2020 Dual option plans
Dual options provide your employees the chance to choose a plan that best fits their lifestyles and budgets.
Group Health Coverage - Dual Option plans [pdf]: Additional benefits available for individuals and families for these Small Group Plans.
Platinum 500 ELITE and Gold 1500 ESSENTIAL
| Benefits | Platinum 500 ELITE | Gold 1500 ESSENTIAL |
|---|
| Deductible | $500 | $1,500 |
| Coinsurance | 20% | 20% |
| Out-of-Pocket Costs | $1,500 | $7,000 |
| Primary Care Physician Office Visit | $5 copay | $5 copay |
| Specialist Office Visit | $55 copay | $55 copay |
| Prescription Drugs | - $5 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
| - $5 copay for generics
- $45 copay for preferred brand-name
- $75 copay for non-preferred brand-name
- copay for preferred specialty
- copay for specialty
|
| Deductible Type | Fulfillment | Fulfillment |
Gold 1000 ELITE and Silver 3000 ELITE
| Benefits | Gold 1000 ELITE | Silver 3000 ELITE |
|---|
| Deductible | $1,000 | $3,000 |
| Coinsurance | 20% | 20% |
| Out-of-Pocket Costs | $5,500 | $8,150 |
| Primary Care Physician Office Visit | $5 copay | $25 |
| Specialist Office Visit | $55 copay | $65 |
| Prescription Drugs | - $5 copay for generics
- $35 copay for preferred brand-name
- $60 copay for non-preferred brand-name
- $120 copay for preferred specialty
- $240 copay for specialty
| - $20 copay for generics
- $60 copay for preferred brand-name
- $100 copay for non-preferred brand-name
- copay for preferred specialty
- copay for specialty
|
| Deductible Type | Fulfillment | Fulfillment |
Platinum 250 ELITE and Gold 2100 HSA
| Benefits | Platinum 250 ELITE | Gold 2100 HSA |
|---|
| Deductible | $250 | $2,100 |
| Coinsurance | 20% | 0% |
| Out-of-Pocket Costs | $1,250 | $2,100 |
| Primary Care Physician Office Visit | $5 copay | N/A |
| Specialist Office Visit | $55 copay | N/A |
| Prescription Drugs | - $5 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 ELITE and Gold 2100 HSA
| Benefits | Platinum 500 ELITE | Gold 2100 HSA |
|---|
| Deductible | $500 | $2,100 |
| Coinsurance | 20% | 0% |
| Out-of-Pocket Costs | $1,500 | $2,100 |
| Primary Care Physician Office Visit | $5 copay | N/A |
| Specialist Office Visit | $55 copay | N/A |
| Prescription Drugs | - $5 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 750 ELITE and Gold 2800 HSA
| Benefits | Platinum 750 ELITE | Gold 2800 HSA |
|---|
| Deductible | $750 | $2,800 |
| Coinsurance | 20% | 0% |
| Out-of-Pocket Costs | $1,750 | $2,800 |
| Primary Care Physician Office Visit | $5 copay | N/A |
| Specialist Office Visit | $55 copay | N/A |
| Prescription Drugs | - $5 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 | $1,000 | $2,800 |
| Coinsurance | 20% | 0% |
| Out-of-Pocket Costs | $2,000 | $2,800 |
| Primary Care Physician Office Visit | $5 copay | N/A |
| Specialist Office Visit | $55 copay | N/A |
| Prescription Drugs | - $5 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 4100 HSA
| Benefits | Gold 1000 ELITE | Silver 4100 HSA |
|---|
| Deductible | $1,000 | $4,100 |
| Coinsurance | 20% | 0% |
| Out-of-Pocket Costs | $5,500 | $4,100 |
| Primary Care Physician Office Visit | $5 copay | N/A |
| Specialist Office Visit | $55 copay | N/A |
| Prescription Drugs | - $5 copay for generics
- $35 copay for preferred brand-name
- $60 copay for non-preferred brand-name
- $120 copay for preferred specialty
- $240 copay for specialty
| N/A |
| Deductible Type | Fulfillment | Embedded |
Gold 1500 ELITE and Silver 4100 HSA
| Benefits | Gold 1500 ELITE | Silver 4100 HSA |
|---|
| Deductible | $1,500 | $4,100 |
| Coinsurance | 20% | 0% |
| Out-of-Pocket Costs | $3,750 | $4,100 |
| Primary Care Physician Office Visit | $5 copay | N/A |
| Specialist Office Visit | $55 copay | N/A |
| Prescription Drugs | - $5 copay for generics
- $35 copay for preferred brand-name
- $60 copay for non-preferred brand-name
- $120 copay for preferred specialty
- $240 copay for specialty
| N/A |
| Deductible Type | Fulfillment | Embedded |
Gold 1000 ELITE and Bronze 5500 ELITE**
| Benefits | Gold 1000 ELITE | Bronze 5500 ELITE |
|---|
| Deductible | $1,000 | $5,500 |
| Coinsurance | 20% | 50% |
| Out-of-Pocket Costs | $5,500 | $8,150 |
| Primary Care Physician Office Visit | $5 copay | $25 copay |
| Specialist Office Visit | $55 copay | N/A |
| Prescription Drugs | - $5 copay for generics
- $35 copay for preferred brand-name
- $60 copay for non-preferred brand-name
- $120 copay for preferred specialty
- $240 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 Type | Fulfillment | Embedded |
Silver 2000 ELITE and Bronze 5500 ELITE**
| Benefits | Silver 2000 ELITE | Bronze 5500 ELITE |
|---|
| Deductible | $2,000 | $5,500 |
| Coinsurance | 20% | 50% |
| Out-of-Pocket Costs | $5,750 | $8,150 |
| Primary Care Physician Office Visit | $5 copay | $25 copay |
| Specialist Office Visit | $55 copay | N/A |
| Prescription Drugs | - $5 copay for generics
- $45 copay for preferred brand-name
- $75 copay for non-preferred brand-name
- $150 copay for preferred specialty
- $300 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 Type | Fulfillment | Embedded |
Gold 2000 ELITE and Bronze 6750 HSA**
| Benefits | Silver 2000 ELITE | Bronze 6750 HSA |
|---|
| Deductible | $2,000 | $6,750 |
| Coinsurance | 20% | 0% |
| Out-of-Pocket Costs | $5,750 | $6,750 |
| Primary Care Physician Office Visit | $5 copay | N/A |
| Specialist Office Visit | $55 copay | N/A |
| Prescription Drugs | - $5 copay for generics
- $45 copay for preferred brand-name
- $75 copay for non-preferred brand-name
- $150 copay for preferred specialty
- $300 copay for specialty
| N/A |
| Deductible Type | Fulfillment | Embedded |
Silver 2500 ELITE and Bronze 6750 HSA**
| Benefits | Silver 2500 ELITE | Bronze 6750 HSA |
|---|
| Deductible | $2,500 | $6,750 |
| Coinsurance | 20% | 0% |
| Out-of-Pocket Costs | $7,800 | $6,750 |
| Primary Care Physician Office Visit | N/A | N/A |
| Specialist Office Visit | N/A | N/A |
| Prescription Drugs | - $5 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