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Summary of small business health plan options

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Options for groups with 2-50 members
Options for sole proprietorships (groups with one member)

Options for groups with 2-50 members

PriorityHMOSM PriorityPOSSM PriorityPPOSM
Associated consumer engaged health care (CEH) product
PriorityHRASM
PriorityHSASM
PriorityHRA
PriorityHSA
PriorityHRA
PriorityHSA
Hospital coverage 100%
80%/20%
100% in-network; 70%/30% out-of-network
80%/20% in-network; 60%/40% out -of-network
100% in-network; 70%/30% out-of-network
80%/20% in-network; 60%/40% out -of-network
Deductibles
  • None
  • $250/$500 (available only on 80/20)
  • $500/$1000
  • $1000/$2000
  • $1150/$2300 (HSA only)
  • $2000/$4000
  • $3000/$6000
  • None
  • $250/$500 (available only on 80/20)
  • $500/$1000
  • $1000/$2000
  • $1150/$2300 (HSA only)
  • $2000/$4000
  • $3000/$6000
  • None
  • $250/$500
  • $500/$1000
  • $1000/$2000
  • $1150/$2300 (HSA only)
  • $2000/$4000
  • $3000/$6000
ER copay
  • $50
  • $100 (required for copay alignment plans)
  • $50
  • $100 (required for copay alignment plans)
  • $50
  • $100 (required for copay alignment plans)
Ambulance copay
  • $50
  • $100 (this choice not available with HSA)
  • $50
  • $100 (this choice not available with HSA)
  • $50
  • $100 (this choice not available with HSA)
Prescription drug copay
  • None
  • $15
  • $20
  • $25
  • $10/$30
  • $10/$40
  • $15/$25
  • $15/$50
  • None
  • $15
  • $20
  • $25
  • $10/$30
  • $10/$40
  • $15/$25
  • $15/$50
  • None
  • $15
  • $20
  • $25
  • $10/$30
  • $10/$40
  • $15/$25
  • $15/$50
Contraceptive medications
Include or exclude
Include or exclude Include or exclude
Rx deductible
  • None
  • $100/$200 (available with split copays only)
  • $200/$400 (available with split copays only)
  • None
  • $100/$200 (available with split copays only)
  • $200/$400 (available with split copays only)
  • None
  • $100/$200 (available with split copays only)
  • $200/$400 (available with split copays only)
Office visit copays - choose standard OR copay alignment
   Standard office visit copay
  • $15
  • $20
  • $30
  • $15
  • $20
  • $30
  • $15
  • $20
  • $30
   Copay alignment
  • $15 primary/$30 specialist/$45 urgent care
  • $20 primary/$35 specialist/$50 urgent care
  • $30 primary/$45 specialist/$60 urgent care
  • $15 primary/$30 specialist/$45 urgent care
  • $20 primary/$35 specialist/$50 urgent care
  • $30 primary/$45 specialist/$60 urgent care
  • $15 primary/$30 specialist/$45 urgent care
  • $20 primary/$35 specialist/$50 urgent care
  • $30 primary/$45 specialist/$60 urgent care
Base plans associated with HealthbyChoice IncentivesSM (HBCI)*
Six HMO options Five POS options
*Plans set up with Choice vs. Standard benefits. Includes copay alignment with $100 ER copay and $10 generic/$40 brand name prescription drug copay. Contraceptive medications must be either included or excluded on both Choice and Standard designs. Deductible may apply.


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Options for sole proprietorships
PriorityHMO
Hospital coverage
80%/20%
Deductibles
  • $500/$1000
  • $1000/$2000
  • $2000/$4000
Office visit copay
  • $30 for PCP
  • $45 for specialist
ER copay
$100
Ambulance copay
$50
Prescription drug copay
50% copay
($1000 maximum benefit per subscriber on
prescription drugs for first 12 months of coverage.
Doesn't include contraceptives.)
All sole proprietor plans must sign up for electronic funds transfer for monthly premiums.


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Last modified 09/24/09