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Employers with 2 to 50 employees

2019 Platinum plans

Platinum plans provide the richest benefit offering. Because of this, employees will pay less out of pocket for medical services. The benefits below apply to each employee.

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

Platinum 250 ELITE

BenefitsPlatinum 250 ELITE
Deductible$250
Coinsurance20%
Out-of-Pocket Costs$1,000
Primary Care Physician Office Visit$35 copay
Specialist Office Visit$55 copay
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
Deductible TypeFulfillment

Platinum 500 ELITE

BenefitsPlatinum 500 ELITE
Deductible$500
Coinsurance20%
Out-of-Pocket Costs$1,000
Primary Care Physician Office Visit$35 copay
Specialist Office Visit$55 copay
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
Deductible TypeFulfillment

Platinum 750 ELITE

BenefitsPlatinum 750 ELITE
Deductible$750
Coinsurance20%
Out-of-Pocket Costs$1,500
Primary Care Physician Office Visit$35 copay
Specialist Office Visit$55 copay
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
Deductible TypeFulfillment

Platinum 1000 ELITE

BenefitsPlatinum 1000 ELITE
Deductible$1,000
Coinsurance20%
Out-of-Pocket Costs$1,500
Primary Care Physician Office Visit$35 copay
Specialist Office Visit$55 copay
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
Deductible TypeFulfillment

*Copayments apply only to in-network providers.