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2018 Gold Plans

Gold plans cover more services, and have a higher monthly premium. The employee will pay less out of pocket for medical services. The benefits below apply to each employee.

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

Benefits Gold 500-1 Gold 1000-1 Gold 1000-2
Deductible $500 $1,000 $1,000
Coinsurance 80% 80% 80%
Out-of-Pocket Costs $7,000 $3,800 $5,000
Primary Care Physician Office Visit $30 copay $30 copay $20 copay
Specialist Office Visit N/A N/A $40 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
$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 Fulfillment

Benefits Gold 1000-3 Gold 1000-4 Gold 1000-5
Deductible $1,000 $1,000 $1,000
Coinsurance 80% 80% 80%
Out-of-Pocket Costs $6,500 $4,500 $4,550
Primary Care Physician Office Visit $30 copay $30 copay $20 copay
Specialist Office Visit $50 copay N/A $40 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
$40 copay for preferred brand-name
$60 copay for non-preferred brand-name
$120 copay for preferred specialty
$240 copay for specialty
$10 copay for generics
$40 copay for preferred brand-name
$60 copay for non-preferred brand-name
$120 copay for preferred specialty
$240 copay for specialty
Deductible Type Fulfillment Fulfillment Fulfillment

Benefits Gold 1000-6 Gold 1500-1 Gold 1500-2
Deductible $1,000 $1,500 $1,500
Coinsurance 80% 80% 80%
Out-of-Pocket Costs $7,150 $3,000 $3,600
Primary Care Physician Office Visit $30 copay N/A $20 copay
Specialist Office Visit $50 copay N/A $40 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
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
$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 Fulfillment

Benefits Gold 1500-3 Gold 2000-1 Gold 2500 HSA
Deductible $1,500 $2,000 $2,500
Coinsurance 80% 80% 100%
Out-of-Pocket Costs $3,500 $7,150 $2,500
Primary Care Physician Office Visit $30 copay $30 copay N/A
Specialist Office Visit $50 copay $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
$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 Fulfillment True Family

*Copayments apply only to in-network providers.

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