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Employers with 2 to 50 employees

2018 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 Option [pdf]: Additional benefits available for individuals and families for these Small Group Plans.

Platinum 250-1

BenefitsPlatinum 250-1
Deductible$250
Coinsurance80%
Out-of-Pocket Costs$1,000
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 TypeFulfillment

Platinum 500-1

BenefitsPlatinum 500-1
Deductible$500
Coinsurance80%
Out-of-Pocket Costs$1,000
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 TypeFulfillment

Platinum 750-1

BenefitsPlatinum 750-1
Deductible$750
Coinsurance80%
Out-of-Pocket Costs$1,000
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 TypeFulfillment

Platinum 1000-1

BenefitsPlatinum 1000-1
Deductible$1,000
Coinsurance80%
Out-of-Pocket Costs$1,250
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 TypeFulfillment

*Copayments apply only to in-network providers.