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Health Plans for Employers

Number of employees:
Plan availability varies by location. Please enter your ZIP code to see plans available in your area.

If members receive services from out-of-network providers, their deductible and out-of-pocket limit will be higher than the amounts listed in the chart below.

Platinum 500‡‡
Office Visits

Primary care
No deductible, $10

Urgent care
No deductible, $10

Specialist
No deductible, $20

Tier 1 prescription
Drug coverage No deductible, $5

In-network Costs 

Deductible
Individual $500
Family $1,000

Out-of-pocket max
Individual $3,000
Family $6,000

Preventive services
No deductible, covered in full

Plan Downloads (PDFs)

More details for this plan on the following networks

Gold 1000‡‡
Office Visits

Primary care
No deductible, $30

Urgent care
No deductible, $30

Specialist
No deductible, $60

Tier 1 prescription
Drug coverage No deductible, $15

In-network Costs 

Deductible
Individual $1,000
Family $2,000

Out-of-pocket max
Individual $6,000
Family $12,000

Preventive services
No deductible, covered in full

Plan Downloads (PDFs)

More details for this plan on the following networks

Gold 2000‡‡
Office Visits

Primary care
No deductible, $25

Urgent care
No deductible, $25

Specialist
No deductible, $60

Tier 1 prescription
Drug coverage No deductible, $10

In-network Costs 

Deductible
Individual $2,000
Family $4,000

Out-of-pocket max
Individual $5,500
Family $11,000

Preventive services
No deductible, covered in full

Plan Downloads (PDFs)

More details for this plan on the following networks

Gold 2500‡‡
Office Visits

Primary care
No deductible, $25

Urgent care
No deductible, $25

Specialist
No deductible, $60

Tier 1 prescription
Drug coverage No deductible, $10

In-network Costs 

Deductible
Individual $2,500
Family $5,000

Out-of-pocket max
Individual $5,500
Family $11,000

Preventive services
No deductible, covered in full

Plan Downloads (PDFs)

More details for this plan on the following networks

Gold 3500‡‡
Office Visits

Primary care
No deductible, $25

Urgent care
No deductible, $25

Specialist
No deductible, $60

Tier 1 prescription
Drug coverage No deductible, $10

In-network Costs 

Deductible
Individual $3,500
Family $7,000

Out-of-pocket max
Individual $5,500
Family $11,000

Preventive services
No deductible, covered in full

Plan Downloads (PDFs)

More details for this plan on the following networks

Silver 3000
Office Visits

Primary care
No deductible, $35

Urgent care
No deductible, $35

Specialist
After deductible, 40%

Tier 1 prescription
Drug coverage No deductible, $15

In-network Costs 

Deductible
Individual $3,000
Family $6,000

Out-of-pocket max
Individual $8,150
Family $16,300

Preventive services
No deductible, covered in full

Plan Downloads (PDFs)

More details for this plan on the following networks

Silver 4500‡‡
Office Visits

Primary care
No deductible, $30

Urgent care
No deductible, $30

Specialist
No deductible, $60

Tier 1 prescription
Drug coverage No deductible, $15

In-network Costs 

Deductible
Individual $4,500
Family $9,000

Out-of-pocket max
Individual $8,500
Family $17,000

Preventive services
No deductible, covered in full

Plan Downloads (PDFs)

More details for this plan on the following networks

Silver 5500‡‡
Office Visits

Primary care
No deductible, $30

Urgent care
No deductible, $30

Specialist
No deductible, $60

Tier 1 prescription
Drug coverage No deductible, $15

In-network Costs 

Deductible
Individual $5,500
Family $11,000

Out-of-pocket max
Individual $8,000
Family $16,000

Preventive services
No deductible, covered in full

Plan Downloads (PDFs)

More details for this plan on the following networks

Silver 6500‡‡
Office Visits

Primary care
No deductible, $30

Urgent care
No deductible, $30

Specialist
No deductible, $60

Tier 1 prescription
Drug coverage No deductible, $15

In-network Costs 

Deductible
Individual $6,500
Family $13,000

Out-of-pocket max
Individual $7,500
Family $15,000

Preventive services
No deductible, covered in full

Plan Downloads (PDFs)

More details for this plan on the following networks

Bronze 8150
Office Visits

Primary care
No deductible, $35

Urgent care
No deductible, $35

Specialist
After deductible, covered in full

Tier 1 prescription
Drug coverage After deductible, covered in full

In-network Costs 

Deductible
Individual $8,150
Family $16,300

Out-of-pocket max
Individual $8,150
Family $16,300

Preventive services
No deductible, covered in full

Plan Downloads (PDFs)

