Gold  2017 Small Group Plans

Our Gold plans have a robust level of coverage combined with low cost-sharing. View the 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 Gold plan, please contact your broker or account executive.

  Gold Standard Gold align*
Gold focus*
Gold Aqua
$500/$1,000 first dollar
Gold Complete
Monthly Premium        
  Single $490.51 $444.49 $461.37 $446.55
  Employee & Child(ren) $833.87 $755.64 $784.33 $759.14
  Employee & spouse/domestic partner $981.02 $888.98 $922.74 $893.10
  Family $1,397.95 $1,266.80 $1,314.91 $1,272.67
Primary Care Doctor/Specialist $25/$40
after deductible
$20/40 after deductible,
Optimum/Preferred

40% after deductible,
Flexible/Participating
20% after first dollar and deductible  0% after deductible 
Deductible (Single/Family) $600/$1,200 embedded $1,300/$2,600 true family,
Optimum/Preferred

$1,300/$2,600 true family,
Flexible/Participating
$1,000/$2,000 embedded  $2,500/ $5,000
true family 
Inpatient Hospital Stay (per admission) $1,000 after deductible  $500 after deductible,
Optimum/Preferred

40% after deductible,
Flexible/Participating 
20% after first dollar  0% after deductible 
Prescription Drugs:        
   Tier 1/2/3 $10/$35/$70  $5/$30/$50 after deductible $15/$50/50%  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, align

 

Benefits & Coverage, focus

Benefits & Coverage

Benefits & Coverage

  Gold POS 7100 NQ Gold POS 7100
Gold POS 7100 EX Gold PPO 7100
Monthly Premium        
   Single $473.41 $468.74 $492.86 $555.28
   Employee & Child(ren) $804.79 $796.86 $837.87 $943.98
   Employee & spouse/domestic partner $946.82 $937.48 $985.72 $1,110.56
   Family $1,349.22 $1,335.91 $1,404.65 $1,582.55
Primary Care Doctor/Specialist $20/$40 after deductible  $20/$40  after deductible     $20/$40  after deductible $20/$40  after deductible
Deductible (Single/Family) $1,300/$2,600 embedded  $1,300/$2,600 true family $1,300/$2,600 true family

$1,300/$2,600 true family
 
Inpatient Hospital Stay (per admission)  $500 after deductible $500 after deductible $500 after deductible $500 after deductible
Prescription Drugs:        
   Tier 1/2/3 $5/$30/$50  $5/$30/$50 after deductible $5/$30/$50 after deductible $5/$30/$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

*Available in Erie & Niagara counties only.

Gold Standard
   
Monthly Premium  
   Single $490.51
   Employee & Child(ren) $833.87
   Employee and spouse/domestic partner  $981.02
   Family $1,397.95
Primary Care Doctor/Specialist $25/$40  after deductible
Deductible (Single/Family) $600/$1,200 embedded 
Inpatient Hospital Stay (per admission)  $1,000 after deductible 
Prescription Drugs:  
   Tier 1/2/3 $10/$35/$70 
   Generic Oral Contraceptives Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Gold align* & Gold focus*
   
Monthly Premium  
   Single $444.49
   Employee & Child(ren) $755.64
   Employee and spouse/domestic partner  $888.98
   Family $1,266.80
Primary Care Doctor/Specialist $20/$40 after deductible, Optimum/Preferred
40% after deductible, Flexible/Participating 
Deductible (Single/Family) $1,300/$2,600 true family, Optimum/Preferred
$1,300/$2,600 true family, Flexible/Participating 
Inpatient Hospital Stay (per admission) $500 after deductible, Optimum/Preferred
40% after deductible, Flexible/Participating 
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, Align

 

Benefits & Coverage, Focus

Gold Aqua
   
Monthly Premium  
   Single $461.37
   Employee & Child(ren) $784.33
    Employee and spouse/domestic partner $922.74
   Family $1,314.91
Primary Care Doctor/Specialist 20% after first dollar and deductible 
Deductible (Single/Family) $1,000/$2,000 embedded 
Inpatient Hospital Stay (per admission)  20% after first dollar 
Prescription Drugs:  
   Tier 1/2/3 $15/$50/50% 
   Generic Oral Contraceptives Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Gold Complete
   
Monthly Premium  
   Single $446.55
   Employee & Child(ren) $759.14
   Employee & spouse/domestic partner  $893.10
   Family $1,272.67
Primary Care Doctor/Specialist 0% after deductible
Deductible (Single/Family) $2,500/$5,000 true family 
Inpatient Hospital Stay (per admission)  0% after deductible
Prescription Drugs:  
   Tier 1/2/3 0% after deductible
   Generic Oral Contraceptives Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Gold POS 7100 NQ
   
Monthly Premium  
   Single $473.41
   Employee & Child $804.79
   Employee & spouse/domestic partner  $946.82
   Family $1,349.22
Primary Care Doctor/Specialist $20/$40 after deductible
Deductible (Single/Family) $1,300/$2,600 embedded 
Inpatient Hospital Stay (per admission) $500 after deductible
Prescription Drugs:  
   Tier 1/2/3 $5/$30/$50 
   Generic Oral Contraceptives Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Gold POS 7100
   
Monthly Premium  
   Single $468.74
   Employee & Child(ren) $796.86
   Employee & spouse/domestic partner  $937.48
   Family $1,335.91
Primary Care Doctor/Specialist $20/$40 after deductible 
Deductible (Single/Family) $1,300/$2,600 true family 
Inpatient Hospital Stay (per admission)  $500 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

