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2020 Plan Categories and Benefits
Gold Copay
Key Benefits:
- Primary Care Office Visits-
$25 copay/visit DW - Specialist Office Visits-
$40 copay/visit DW - Urgent Care-
$25 copay/visit DW
Annual Deductible:
$1,500/$3,000
Prescription Drug Deductible:
$500/$1,000
Out-of-Pocket Maximum:
$7,000/$14,000
Silver Copay
Key Benefits:
- Primary Care Office Visits-
$30 copay/visit DW - Specialist Office Visits-
$70 copay/visit DW - Urgent Care-
$30 copay/visit DW
Annual Deductible:
$3,500/$7,000
Prescription Drug Deductible:
$2,000/$4,000
Out-of-Pocket Maximum:
$8,000/$16,000
Silver Copay (Off)
Key Benefits:
- Primary Care Office Visits-
$30 copay/visit DW - Specialist Office Visits-
$75 copay/visit DW - Urgent Care-
$30 copay/visit DW
Deductible:
$4,500/$9,000
Prescription Drug Deductible:
Included with MD
Out-of-Pocket Maximum:
$8,150/$16,300
Bronze 3 Copay
Key Benefits:
- Primary Care Office Visits-
$45 copay/ first 3 visits then 40% AD - Specialist Office Visits-
40% coinsurance AD - Urgent Care-
$45 /copay first 3 visits then 40% coinsurance AD
Deductible:
$6,550/$13,100
Prescription Drug Deductible:
Included with MD
Out-of-Pocket Maximum:
$8,150/$16,300
Bronze HSA
Key Benefits:
- Primary Care Office Visits-
0% coinsurance AD - Specialist Office Visits-
0% coinsurance AD - Urgent Care-
0% coinsurance AD
Deductible:
$6,900/$13,800
Prescription Drug Deductible:
Included with MD
Out-of-Pocket Maximum:
$6,900/$13,800
Expanded Bronze HSA
Key Benefits:
- Primary Care Office Visits- $25 copay AD
- Specialist Office Visits- $40 copay AD
- Urgent Care- $25 copay AD
Deductible:
$4,000/$8,000
Prescription Drug Deductible:
Included with MD
Out-of-Pocket Maximum:
$6,900/$13,800
Expanded Bronze
Key Benefits:
- Primary Care Office Visits-
$45 copay/visit DW - Specialist Office Visits-
$75 copay AD - Urgent Care-
$45 copay/visit DW
Deductible:
$3,500/$6,000
Prescription Drug Deductible:
$1,650/$3,300
Out-of-Pocket Maximum:
$8,150/$16,300