Ind Focus Gold NS OON Tiered by HealthNow - BlueCross BlueShield of Western NY
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Plan Information
- Plan Name
- Ind Focus Gold NS OON Tiered
- Insurance Company
- HealthNow - BlueCross BlueShield of Western NY
In Network Benefits
- Office Co-pay
- $20 after deductible
- Specialist Co-pay
- $40 after deductible
- Hospital Co-pay
- $750 after deductible
- Emergency Room
- $150 after deductible
- Referrals Needed
- No
- Rx: Generic/Brand/High Brand
- $5/$40/50%
- In-Network Deductible (single/family)
- $500/$1,000
- In-Network Co-Insurance
- $0
- Max Out of Pocket (single/family)
- $6,850/$13,700
Out Of Network Benefits
- Co-Insurance
- 50%
- Out of Pocket Max (single/family)
- $10,000/$20,000
Other Benefits
- Vision/Dental
- Adult Dental Excluded
- Renewal Date
- 01/01/2018
- HSA Eligible
- No
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