More details for this plan on the following networks

Gold HSA 3000
Office Visits

Primary care
After deductible, covered in full

Urgent care
After deductible, covered in full

Specialist
After deductible, covered in full

Tier 1 prescription
Drug coverage After deductible, covered in full

In-network Costs 

Deductible
Individual $3,000
Family $6,000

Out-of-pocket max
Individual $3,000
Family $6,000

Preventive services
No deductible, covered in full

Plan Downloads (PDFs)

More details for this plan on the following networks

Silver HSA 3000
Office Visits

Primary care
After deductible, 20%

Urgent care
After deductible, 20%

Specialist
After deductible, 20%

Tier 1 prescription
Drug coverage After deductible, 20%

In-network Costs 

Deductible
Individual $3,000
Family $6,000

Out-of-pocket max
Individual $6,750
Family $13,500

Preventive services
No deductible, covered in full

Plan Downloads (PDFs)

More details for this plan on the following networks

Silver HSA 4500
Office Visits

Primary care
After deductible, covered in full

Urgent care
After deductible, covered in full

Specialist
After deductible, covered in full

Tier 1 prescription
Drug coverage After deductible, covered in full

In-network Costs 

Deductible
Individual $4,500
Family $9,000

Out-of-pocket max
Individual $4,500
Family $9,000

Preventive services
No deductible, covered in full

Plan Downloads (PDFs)

More details for this plan on the following networks

Silver HSA 5500
Office Visits

Primary care
After deductible, covered in full

Urgent care
After deductible, covered in full

Specialist
After deductible, covered in full

Tier 1 prescription
Drug coverage After deductible, covered in full

In-network Costs 

Deductible
Individual $5,500
Family $11,000

Out-of-pocket max
Individual $5,500
Family $11,000

Preventive services
No deductible, covered in full

Plan Downloads (PDFs)

More details for this plan on the following networks

Bronze HSA 7000
Office Visits

Primary care
After deductible, covered in full

Urgent care
After deductible, covered in full

Specialist
After deductible, covered in full

Tier 1 prescription
Drug coverage After deductible, covered in full

In-network Costs 

Deductible
Individual $7,000
Family $14,000

Out-of-pocket max
Individual $7,000
Family $14,000

Preventive services
No deductible, covered in full

Plan Downloads (PDFs)

More details for this plan on the following networks

Standard Gold
Office Visits

Primary care
No deductible, $20

Urgent care
No deductible, $60

Specialist
No deductible, $40

Tier 1 prescription
Drug coverage No deductible, $10

In-network Costs 

Deductible
Individual $1,500
Family $3,000

Out-of-pocket max
Individual $7,300
Family $14,600

Preventive services
No deductible, covered in full

Plan Downloads (PDFs)

More details for this plan on the following networks

Standard Silver
Office Visits

Primary care
No deductible, $40

Urgent care
No deductible, $70

Specialist
No deductible, $80

Tier 1 prescription
Drug coverage No deductible, $15

In-network Costs 

Deductible
Individual $3,650
Family $7,300

Out-of-pocket max
Individual $8,550
Family $17,100

Preventive services
No deductible, covered in full

Plan Downloads (PDFs)

More details for this plan on the following networks

Standard Bronze
Office Visits

Primary care
No deductible, $50

Urgent care
No deductible, $100

Specialist
No deductible, $100

Tier 1 prescription
Drug coverage No deductible, $20

In-network Costs 

Deductible
Individual $8,700
Family $17,400

Out-of-pocket max
Individual $8,700
Family $17,400

Preventive services
No deductible, covered in full

Plan Downloads (PDFs)

More details for this plan on the following networks

Dental Choice 0-20-50 50-1000^|||
Members Pay

Deductible
Individual $50
Family $150

Services Preventive No deductible, 0% Basic After deductible, 20% Major After deductible, 50%

Annual Max. Benefit

$1,000 per person, age 19 and older

More about this plan Summary of benefits

Dental Choice Plus 0-20-50 25-1000^
Members Pay

Deductible
Individual $25
Family $75

Services Preventive No deductible, 0% Basic After deductible, 20% Major After deductible, 50%

Annual Max. Benefit

$1,000 per person, age 19 and older

More about this plan Summary of benefits

Dental Choice Plus 0-20-50 50-1000^
Members Pay

Deductible
Individual $50
Family $150

Services Preventive No deductible, 0% Basic After deductible, 20% Major After deductible, 50%

Annual Max. Benefit

$1,000 per person, age 19 and older

More about this plan Summary of benefits

Dental Choice Plus 0-20-50 25-1500^
Members Pay

Deductible
Individual $25
Family $75

Services Preventive No deductible, 0% Basic After deductible, 20% Major After deductible, 50%

