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2017 SIGNATURE PLANS

Consider Signature Plans if providing your employees the freedom to choose a plan with the richest benefits is important. The benefits below apply to each employee.


Benefits Platinum 500-2 Gold 1000-2 Gold 1500-3
Deductible $500 $1,000 $1,500
Coinsurance 80% 80% 80%
Out-of-Pocket Costs $1,250 $4,000 $3,500
Primary Care Physician Office Visit $30 copay $20 copay $30 copay
Specialist Office Visit $50 copay $40 copay $50 copay
Prescription Drugs $10 copay for generics
$30 copay for preferred brand-name
$50 copay for non-preferred brand-name
$50 for specialty
$10 copay for generics
$30 copay for preferred brand-name
$50 copay for non-preferred brand-name
$100 for specialty
$10 copay for generics
$30 copay for preferred brand-name
$50 copay for non-preferred brand-name
$50 for specialty
Deductible Type Fulfillment Fulfillment Fulfillment

Benefits Silver 3600 HSA Silver 2000-2
Deductible $3,600 $2,000
Coinsurance 100% 70%
Out-of-Pocket Costs $3,600 $7,150
Primary Care Physician Office Visit N/A $30
Specialist Office Visit N/A N/A
Prescription Drugs N/A $15 copay for generics
$50 copay for preferred brand-name
$75 copay for non-preferred brand-name
$150 for specialty
Deductible Type Embedded Fulfillment


These Simple Select health plans are preset bundles; no plan substitutions are allowed. All medical plans meet the requirements of the Affordable Care Act and include essential health bene ts. Minimum participation rules apply. Employer contribution must be a minimum of 50 percent of employee-only cost of lowest-cost medical plan in bundle.

*Copayments apply only to in-network providers.

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