2020 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 – Metallic Plans[pdf]: Additional benefits available for individuals and families for these Small Group Plans.
Group Health Coverage - Dual Option Plans [pdf]: Additional benefits available for individuals and families for these Small Group Plans.
Gold 1000 ELITE
| Benefits | Gold 1000 ELITE |
|---|
| Deductible | $1,000 |
| Coinsurance | 20% |
| Out-of-Pocket Costs | $5,000 |
| Primary Care Physician Office Visit | $20 copay |
| Specialist Office Visit | $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
|
| Deductible Type | Fulfillment |
Gold 1000 ESSENTIAL
| Benefits | Gold 1000 ESSENTIAL |
|---|
| Deductible | $1,000 |
| Coinsurance | 20% |
| Out-of-Pocket Costs | $7,000 |
| Primary Care Physician Office Visit | $30 copay |
| Specialist Office Visit | $50 copay |
| Prescription Drugs | - $10 copay for generics
- $40 copay for preferred brand-name
- $70 copay for non-preferred brand-name
- $140 copay for preferred specialty
- $280 copay for specialty
|
| Deductible Type | Fulfillment |
Gold 1000 Value
| Benefits | Gold 1000 Value |
|---|
| Deductible | $1,000 |
| Coinsurance | 20% |
| Out-of-Pocket Costs | $8,150 |
| Primary Care Physician Office Visit | $30 copay |
| Specialist Office Visit | $60 copay |
| Prescription Drugs | - $20 copay for generics
- $60 copay for preferred brand-name
- $150 copay for non-preferred brand-name
- $300 copay for preferred specialty
- $600 copay for specialty
|
| Deductible Type | Fulfillment |
Gold 1500 ELITE
| Benefits | Gold 1500 ELITE |
|---|
| Deductible | $1,500 |
| Coinsurance | 20% |
| Out-of-Pocket Costs | $4,000 |
| Primary Care Physician Office Visit | $20 copay |
| Specialist Office Visit | $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
|
| Deductible Type | Fulfillment |
Gold 1500 ESSENTIAL
| Benefits | Gold 1500 ESSENTIAL |
|---|
| Deductible | $1,500 |
| Coinsurance | 20% |
| Out-of-Pocket Costs | $4,500 |
| Primary Care Physician Office Visit | $30 copay |
| Specialist Office Visit | $50 copay |
| Prescription Drugs | - $10 copay for generics
- $40 copay for preferred brand-name
- $70 copay for non-preferred brand-name
- $140 copay for preferred specialty
- $280 copay for specialty
|
| Deductible Type | Fulfillment |
Gold 2000 ELITE
| Benefits | Gold 2000 ELITE |
|---|
| Deductible | $2,000 |
| Coinsurance | 20% |
| Out-of-Pocket Costs | $6,500 |
| Primary Care Physician Office Visit | $20 copay |
| Specialist Office Visit | $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
|
| Deductible Type | Fulfillment |
Gold 2000 ESSENTIAL
| Benefits | Gold 2000 ESSENTIAL |
|---|
| Deductible | $2,000 |
| Coinsurance | 20% |
| Out-of-Pocket Costs | $7,750 |
| Primary Care Physician Office Visit | $30 copay |
| Specialist Office Visit | $50 copay |
| Prescription Drugs | - $10 copay for generics
- $40 copay for preferred brand-name
- $70 copay for non-preferred brand-name
- $140 copay for preferred specialty
- $280 copay for specialty
|
| Deductible Type | Fulfillment |
Gold 2100 HSA
| Benefits | Gold 2100 HSA |
|---|
| Deductible | $2,100 |
| Coinsurance | 0% |
| Out-of-Pocket Costs | $2,100 |
| Primary Care Physician Office Visit | N/A |
| Specialist Office Visit | N/A |
| Prescription Drugs | N/A |
| Deductible Type | True Family |
Gold 2800 HSA
| Benefits | Gold 2800 HSA |
|---|
| Deductible | $2,800 |
| Coinsurance | 0% |
| Out-of-Pocket Costs | $2,800 |
| Primary Care Physician Office Visit | N/A |
| Specialist Office Visit | N/A |
| Prescription Drugs | N/A |
| Deductible Type | Embedded |