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   $451.32
     Employee/Child   $767.24
     Employee/Spouse   $902.64
     Family $1,286.26
     Pediatric Dental Rate      $14.61
   
 
 

 

*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 independents under the age of 19.Optional coverage is available with all plans.