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Small Group Dual Option
Objective: Dual Option provides a defined contribution model to small employers who seek to reduce and control their healthcare premiums and offer employees a choice of benefit plans. The employer may fund a lower benefit plan and employees may "buy-up" to a richer benefit.

Market Segment: Dual Option will be offered to small groups with a 10 subscriber minimum.

Description: The employer selects two medical benefit plan options from current HMO and PPO PrimeCare plans. The employer also selects one pharmacy benefit plan to be offered with both benefit plans selected. Each enrollee (subscriber) selects one benefit plan for their family from the two medical/pharmacy combinations offered.

Guidelines:
  • 10 subscribers must enroll in the Dual Option offering (enrollees in life or disability only do not count toward the minimum).
  • The lower benefit plan must be a PPO plan. The higher benefit plan may be a PPO or HMO plan.
  • If a group chooses to offer a rider (vision, dental, etc.), the rider(s) must be offered with both benefit plan options.
  • Employer contribution toward the High Option plan cannot exceed the employer contribution toward the lower benefit plan.
  • If, upon renewal, group enrollment is fewer than 10 subscribers, the group is not eligible to renew with a Dual Option, but may renew with any benefit plan offered in the small group market.
  • Dual Option is not available in a dual carrier environment.


For more information, please contact your Account Executive or Account Manager.
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