Gold plan offered through HealthSource RI that has low copays and a 0% coinsurance after the deductible. Preventative services are covered at 100%. Out of network coverage with separate cost sharing, deductible, and out of pocket maximum included.
Who is Eligible?
Qualifying small employers with 2-50 employees.
Deductible: $2,300 (Individual) / $4,600 (Family)
Out of Pocket Max: $5,500 (Individual) / $11,000 (Family)
Primary Care/Behavioral Health Office Visits: $20 copay
Specialist/Urgent Care Visits: $55 copay
Out of Network Deductible: $6,900 (Individual)/ $13,800 (Family)
Out of Network OOPM: $16,500 (Individual)/$33,000 (Family)
Out of Network Services: 50%*
Inpatient/Imaging/Lab Services: Only deductible applies
Pharmacy (Tiers 1-6): $5/$10/$35/$50/$200/$200
*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
- I want to access my Behavioral Health Member Portal.
Where can I learn about my benefits?
- Price Information for Your Medical Benefits
- Price Information for Your Pharmacy Benefits
- Plan Summary
- 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.