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