Annual Max. Benefit

$1,500 per person, age 19 and older

More about this plan Summary of benefits

Dental Choice Plus 0-20-50 50-1500^
Members Pay

Deductible
Individual $50
Family $150

Services Preventive No deductible, 0% Basic After deductible, 20% Major After deductible, 50%

Annual Max. Benefit

$1,500 per person, age 19 and older

More about this plan Summary of benefits

Dental Advantage Core|||
Members Pay

Deductible
Individual $0
Family $0

Services Preventive No deductible, 0% Basic No deductible, 20% Major No deductible, 50% (age 19+ not covered)

Annual Max. Benefit

$500 on basic dental services, per person, age 19 and older

More about this plan Summary of benefits

Dental Advantage 20-20-50 1000^|||
Members Pay

Deductible
Individual $0
Family $0

Services Preventive No deductible, 20% Basic No deductible, 20% Major No deductible, 50%

Annual Max. Benefit

$1,000 per person, age 19 and older

More about this plan Summary of benefits

Dental Advantage 20-20-50 1500^|||
Members Pay

Deductible
Individual $0
Family $0

Services Preventive No deductible, 20% Basic No deductible, 20% Major No deductible, 50%

Annual Max. Benefit

$1,500 per person, age 19 and older

More about this plan Summary of benefits

Dental Advantage 0-20-50 1000^|||
Members Pay

Deductible
Individual $0
Family $0

Services Preventive No deductible, 0% Basic No deductible, 20% Major No deductible, 50%

Annual Max. Benefit

$1,000 per person, age 19 and older

More about this plan Summary of benefits

Dental Advantage 0-20-50 1500^|||
Members Pay

Deductible
Individual $0
Family $0

Services Preventive No deductible, 0% Basic No deductible, 20% Major No deductible, 50%

Annual Max. Benefit

$1,500 per person, age 19 and older

More about this plan Summary of benefits

Dental Advantage Plus 0-20-50 1000^
Members Pay

Deductible
Individual $0
Family $0

Services Preventive No deductible, 0% Basic No deductible, 20% Major No deductible, 50%

Annual Max. Benefit

$1,000 per person, age 19 and older

More about this plan Summary of benefits

Dental Advantage Plus 0-20-50 1500^
Members Pay

Deductible
Individual $0
Family $0

Services Preventive No deductible, 0% Basic No deductible, 20% Major No deductible, 50%

Annual Max. Benefit

$1,500 per person, age 19 and older

More about this plan Summary of benefits

Kids Dental Advantage 0-20-50
Members Pay

Deductible
Individual $0
Family $0

Services Preventive No deductible, 0% Basic No deductible, 20% Major No deductible, 50%

Annual Max. Benefit

N/A

More about this plan Summary of benefits

Kids Dental Advantage 20-40-50^
Members Pay

Deductible
Individual $0
Family $0

Services Preventive No deductible, 20% Basic No deductible, 40% Major No deductible, 50%

Annual Max. Benefit

N/A

More about this plan Summary of benefits

Platinum 500‡‡
Office Visits

Primary care
No deductible, $10

Urgent care
No deductible, $10

Specialist
No deductible, $20

Tier 1 prescription
Drug coverage No deductible, $5

In-network Costs 

Deductible
Individual $500
Family $1,000

Out-of-pocket max
Individual $4,000
Family $8,000

Preventive services
No deductible, covered in full

Plan Downloads (PDFs)

More details for this plan on the following networks

Gold 1000‡‡
Office Visits

Primary care
No deductible, $25

Urgent care
No deductible, $25

Specialist
No deductible, $75

Tier 1 prescription
Drug coverage No deductible, $15

In-network Costs 

Deductible
Individual $1,000
Family $2,000

Out-of-pocket max
Individual $7,000
Family $14,000

Preventive services
No deductible, covered in full

Plan Downloads (PDFs)

More details for this plan on the following networks

Gold 2000‡‡
Office Visits

Primary care
No deductible, $25

Urgent care
No deductible, $25

Specialist
No deductible, $75

Tier 1 prescription
Drug coverage No deductible, $15

In-network Costs 

Deductible
Individual $2,000
Family $4,000

Out-of-pocket max
Individual $6,500
Family $13,000

Preventive services
No deductible, covered in full

Plan Downloads (PDFs)

More details for this plan on the following networks

Gold 2500‡‡
Office Visits

Primary care
No deductible, $25

Urgent care
No deductible, $25

Specialist
No deductible, $75

Tier 1 prescription
Drug coverage No deductible, $15

In-network Costs 

Deductible
Individual $2,500
Family $5,000

Out-of-pocket max
Individual $6,500
Family $13,000

Preventive services
No deductible, covered in full

Plan Downloads (PDFs)

