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2021 Dual option plans

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

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.

Platinum 500 ESSENTIAL and Gold 2500 HSA

BenefitsPlatinum 500 ESSENTIALGold 2500 HSA
Deductible$500$2,500
Coinsurance20%0%
Out-of-Pocket Costs$2,000$2,500
Primary Care Physician Office Visit$20 copayN/A
Specialist Office Visit$40 copayN/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 TypeFulfillmentTrue Family

Platinum 500 ESSENTIAL and Gold 2800 HSA

BenefitsPlatinum 500 ESSENTIALGold 2800 HSA
Deductible$500$2,800
Coinsurance20%0%
Out-of-Pocket Costs$2,000$2,800
Primary Care Physician Office Visit$20 copayN/A
Specialist Office Visit$40 copayN/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 TypeFulfillmentEmbedded

Platinum 1000 ELITE and Gold 2800 HSA

BenefitsPlatinum 1000 ELITEGold 2800 HSA
Deductible$1000$2,800
Coinsurance20%0%
Out-of-Pocket Costs$2,350$2,800
Primary Care Physician Office Visit$30 copayN/A
Specialist Office Visit$50 copayN/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 TypeFulfillmentEmbedded

Gold 1000 ELITE and Silver 4500 HSA

BenefitsGold 1000 ELITESilver 4500 HSA
Deductible$1,000$4,500
Coinsurance20%0%
Out-of-Pocket Costs$6,500$4,500
Primary Care Physician Office Visit$25 copayN/A
Specialist Office Visit$50 copayN/A
Prescription Drugs
  • $15copay for generics
  • $35copay for preferred brand-name
  • $65 copay for non-preferred brand-name
  • $130 copay for preferred specialty
  • $260 copay for specialty
N/A
Deductible TypeFulfillmentEmbedded

Gold 1500 ELITE and Silver 4500 HSA

BenefitsGold 1500 ELITESilver 4500 HSA
Deductible$1,500$4,500
Coinsurance20%0%
Out-of-Pocket Costs$4,900$4,500
Primary Care Physician Office Visit$25 copayN/A
Specialist Office Visit$50 copayN/A
Prescription Drugs
  • $15 copay for generics
  • $35 copay for preferred brand-name
  • $65 copay for non-preferred brand-name
  • $130 copay for preferred specialty
  • $260 copay for specialty
N/A
Deductible TypeFulfillmentEmbedded

Gold 1000 ELITE and Bronze 6250 ELITE**

BenefitsGold 1000 ELITEBronze 6250 ELITE
Deductible$1,000$6,250
Coinsurance20%50%
Out-of-Pocket Costs$6,500$8,500
Primary Care Physician Office Visit$25 copay$30 copay
Specialist Office Visit$50 copayN/A
Prescription Drugs
  • $15 copay for generics
  • $35 copay for preferred brand-name
  • $65 copay for non-preferred brand-name
  • $130 copay for preferred specialty
  • $260 copay for specialty
  • $30 copay for generics
  • N/A copay for preferred brand-name
  • N/A copay for non-preferred brand-name
  • N/A copay for preferred specialty
  • N/A copay for specialty
Deductible TypeFulfillmentEmbedded

Gold 2000 ELITE and Bronze 6250 ELITE**

BenefitsGold 1000 ELITEBronze 6250 ELITE
Deductible$2,000$6,250
Coinsurance20%50%
Out-of-Pocket Costs$6,500$8,500
Primary Care Physician Office Visit$25 copay$30 copay
Specialist Office Visit$50 copayN/A
Prescription Drugs
  • $15 copay for generics
  • $35 copay for preferred brand-name
  • $65 copay for non-preferred brand-name
  • $130 copay for preferred specialty
  • $260 copay for specialty
  • $30 copay for generics
  • N/A copay for preferred brand-name
  • N/A copay for non-preferred brand-name
  • N/A copay for preferred specialty
  • N/A copay for specialty
Deductible TypeFulfillmentEmbedded

