Core Plan

Maximize your HSA, get the preventative care you need.

Overview

  • A high deductible plan.
  • Health Savings Account (HSA) eligible – a tax free savings account used to pay your out-of-pocket costs.  Learn about HSAs

Good option if...

you consider yourself healthy and typically get health care for preventive services, occasional illness or accidents, and you have the means to contribute to your HSA.
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At-A-Glance

 Bronze Plan
 Single PlanFamily Plan

HSA Eligible

Learn More

YesYes
Participant deductible$4,500NA
Family deductibleNA$9,000
Participant out-of-pocket$6,750$6,750
Family out-of-pocketNA$13,500

Coinsurance

BCBSWY Pays

Participant Pays

 

50%

50%

 

50%

50%

Preventive CarePaid at 100% of maximum allowable amount at appropriate intervals.

Primary Care

Copay

 

Subject to the deductible

& coinsurance

 

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 » 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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