Lowest-priced Gold plan offered through HealthSource RI. This plan offers low copays on certain services. Preventive services are covered at 100% and include access to our full network of doctors and hospitals.
View Cost-Sharing
Deductible: $1,000 (Individual) / $2,000 (Family)
Out of Pocket Max: $5,900 (Individual) / $11,800 (Family)
Primary Care/Behavioral Health Office Visits: $20
Specialist/Urgent Care Visits: $40
Inpatient/Imaging/Lab Services: 20% co-insurance*
Pharmacy (Tiers 1-6): $5/$10/$35/$50/30%*/30%*
*after deductible
What do you need help with today?
- I need a doctor.
- I want to know if my medicine is covered.
- I want to know my rights and privacy.
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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
- I want to access my Behavioral Health Member Portal.
Where can I learn about my benefits?
- Price Information for Your Medical Benefits [PDF, 301KB]
- Price Information for Your Pharmacy Benefits
- Plan Summary [PDF, 1209KB]
- Certificate of Coverage [PDF, 1,490KB]
- Pediatric Dental Benefits
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Summary of Benefits and Coverage
- 10010-01 PLUS [PDF, 476KB]
- 10010-03 PLUS (LimitedCS) [PDF 476KB]
- Glossary of Health Coverage and Medical Terms [PDF, 139KB]
Read the latest issue of our quarterly member newsletter, Healthy You.
Questions about PLUS? We're happy to help.
Call us today at 1-855-321-9244.