Platinum Plan

Our Platinum plans contain our plans with the highest premiums and are designed to include the lowest cost sharing (deductible and copays) than other plans.

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 Platinum Standard Platinum align Platinum HMO 110 Plus Platinum PPO 843
Monthly Premium        
     Single $520.36 $474.88 $508.31 $584.82
     Single + Child $884.61 $807.30 $864.12 $994.20
     2 Person $1,040.72 $949.76 $1,016.62 $1,169.64
     Family  $1,483.03 $1,353.40 $1,448.68 $1,666.73
             
Primary Care Doctor / Specialist $15 / $35 $20 / $30  (optimum)
$20/40% after deductible (flexible)
$20/$30 20% after deductible
          
Deductible (Single / Family) $0 $0 (optimum)
$1,500/$3,000 embedded (flexible)
$0  $500 / $1,000 embedded
         
Inpatient Hospital Stay $500 $500 (optimum)
40% after deductible (flexible)
$500 20% after deductible
         
Prescription Drugs        
     Tier 1/2/3 $10 / $30 / $60 $5 / $30 / 50% $5 / $30 / 50%  $10 / $30 / 50% after deductible
     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
         
  View Summary of Benefits and Coverage View Summary of Benefits and Coverage  View Summary of Benefits and Coverage View Summary of Benefits and Coverage

 

 



 

Q4 2015 Plan Information Platinum Standard Platinum HMO 110 Plus Platinum PPO 843
Monthly Premium      
     Single $516.36 $518.45 $579.96
     Single + Child $877.81 $881.36 $985.93
     2 Person $1,032.72 $1,036.90 $1,159.92
     Family  $1,471.63 $1,477.59 $1,652.89
           
Primary Care Doctor / Specialist $15 / $35 $20 / $30 20% after deductible
        
Deductible (Single / Family) $0 $0 $500 / $1,000
       
Inpatient Hospital Stay $500 $500 20% after deductible
       
Prescription Drugs      
     Tier 1/2/3 $10 / $30 / $60 $5 / $30 / 50% $10 / $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