Gold Health Savings Account plan offered through HealthSource RI that has 0% coinsurance after the deductible has been met. Preventative services are covered at 100%. Includes Out of network coverage with separate cost sharing, deductible, and out of pocket maximum
Who is Eligible?
Qualifying small employers with 2-50 employees.
Deductible: $2,500 (Individual) / $5,000 (Family)
Out of Pocket Max: $3,000 (Individual) / $6,000 (Family)
Primary Care/Behavioral Health Office Visits: $25*
Specialist/Urgent Care Visits: $55*
Inpatient/Imaging/Lab Services: Only deductible applies
Pharmacy (Tiers 1-6): $5*/$10*/$40*/$55*/30%*/30%*
Out of Network Deductible: $7,500 (Individual) / $15,000 (Family)
Out of Network OOPM: $9,000 (Individual) / $18,000 (Family)
Out of Network Services: 50%**
**after Out of Network deductible
What do you need help with today?
- I need a doctor.
- I want to know my rights and privacy.
- I want to know if my medicine is covered.
- I want to access my Pharmacy Member Portal.
- Use this portal to check your medications, sign up for mail order pharmacy and review drug costs
- Formulary Foreword
- You can also sign up for mail order pharmacy by calling: 1-844-254-9483
- I want to access my Behavioral Health Member Portal.
Where can I learn about my benefits?
- Price Information for Your Pharmacy Benefits
- Plan Summary (English) 2023
- Plan Summary (Spanish) 2023
- Pediatric Dental Benefits
- Certificate of Coverage
- Summary of Benefits and Coverage
- Your Rights and Protections Against Surprise Medical Bills
- Glossary of Health Coverage and Medical Terms
- Creditable Coverage Disclosure Notice
Read the latest issue of our quarterly member newsletter, Healthy You.
Questions about PREMIER? We’re happy to help.
Call us today at 1-855-321-9244.