More details for this plan on the following networks

Gold 3500‡‡
Office Visits

Primary care
No deductible, $25

Urgent care
No deductible, $25

Specialist
No deductible, $75

Tier 1 prescription
Drug coverage No deductible, $15

In-network Costs 

Deductible
Individual $3,500
Family $7,000

Out-of-pocket max
Individual $6,500
Family $13,000

Preventive services
No deductible, covered in full

Plan Downloads (PDFs)

More details for this plan on the following networks

Silver 3500
Office Visits

Primary care
No deductible, $50

Urgent care
No deductible, $50

Specialist
No deductible, $100

Tier 1 prescription
Drug coverage No deductible, $20

In-network Costs 

Deductible
Individual $3,500
Family $7,000

Out-of-pocket max
Individual $9,100
Family $18,200

Preventive services
No deductible, covered in full

Plan Downloads (PDFs)

More details for this plan on the following networks

Silver 4500‡‡
Office Visits

Primary care
No deductible, $40

Urgent care
No deductible, $40

Specialist
No deductible, $80

Tier 1 prescription
Drug coverage No deductible, $20

In-network Costs 

Deductible
Individual $4,500
Family $9,000

Out-of-pocket max
Individual $9,100
Family $18,200

Preventive services
No deductible, covered in full

Plan Downloads (PDFs)

More details for this plan on the following networks

Silver 5500‡‡
Office Visits

Primary care
No deductible, $35

Urgent care
No deductible, $35

Specialist
No deductible, $70

Tier 1 prescription
Drug coverage No deductible, $20

In-network Costs 

Deductible
Individual $5,500
Family $11,000

Out-of-pocket max
Individual $9,100
Family $18,200

Preventive services
No deductible, covered in full

Plan Downloads (PDFs)

More details for this plan on the following networks

Silver 6500‡‡
Office Visits

Primary care
No deductible, $30

Urgent care
No deductible, $30

Specialist
No deductible, $60

Tier 1 prescription
Drug coverage No deductible, $20

In-network Costs 

Deductible
Individual $6,500
Family $13,000

Out-of-pocket max
Individual $9,100
Family $18,200

Preventive services
No deductible, covered in full

Plan Downloads (PDFs)

More details for this plan on the following networks

Bronze 8150
Office Visits

Primary care
No deductible, $35

Urgent care
No deductible, $35

Specialist
After deductible, covered in full

Tier 1 prescription
Drug coverage After deductible, covered in full

In-network Costs 

Deductible
Individual $8,150
Family $16,300

Out-of-pocket max
Individual $8,150
Family $16,300

Preventive services
No deductible, covered in full

Plan Downloads (PDFs)

More details for this plan on the following networks

Bronze 9100
Office Visits

Primary care
After deductible, covered in full

Urgent care
After deductible, covered in full

Specialist
After deductible, covered in full

Tier 1 prescription
Drug coverage After deductible, covered in full

In-network Costs 

Deductible
Individual $9,100
Family $18,200

Out-of-pocket max
Individual $9,100
Family $18,200

Preventive services
No deductible, covered in full

Plan Downloads (PDFs)

More details for this plan on the following networks

Gold HSA 3000
Office Visits

Primary care
After deductible, covered in full

Urgent care
After deductible, covered in full

Specialist
After deductible, covered in full

Tier 1 prescription
Drug coverage After deductible, covered in full

In-network Costs 

Deductible
Individual $3,000
Family $6,000

Out-of-pocket max
Individual $3,000
Family $6,000

Preventive services
No deductible, covered in full

Plan Downloads (PDFs)

More details for this plan on the following networks

Silver HSA 3000
Office Visits

Primary care
After deductible, 20%

Urgent care
After deductible, 20%

Specialist
After deductible, 20%

Tier 1 prescription
Drug coverage After deductible, 20%

In-network Costs 

Deductible
Individual $3,000
Family $6,000

Out-of-pocket max
Individual $7,050
Family $14,100

Preventive services
No deductible, covered in full

Plan Downloads (PDFs)

More details for this plan on the following networks

Silver HSA 4800
Office Visits

Primary care
After deductible, covered in full

Urgent care
After deductible, covered in full

Specialist
After deductible, covered in full

Tier 1 prescription
Drug coverage After deductible, covered in full

In-network Costs 

Deductible
Individual $4,800
Family $9,600

Out-of-pocket max
Individual $4,800
Family $9,600

Preventive services
No deductible, covered in full

Plan Downloads (PDFs)

