Gold Plan


With Gold Plans, you pay about 20% of your medical costs along with your monthly premium. BlueCross BlueShield of Western New York pays for the first $500/$1000 in medical claims. This is referred to as "1st dollar."

For more information, contact us at 1-888-249-2583.

 





Aqua
In-Network:
     Deductible (single/family) $500 / $1,000 after 1st dollar
     Coinsurance 20% after 1st dollar and deductible 
     Out-of-Pocket Maximum (single/family) $5,000 / $10,000
Medical Services:
     PCP/Specialist Visit 20% after 1st dollar and deductible 
Hospital Services:
     Inpatient Hospital 20% after 1st dollar coverage
     Outpatient Surgery 20% after 1st dollar and deductible
     Emergency Room Visit 20% after 1st dollar and deductible
     Urgent Care 20% after 1st dollar and deductible
Prescription Drugs*
     Generic/Formulary/Non-Formulary $15 / $50 / 50% 
Rates (Single/Family):
     Single $445
     Employee/Child $756
     Employee/Spouse $889
     Family $1,267
     Pediatric Dental Rate $19





*Generic oral contraceptives are covered in full.
*Mail order drugs are 2.5 copays / 90 day supply.
*Pediatric Dental is an essential health benefit required for dependents under the age of 19. Optional coverage is available with all plans.