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2020 Individual Plan Document

Healthy Premier	Healthy Preferred
Summary of Benefits	Summary of Benefits
Plan Brochure	Plan Brochure
Search for a Provider	Search for a Provider

SBC= Summary of Benefits

OOC= Plan Brochure

2020 Individual Plan Document

Preventive Care Services

Healthy Premier	Healthy Preferred
Summary of Benefits	Summary of Benefits
Plan Brochure	Plan Brochure
Search for a Provider	Search for a Provider

SBC= Summary of Benefits

OOC= Plan Brochure

2020 Individual Plan Document

Preventive Care Services

Healthy Premier	Healthy Preferred
Summary of Benefits	Summary of Benefits
Plan Brochure	Plan Brochure
Search for a Provider	Search for a Provider

SBC= Summary of Benefits

OOC= Plan Brochure

2020 Individual Plan Document

Preventive Care Services

Healthy Premier	Healthy Preferred
Summary of Benefits	Summary of Benefits
Plan Brochure	Plan Brochure
Search for a Provider	Search for a Provider

SBC= Summary of Benefits

OOC= Plan Brochure

2020 Individual Plan Document

Preventive Care Services

Healthy Premier	Healthy Preferred
Summary of Benefits	Summary of Benefits
Plan Brochure	Plan Brochure
Search for a Provider	Search for a Provider

SBC= Summary of Benefits

OOC= Plan Brochure

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Prescription Drugs

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

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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

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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

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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

Get a Quote Learn More

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

Get a Quote Learn More

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

Get a Quote Learn More

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

Get a Quote Learn More

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

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View 2018 Plans

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2019 Plan Categories and Benefits

Gold Copay

Short Summary

Gold level plan offers the lowest deductible and out of pocket expenses with first dollar copays for many benefits.

Key Benefits

Primary Care Office Visits- $25 copay/visit ded waived
Specialist Office Visits- $40 copay/visit ded waived
Urgent Care- $65 copay/visit ded waived

Deductible

$1,500/$3,000

Out-of-Pocket Maximum

$7,000/$14,000

Get a Quote Learn More

Silver Copay

Short Summary

Silver level plan offers a mid level deductible and out of pocket maximum with first dollar copays for many benefits.

Key Benefits

Primary Care Office Visits- $30 copay/visit ded waived
Specialist Office Visits- $70 copay/visit ded waived
Urgent Care- $75 copay/visit ded waived

Deductible

$4,500/$9,000

Out-of-Pocket Maximum

$7,350/$14,700

Get a Quote Learn More

Silver Copay (Off)

Short Summary

Silver level plan offers a mid level deductible and out of pocket maximum with first dollar copays for many benefits.

Key Benefits

Primary Care Office Visits- $30 copay/visit ded waived
Specialist Office Visits- $75 copay/visit ded waived
Urgent Care- $75 copay/visit ded waived

Deductible

$4,000/$8,000

Out-of-Pocket Maximum

$7,900/$15,800

Get a Quote Learn More

Bronze HSA

Short Summary

Bronze level plan offers a high deductible and out of pocket maximum, but low premium. All benefits are subject to the deductible being met first other than preventive. This plan is a qualified high deductible health plan.

Key Benefits

Primary Care Office Visits- 0% coinsurance after ded
Specialist Office Visits- 0% coinsurance after ded
Urgent Care- 0% coinsurance after ded

Deductible

$6,750/$13,500

Out-of-Pocket Maximum

$6,750/$13,500

Get a Quote Learn More

Bronze 3 Copay

Short Summary

Bronze level plan offers a high deductible and out of pocket maximum, but low premium. Many benefits are subject to the deductible being met first. This plan does have 3 office visits before meeting the deductible.

Key Benefits

Primary Care Office Visits- $45 copay/ first 3 visits then 50% after ded
Specialist Office Visits- 50% coinsurance after ded
Urgent Care- 50% coinsurance after ded

Deductible

$6,550/$13,100

Out-of-Pocket Maximum

$7,350/$14,700

Get a Quote Learn More

Expanded Bronze

Short Summary

Key Benefits

Primary Care Office Visits- $45 copay
Specialist Office Visits- $75 copay after ded
Urgent Care- 50% coinsurance after ded

Deductible

$3,000/$6,000

Out-of-Pocket Maximum

$7,900/$15,800

Get a Quote Learn More

2018 Plan Categories and Benefits

Bronze

Short Summary

Bronze level plan offers a high deductible and out of pocket maximum, but low premium. Many benefits are subject to the deductible being met first.

Key Benefits

Primary Care Office Visits- 50% coinsurance after ded
Specialist Office Visits- 50% coinsurance after ded
Urgent Care- 50% coinsurance after ded

Deductible

$6,550/$13,100

Out-of-Pocket Maximum

$7,350/$14,700

Get a Quote Learn More

Bronze HSA

Short Summary

Key Benefits

Primary Care Office Visits- 0% coinsurance after ded
Specialist Office Visits- 0% coinsurance after ded
Urgent Care- 0% coinsurance after ded

Deductible

$6,550/$13,100

Out-of-Pocket Maximum

$6,500/$13,100

Get a Quote Learn More

Bronze 3 Copay

Short Summary

Key Benefits

Primary Care Office Visits- $45 copay first three visits, then ded applies
Specialist Office Visits- 60% coinsurance after ded
Urgent Care- 60% coinsurance after ded

Deductible

$45 copay first three visits, then ded applies

Out-of-Pocket Maximum

$6,000/$12,000

Get a Quote Learn More

Silver Copay

Short Summary

ilver level plan offers a mid level deductible and out of pocket maximum with first dollar copays for many benefits.

Key Benefits

Primary Care Office Visits- $30 copay/visit ded waived
Specialist Office Visits- $75 copay/visit ded waived
Urgent Care- $75 copay/visit ded waived

Deductible

$3,500/$7,000

Out-of-Pocket Maximum

$7,150/$14,300

Get a Quote Learn More

Gold Copay

Short Summary

Gold level plan offers the lowest deductible and out of pocket expenses with first dollar copays for many benefits.

Key Benefits

Primary Care Office Visits- $25 copay/visit
Specialist Office Visits- $40 copay/visit
Urgent Care- $65 copay/visit

Deductible

$1,500/3,000

Out-of-Pocket Maximum

$7,000/$14,000

Get a Quote Learn More

Essential Member Benefits

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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Resources

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Rx Information

Silver Copay		Silver Copay (Off)		Silver Copay 73% CSR		Silver Copay 87% CSR		Silver Copay 94% CSR
Healthy Premier	Healthy Preferred	Healthy Premier	Healthy Preferred	Healthy Premier	Healthy Preferred	Healthy Premier	Healthy Preferred	Healthy Premier	Healthy Preferred
SBC	SBC	SBC	SBC	SBC	SBC	SBC	SBC	SBC	SBC
OOC	OOC	OOC	OOC	OOC	OOC	OOC	OOC	OOC	OOC
Find a Provider	Find a Provider	Find a Provider	Find a Provider	Find a Provider	Find a Provider	Find a Provider	Find a Provider	Find a Provider	Find a Provider