More details for this plan on the following networks

Silver HSA 5500
Office Visits

Primary care
After deductible, covered in full

Urgent care
After deductible, covered in full

Specialist
After deductible, covered in full

Tier 1 prescription
Drug coverage After deductible, covered in full

In-network Costs 

Deductible
Individual $5,500
Family $11,000

Out-of-pocket max
Individual $5,500
Family $11,000

Preventive services
No deductible, covered in full

Plan Downloads (PDFs)

More details for this plan on the following networks

Bronze HSA 7050
Office Visits

Primary care
After deductible, covered in full

Urgent care
After deductible, covered in full

Specialist
After deductible, covered in full

Tier 1 prescription
Drug coverage After deductible, covered in full

In-network Costs 

Deductible
Individual $7,050
Family $14,100

Out-of-pocket max
Individual $7,050
Family $14,100

Preventive services
No deductible, covered in full

Plan Downloads (PDFs)

More details for this plan on the following networks

Standard Gold
Office Visits

Primary care
No deductible, $20

Urgent care
No deductible, $60

Specialist
No deductible, $40

Tier 1 prescription
Drug coverage No deductible, $10

In-network Costs 

Deductible
Individual $1,800
Family $3,600

Out-of-pocket max
Individual $7,300
Family $14,600

Preventive services
No deductible, covered in full

Plan Downloads (PDFs)

More details for this plan on the following networks

Standard Silver
Office Visits

Primary care
No deductible, $40

Urgent care
No deductible, $70

Specialist
No deductible, $80

Tier 1 prescription
Drug coverage No deductible, $15

In-network Costs 

Deductible
Individual $4,800
Family $9,600

Out-of-pocket max
Individual $9,100
Family $18,200

Preventive services
No deductible, covered in full

Plan Downloads (PDFs)

More details for this plan on the following networks

Standard Bronze
Office Visits

Primary care
No deductible, $50

Urgent care
No deductible, $100

Specialist
No deductible, $100

Tier 1 prescription
Drug coverage No deductible, $20

In-network Costs 

Deductible
Individual $8,800
Family $17,600

Out-of-pocket max
Individual $8,800
Family $17,600

Preventive services
No deductible, covered in full

Plan Downloads (PDFs)

More details for this plan on the following networks

Dental Choice 0-20-50 50-1000^|||
Members Pay

Deductible
Individual $50
Family $150

Services Preventive No deductible, 0% Basic After deductible, 20% Major After deductible, 50%

Annual Max. Benefit

$1,000 per person, age 19 and older

More about this plan Summary of benefits

Dental Choice Plus 0-20-50 25-1000^
Members Pay

Deductible
Individual $25
Family $75

Services Preventive No deductible, 0% Basic After deductible, 20% Major After deductible, 50%

Annual Max. Benefit

$1,000 per person, age 19 and older

More about this plan Summary of benefits

Dental Choice Plus 0-20-50 50-1000^
Members Pay

Deductible
Individual $50
Family $150

Services Preventive No deductible, 0% Basic After deductible, 20% Major After deductible, 50%

Annual Max. Benefit

$1,000 per person, age 19 and older

More about this plan Summary of benefits

Dental Choice Plus 0-20-50 25-1500^
Members Pay

Deductible
Individual $25
Family $75

Services Preventive No deductible, 0% Basic After deductible, 20% Major After deductible, 50%

Annual Max. Benefit

$1,500 per person, age 19 and older

More about this plan Summary of benefits

Dental Choice Plus 0-20-50 50-1500^
Members Pay

Deductible
Individual $50
Family $150

Services Preventive No deductible, 0% Basic After deductible, 20% Major After deductible, 50%

Annual Max. Benefit

$1,500 per person, age 19 and older

More about this plan Summary of benefits

Dental Advantage Core|||
Members Pay

Deductible
Individual $0
Family $0

Services Preventive No deductible, 0% Basic No deductible, 20% Major No deductible, 50% (age 19+ not covered)

Annual Max. Benefit

$500 on basic dental services, per person, age 19 and older

More about this plan Summary of benefits

Dental Advantage 20-20-50 1000^|||
Members Pay

Deductible
Individual $0
Family $0

Services Preventive No deductible, 20% Basic No deductible, 20% Major No deductible, 50%

Annual Max. Benefit

$1,000 per person, age 19 and older

More about this plan Summary of benefits

Dental Advantage 20-20-50 1500^|||
Members Pay

Deductible
Individual $0
Family $0

Services Preventive No deductible, 20% Basic No deductible, 20% Major No deductible, 50%

Annual Max. Benefit

$1,500 per person, age 19 and older

More about this plan Summary of benefits

Dental Advantage 0-20-50 1000^|||
Members Pay

Deductible
Individual $0
Family $0

Services Preventive No deductible, 0% Basic No deductible, 20% Major No deductible, 50%

