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: $2,525 (Individual) / $5,050 (Family)
Out of Pocket Max: $5,700 (Individual) / $11,400 (Family)
Primary Care/Behavioral Health Office Visits: $20 copay
Specialist/Urgent Care Visits: $55 copay
Inpatient/Imaging/Lab Services: Only deductible applies
Pharmacy (Tiers 1-6): $5/$10/$35/$50/$200/$200
Out of Network Deductible: $7,575 (Individual) / $15,150 (Family)
Out of Network OOPM: $17,100 (Individual) / $34,200 (Family)
Out of Network Services: 50%*
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
- 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)
- Plan Summary (Spanish) (Coming Soon)
- Pediatric Dental Benefits
- Certificate of Coverage
- Summary of Benefits and Coverage
- Your Rights and Protections Against Surprise Medical Bills
- Creditable Coverage Disclosure Notice
Read the latest issue of our quarterly member newsletter, Healthy You.
Members who enrolled in PREMIER Elite for the 2023 benefit year, click here for plan details.
Questions about PREMIER Elite? We’re happy to help.
Call us today at 1-855-321-9244.