Silver 2018 Small Group Plans, Q2

Our Silver plans offer a variety of coverage options at lower than average premiums. View plan details below. Please note, all premiums listed represent coverage for dependents up to age 26. 

 

Region 1: Albany, Columbia, Fulton, Greene, Montgomery, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, and Washington.

Region 7: Clinton & Essex

 

If you are an existing group with BlueShield of Northeastern New York, visit BlueConnect to enroll. If you are a new group and would like to enroll in a Silver plan, please contact your broker or account executive.

 
Region 1 Silver Standard Silver POS Hybrid Silver EPO 6300 Silver PPO 8000
Monthly Premium        
   Single $546.04 $553.69 $602.91 $612.04
   Employee and child $928.26 $941.28 $1,024.96 $1,040.48
   Employee and spouse/domestic partner $1,092.07
$1,107.39 $1,205.96 $1,224.09
   Family $1,556.21 $1,578.05 $1,718.32 $1,744.32
Primary Care Doctor/Specialist $30/$50 after deductible $40/$60 $40/$60 after dedutible

0% after deductible
Deductible (Single/Family) $2,000/$4,000 embedded $6,350/$12,700 embedded $1,350/$2,700 true family $3,250/$6,500 embedded
Inpatient Hospital (per admission) $1,500 after deductible 20% after deductible $500 after deductible   0% after deductible
Prescription Drugs:        
   Tier 1/2/3 $10/$35/$70  $4/$50/$100
$4/$35/$70 after
deductible
 $10/$35/$70 after
deductible
   Generic Oral Contraceptives Covered in full Covered in full Covered in full Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply 2.5 Copays/90-day supply 2.5 Copays/90-day supply 2.5 Copays/90-day supply
 

Benefits & Coverage

Benefits & Coverage

Benefits & Coverage

Benefits & Coverage

 

 
Region 1 Silver EX 8000 Silver POS 8000 Silver  EPO 8000
Monthly Premium        
   Single $566.82 $543.91 $593.43
   Employee and child $963.59 $924.65 $1,008.82
   Employee and spouse/domestic partner $1,133.63 $1,087.82 $1,186.85
   Family $1,615.42 $1,550.14 $1,691.26
Primary Care Doctor/Specialist 0% after deductible $0 after deductible $0 after deductible
Deductible (Single/Family) $3,250/$6,500 embedded $3,250/$6,500 embedded $3,250/$6,500 embedded 
Inpatient Hospital Stay 0% after deductible 0% after deductible 0% after deductible 

Prescription Drugs:      
   Tier 1/2/3 $10/$35/$70 after deductible $10/$35/$70 after deductible $10/$35/$70 embedded
   Generic Oral Contraceptives Covered in full Covered in full Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply 2.5 Copays/90-day supply 2.5 Copays/90-day supply
 

Benefits & Coverage

Benefits & Coverage

Benefits & Coverage

 

 
Region 7 Silver Standard Silver POS Hybrid Silver EPO 6300 Silver PPO 8000
Monthly Premium        
   Single $658.03 $667.39 $727.59 $738.76
   Employee and child $1,118.65 $1,134.56 $1,236.91 $1,255.89
   Employee and spouse/domestic partner $1,316.05 $1,334.77 $1,455.20 $1,477.52
   Family $1,875.37 $1,902.04 $2,073.66 $2,105.47
Primary Care Doctor/Specialist $30/$50 after deductible $40/$60 $40/$60 after dedutible

0% after deductible
Deductible (Single/Family) $2,000/$4,000 embedded $6,350/$12,700 embedded $1,350/$2,700 true family $3,250/$6,500 embedded
Inpatient Hospital (per admission) $1,500 after deductible 20% after deductible $500 after deductible   0% after deductible
Prescription Drugs:        
   Tier 1/2/3 $10/$35/$70  $4/$50/$100 $4/$35/$70 after
deductible
 $10/$35/$70 after
deductible
   Generic Oral Contraceptives Covered in full Covered in full Covered in full Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply 2.5 Copays/90-day supply 2.5 Copays/90-day supply 2.5 Copays/90-day supply
 

