Employers with 2 to 50 employees
2018 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 - Metallics and Dual Option [pdf]: Additional benefits available for individuals and families for these Small Group Plans.
Gold 500-1
| Benefits | Gold 500-1 |
|---|---|
| Deductible | $500 |
| Coinsurance | 80% |
| Out-of-Pocket Costs | $5,500 |
| Primary Care Physician Office Visit | $35 copay |
| Specialist Office Visit | $55 copay |
| Prescription Drugs | $10 copay for generics
$40 copay for preferred brand-name $60 copay for non-preferred brand-name $120 copay for preferred specialty $240 copay for specialty |
| Deductible Type | Fulfillment |
Gold 1000-1
| Benefits | Gold 1000-1 |
|---|---|
| Deductible | $1,000 |
| Coinsurance | 80% |
| Out-of-Pocket Costs | $3,500 |
| Primary Care Physician Office Visit | $35 copay |
| Specialist Office Visit | $55 copay |
| Prescription Drugs | $10 copay for generics
$40 copay for preferred brand-name $60 copay for non-preferred brand-name $120 copay for preferred specialty $240 copay for specialty |
| Deductible Type | Fulfillment |
Gold 1000-2
| Benefits | Gold 1000-2 |
|---|---|
| Deductible | $1,000 |
| Coinsurance | 80% |
| Out-of-Pocket Costs | $5,000 |
| Primary Care Physician Office Visit | $35 copay |
| Specialist Office Visit | $55 copay |
| Prescription Drugs | $10 copay for generics
$50 copay for preferred brand-name $75 copay for non-preferred brand-name $150 copay for preferred specialty $300 copay for specialty |
| Deductible Type | Fulfillment |
Gold 1500-1
| Benefits | Gold 1500-1 |
|---|---|
| Deductible | $1,500 |
| Coinsurance | 80% |
| Out-of-Pocket Costs | $3,000 |
| Primary Care Physician Office Visit | $35 copay |
| Specialist Office Visit | $55 copay |
| Prescription Drugs | $10 copay for generics
$40 copay for preferred brand-name $60 copay for non-preferred brand-name $120 copay for preferred specialty $240 copay for specialty |
| Deductible Type | Fulfillment |
Gold 1500-3
| Benefits | Gold 1500-3 |
|---|---|
| Deductible | $1,500 |
| Coinsurance | 80% |
| Out-of-Pocket Costs | $5,000 |
| Primary Care Physician Office Visit | $35 copay |
| Specialist Office Visit | $55 copay |
| Prescription Drugs | $10 copay for generics
$50 copay for preferred brand-name $75 copay for non-preferred brand-name $150 copay for preferred specialty $300 copay for specialty |
| Deductible Type | Fulfillment |
Gold 2000 HSA
| Benefits | Gold 2000 HSA |
|---|---|
| Deductible | $2,000 |
| Coinsurance | 100% |
| Out-of-Pocket Costs | $2,000 |
| Primary Care Physician Office Visit | N/A |
| Specialist Office Visit | N/A |
| Prescription Drugs | N/A |
| Deductible Type | True Family |
Gold 2000-1
| Benefits | Gold 2000-1 |
|---|---|
| Deductible | $2,000 |
| Coinsurance | 80% |
| Out-of-Pocket Costs | $4,250 |
| Primary Care Physician Office Visit | $35 copay |
| Specialist Office Visit | $55 copay |
| Prescription Drugs | $10 copay for generics
$50 copay for preferred brand-name $75 copay for non-preferred brand-name $150 copay for preferred specialty $300 copay for specialty |
| Deductible Type | Fulfillment |
*Copayments apply only to in-network providers.