Gold 2000 ELITE and Bronze 6850 HSA**

BenefitsGold 2000 ELITEBronze 6850 HSA
Deductible$2,000$6,850
Coinsurance20%0%
Out-of-Pocket Costs$6,500$6,850
Primary Care Physician Office Visit$25N/A
Specialist Office Visit$50N/A
Prescription Drugs
  • $15 copay for generics
  • $35 copay for preferred brand-name
  • $65 copay for non-preferred brand-name
  • $130 copay for preferred specialty
  • $260 copay for specialty
N/A
Deductible TypeFulfillmentEmbedded

Gold 1000 ESSENTIAL and Silver 2000 ESSENTIAL

BenefitsGold 1000 ESSENTIALSilver 2000 ESSENTIAL
Deductible$1,000$2,000
Coinsurance20%30%
Out-of-Pocket Costs$7,000$8,500
Primary Care Physician Office Visit$30 copay$45
Specialist Office Visit$50 copayN/A
Prescription Drugs
  • $15 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
  • $25 copay for generics
  • $60 copay for preferred brand-name
  • $100 copay for non-preferred brand-name
  • $200 copay for preferred specialty
  • $400 copay for specialty
Deductible TypeFulfillmentFulfillment

Gold 1000 ESSENTIAL and Silver 3000 ELITE

BenefitsGold 1000 ESSENTIALSilver 3000 ELITE
Deductible$1,000$3,000
Coinsurance20%20%
Out-of-Pocket Costs$7,000$8,500
Primary Care Physician Office Visit$30 copay$35
Specialist Office Visit$50 copay$70
Prescription Drugs
  • $15 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
  • $25 copay for generics
  • $60 copay for preferred brand-name
  • $100 copay for non-preferred brand-name
  • $200 copay for preferred specialty
  • $400 copay for specialty
Deductible TypeFulfillmentFulfillment

Gold 1000 ESSENTIAL and Silver 4000 ELITE

BenefitsGold 1000 ESSENTIALSilver 4000 ELITE
Deductible$1,000$4,000
Coinsurance20%30%
Out-of-Pocket Costs$7,000$8,500
Primary Care Physician Office Visit$30 copay$45
Specialist Office Visit$50 copay$60
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
  • $20 copay for generics
  • $60 copay for preferred brand-name
  • $100 copay for non-preferred brand-name
  • $200 copay for preferred specialty
  • $400 copay for specialty
Deductible TypeFulfillmentFulfillment

Gold 1500 ESSENTIAL and Silver 3000 ELITE

BenefitsGold 1500 ESSENTIALSilver 3000 ELITE
Deductible$1,500$3,000
Coinsurance20%20%
Out-of-Pocket Costs$5,400$8,500
Primary Care Physician Office Visit$30 copay$35
Specialist Office Visit$50 copay$70
Prescription Drugs
  • $15 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
  • $25 copay for generics
  • $60 copay for preferred brand-name
  • $100 copay for non-preferred brand-name
  • $200 copay for preferred specialty
  • $400 copay for specialty
Deductible TypeFulfillmentFulfillment

Gold 2000 ESSENTIAL and Silver 4000 ELITE

BenefitsGold 2000 ESSENTIALSilver 4000 ELITE
Deductible$2,000$4,000
Coinsurance20%30%
Out-of-Pocket Costs$7,750$8,500
Primary Care Physician Office Visit$30 copay$45
Specialist Office Visit$50 copay$60
Prescription Drugs
  • $15 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
  • $25 copay for generics
  • $60 copay for preferred brand-name
  • $100 copay for non-preferred brand-name
  • $200 copay for preferred specialty
  • $400 copay for specialty
Deductible TypeFulfillmentFulfillment

Gold 1000 ESSENTIAL and Gold 2800 HSA

BenefitsGold 1000 ESSENTIALGold 2800 HSA
Deductible$1,000$2,800
Coinsurance20%0%
Out-of-Pocket Costs$7,000$2,800
Primary Care Physician Office Visit$30 copayN/A
Specialist Office Visit$50 copayN/A
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
N/A
Deductible TypeFulfillmentEmbedded