Gold POS 7100 EX
   
Monthly Premium  
   Single $492.86
   Employee & Child(ren) $837.87
   Employee & spouse/domestic partner  $985.72
   Family $1,404.65
Primary Care Doctor/Specialist $20/$40  after deductible
Deductible (Single/Family) $1,300/$2,600 true family 
Inpatient Hospital Stay (per admission)  $500 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

Gold PPO 7100
   
Monthly Premium  
   Single $555.28
   Employee & Child(ren) $943.98
   Employee & spouse/domestic partner  $1,110.56
   Family $1,582.55
Primary Care Doctor/Specialist $20/$40 after deductible
Deductible (Single/Family) $1,300/$2,600 true family 
Inpatient Hospital Stay $500 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

>> View Gold Plan Contracts

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

If you are already part of a group, visit BlueConnect to enroll. If you are a new group and would like to enroll in a Gold plan, please contact your broker or account executive.

Fourth Quarter Gold Standard* Gold align**
Gold Aqua Gold POS 7100
Monthly Premium        
   Single $456.29 $406.91 $444.14 $430.98
   Employee & Child(ren) $775.69 $691.75 $755.04 $732.67
   Employee and spouse/domestic partner $912.58 $813.82 $888.28 $861.96
   Family $1,300.43 $1,159.69 $1,265.80 $1,228.29
Primary Care Doctor/Specialist $25/$40 after deductible $20/40 after deductible, Optimum
$20/40% after deductible, Flexible
20% after first dollar and deductible  20% after first dollar and deductible 
Deductible (Single/Family) $600 / $1,200 embedded  $1,300/$2,600 true family  $1,000 / $2,000 embedded  $1,300/$2,600 true family  
Inpatient Hospital Stay (per admission) $1,000 after deductible  $500 after deductible, Optimum
$40% after deductible Flexible 
20% after first dollar  20% after first dollar 
Prescription Drugs:        
   Tier 1/2/3 $10 / $35 / $70 $5 / $30 / $50 after deductible $15 / $50 / 50% $15/$50/50%
   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

Fourth Quarter Gold POS 7100EX Gold PPO 7100
Monthly Premium      
   Single $458.32 $503.83
   Employee & Child $779.14 $856.52
   Employee and spouse/domestic partner $916.64 $1,007.66
   Family $1,306.21 $1,435.92
Primary Care Doctor/Specialist $20/$40 after deductible $20/$40 after deducdible 
Deductible (Single/Family) $1,300/$2,600 true family  $1,300/$2,600 true family 
Inpatient Hospital Stay $500 after deductible $500 after deductible
Prescription Drugs:    
   Tier 1/2/3 $5/$30/50% after deductible  $5 / $30 / 50% after deductible
   Generic Oral Contraceptives Covered in full Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply 2.5 Copays/90-day supply
 

Benefits & Coverage

Benefits & Coverage

*Available on SHOP
**Available in Erie and Niagara counties only

Gold Standard*
Fourth Quarter   
Monthly Premium  
   Single $456.29
   Employee & Child $775.69
   Employee and spouse/domestic partner  $912.58
   Family $1,300.43
Primary Care Doctor/Specialist $25/$40  after deductible
Deductible (Single/Family) $600 / $1,200 embedded 
Inpatient Hospital Stay (per admission)  $1,000 after deductible 
Prescription Drugs:  
   Tier 1/2/3 $10/$35/$70 
   Generic Oral Contraceptives Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

*Available on SHOP

Gold Aqua
Fourth Quarter   
Monthly Premium  
   Single $444.14
   Employee & Child $755.04
   Employee and spouse/domestic partner  $888.28
   Family $1,265.80
Primary Care Doctor/Specialist 20% after first dollar and deductible 
Deductible (Single/Family) $1,000/$2,000 embedded 
Inpatient Hospital Stay (per admission)  20% after first dollar 
Prescription Drugs:  
   Tier 1/2/3 $15/$50/50%
   Generic Oral Contraceptives Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Gold align**
Fourth Quarter   
Monthly Premium  
   Single $406.91
   Employee & Child $691.75
   Employee and spouse/domestic partner  $813.82
   Family $1,159.69
Primary Care Doctor/Specialist $20/$40  after deductible, Optimum
$20/40% after deductible, Flexible 
Deductible (Single/Family) $1,300/$2,600 true family 
Inpatient Hospital Stay (per admission)  $500 after deductible, Optimum
40% after deductible, Flexible 
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

**Available in Erie and Niagara counties only

Gold POS 7100
Fourth Quarter   
Monthly Premium  
   Single $430.98
   Employee & Child $732.67
   Employee and spouse/domestic partner  $861.96
   Family $1,228.29
Primary Care Doctor/Specialist $20/$40  after deductible
Deductible (Single/Family) $1,300/$2,600 true family 
Inpatient Hospital Stay (per admission)  $500 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

Gold POS 7100EX
Fourth Quarter   
Monthly Premium  
   Single $458.32
   Employee & Child $779.14
   Employee and spouse/domestic partner  $916.64
   Family $1,306.21
Primary Care Doctor/Specialist $20/$40  after deductible
Deductible (Single/Family) $1,300/$2,600 true family 
Inpatient Hospital Stay (per admission)  $500 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

Gold PPO 7100
Fourth Quarter   
Monthly Premium  
   Single $503.83
   Employee & Child $856.52
   Employee and spouse/domestic partner  $1,007.66
   Family $1,435.92
Primary Care Doctor/Specialist $20/$40  after deductible
Deductible (Single/Family) $1,300/$2,600 true family  
Inpatient Hospital Stay (per admission)  $500 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

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.