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
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
Bronze Guided Access - caat
Bronze Guided Access - cabs
Bronze Guided Access w/Dep Age 29 - cbra
Bronze Guided Access w/HAS - cacm
Bronze Guided Access w/Dep Age 29 - ccra
Bronze Guided Access w/Dep Age 29 - cara
Silver Guided Access w/HSA - cdib
Silver Guided Access - cbjw
Silver Guided Access w/HSA w/Dep Age 29 - cefa
Silver Guided Access - cbnw
Silver Guided Access w/Dep Age 29 - ceae
Silver Guided Access a Multi-State Plan
Silver Guided Access w/Dep Age 29 - ceaa
Silver guided Access w/dep age 29 a Multi State Plan
Gold Guided Access - cecb
Gold Guided Access - ccav
Gold Guided Access w/Dep Age 29 - ceea
Gold Guided Access w/Dep Age 29 - ceod
Gold Guided Access a Multi State Plan
Gold Guided Access w/dep age 29 a Mutli-State Plan
Platinum Guided Access - cazd
Platinum Guided Access - ceaf
Platinum guided Access w/Dep Age 29 - cayd
Platinum guided Access w/Dep Age 29 - ceyd
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This tool is for research purposes only. The numbers shown are estimates based on the information you have provided and our best efforts to provide accurate data. We try to keep the information up to date however we cannot make warranties about the accuracy of our information. We advise that users confirm any research with the respective health insurance companies and health exchanges.