Annual Max. Benefit

$1,000 per person, age 19 and older

More about this plan Summary of benefits

Dental Advantage 0-20-50 1500^|||
Members Pay

Deductible
Individual $0
Family $0

Services Preventive No deductible, 0% Basic No deductible, 20% Major No deductible, 50%

Annual Max. Benefit

$1,500 per person, age 19 and older

More about this plan Summary of benefits

Dental Advantage Plus 0-20-50 1000^
Members Pay

Deductible
Individual $0
Family $0

Services Preventive No deductible, 0% Basic No deductible, 20% Major No deductible, 50%

Annual Max. Benefit

$1,000 per person, age 19 and older

More about this plan Summary of benefits

Dental Advantage Plus 0-20-50 1500^
Members Pay

Deductible
Individual $0
Family $0

Services Preventive No deductible, 0% Basic No deductible, 20% Major No deductible, 50%

Annual Max. Benefit

$1,500 per person, age 19 and older

More about this plan Summary of benefits

Kids Dental Advantage 0-20-50
Members Pay

Deductible
Individual $0
Family $0

Services Preventive No deductible, 0% Basic No deductible, 20% Major No deductible, 50%

Annual Max. Benefit

N/A

More about this plan Summary of benefits

Kids Dental Advantage 20-40-50^
Members Pay

Deductible
Individual $0
Family $0

Services Preventive No deductible, 20% Basic No deductible, 40% Major No deductible, 50%

Annual Max. Benefit

N/A

More about this plan Summary of benefits

Platinum 500‡‡
Office Visits

Primary care
1-3 no deductible, $5; visits 4+ no deductible, $10

Urgent care
No deductible, $10

Specialist
No deductible, $20

Tier 1 prescription
Drug coverage No deductible, $5

In-network Costs 

Deductible
Individual $500
Family $1,000

Out-of-pocket max
Individual $4,000
Family $8,000

Preventive services
No deductible, covered in full

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Gold 1000‡‡
Office Visits

Primary care
1-3 no deductible, $5; visits 4+ no deductible, $25

Urgent care
No deductible, $25

Specialist
No deductible, $75

Tier 1 prescription
Drug coverage No deductible, $15

In-network Costs 

Deductible
Individual $1,000
Family $2,000

Out-of-pocket max
Individual $7,000
Family $14,000

Preventive services
No deductible, covered in full

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Gold 2000‡‡
Office Visits

Primary care
1-3 no deductible, $5; visits 4+ no deductible, $25

Urgent care
No deductible, $25

Specialist
No deductible, $75

Tier 1 prescription
Drug coverage No deductible, $15

In-network Costs 

Deductible
Individual $2,000
Family $4,000

Out-of-pocket max
Individual $6,500
Family $13,000

Preventive services
No deductible, covered in full

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Gold 2500‡‡
Office Visits

Primary care
1-3 no deductible, $5; visits 4+ no deductible, $25

Urgent care
No deductible, $25

Specialist
No deductible, $75

Tier 1 prescription
Drug coverage No deductible, $15

In-network Costs 

Deductible
Individual $2,500
Family $5,000

Out-of-pocket max
Individual $6,500
Family $13,000

Preventive services
No deductible, covered in full

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Gold 3500‡‡
Office Visits

Primary care
1-3 no deductible, $5; visits 4+ no deductible, $25

Urgent care
No deductible, $25

Specialist
No deductible, $75

Tier 1 prescription
Drug coverage No deductible, $15

In-network Costs 

Deductible
Individual $3,500
Family $7,000

Out-of-pocket max
Individual $6,500
Family $13,000

Preventive services
No deductible, covered in full

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Silver 3500
Office Visits

Primary care
1-3 no deductible, $5; visits 4+ no deductible, $50

Urgent care
No deductible, $50

Specialist
No deductible, $100

Tier 1 prescription
Drug coverage No deductible, $20

In-network Costs 

Deductible
Individual $3,500
Family $7,000

Out-of-pocket max
Individual $9,400
Family $18,800

Preventive services
No deductible, covered in full

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More details for this plan on the following networks

