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.
|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|
|PCP/Specialist Visit||20% after 1st dollar and deductible|
|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|
|Generic/Formulary/Non-Formulary||$15 / $50 / 50%|
|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.