Employer
Compare Qualified Health Plans
If you have a small businesses with 1 to 50 qualifying employees, you can purchase a Qualified Health Plan for your employees and their families.
| Plan Name |
Annual Deductible |
Annual Max Out-of-Pocket |
Office Visits |
Prescriptions 30-day supply |
ER Waived if admitted |
Hospitalization Per admission |
|---|---|---|---|---|---|---|
| Platinum |
Individual: $0* Family: $0* |
Medical: $3,000* Pharmacy, & Pediatric Dental: $6,000* |
PCP: $20 Specialist: $40 |
Tier 1: $10 Tier 2: $25 Tier 3: $50 |
$150 per visit | $500 |
| Gold |
Individual: $1,000* (Medical) Family: $2,000* (Medical) |
Medical: $5,000* Pharmacy, & Pediatric Dental: $10,000* |
PCP: $25 Specialist: $45 |
Tier 1: $20 Tier 2: $40 Tier 3: $60 |
$150 per visit after deductible |
$500 after deductible |
| Low Gold |
Individual: $2,000* (Medical) Individual: $250* (Pharmacy)
Family: $4,000* (Medical) Family: $500 (Pharmacy) |
Medical: $5,600* Pharmacy, & Pediatric Dental: $11,200* |
PCP: $30 Specialist: $55 |
Tier 1: $25 Tier 2: $50 after deductible Tier 3: $125 after deductible |
$350 per visit after deductible | $750 after deductible |
| Silver A |
Individual: $2,000 Family: $4,000* |
Medical: $8,150* Pharmacy, & Pediatric Dental: $16,300* |
PCP: $30 Specialist: $60 |
Tier 1: $30 Tier 2: $60 Tier 3: $100 after deductible |
$350 per visit after deductible | $1000 after deductible |
| Silver A II |
Individual: $2,000 Family: $4,000* |
Medical: $8,150* Pharmacy, & Pediatric Dental: $16,300* |
PCP: $30 Specialist: $60 |
Tier 1: $30 Tier 2: $60 Tier 3: $100 after deductible |
$350 per visit after deductible | $1000 after deductible |
| Silver B |
Individual: $3,000 Family: $6,000* |
Medical: $7,900* Pharmacy, & Pediatric Dental: $15,800* |
PCP: $30 Specialist: $55 |
Tier 1: $30 copay Tier 2: 35% coinsurance (all after deductible) Tier 3: 35% coinsurance (all after deductible) |
$500 per visit after deductible | 30% coinsurance after deductible |
| Bronze |
Individual: $2,900 Family: $5,800* |
Medical: $8,150* Pharmacy, & Pediatric Dental: $16,300* |
PCP: $30 after deductible Specialist: $60 after deductible |
Tier 1: $30 Tier 2: $60 after deductible Tier 3: $125 after deductible |
$350 per visit after deductible | $750 after deductible |
All preventive services are covered in full. Our plans meet the state mandate for health insurance coverage and offer a variety of cost sharing options to employers.
*See plan document for more information.
Is your business located in one of our service areas?
Your business must be located in the service area for the plan you choose. Keep in mind, employees will need to see in-network providers located in or near our service areas.
- See service areas and provider listings for Silver plans
- See service areas and provider listings for Bronze, Gold and Platinum plans
Choose from seven different plan options for your employees. Our Qualified Health Plans have the same benefits, but differ based on how your employees share the costs of care with us.
Need coverage for you and your employees?
- Qualifying groups seeking to cover 1 to 5 employees must enroll through the Massachusetts Health Connector.
- Qualifying groups with 6 to 50 employees can enroll online through the Health Connector where they will receive the highest amount of tax credits, or directly through us.
For more information, please contact the Health Connector, or call us at 855-833-8120.
With Our Plan Your Employees Will...*
- See a doctor who will help coordinate all of their healthcare
- See specialists
- Fill prescriptions at a local pharmacy
- Go to in-network hospitals for treatment
- Get 24/7 access to a nurse for their health questions
- Get access to mental health and substance abuse services
- Get extra help managing conditions like asthma and diabetes
- Get care before and after a baby is born
- Get a routine eye exam
- Get money back for staying healthy with our Member Extras
Member Extras
Our members can get and stay healthy by taking advantage of Member Extras including:
- Money back for participating in Weight Watchers® or a qualifying health club
- Discounts on eyewear
- Access to Good Measures registered dietitian services
What's Covered?
Find out which doctors, hospitals, and pharmacies are in our provider networks here.
*See the Benefit Documents for each of our plans for an overview of benefits and cost sharing. For full details regarding covered benefits, limitations, and exclusions for Qualified Health Plans, see the Evidence of Coverage (EOC) and Schedule of Benefits for the plan you choose. These plans meet all MA requirements for participation, rating, mandatory offer/renewal and benefit mandates. There are no pre-existing condition limitations or waiting periods. Employers must comply with MA non-discrimination standards. All covered services must be medically necessary and some require prior authorization.