Benefits & Coverage

Benefits & Coverage

Benefits & Coverage

Benefits & Coverage

 

 
Region 7 Silver EX 8000 Silver POS 8000 Silver  EPO 8000
Monthly Premium        
   Single $683.43 $655.41 $715.98
   Employee and child $1,161.83 $1,114.18 $1,217.18
   Employee and spouse/domestic partner $1,366.86 $1,310.80 $1,431.98
   Family $1,947.77 $1,867.90 $2,040.57
Primary Care Doctor/Specialist 0% after deductible $0 after deductible $0 after deductible
Deductible (Single/Family) $3,250/$6,500 embedded $3,250/$6,500 embedded $3,250/$6,500 embedded 
Inpatient Hospital Stay 0% after deductible 0% after deductible 0% after deductible 

Prescription Drugs:      
   Tier 1/2/3 $10/$35/$70 after deductible $10/$35/$70 after deductible $10/$35/$70 embedded
   Generic Oral Contraceptives Covered in full Covered in full Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply 2.5 Copays/90-day supply 2.5 Copays/90-day supply
 

Benefits & Coverage

Benefits & Coverage

Benefits & Coverage

 

Silver Standard
Region 1  
Monthly Premium  
   Single $546.04
   Employee and child $928.26
   Employee and spouse/
domestic partner
$1,092.07
   Family $1,556.21
Primary Care
Doctor/Specialist
$30/$50 after deductible
Deductible (Single/Family) $2,000/$4,000 embedded
Inpatient Hospital
(per admission)
$1,500 after deductible
Prescription Drugs:  
   Tier 1/2/3 $10/$35/$70
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Silver Standard
Region 7  
Monthly Premium  
   Single $658.03
   Employee and child $1,118.65
   Employee and spouse/
domestic partner
$1,316.05
   Family $1,875.37
Primary Care
Doctor/Specialist
$30/$50 after deductible
Deductible (Single/Family) $2,000/$4,000 embedded
Inpatient Hospital
(per admission)
$1,500 after deductible
Prescription Drugs:  
   Tier 1/2/3 $10/$35/$70
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Summary

Silver  POS Hybrid
Region 1  
Monthly Premium  
   Single $553.69
   Employee and child $941.28
   Employee and spouse/
domestic partner
$1,107.39
   Family $1,578.05
Primary Care
Doctor/Specialist
$40/$60
Deductible (Single/Family)$40/. $6,350/$12,700 embedded
Inpatient Hospital
(per admission)
20% after deductible
Prescription Drugs:  
   Tier 1/2/3 $4/$50/$100
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Summary

Silver  POS Hybrid
Region 7  
Monthly Premium  
   Single $667.39
   Employee and child $1,134.56
   Employee and spouse/
domestic partner
$1,334.77
   Family $1,902.04
Primary Care
Doctor/Specialist
$40/$60
Deductible (Single/Family) $6,350/$12,700 embedded
Inpatient Hospital
(per admission)
20% after deductible
Prescription Drugs:  
   Tier 1/2/3 $4/$50/$100
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Summary

