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Employers

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

Benefits	Platinum 500 ESSENTIAL	Gold 2500 HSA
Deductible	$500	$2,500
Coinsurance	20%	0%
Out-of-Pocket Costs	$2,000	$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

Platinum 500 ESSENTIAL and Gold 2800 HSA

Benefits	Platinum 500 ESSENTIAL	Gold 2800 HSA
Deductible	$500	$2,800
Coinsurance	20%	0%
Out-of-Pocket Costs	$2,000	$2,800
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

Platinum 1000 ELITE and Gold 2800 HSA

Benefits	Platinum 1000 ELITE	Gold 2800 HSA
Deductible	$1000	$2,800
Coinsurance	20%	0%
Out-of-Pocket Costs	$2,350	$2,800
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

Gold 1000 ELITE and Silver 4500 HSA

Benefits	Gold 1000 ELITE	Silver 4500 HSA
Deductible	$1,000	$4,500
Coinsurance	20%	0%
Out-of-Pocket Costs	$6,500	$4,500
Primary Care Physician Office Visit	$25 copay	N/A
Specialist Office Visit	$50 copay	N/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 Type	Fulfillment	Embedded

Gold 1500 ELITE and Silver 4500 HSA

Benefits	Gold 1500 ELITE	Silver 4500 HSA
Deductible	$1,500	$4,500
Coinsurance	20%	0%
Out-of-Pocket Costs	$4,900	$4,500
Primary Care Physician Office Visit	$25 copay	N/A
Specialist Office Visit	$50 copay	N/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 Type	Fulfillment	Embedded

Gold 1000 ELITE and Bronze 6250 ELITE**

Benefits	Gold 1000 ELITE	Bronze 6250 ELITE
Deductible	$1,000	$6,250
Coinsurance	20%	50%
Out-of-Pocket Costs	$6,500	$8,500
Primary Care Physician Office Visit	$25 copay	$30 copay
Specialist Office Visit	$50 copay	N/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 Type	Fulfillment	Embedded

Gold 2000 ELITE and Bronze 6250 ELITE**

Benefits	Gold 1000 ELITE	Bronze 6250 ELITE
Deductible	$2,000	$6,250
Coinsurance	20%	50%
Out-of-Pocket Costs	$6,500	$8,500
Primary Care Physician Office Visit	$25 copay	$30 copay
Specialist Office Visit	$50 copay	N/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 Type	Fulfillment	Embedded

Gold 2000 ELITE and Bronze 6850 HSA**

Benefits	Gold 2000 ELITE	Bronze 6850 HSA
Deductible	$2,000	$6,850
Coinsurance	20%	0%
Out-of-Pocket Costs	$6,500	$6,850
Primary Care Physician Office Visit	$25	N/A
Specialist Office Visit	$50	N/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 Type	Fulfillment	Embedded

Gold 1000 ESSENTIAL and Silver 2000 ESSENTIAL

Benefits	Gold 1000 ESSENTIAL	Silver 2000 ESSENTIAL
Deductible	$1,000	$2,000
Coinsurance	20%	30%
Out-of-Pocket Costs	$7,000	$8,500
Primary Care Physician Office Visit	$30 copay	$45
Specialist Office Visit	$50 copay	N/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 Type	Fulfillment	Fulfillment

Gold 1000 ESSENTIAL and Silver 3000 ELITE

Benefits	Gold 1000 ESSENTIAL	Silver 3000 ELITE
Deductible	$1,000	$3,000
Coinsurance	20%	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 Type	Fulfillment	Fulfillment

Gold 1000 ESSENTIAL and Silver 4000 ELITE

Benefits	Gold 1000 ESSENTIAL	Silver 4000 ELITE
Deductible	$1,000	$4,000
Coinsurance	20%	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 Type	Fulfillment	Fulfillment

Gold 1500 ESSENTIAL and Silver 3000 ELITE

Benefits	Gold 1500 ESSENTIAL	Silver 3000 ELITE
Deductible	$1,500	$3,000
Coinsurance	20%	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 Type	Fulfillment	Fulfillment

Gold 2000 ESSENTIAL and Silver 4000 ELITE

Benefits	Gold 2000 ESSENTIAL	Silver 4000 ELITE
Deductible	$2,000	$4,000
Coinsurance	20%	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 Type	Fulfillment	Fulfillment

Gold 1000 ESSENTIAL and Gold 2800 HSA

Benefits	Gold 1000 ESSENTIAL	Gold 2800 HSA
Deductible	$1,000	$2,800
Coinsurance	20%	0%
Out-of-Pocket Costs	$7,000	$2,800
Primary Care Physician Office Visit	$30 copay	N/A
Specialist Office Visit	$50 copay	N/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 Type	Fulfillment	Embedded

Gold 2000 ESSENTIAL and Gold 2800 HSA

Benefits	Gold 2000 ESSENTIAL	Gold 2800 HSA
Deductible	$2,000	$2,800
Coinsurance	20%	0%
Out-of-Pocket Costs	$7,750	$2,800
Primary Care Physician Office Visit	$30 copay	N/A
Specialist Office Visit	$50 copay	N/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 Type	Fulfillment	Embedded

Gold 2000 ESSENTIAL and Silver 8500 HRA

Benefits	Gold 2000 ESSENTIAL	Silver 8500 HRA
Deductible	$2,000	$8,500
Coinsurance	20%	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 Type	Fulfillment	Fulfillment

Silver 3000 ELITE and Silver 4500 HSA

Benefits	SILVER 3000 ELITE	Silver 4500 HSA
Deductible	$3,000	$4,500
Coinsurance	20%	0%
Out-of-Pocket Costs	$8,500	$4,500
Primary Care Physician Office Visit	$35 copay	N/A
Specialist Office Visit	$70 copay	N/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 Type	Fulfillment	Embedded

Silver 2000 ELITE and Silver 8500 HRA

Benefits	SILVER 2000 ELITE	Silver 8500 HRA
Deductible	$2,000	$8,500
Coinsurance	20%	0%
Out-of-Pocket Costs	$8,500	$8,500
Primary Care Physician Office Visit	$35 copay	$40 copay
Specialist Office Visit	N/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 Type	Fulfillment	Fulfillment

Silver 3000 ELITE and Silver 8500 HRA

Benefits	SILVER 3000 ELITE	Silver 8500 HRA
Deductible	$3,000	$8,500
Coinsurance	20%	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 Type	Fulfillment	Fulfillment

Silver 3000 ELITE and Bronze 6850 HSA**

Benefits	SILVER 3000 ELITE	Bronze 6850 HSA
Deductible	$3,000	$6,850
Coinsurance	20%	0%
Out-of-Pocket Costs	$8,500	$6,850
Primary Care Physician Office Visit	$35 copay	N/A
Specialist Office Visit	$70 copay	N/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 Type	Fulfillment	Embedded

**Expanded Bronze

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