50 copay for non-preferred brand-name
$100 copay for preferred specialty
$200 copay for specialty
N/A copay for generics
N/A copay for preferred brand-name
N/A copay for non-preferred brand-name
30% copay for preferred specialty
50% copay for specialty
Deductible Type Fulfillment Fulfillment

Benefits Platinum 500-1 Gold 1500-3
Deductible $500 $1,500
Coinsurance 80% 80%
Out-of-Pocket Costs $1,250 $3,500
Primary Care Physician Office Visit $20 copay $30 copay
Specialist Office Visit $40 copay $50 copay
Prescription Drugs $10 copay for generics
$30 copay for preferred brand-name
$50 copay for non-preferred brand-name
$100 copay for preferred specialty
$200 copay for specialty
$10 copay for generics
$30 copay for preferred brand-name
$50 copay for non-preferred brand-name
$100 copay for preferred specialty
$200 copay for specialty
Deductible Type Fulfillment Fulfillment

Benefits Platinum 1000-1 Gold 2000-1
Deductible $1,000 $2,000
Coinsurance 80% 80%
Out-of-Pocket Costs $1,250 $7,150
Primary Care Physician Office Visit $30 copay $30 copay
Specialist Office Visit $50 copay $50 copay
Prescription Drugs $10 copay for generics
$50 copay for preferred brand-name
$75 copay for non-preferred brand-name
$150 copay for preferred specialty
$300 copay for specialty
$10 copay for generics
$30 copay for preferred brand-name
$50 copay for non-preferred brand-name
$100 copay for preferred specialty
$200 copay for specialty
Deductible Type Fulfillment Fulfillment

Benefits Gold 1500-3 Silver 3000 HSA
Deductible $1,500 $3,000
Coinsurance 80% 90%
Out-of-Pocket Costs $3,500 $6,550
Primary Care Physician Office Visit $30 copay N/A
Specialist Office Visit $50 copay N/A
Prescription Drugs $10 copay for generics
$30 copay for preferred brand-name
$50 copay for non-preferred brand-name
$100 copay for preferred specialty
$200 copay for specialty
N/A
Deductible Type Fulfillment Embedded

*Copayments apply only to in-network providers.

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