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Employers with 2 to 50 employees

2019 Dual option plans

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

Group Health Coverage - Metallics and Dual Options [pdf]: Additional benefits available for individuals and families for these Small Group Plans.

Platinum 250 ELITE and Gold 2000 HSA

BenefitsPlatinum 250 ELITEGold 2000 HSA
Deductible$250$2,000
Coinsurance20%0%
Out-of-Pocket Costs$1,000$2,000
Primary Care Physician Office Visit$35 copayN/A
Specialist Office Visit$55 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 ELITE and Gold 2000 HSA

BenefitsPlatinum 500 ELITEGold 2000 HSA
Deductible$500$2,000
Coinsurance20%0%
Out-of-Pocket Costs$1,000$2,000
Primary Care Physician Office Visit$35 copayN/A
Specialist Office Visit$55 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 750 ELITE and Gold 2700 HSA

BenefitsPlatinum 750 ELITEGold 2700 HSA
Deductible$750$2,700
Coinsurance20%0%
Out-of-Pocket Costs$1,500$2,700
Primary Care Physician Office Visit$35 copayN/A
Specialist Office Visit$55 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 2700 HSA

BenefitsPlatinum 1000 ELITEGold 2700 HSA
Deductible$1,000$2,700
Coinsurance20%0%
Out-of-Pocket Costs$1,500$2,700
Primary Care Physician Office Visit$35 copayN/A
Specialist Office Visit$55 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 4000 HSA

BenefitsGold 1000 ELITESilver 4000 HSA
Deductible$1,000$4,000
Coinsurance20%0%
Out-of-Pocket Costs$4,000$4,000
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

Gold 1500 ELITE and Silver 4000 HSA

BenefitsGold 1500 ELITESilver 4000 HSA
Deductible$1,500$4,000
Coinsurance20%0%
Out-of-Pocket Costs$3,600$4,000
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

Gold 1000 ELITE and Bronze 5000 ELITE

BenefitsGold 1000 ELITEBronze 5000 ELITE
Deductible$1,000$5,000
Coinsurance20%50%
Out-of-Pocket Costs$4,000$7,900
Primary Care Physician Office Visit$20 copay$25 copay
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
$25 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 5000 ELITE

BenefitsGold 2000 ELITEBronze 5000 ELITE
Deductible$2,000$5,000
Coinsurance20%50%
Out-of-Pocket Costs$4,250$7,900
Primary Care Physician Office Visit$20 copay$25 copay
Specialist Office Visit$40 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
$25 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 6500 HSA

BenefitsGold 2000 ELITEBronze 6500 HSA
Deductible$2,000$6,500
Coinsurance20%0%
Out-of-Pocket Costs$4,250$6,500
Primary Care Physician Office Visit$20 copayN/A
Specialist Office Visit$40 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

Silver 2500 ELITE and Bronze 6500 HSA

BenefitsSilver 2500 ELITEBronze 6500 HSA
Deductible$2,500$6,500
Coinsurance20%0%
Out-of-Pocket Costs$6,450$6,500
Primary Care Physician Office VisitN/AN/A
Specialist Office VisitN/AN/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

*Copayments apply only to in-network providers.