Silver EPO 6300
Region 1  
Monthly Premium  
   Single $602.91
   Employee and child $1,024.96
   Employee and spouse/
domestic partner
$1,205.84
   Family $1,718.32
Primary Care
Doctor/Specialist
$40/$60 after deductible
Deductible (Single/Family) $1,350/$2,700 true family
Inpatient Hospital
(per admission)
$500 after deductible
Prescription Drugs:  
   Tier 1/2/3 $4/$35/$70 after deductible
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Silver EPO 6300
Region 7  
Monthly Premium  
   Single $727.59
   Employee and child $1,236.91
   Employee and spouse/
domestic partner
$1,455.20
   Family $2,073.66
Primary Care
Doctor/Specialist
$40/$60 after deductible
Deductible (Single/Family) $1,350/$2,700 true family 
Inpatient Hospital
(per admission)
$500 after deductible
Prescription Drugs:  
   Tier 1/2/3 $4/$35/$70 after deductible
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Silver  PPO 8000
Region 1  
Monthly Premium  
   Single $612.04
   Employee and child $1,040.48
   Employee and spouse/
domestic partner
$1,224.09
   Family $1,744.32
Primary Care
Doctor/Specialist
0% after deductible
Deductible (Single/Family) $3,250/$6,500 embedded
Inpatient Hospital
(per admission)
0% after deductible
Prescription Drugs:  
   Tier 1/2/3 $10/$35/$70 after deductible
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Summary

Silver  PPO 8000
Region 7  
Monthly Premium  
   Single $738.76
   Employee and child $1,255.89
   Employee and spouse/
domestic partner
$1,477.52
   Family $2,105.47
Primary Care
Doctor/Specialist
0% after deductible
Deductible (Single/Family) $3,250/$6,500 embedded
Inpatient Hospital
(per admission)
0% after deductible
Prescription Drugs:  
   Tier 1/2/3 $10/$35/$70 after deductible
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Summary

Silver  EX 8000
Region 1  
Monthly Premium  
   Single $566.82
   Employee and child $963.59
   Employee and spouse/
domestic partner
$1,133.63
   Family $1,615.42
Primary Care
Doctor/Specialist
0% after deductible
Deductible (Single/Family) $3,250/$6,500 embedded
Inpatient Hospital
(per admission)
0% after deductible
Prescription Drugs:  
   Tier 1/2/3 $10/$35/$70 after deductible
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Silver  EX 8000
Region 7  
Monthly Premium  
   Single $683.43
   Employee and child $1,161.83
   Employee and spouse/
domestic partner
$1,366.86
   Family $1,947.77
Primary Care
Doctor/Specialist
0% after deductible
Deductible (Single/Family) $3,250/$6,500 embedded
Inpatient Hospital
(per admission)
0% after deductible
Prescription Drugs:  
   Tier 1/2/3 $10/$35/$70 after deductible
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Silver POS 8000
Region 1  
Monthly Premium  
   Single $543.91
   Employee and child  $924.65
   Employee and spouse/
domestic partner
$1,087.82
   Family $1,550.14
Primary Care
Doctor/Specialist
0% after deductible
Deductible (Single/Family) $3,250/$6,500 embedded
Inpatient Hospital
(per admission)
0% after deductible
Prescription Drugs:  
   Tier 1/2/3 $10/$35/$70 after deductible
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Summary

Silver POS 8000
Region 7  
Monthly Premium  
   Single $655.41
   Employee and child  $1,114.18
   Employee and spouse/
domestic partner
$1,310.80
   Family $1,867.90
Primary Care
Doctor/Specialist
0% after deductible
Deductible (Single/Family) $3,250/$6,500 embedded
Inpatient Hospital
(per admission)
0% after deductible
Prescription Drugs:  
   Tier 1/2/3 $10/$35/$70 after deductible
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Silver EPO 8000
Region 1  
Monthly Premium  
   Single $593.43
   Employee and child $1,008.82
   Employee and spouse/
domestic partner
$1,186.85
   Family $1,691.26
Primary Care
Doctor/Specialist
0% after deductible
Deductible (Single/Family) $3,250/$6,500 embedded
Inpatient Hospital
(per admission)
0% after deductible
Prescription Drugs:  
   Tier 1/2/3 $10/$35/$70 embedded
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Silver  EPO 8000
Region 7  
Monthly Premium  
   Single $715.98
   Employee and child $1,217.18
   Employee and spouse/
domestic partner
$1,431.98
   Family $2,040.57
Primary Care
Doctor/Specialist
0% after deductible
Deductible (Single/Family) $3,250/$6,500 embedded
Inpatient Hospital
(per admission)
0% after deductible
Prescription Drugs:  
   Tier 1/2/3 $10/$35/$70 embedded
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Summary

>> View Silver Plan Contracts

>> Some preventive drugs are a $0 cost--share; not subject to deductible on select plans: Silver EPO 6300, Silver PPO 8000, Silver EPO 8000, Silver EX 8000, Silver POS 8000.