Gold 2000 ESSENTIAL and Gold 2800 HSA

BenefitsGold 2000 ESSENTIALGold 2800 HSA
Deductible$2,000$2,800
Coinsurance20%0%
Out-of-Pocket Costs$7,750$2,800
Primary Care Physician Office Visit$30 copayN/A
Specialist Office Visit$50 copayN/A
Prescription Drugs
  • $15 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
N/A
Deductible TypeFulfillmentEmbedded

Gold 2000 ESSENTIAL and Silver 8500 HRA

BenefitsGold 2000 ESSENTIALSilver 8500 HRA
Deductible$2,000$8,500
Coinsurance20%0%
Out-of-Pocket Costs$7,750$8,500
Primary Care Physician Office Visit$30 copay$40
Specialist Office Visit$50 copay$80
Prescription Drugs
  • $15 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
  • $25 copay for generics
  • $60 copay for preferred brand-name
  • $100 copay for non-preferred brand-name
  • $200 copay for preferred specialty
  • $400 copay for specialty
Deductible TypeFulfillmentFulfillment

Silver 3000 ELITE and Silver 4500 HSA

BenefitsSILVER 3000 ELITESilver 4500 HSA
Deductible$3,000$4,500
Coinsurance20%0%
Out-of-Pocket Costs$8,500$4,500
Primary Care Physician Office Visit$35 copayN/A
Specialist Office Visit$70 copayN/A
Prescription Drugs
  • $25 copay for generics
  • $60 copay for preferred brand-name
  • $100 copay for non-preferred brand-name
  • $200 copay for preferred specialty
  • $400 copay for specialty
N/A
Deductible TypeFulfillmentEmbedded

Silver 2000 ELITE and Silver 8500 HRA

BenefitsSILVER 2000 ELITESilver 8500 HRA
Deductible$2,000$8,500
Coinsurance20%0%
Out-of-Pocket Costs$8,500$8,500
Primary Care Physician Office Visit$35 copay$40 copay
Specialist Office VisitN/A$80 copay
Prescription Drugs
  • $25 copay for generics
  • $60 copay for preferred brand-name
  • $100 copay for non-preferred brand-name
  • $200 copay for preferred specialty
  • $400 copay for specialty
  • $25 copay for generics
  • $60 copay for preferred brand-name
  • $100 copay for non-preferred brand-name
  • $200 copay for preferred specialty
  • $400 copay for specialty
Deductible TypeFulfillmentFulfillment

Silver 3000 ELITE and Silver 8500 HRA

BenefitsSILVER 3000 ELITESilver 8500 HRA
Deductible$3,000$8,500
Coinsurance20%0%
Out-of-Pocket Costs$8,500$8,500
Primary Care Physician Office Visit$35 copay$40 copay
Specialist Office Visit$70 copay$80 copay
Prescription Drugs
  • $25 copay for generics
  • $60 copay for preferred brand-name
  • $100 copay for non-preferred brand-name
  • $200 copay for preferred specialty
  • $400 copay for specialty
  • $25 copay for generics
  • $60 copay for preferred brand-name
  • $100 copay for non-preferred brand-name
  • $200 copay for preferred specialty
  • $400 copay for specialty
Deductible TypeFulfillmentFulfillment

Silver 3000 ELITE and Bronze 6850 HSA**

BenefitsSILVER 3000 ELITEBronze 6850 HSA
Deductible$3,000$6,850
Coinsurance20%0%
Out-of-Pocket Costs$8,500$6,850
Primary Care Physician Office Visit$35 copayN/A
Specialist Office Visit$70 copayN/A
Prescription Drugs
  • $25 copay for generics
  • $60 copay for preferred brand-name
  • $100 copay for non-preferred brand-name
  • $200 copay for preferred specialty
  • $400 copay for specialty
N/A
Deductible TypeFulfillmentEmbedded

**Expanded Bronze