Bronze  2017 Small Group Plans

Our Bronze plans are our most affordable plans with the lowest monthly premiums. View plan details below. Please note, all premiums listed represent coverage for dependents up to age 26. 

If your clients are part of an existing group with BlueCross BlueShield of Western New York, visit BlueConnect to enroll or contact the appropriate account executive. If your clients are a new group and would like to enroll in a Bronze plan, please contact the appropriate new sales representative.

  Bronze Standard Bronze POS 8100EX Bronze PPO 8100 Bronze align*
Bronze focus*
Monthly Premium        
   Single $364.00 $401.09 $450.54 $349.40
   Employee & Child $618.80 $681.85 $765.92 $593.98
   Employee and spouse/domestic partner $728.00 $802.18 $901.08 $698.80
   Family $1,037.40 $1,143.10 $1,284.04 $995.80
Primary Care Doctor/Specialist 50% after deductible 20% after deductible 20% after deductible 50% after deductible, Optimum/Preferred
0% AD, Flexible Choice/Participating
Deductible (Single/Family) $4,000/$8,000
embedded
$5,500/$11,000
embedded
$5,500/$11,000
embedded
$7,000/$14,000 embedded
Optimum Choice/Preferred
$7,150/$14,300 embedded
Flexible Choice/Participating
Inpatient Hospital Stay (per admission) 50% after deductible 20% after deductible 50% after deductible 50% after deductible, Optimum/Preferred
0% AD, Flexible Choice/Participating
Prescription Drugs:        
   Tier 1/2/3 $10/$35/$70
after deductible
$15/$50/50%
after deductible
 $15/$50/50%
after deductible
 $10/50%/50%
after deductible
   Generic Oral Contraceptives Covered in full Covered in full Covered in full Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply 2.5 Copays/90-day supply 2.5 Copays/90-day supply 2.5 Copays/90-day supply
 

Benefits & Coverage

Benefits & Coverage

Benefits & Coverage

Benefits & Coverage, align

 

Benefits & Coverage, focus

* Available in Erie & Niagara counties only
Bronze Standard
   
Monthly Premium  
   Single $364.00
   Employee & Child $618.80
   Employee and spouse/domestic partner $728.00
   Family $1,037.40
Primary Care Doctor/Specialist 50% after deductible
Deductible (Single/Family) $4,000 / $8,000 embedded
Inpatient Hospital Stay (per admission) 50% after deductible
Prescription Drugs:  
   Tier 1/2/3 $10/$35/$70 after deductible
   Generic Oral Contraceptives Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Bronze  POS 8100EX
   
Monthly Premium  
   Single $401.09
   Employee & Child $681.85
   Employee and spouse/domestic partner $802.18
   Family $1,143.10
Primary Care Doctor/Specialist 20% after deductible
Deductible (Single/Family) $5,500 / $11,000 embedded
Inpatient Hospital Stay (per admission) 20% after deductible
Prescription Drugs:  
   Tier 1/2/3 $15/$50/50% after deductible
   Generic Oral Contraceptives Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Bronze  PPO 8100
   
Monthly Premium  
   Single $450.54
   Employee & Child $765.92
   Employee and spouse/domestic partner $901.08
   Family $1,284.04
Primary Care Doctor/Specialist 20% after deductible
Deductible (Single/Family) $5,500 / $11,000 embedded
Inpatient Hospital Stay (per admission) 20% after deductible
Prescription Drugs:  
   Tier 1/2/3 $15/$50/50% after deductible
   Generic Oral Contraceptives Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Bronze align* & focus*
   
Monthly Premium  
   Single $349.40
   Employee & Child $593.98
   Employee and spouse/domestic partner $698.80
   Family $995.80
Primary Care Doctor/Specialist 50% after deductible, Optimum/Preferred
0% after deductible, Flexible Choice/Participating
Deductible (Single/Family) $7,150/$14,300 Flexible Choice/Optimum Participating
Inpatient Hospital Stay (per admission)
50% after deductible, Optimum/Preferred
0% after deductible, Flexible Choice/Participating
Prescription Drugs:  
   Tier 1/2/3  $10/50%/50% after deductible
   Generic Oral Contraceptives Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage, align

Benefits & Coverage, focus

Visit BlueConnect to enroll or contact the appropriate account executive. If your clients are a new group and would like to enroll in a Bronze plan, please contact the appropriate new sales representative.