Visit BlueConnect to enroll. If you are a new group and would like to enroll in a Silver plan, please contact your broker or account executive.

Region 1 Silver Standard Silver EPO 8000 Silver PPO 8000 Silver POS 8000
Monthly Premium      
   Single $500.59 $543.01 $558.96 $481.96
   Employee and child $851.00 $923.12 $950.23 $819.34
   Employee and spouse/domestic partner $1,001.18 $1,086.02 $1,117.92 $963.92
   Family $1,426.68 $1,547.57 $1,593.03 $1,373.59
Primary Care Doctor/Specialist $30/$50 after deductible 0% after deductible 0% after deductible 0% after deductible
Deductible (Single/Family) $2,000/$4,000 
$3,000/$6,000
$3,000/$6,000
$3,000/$6,000
Inpatient Hospital Stay (per admission) $1,500 after deductible 0% after deductible 0% after deductible 0% after deductible
Prescription Drugs:        
   Tier 1/2/3 $10/$35/$70  $10/$35/$70 after deductible  $10/$35/$70 after deductible  $10/$35/$70 after deductible
   Generic Oral Contraceptives Covered in full Covered in full Covered in full Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply 2.5 Copays/90-day supply 2.5 Copays/90-day supply 2.5 Copays/90-day supply
 

Benefits & Coverage

Benefits & Coverage

Benefits & Coverage

Benefits & Coverage

 
Region 1 Silver EX 8000 Silver EPO 6300 Silver EPO 6000
Monthly Premium      
   Single $511.32 $541.84 $585.95
   Employee and child $869.24 $921.13 $996.12
   Employee and spouse/domestic partner $1,022.64 $1,083.68 $1,171.90
   Family $1,457.27 $1,544.24 $1,669.96
Primary Care Doctor/Specialist 0%  after deductible $40/$60 after deductible $30/$50
Deductible (Single/Family) $3,000/$6,000
$2,000/$4,000
$2,500/$5,000
Inpatient Hospital Stay (per admission) 0% after deductible $500 after deductible 20% after deductible
Prescription Drugs:      
   Tier 1/2/3 $10/$35/$70 after deductible $4/$35/$70 after deductible  $10/$50/$80 
   Generic Oral Contraceptives Covered in full Covered in full Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply 2.5 Copays/90-day supply 2.5 Copays/90-day supply
 

Benefits & Coverage

Benefits & Coverage

Benefits & Coverage

 
Region 7 Silver Standard Silver EPO 8000 Silver PPO 8000 Silver POS 8000
Monthly Premium      
   Single $595.83 $647.86 $667.44 $572.96
   Employee and child $1,012.92 $1,101.36 $1,134.65 $947.03
   Employee and spouse/domestic partner $1,191.66 $1,295.72 $1,334.88 $1,145.92
   Family $1,698.11 $1,846.40 $1,902.20 $1,632.93
Primary Care Doctor/Specialist $30/$50 after deductible 0% after deductible 0% after deductible 0% after deductible
Deductible (Single/Family) $2,000/$4,000 
$3,000/$6,000
$3,000/$6,000
$3,000/$6,000
Inpatient Hospital Stay (per admission) $1,500 after deductible 0% after deductible 0% after deductible 0% after deductible
Prescription Drugs:        
   Tier 1/2/3 $10/$35/$70  $10/$35/$70 after deductible  $10/$35/$70 after deductible  $10/$35/$70 after deductible
   Generic Oral Contraceptives Covered in full Covered in full Covered in full Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply 2.5 Copays/90-day supply 2.5 Copays/90-day supply 2.5 Copays/90-day supply
 

