Empire Silver Guided Access a Multi-State Plan NY

Plan Information
Company Empire Blue Cross
State NY
Metal Tier Silver
Plan Type

Cost Sharing Benefits

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.

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $2,450 $0
Deductible (Family) $4,900 $0
Coinsurance 10% $0
Out of Pocket Maximum (Individual) $6,350 $0
Out of Pocket Maximum (Family) $12,700 $0
Services In Network Out of Network
Primary Care Visit 10% coinsurance $0
Specialist Visit 10% coinsurance $0
In Patient Hospital Services $1,000 copay $0
Emergency Room Services $200 copay $200 copay
Mental / Behavioral Health 10% coinsurance $0
Imaging (CT/PET Scans, MRIs) 10% coinsurance $0
Rehabilitative Speech Therapy 10% coinsurance $0
Rehabilitative Occupational & Physical Therapy 10% coinsurance $0
Preventative Care $0 $0
Laboratory Outpatient and Professional Services 10% coinsurance $0
X-ray and Diagnostic Imaging 10% coinsurance $0
Outpatient Facility 10% coinsurance $0
Outpatient Surgery 10% coinsurance $0
Prescription Drugs In Network Out of Network
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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