Core Plans – 2025

A high deductible plan that can be paired with a health savings account (HSA).

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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
  • No cost for preventative services.

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.

At-A-Glance

Gold Plan Bronze Plan
Single Plan Family Plan Single Plan Family Plan
HSA Eligible
Learn More
Yes Yes Yes Yes
Participant deductible $1,650 NA $6,000 NA
Family deductible NA $3,200 NA $12,000
Participant out-of-pocket $7,000 $7,000 $7,150 $7,150
Family out-of-pocket NA $14,000 NA $14,300
Coinsurance

BCBSWY Pays

Participant Pays

 

80%

20%

 

80%

20%

 

50%

50%

 

50%

50%

Preventive Care Paid at 100% of maximum allowable amount at appropriate intervals when services are rendered by a network provider. Paid at 100% of maximum allowable amount at appropriate intervals when services are rendered by a network provider.
Primary Care

Copay

 

Subject to the deductible & coinsurance

 

Subject to the deductible & coinsurance

 

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

 

Subject to the deductible & coinsurance

 

Subject to the deductible & coinsurance

Summary of Benefits and Coverage (SBC) View SBC » View 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. 

Rx Tools

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

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