Affordably priced Gold plan offered through HealthSource RI that offers low copays on certain services and high coverage once the deductible has been met. Preventive services are covered at 100% and include access to our full network of doctors and hospitals.
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View Cost-Sharing
Deductible: $2,100 (Individual) / $4,200 (Family)
Out of Pocket Max: $4,000 (Individual) / $8,000 (Family)
Primary Care/Behavioral Health Office Visits: $25
Specialist/Urgent Care Visits: $40
Inpatient/Imaging/Lab Services: Only deductible applies
Pharmacy (Tiers 1-6): $5/$10/$35/$50/30%*/30%*
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]
- Pediatric Dental Benefits
- Certificate of Coverage [PDF, 2072KB]
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Summary of Benefits and Coverage:
- 10005-01 PRINCIPAL [PDF, 473KB]
- 10005-03 PRINCIPAL (LimitedCS) [PDF, 476KB]
- Glossary of Health Coverage and Medical Terms [PDF, 139KB]
Read the latest issue of our quarterly member newsletter, Healthy You.