Benefits & Coverage

Benefits & Coverage

Benefits & Coverage

Benefits & Coverage

 
Region 7 Silver EX 8000 Silver EPO 6300 Silver EPO 6000
Monthly Premium      
   Single $605.36 $646.44 $700.57
   Employee and child $1,029.12 $1,098.95 $1,190.97
   Employee and spouse/domestic partner $1,210.72 $1,292.88 $1,401.14
   Family $1,725.27 $1,842.35 $1,996.63
Primary Care Doctor/Specialist 0%  after deductible $40/$60 after deductible $30/$50
Deductible (Single/Family) $3,000/$6,000
$2,000/$4,000
$2,500/$5,000
Inpatient Hospital Stay (per admission) 0% after deductible $500 after deductible 20% after deductible
Prescription Drugs:      
   Tier 1/2/3 $10/$35/$70 after deductible $4/$35/$70 after deductible  $10/$50/$80 
   Generic Oral Contraceptives Covered in full Covered in full Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply 2.5 Copays/90-day supply 2.5 Copays/90-day supply
 

Benefits & Coverage

Benefits & Coverage

Benefits & Coverage

 
Silver Standard
Region 1  
Monthly Premium  
   Single $500.59
   Employee and child $851.00
   Employee and spouse/
domestic partner
$1,001.18
   Family $1,426.68
Primary Care
Doctor/Specialist
$30/$50 after deductible
Deductible (Single/Family) $2,000/$4,000
Inpatient Hospital
(per admission)
$1,500 after deductible
Prescription Drugs:  
   Tier 1/2/3 $10/$35/$70 
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Silver Standard
Region 7  
Monthly Premium  
   Single $595.83
   Employee and child $1,012.92
   Employee and spouse/
domestic partner
$1,191.66
   Family $1,698.11
Primary Care
Doctor/Specialist
$30/$50  after deductible
Deductible (Single/Family) $2,000/$4,000 
Inpatient Hospital
(per admission)
$1,500 after deductible
Prescription Drugs:  
   Tier 1/2/3 $10/$35/$70 
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Silver EPO 8000
Region 1  
Monthly Premium  
   Single $543.01
   Employee and child $923.12
   Employee and spouse/
domestic partner
$1,086.02
   Family $1,547.57
Primary Care
Doctor/Specialist
0% after deductible
Deductible (Single/Family) $3,000/$6,000
Inpatient Hospital
(per admission)
0% after deductible
Prescription Drugs:  
   Tier 1/2/3 $10/$35/$70 after deductible
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Silver EPO 8000
Region 7  
Monthly Premium  
   Single $647.86
   Employee and child $1,101.36
   Employee and spouse/
domestic partner
$1,295.72
   Family $1,846.40
Primary Care
Doctor/Specialist
0% after deductible
Deductible (Single/Family) $3,000/$6,000
Inpatient Hospital
(per admission)
0% after deductible
Prescription Drugs:  
   Tier 1/2/3 $10/$35/$70 after deductible
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Silver PPO 8000
Region 1  
Monthly Premium  
   Single $558.96
   Employee and child $950.23
   Employee and spouse/
domestic partner
$1,117.92
   Family $1,593.03
Primary Care
Doctor/Specialist
0% after deductible
Deductible (Single/Family) $3,000/$6,000
Inpatient Hospital
(per admission)
0% after deductible
Prescription Drugs:  
   Tier 1/2/3 $10/$35/$70 after deductible
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Silver PPO 8000
Region 7  
Monthly Premium  
   Single $667.44
   Employee and child $1,134.65
   Employee and spouse/
domestic partner
$1,334.88
   Family $1,902.20
Primary Care
Doctor/Specialist
0% after deductible
Deductible (Single/Family) $3,000/$6,000
Inpatient Hospital
(per admission)
0% after deductible
Prescription Drugs:  
   Tier 1/2/3 $10/$35/$70 after deductible
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Silver POS 8000
Region 1  
Monthly Premium  
