Gold Plan

Our Gold plans have a robust level of coverage combined with a low cost sharing.

We are happy to include $250 Wellness Debit Card as an added benefit on all of our 2016 group plans. This card can be used for many products and services including: gym memberships, massage therapy and nutritional supplements.

View more details
on the Wellness Debit Card.

All premiums listed represent coverage for dependents up to age 26.

The contracts on this page are generic versions. For a detailed version, specific to your plan, please log in to your member portal.







Q3 2016 Plan Information Gold Standard Gold Aqua Gold Align
Monthly Premium      
     Single $451.78 $439.74 $402.88
     Employee and Child $768.03 $747.56 $684.89
     Employee and Spouse/Domestic Partner $903.56 $879.48 $805.76
     Family  $1,287.57 $1,253.26 $1,148.21
           
Primary Care Doctor / Specialist $25 / $40 after deductible 20% after first dollar and deductible $20 / $40 after deductible (optimum)
$20 / 40% after deductible (flexible)
        
Deductible (Single / Family) $600 / $1,200 embedded $1,000 / $2,000 embedded $1,300 / $2,600  true family
       
Inpatient Hospital Stay $1,000 after deductible 20% after first dollar $500 after deductible (optimum)
40% after deductible (flexible)
       
Prescription Drugs      
     Tier 1/2/3 $10 / $35 / $70 $15 / $50 / 50% $5 / $30 / $50 after deductible
     Generic Oral Contraceptives   Covered in full  Covered in full Covered in full
     Mail Order Drugs   2.5 copays / 90-day supply   2.5 copays / 90-day supply 2.5 copays / 90-day supply
       
  View Summary of Benefits and Coverage Summary of Benefits and Coverage Summary of Benefits and Coverage



Q3 2016 Plan Information Gold POS 7100 Gold POS 7100 EX Gold PPO 7100
Monthly Premium      
     Single $426.71 $453.78 $498.84
     Employee and Child $725.41 $771.43 $848.03
     Two Person $853.42 $907.56 $997.68
     Family  $1,216.12 $1,293.27 $1,421.69
           
Primary Care Doctor / Specialist $20 / $40 after deductible $20 / $40 after deductible
$20 / $40 after deductible
        
Deductible (Single / Family) $1,300/$2,600 true family $1,300/$2,600 true family $1,300/$2,600 true family
       
Inpatient Hospital Stay $500 after deductible $500 after deductible $500 after deductible
       
Prescription Drugs      
     Tier 1/2/3 $5 / $30 / $50 after deductible $5 / $30 / $50 after deductible $5 / $30 / $50 after deductible
     Generic Oral Contraceptives   Covered in full  Covered in full Covered in full
     Mail Order Drugs   2.5 copays / 90-day supply   2.5 copays / 90-day supply 2.5 copays / 90-day supply
       
  View Summary of Benefits and Coverage View Summary of Benefits and Coverae View Summary of Benefits and Coverage

 

 

 

Q4 2015 Plan Information Gold Standard Gold Aqua Gold POS 250 Gold POS 250EX
Monthly Premium        
     Single $482.36 $455.98 $438.03 $467.16
     Single + Child $820.02 $775.17 $744.65 $794.18
     2 Person $964.72 $911.96 $876.06 $934.32
     Family  $1,374.72 $1,299.55 $1,248.38 $1,331.41
             
Primary Care Doctor / Specialist $25 / $40 after deductible 20% after first dollar and deductible $0 pediatric PCP visits
$0 for first three adult PCP visits
$25/$40
$0 pediatric PCP visits
$0 for first three adult PCP visits
$25 / $40
          
Deductible (Single / Family) $600 / $1,200 $1,000 / $2,000 $1,500 / $3,000 $1,500 / $3,000
         
Inpatient Hospital Stay $1,000 after deductible 20% after first dollar 20% after deductible 20% after deductible 
         
Prescription Drugs        
     Tier 1/2/3 $10 / $35 / $70 $15 / $50 / 50% $5 / $30 / 50% $5 / $30 / 50%
     Generic Oral Contraceptives   Covered in full  Covered in full Covered in full  Covered in full
     Mail Order Drugs   2.5 copays / 90-day supply   2.5 copays / 90-day supply 2.5 copays / 90-day supply 2.5 copays / 90-day supply