Silver 4500‡‡
Office Visits

Primary care
1-3 no deductible, $5; visits 4+ no deductible, $40

Urgent care
No deductible, $40

Specialist
No deductible, $100

Tier 1 prescription
Drug coverage No deductible, $20

In-network Costs 

Deductible
Individual $4,500
Family $9,000

Out-of-pocket max
Individual $9,400
Family $18,800

Preventive services
No deductible, covered in full

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Silver 5000‡‡
Office Visits

Primary care
1-3 no deductible, $5; visits 4+ no deductible, $40

Urgent care
No deductible, $40

Specialist
No deductible, $80

Tier 1 prescription
Drug coverage No deductible, $10

In-network Costs 

Deductible
Individual $5,000
Family $10,000

Out-of-pocket max
Individual $9,400
Family $18,800

Preventive services
No deductible, covered in full

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Silver 5500‡‡
Office Visits

Primary care
1-3 no deductible, $5; visits 4+ no deductible, $35

Urgent care
No deductible, $35

Specialist
No deductible, $70

Tier 1 prescription
Drug coverage No deductible, $20

In-network Costs 

Deductible
Individual $5,500
Family $11,000

Out-of-pocket max
Individual $9,400
Family $18,800

Preventive services
No deductible, covered in full

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Silver 6500‡‡
Office Visits

Primary care
1-3 no deductible, $5; visits 4+ no deductible, $35

Urgent care
No deductible, $35

Specialist
No deductible, $70

Tier 1 prescription
Drug coverage No deductible, $20

In-network Costs 

Deductible
Individual $6,500
Family $13,000

Out-of-pocket max
Individual $9,400
Family $18,800

Preventive services
No deductible, covered in full

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Bronze 7500
Office Visits

Primary care
1-3 no deductible, $5; visits 4+ no deductible, $35

Urgent care
No deductible, $35

Specialist
No deductible, $100

Tier 1 prescription
Drug coverage After deductible, 30%

In-network Costs 

Deductible
Individual $7,500
Family $15,000

Out-of-pocket max
Individual $9,400
Family $18,800

Preventive services
No deductible, covered in full

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Bronze 9400
Office Visits

Primary care
1-3 no deductible, $5; visits 4+ after deductible, covered in full

Urgent care
After deductible, covered in full

Specialist
After deductible, covered in full

Tier 1 prescription
Drug coverage After deductible, covered in full

In-network Costs 

Deductible
Individual $9,400
Family $18,800

Out-of-pocket max
Individual $9,400
Family $18,800

Preventive services
No deductible, covered in full

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Gold HSA 3200
Office Visits

Primary care
After deductible, covered in full

Urgent care
After deductible, covered in full

Specialist
After deductible, covered in full

Tier 1 prescription
Drug coverage After deductible, covered in full

In-network Costs 

Deductible
Individual $3,200
Family $6,400

Out-of-pocket max
Individual $3,200
Family $6,400

Preventive services
No deductible, covered in full

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Silver HSA 3500
Office Visits

Primary care
After deductible, 20%

Urgent care
After deductible, 20%

Specialist
After deductible, 20%

Tier 1 prescription
Drug coverage After deductible, 20%

In-network Costs 

Deductible
Individual $3,500
Family $7,000

Out-of-pocket max
Individual $7,500
Family $15,000

Preventive services
No deductible, covered in full

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Silver HSA 5100
Office Visits

Primary care
After deductible, covered in full

Urgent care
After deductible, covered in full

Specialist
After deductible, covered in full

Tier 1 prescription
Drug coverage After deductible, covered in full

In-network Costs 

Deductible
Individual $5,100
Family $10,200

Out-of-pocket max
Individual $5,100
Family $10,200

Preventive services
No deductible, covered in full

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Silver HSA 5500
Office Visits

Primary care
After deductible, covered in full

Urgent care
After deductible, covered in full

Specialist
After deductible, covered in full

Tier 1 prescription
Drug coverage After deductible, covered in full

In-network Costs 

Deductible
Individual $5,500
Family $11,000

Out-of-pocket max
Individual $5,500
Family $11,000

Preventive services
No deductible, covered in full

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Bronze HSA 7500
Office Visits

Primary care
After deductible, covered in full

Urgent care
After deductible, covered in full

Specialist
After deductible, covered in full

Tier 1 prescription
Drug coverage After deductible, covered in full

In-network Costs 

Deductible
Individual $7,500
Family $15,000

Out-of-pocket max
Individual $7,500
Family $15,000

Preventive services
No deductible, covered in full

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More details for this plan on the following networks

Standard Gold
Office Visits

Primary care
1-3 no deductible, $5; visits 4+ no deductible, $20

Urgent care
No deductible, $60

Specialist
No deductible, $40

Tier 1 prescription
Drug coverage No deductible, $10

In-network Costs 

Deductible
Individual $1,800
Family $3,600

Out-of-pocket max
Individual $7,550
Family $15,100

Preventive services
No deductible, covered in full

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More details for this plan on the following networks

Standard Silver
Office Visits

Primary care
1-3 no deductible, $5; visits 4+ no deductible, $40

Urgent care
No deductible, $70

Specialist
No deductible, $80

Tier 1 prescription
Drug coverage No deductible, $15

In-network Costs 

Deductible
Individual $5,500
Family $10,200

Out-of-pocket max
Individual $9,450
Family $18,900

Preventive services
No deductible, covered in full

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More details for this plan on the following networks

