Empire Silver Guided Access a Multi-State Plan (New York)

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Company Empire Blue Cross
Plan Year 2014
State New York
Metal Tier Silver
Plan Type
Shop For Plans

Cost Sharing Benefits (In Network)

These details are for the standard Silver plan. For reduced Cost Sharing versions scroll down below

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductible (Individual) $2,450
Deductible (Family) $4,900
Coinsurance 10%
Out of Pocket Maximum (Individual) $6,350
Out of Pocket Maximum (Family) $12,700

Doctors Visits

Primary Care Visit 10% coinsurance
Specialist Visit 10% coinsurance
In Patient Hospital Services $1,000 copay
Emergency Room Services $200 copay

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 10% coinsurance
Laboratory Outpatient and Professional Services 10% coinsurance
X-ray and Diagnostic Imaging 10% coinsurance

Other

Mental / Behavioral Health 10% coinsurance
Rehabilitative Speech Therapy 10% coinsurance
Rehabilitative Occupational & Physical Therapy 10% coinsurance
Outpatient Facility 10% coinsurance
Outpatient Surgery 10% coinsurance

Prescription Drugs

Generic Rx 10% coinsurance
Preferred Brand Rx 10% coinsurance
Non Preferred Brand Rx 10% coinsurance
Specialty Drugs 0.1

Other Plans

Other plans that are available in the state.

Plan Name
Empire HMO 6600 Catastrophic
Empire HMO 5600 Bronze
Empire HMO 5600 Bronze Age 29 Rider
Empire HMO 3000 Bronze Standard
Empire HMO 3000 Bronze Standard Age 29 Rider
Empire HMO 6000 Bronze
Empire HMO 6000 Bronze Age 29 Rider
Empire HMO 2250 Silver
Empire HMO 2250 Silver Age 29 Rider
Empire HMO 2450 Silver
Empire HMO 2450 Silver Age 29 Rider
Empire HMO 2000 Silver Standard
Empire HMO 2000 Silver Standard Age 29 Rider
Empire HMO 600 Gold Standard
Empire HMO 600 Gold Standard Age 29 Rider
Empire HMO 1000 Gold
Empire HMO 1000 Gold Age 29 Rider
Empire HMO 200 Platinum
Empire HMO 200 Platinum Age 29 Rider
Empire HMO 0 Platinum Standard
Empire HMO 0 Platinum Standard Age 29 Rider
Empire Blue Cross HMO 2450 Silver, a Multi-State Plan
Empire Blue Cross Blue Shield HMO 2450 Silver, a Multi-State Plan
Empire Blue Cross HMO 2450 Silver Age 29 Rider, a Multi-State Plan
Empire Blue Cross Blue Shield HMO 2450 Silver Age 29 Rider, a Multi-State Plan
Empire Blue Cross HMO 1000 Gold, a Multi State Plan
Empire Blue Cross Blue Shield HMO 1000 Gold, a Multi State Plan
Empire Blue Cross HMO 1000 Gold Age 29 Rider, a Multi State Plan
Empire Blue Cross Blue Shield HMO 1000 Gold Age 29 Rider, a Multi State Plan
Empire HMO 3000 Bronze Standard Child Only
Empire HMO 2000 Silver Standard Child Only
Empire HMO 600 Gold Standard Child Only
Empire HMO 200 Platinum Child Only

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