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Employers

2021 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

BenefitsGold 1000 ELITE
Deductible$1,000
Coinsurance20%
Out-of-Pocket Costs$6,500
Primary Care Physician Office Visit$25 copay
Specialist Office Visit$50 copay
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
Deductible TypeFulfillment

Gold 1000 ESSENTIAL

BenefitsGold 1000 ESSENTIAL
Deductible$1,000
Coinsurance20%
Out-of-Pocket Costs$7,000
Primary Care Physician Office Visit$30 copay
Specialist Office Visit$50 copay
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
Deductible TypeFulfillment

Gold 1000 VALUE

BenefitsGold 1000 Value
Deductible$1,000
Coinsurance30%
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
  • N/A copay for preferred specialty
  • N/A copay for specialty
Deductible TypeFulfillment

Gold 1500 ELITE

BenefitsGold 1500 ELITE
Deductible$1,500
Coinsurance20%
Out-of-Pocket Costs$4,900
Primary Care Physician Office Visit$25 copay
Specialist Office Visit$50 copay
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
Deductible TypeFulfillment

Gold 1500 ESSENTIAL

BenefitsGold 1500 ESSENTIAL
Deductible$1,500
Coinsurance20%
Out-of-Pocket Costs$5,400
Primary Care Physician Office Visit$30 copay
Specialist Office Visit$50 copay
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
Deductible TypeFulfillment

Gold 1500 VALUE

BenefitsGold 1500 Value
Deductible$1,500
Coinsurance30%
Out-of-Pocket Costs$8,500
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
  • N/A copay for preferred specialty
  • N/A copay for specialty
Deductible TypeFulfillment

Gold 2000 ELITE

BenefitsGold 2000 Elite
Deductible$2,000
Coinsurance20%
Out-of-Pocket Costs$6,500
Primary Care Physician Office Visit$25 copay
Specialist Office Visit$50 copay
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
Deductible TypeFulfillment

Gold 2000 ESSENTIAL

BenefitsGold 2000 ESSENTIAL
Deductible$2,000
Coinsurance20%
Out-of-Pocket Costs$7,750
Primary Care Physician Office Visit$30 copay
Specialist Office Visit$50 copay
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
Deductible TypeFulfillment

Gold 2000 VALUE

BenefitsGold 2000 Value
Deductible$2,000
Coinsurance30%
Out-of-Pocket Costs$7,400
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
  • N/A copay for preferred specialty
  • N/A copay for specialty
Deductible TypeFulfillment

Gold 2500 HSA

BenefitsGold 2500 HSA
Deductible$2,500
Coinsurance0%
Out-of-Pocket Costs$2,500
Primary Care Physician Office VisitN/A
Specialist Office VisitN/A
Prescription DrugsN/A
Deductible TypeTrue Family

Gold 2800 HSA

BenefitsGold 2800 HSA
Deductible$2,800
Coinsurance0%
Out-of-Pocket Costs$2,800
Primary Care Physician Office VisitN/A
Specialist Office VisitN/A
Prescription DrugsN/A
Deductible TypeEmbedded