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Member Benefits
Member Benefits
Member Benefits
Member Benefits
Member Benefits

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

MD = Medical Deductible|AD = After Deductible|Co AD = Coinsurance After Deductible|DW = Deductible Waived

  • Trips to the emergency room
  • Treatment in the hospital for inpatient care
  • Outpatient Care - care without being admitted to a hospital
  • Care before and after your baby is born
  • Mental health and substance use disorder services: behavioral health treatment, counseling, and psychotherapy
  • Your prescription drugs
  • Services and devices to help recover if you are injured, or have a disability or chronic condition: physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more.
  • Your lab tests
  • Preventative services: counseling, screening, vaccines, chronic disease - no charge
  • Pediatric services
  • Call a nurse at anytime if you have any health concerns or general information questions
  • Instant care online available 7 days a week

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