Self-Pay Plans
If you become eligible for COBRA coverage or Extended Self-pay Coverage, you may have the option
of choosing the following:
- DGA Gold Plan;
- DGA Silver Plan; or
- DGA Bronze Plan.
The chart below summarizes the differences between your coverage options. For a more detailed explanation of the plans, refer to the March 2020 Health Plan Summary Plan Description beginning on page 22.
DGA–Producer Health Plan Self-Pay Plans |
 Gold Plan |
 Silver Plan |
 Bronze Plan |
|---|---|---|---|
| Medical Coverage | Yes | Yes | Yes |
| Prescription Coverage | Yes | Yes | No |
| Dental Coverage | Yes | No | No |
| Vision Coverage | Yes | No | No |
| Individual Deductible | $325 | $325 | $750 |
| Family Deductible | $975 | $975 | $2,250 |
| Network Co-insurance | 90% | 90% | 70% |
| Network Out of Pocket Limit | $1,000 | $1,000 | $9,450 |
| Non-Network Co-insurance | 70%-Premier Gold* 60%-Choice Gold* |
60% | 50% |
| Non-Network Out of Pocket Limit | $3,550 – Premier Gold* $8,900 – Choice Gold* |
$8,900 | $12,500 |
Once you elect self-pay coverage, you may not switch to a more expensive plan for as long as you remain on self-pay coverage (unless you subsequently requalify for Earned Coverage).
The DGA Gold Plan offers two levels of coverage: a premier level and a choice level. These coverage levels do not affect benefits eligibility but do affect the non-network co-insurance and non-network out of pocket limits for this plan. Participant eligibility for premier or choice level coverage is determined by their plan coverage immediately prior to becoming eligible for a self-pay plan.
For more information, see the DGA Gold Plan section of the March 2020 Health Plan Summary Plan Description beginning on page 22.
