Bronze  2018 Small Group Plans, Q1

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

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

  Bronze Standard* Bronze POS 8100EX Bronze PPO 8100 Bronze align**
Bronze focus**
Monthly Premium        
   Single $409.87 $449.45 $514.10 $393.27
   Employee & Child $819.74 $764.07 $873.97 $668.56
   Employee and spouse/domestic partner $696.78 $898.90 $1,028.20 $786.54
   Family $1,168.13 $1,280.93 $1,465.18 $1,120.82
Primary Care Doctor/Specialist 50% after deductible 20% after deductible 20% after deductible 50% after deductible, Optimum
0% after deductible, Flexible
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
$7,350/$14,700 embedded, Flexible
Inpatient Hospital Stay (per admission) 50% after deductible 20% after deductible 20% after deductible 50% after deductible, Optimum
0% after deductible, Flexible 
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 on SHOP
**Available in Erie & Niagara counties only
Bronze Standard*
   
Monthly Premium  
   Single $409.87
   Employee & Child $696.78
   Employee and spouse/domestic partner $819.74
   Family $1,168.13
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

 

*Available on SHOP

Bronze  POS 8100EX
   
Monthly Premium  
   Single $449.45
   Employee & Child $764.07
   Employee and spouse/domestic partner $898.90
   Family $1,280.93
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 $514.10
   Employee & Child $873.97
   Employee and spouse/domestic partner $1,028.20
   Family $1,465.18
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** & Bronze focus**
   
Monthly Premium  
   Single $393.27
   Employee & Child $668.56
   Employee and spouse/domestic partner $786.54
   Family $1,120.82
Primary Care Doctor/Specialist 50% after deductible, Optimum
0% after deductible, Flexible Choice
Deductible (Single/Family) $7,000/$14,000 embedded, Optimum
$7,350/$14,700 embedded, Flexible
Inpatient Hospital Stay (per admission) 50% after deductible, Optimum
0% after deductible, Flexible
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

**Available in Erie and Niagara counties only.

>> View Bronze Plan Contracts

>> Select preventive drugs are a $0 cost-share; not subject to deductible on select plans. 

Visit BlueConnect to enroll. If you are a new group and would like to enroll in a Bronze plan, please contact your broker or account executive.

Fourth Quarter Bronze Standard Bronze POS 8100EX Bronze PPO 8100 Bronze align*
Bronze focus*
Monthly Premium        
   Single $382.88 $421.89 $473.91 $367.53
   Employee & Child $650.90 $717.21 $805.64 $624.81
   Employee and spouse/domestic partner $765.76 $843.78 $947.82 $735.06
   Family $1,091.21 $1,202.39 $1,350.65 $1,047.46
Primary Care Doctor/Specialist 50% after deductible 20% after deductible 20% after deductible 50% after deductible,
Optimum/Preferred

50% after deductible/0% after deductible,
Flexible/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/Preferred

$7,150/14,300 embedded,
Flexible /Participating
Inpatient Hospital Stay (per admission) 50% after deductible 20% after deductible 20% after deductible 50% after deductible,
Optimum/Preferred

0% after deductible,
Flexible/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
50% after deductible, Optimum/Preferred
0% AD, Flexible Choice/Participating
50% after deductible, Optimum/Preferred
0% AD, Flexible Choice/Participating
Bronze Standard
Fourth Quarter  
Monthly Premium  
   Single $382.88
   Employee & Child $650.90
   Employee and spouse/domestic partner $765.76
   Family $1,091.21
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
Fourth Quarter  
Monthly Premium  
   Single $421.89
   Employee & Child $717.21
   Employee and spouse/domestic partner $843.78
   Family $1,202.39
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
Fourth Quarter  
Monthly Premium  
   Single $473.91
   Employee & Child $805.64
   Employee and spouse/domestic partner $947.82
   Family $1,350.65
Primary Care Doctor/Specialist 20% after deductible
Deductible (Single/Family) $5,500 / $11,000
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* & Bronze  focus*
Fourth Quarter  
Monthly Premium  
   Single $367.53
   Employee & Child $624.81
   Employee and spouse/domestic partner $735.06
   Family $1,047.46
Primary Care Doctor/Specialist 50% after deductible, Optimum Choice/Preferred

50% after deductible/0% after deductible, Flexible/Participating
Deductible (Single/Family) $7,000/$14,000 embedded,  Optimum/Preferred

$7,150/$14,300 embedded, Flexible/Participating
Inpatient Hospital Stay (per admission)  50% after deductible, Optimum/Preferred

 0% after deductible, Flexible/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

**Available in Erie and Niagara counties only

Benefits of Blue

BlueConnect

A comprehensive online benefits solution.

Wellness Card

Offered with every small group plan.

Preventive Services

$0 preventive services.

Tiered Plan Benefits

Keep costs in line while having choices.