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
| Benefits | Gold 1000 ELITE |
|---|
| Deductible | $1,000 |
| Coinsurance | 20% |
| 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 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 | - $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 Type | Fulfillment |
Gold 1000 VALUE
| Benefits | Gold 1000 Value |
|---|
| Deductible | $1,000 |
| Coinsurance | 30% |
| 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 Type | Fulfillment |
Gold 1500 ELITE
| Benefits | Gold 1500 ELITE |
|---|
| Deductible | $1,500 |
| Coinsurance | 20% |
| 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 Type | Fulfillment |
Gold 1500 ESSENTIAL
| Benefits | Gold 1500 ESSENTIAL |
|---|
| Deductible | $1,500 |
| Coinsurance | 20% |
| 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 Type | Fulfillment |
Gold 1500 VALUE
| Benefits | Gold 1500 Value |
|---|
| Deductible | $1,500 |
| Coinsurance | 30% |
| 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 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 | $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 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 | - $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 Type | Fulfillment |
Gold 2000 VALUE
| Benefits | Gold 2000 Value |
|---|
| Deductible | $2,000 |
| Coinsurance | 30% |
| 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 Type | Fulfillment |
Gold 2500 HSA
| Benefits | Gold 2500 HSA |
|---|
| Deductible | $2,500 |
| Coinsurance | 0% |
| Out-of-Pocket Costs | $2,500 |
| 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 |