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  • Available in Gold and Silver plans
  • Covers six primary care office visits at a low copay per visit
  • Gives you access to certain drugs for chronic disease treatment at a lower or no cost copay. See drug list »
  • Lower or no cost for certain lab services to monitor and treat chronic diseases, such as diabetes, hypertension, coronary artery disease, chronic heart failure and asthma.

A good option if you have a chronic disease or health problem which is best controlled by regular visits to your doctor and appropriate drug therapy, and you would like to maintain the best health possible with the least impact to your out-of-pocket costs.

 

HSA Eligible
Learn More »

No

No

Participant deductible

$1,000

$3,500

Family deductible

$2,000

$7,000

Participant out-of-pocket

$7,350

$7,350

Family out-of-pocket

$14,700

$14,700

Coinsurance

BCBSWY Pays

Participant Pays

 

80%

20%

 

75%

25%

Preventive Care

Paid at 100% of maximum allowable amount at appropriate intervals.

Primary Care

Copay

 

$30

 

$45

Prescription Drugs

Tier 1: Generic Drugs

Tier 2: Preferred Brand drugs

 

$5/$0 copay

$20/$10 copay

 

$5/$0 copay

$50/$25 copay

Summary of Benefits
and Coverage (SBC)

View SBC »

View SBC »

 

*At-a-Glance is intended to be a condensed overview of some plan benefits and does not cover all benefits or information contained in the Benefit Document. Limitations and exclusions do exist. At-a-Glance is not a contract. For exact benefits and limitations, please request a copy of the Benefit Document.

 

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