Fourth Quarter Bronze Standard Bronze POS 8100EX Bronze PPO 8100 Bronze Value
Monthly Premium        
   Single $336.60 $362.97 $397.91 $339.14
   Employee & Child $572.22 $617.05 $676.45 $576.54
   Employee and spouse/domestic partner $673.20 $725.94 $795.82 $678.28
   Family $959.31 $1,034.47 $1,132.04 $966.55
Primary Care Doctor/Specialist 50% after deductible 20% after deductible 20% after deductible 0% after deductible
Deductible (Single/Family) $3,500 / $7,000 embedded  $5,000/$10,000 embedded  $5,000 / $10,000 embedded  $6,450/$12,900 embedded 
Inpatient Hospital Stay (per admission) 50% after deductible 20% after deductible 20% after deductible 0% after deductible
Prescription Drugs:        
   Tier 1/2/3 $10/$35/$70 after deductible $5/$30/ 50% after deductible  $5/$30/ 50% after deductible $0/0%/0% after deductible
   Generic Oral Contraceptives Covered in full Covered in full Covered in full Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply 2.5 Copays/90-day supply 2.5 Copays/90-day supply 2.5 Copays/90-day supply
 

Benefits & Coverage

Benefits & Coverage

Benefits & Coverage

Benefits & Coverage

 
Bronze Standard
Fourth Quarter  
Monthly Premium  
   Single $336.60
   Employee & Child $572.22
   Employee and spouse/domestic partner $673.20
   Family $959.31
Primary Care Doctor/Specialist 50% after deductible
Deductible (Single/Family) $3,500/$7,000 embedded 
Inpatient Hospital Stay (per admission) 50% after deductible
Prescription Drugs:  
   Tier 1/2/3 $10/$35/$70 after deductible
   Generic Oral Contraceptives Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Bronze  POS 8100EX
Fourth Quarter  
Monthly Premium  
   Single $362.97
   Employee & Child $617.05
   Employee and spouse/domestic partner $725.94
   Family $1,034.47
Primary Care Doctor/Specialist 20% after deductible
Deductible (Single/Family) $5,000/$10,000 embedded 
Inpatient Hospital Stay (per admission) 20% after deductible
Prescription Drugs:  
   Tier 1/2/3 $5/$30/50% after deductible
   Generic Oral Contraceptives Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Bronze  PPO 8100
Fourth Quarter  
Monthly Premium  
   Single $397.91
   Employee & Child $676.45
   Employee and spouse/domestic partner $795.82
   Family $1,134.04
Primary Care Doctor/Specialist 20% after deductible
Deductible (Single/Family) $5,000 / $10,000
Inpatient Hospital Stay (per admission) 20% after deductible
Prescription Drugs:  
   Tier 1/2/3 $5/$30/50% after deductible
   Generic Oral Contraceptives Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Bronze Value
Fourth Quarter  
Monthly Premium  
   Single $339.14
   Employee & Child $576.54
   Employee and spouse/domestic partner $678.28
   Family $966.55
Primary Care Doctor/Specialist 0% after deductible
Deductible (Single/Family) $6,450/$12,900 embedded 
Inpatient Hospital Stay (per admission) 0% after deductible
Prescription Drugs:  
   Tier 1/2/3 $0/0%/0% after deductible
   Generic Oral Contraceptives Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Benefits of Blue

BlueConnect

A comprehensive online benefits solution.

Wellness Card

Offered with every small group plan.

Preventive Services

$0 preventive drugs for small group plans.

Tiered Plan Benefits

Keep costs in line while having choices.