Basic Plan

Serves as a safety net for large medical costs.

Overview

  • Simple plan option.
  • Premiums are typically lower.
  • Highest deductible plan.
  • No coinsurance to pay.

Good option if...

you would like a “safety net” to cover large medical costs in case of a major accident or illness.

At-A-Glance

Bronze Plan
HSA Eligible

Learn More

No
Participant deductible $8,550
Family deductible $17,100
Participant out-of-pocket $8,550
Family out-of-pocket $17,100
Coinsurance

BCBSWY Pays

Participant Pays

 

100%

0%

Preventive Care Paid at 100% of maximum allowable amount at appropriate intervals.
Primary Care

Copay

 

Subject to the deductible & coinsurance


Prescription Drugs

Tier 1: Generic Drugs

Tier 2: Preferred Brand drugs

 

 

Subject to the deductible & coinsurance

Subject to the deductible & coinsurance

Summary of Benefits and Coverage (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 Booklet.  Limitations and exclusions do exist.  At-a-Glance is not a contract.  For exact benefits and limitations, please request a copy of the Benefit Booklet.

Cost Assistance

Based on certain income requirements, you may qualify for assistance, through government subsidies, with your monthly premiums. 

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Rx Tools

Find important information on your prescriptions, including how to select a pharmacy, request prescription benefits, and more.

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