Standard Bronze
Office Visits

Primary care
1-3 no deductible, $5; visits 4+ no deductible, $50

Urgent care
No deductible, $100

Specialist
No deductible, $150

Tier 1 prescription
Drug coverage No deductible, $25

In-network Costs 

Deductible
Individual $9,450
Family $18,900

Out-of-pocket max
Individual $9,450
Family $18,900

Preventive services
No deductible, covered in full

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Dental Choice 0-20-50 50-1000^|||
Members Pay

Deductible
Individual $50
Family $150

Services Preventive No deductible, 0% Basic After deductible, 20% Major After deductible, 50%

Annual Max. Benefit

$1,000 per person, age 19 and older

More about this plan Summary of benefits

Dental Choice Plus 0-20-50 25-1000^
Members Pay

Deductible
Individual $25
Family $75

Services Preventive No deductible, 0% Basic After deductible, 20% Major After deductible, 50%

Annual Max. Benefit

$1,000 per person, age 19 and older

More about this plan Summary of benefits

Dental Choice Plus 0-20-50 50-1000^
Members Pay

Deductible
Individual $50
Family $150

Services Preventive No deductible, 0% Basic After deductible, 20% Major After deductible, 50%

Annual Max. Benefit

$1,000 per person, age 19 and older

More about this plan Summary of benefits

Dental Choice Plus 0-20-50 25-1500^
Members Pay

Deductible
Individual $25
Family $75

Services Preventive No deductible, 0% Basic After deductible, 20% Major After deductible, 50%

Annual Max. Benefit

$1,500 per person, age 19 and older

More about this plan Summary of benefits

Dental Choice Plus 0-20-50 50-1500^
Members Pay

Deductible
Individual $50
Family $150

Services Preventive No deductible, 0% Basic After deductible, 20% Major After deductible, 50%

Annual Max. Benefit

$1,500 per person, age 19 and older

More about this plan Summary of benefits

Dental PPO Core|||
Members Pay

Deductible
Individual $0
Family $0

Services Preventive No deductible, 0% Basic No deductible, 20% Major No deductible, 50% (age 19+ not covered)

Annual Max. Benefit

$500 on basic dental services, per person, age 19 and older

More about this plan Summary of benefits

Dental PPO 20-20-50 1000^|||
Members Pay

Deductible
Individual $0
Family $0

Services Preventive No deductible, 20% Basic No deductible, 20% Major No deductible, 50%

Annual Max. Benefit

$1,000 per person, age 19 and older

More about this plan Summary of benefits

Dental PPO 20-20-50 1500^|||
Members Pay

Deductible
Individual $0
Family $0

Services Preventive No deductible, 20% Basic No deductible, 20% Major No deductible, 50%

Annual Max. Benefit

$1,500 per person, age 19 and older

More about this plan Summary of benefits

Dental PPO 0-20-50 1000^|||
Members Pay

Deductible
Individual $0
Family $0

Services Preventive No deductible, 0% Basic No deductible, 20% Major No deductible, 50%

Annual Max. Benefit

$1,000 per person, age 19 and older

More about this plan Summary of benefits

Dental PPO 0-20-50 1500^|||
Members Pay

Deductible
Individual $0
Family $0

Services Preventive No deductible, 0% Basic No deductible, 20% Major No deductible, 50%

Annual Max. Benefit

$1,500 per person, age 19 and older

More about this plan Summary of benefits

Dental PPO Plus 0-20-50 1000^
Members Pay

Deductible
Individual $0
Family $0

Services Preventive No deductible, 0% Basic No deductible, 20% Major No deductible, 50%

Annual Max. Benefit

$1,000 per person, age 19 and older

More about this plan Summary of benefits

Dental PPO Plus 0-20-50 1500^
Members Pay

Deductible
Individual $0
Family $0

Services Preventive No deductible, 0% Basic No deductible, 20% Major No deductible, 50%

Annual Max. Benefit

$1,500 per person, age 19 and older

More about this plan Summary of benefits

Kids Dental PPO 0-20-50
Members Pay

Deductible
Individual $0
Family $0

Services Preventive No deductible, 0% Basic No deductible, 20% Major No deductible, 50%

Annual Max. Benefit

N/A

More about this plan Summary of benefits

Kids Dental PPO 20-40-50^
Members Pay

Deductible
Individual $0
Family $0

Services Preventive No deductible, 20% Basic No deductible, 40% Major No deductible, 50%

Annual Max. Benefit

N/A

More about this plan Summary of benefits