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Standard Plans

Key coverage you can count on.

Overview

  • Flexible copayment options
  • Premiums are typically lower
  • Higher deductible plans
  • Does not include kids dental options

Good option if...

you’d like a straightforward plan to cover large medical expenses.

At-A-Glance

Gold Plan Silver Plan Bronze Plan
HSA Eligible

Learn More

No No No
Participant deductible $2,000 $5,800 $9,100
Family deductible $4,000 $11,600 $18,200
Participant out-of-pocket $8,700 $8,900 $9,100
Family out-of-pocket $17,400 $17,800 $18,200
Coinsurance

BCBSWY Pays

Participant Pays

 

75%

25%

 

60%

40%

 

100%

0%

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

Copay
 

$30

 

$40

Subject to the
deductible &
coinsurance
Prescription Drugs
 
Tier 1: Generic Drugs  $15 copay $20 copay Subject to the
deductible &
coinsurance
 Tier 2: Preferred Brand drugs $30 copay $40 copay Subject to the
deductible &
coinsurance
Summary of Benefits and Coverage (SBC)
View SBC

View SBC

View SBC

*This plan does not include kid’s dental coverage.

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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