   Single $481.96
   Employee and child $819.34
   Employee and spouse/
domestic partner
$963.92
   Family $1,373.59
Primary Care
Doctor/Specialist
0% after deductible
Deductible (Single/Family) $3,000/$6,000
Inpatient Hospital
(per admission)
0% after deductible
Prescription Drugs:  
   Tier 1/2/3 $10/$35/$70 after deductible
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Silver POS 8000
Region 7  
Monthly Premium  
   Single $572.96
   Employee and child $974.03
   Employee and spouse/
domestic partner
$1,145.92
   Family $1,632.93
Primary Care
Doctor/Specialist
0% after deductible
Deductible (Single/Family) $3,000/$6,000
Inpatient Hospital
(per admission)
0% after deductible
Prescription Drugs:  
   Tier 1/2/3 $10/$35/$70 after deductible
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Silver EX 8000
Region 1  
Monthly Premium  
   Single $511.32
   Employee and child $869.24
   Employee and spouse/
domestic partner
$1,022.64
   Family $1,457.27
Primary Care
Doctor/Specialist
0% after deductible
Deductible (Single/Family) $3,000/$6,000
Inpatient Hospital
(per admission)
0% after deductible
Prescription Drugs:  
   Tier 1/2/3 $10/$35/$70 after deductible
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Silver EX 8000
Region 7  
Monthly Premium  
   Single $605.36
   Employee and child $1,029.12
   Employee and spouse/
domestic partner
$1,210.72
   Family $1,725.27
Primary Care
Doctor/Specialist
0% after deductible
Deductible (Single/Family) $3,000/$6,000
Inpatient Hospital
(per admission)
0% after deductible
Prescription Drugs:  
   Tier 1/2/3 $10/$35/$70 after deductible
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Silver EPO 6300
Region 1  
Monthly Premium  
   Single $541.84
   Employee and child $921.13
   Employee and spouse/
domestic partner
$1,083.68
   Family $1,544.24
Primary Care
Doctor/Specialist
$40/$60 after deductible
Deductible (Single/Family) $2,000/$4,000
Inpatient Hospital
(per admission)
$500 after deductible
Prescription Drugs:  
   Tier 1/2/3 $4/$35/$70 after deductible
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Silver EPO 6300
Region 7  
Monthly Premium  
   Single $646.44
   Employee and child $1,098.95
   Employee and spouse/
domestic partner
$1,292.88
   Family $1,842.35
Primary Care
Doctor/Specialist
$40/$60 after deductible
Deductible (Single/Family) $2,000/$4,000
Inpatient Hospital
(per admission)
$500 after deductible
Prescription Drugs:  
   Tier 1/2/3 $4/$35/$70 after deductible
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Silver EPO 6000
Region 1  
Monthly Premium  
   Single $585.95
   Employee and child $996.12
   Employee and spouse/
domestic partner
$1,171.90
   Family $1,669.96
Primary Care
Doctor/Specialist
$30/$50 
Deductible (Single/Family) $2,500/$5,000 
Inpatient Hospital
(per admission)
20% after deductible
Prescription Drugs:  
   Tier 1/2/3 $10/$50/$80 
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Silver EPO 6000
Region 1  
Monthly Premium  
   Single $700.57
   Employee and child $1,190.97
   Employee and spouse/
domestic partner
$1,401.14
   Family $1,996.63
Primary Care
Doctor/Specialist
$30/$50 
Deductible (Single/Family) $2,500/$5,000 
Inpatient Hospital
(per admission)
20% after deductible
Prescription Drugs:  
   Tier 1/2/3 $10/$50/$80 
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Benefits of Blue

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Wellness Card

 

Offered with every small group plan

Preventive Services

$0 preventive services

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