Healthfirst Silver Leaf Premier NS by Healthfirst New York
Scroll down to the Summary of Benefits PDF
Plan Information
- Plan Name
- Healthfirst Silver Leaf Premier NS
- Insurance Company
- Healthfirst New York
In Network Benefits
- Office Co-pay
- $30 after deductible
- Specialist Co-pay
- $50 after deductible
- Hospital Co-pay
- $1,500 after deductible
- Emergency Room
- $250 after deductible
- Referrals Needed
- Yes
- Rx: Generic/Brand/High Brand
- $9/$40/$80
- In-Network Deductible (single/family)
- $2,670 /$5,340
- In-Network Co-Insurance
- 0%
- Max Out of Pocket (single/family)
- $7,150/$14,300
Out Of Network Benefits
- Co-Insurance
- N/A
- Out of Pocket Max (single/family)
- N/A
Other Benefits
- Vision/Dental
- Vision and Dental
- Renewal Date
- 01/01/2018
- HSA Eligible
- No
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