North Shore LIJ CareConnect Silver EPO (New York)

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Company North Shore LIJ Insurance Company
Plan Year 2014
State New York
Metal Tier Silver
Plan Type
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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) $2,000
Deductible (Family) $4,000
Coinsurance $0
Out of Pocket Maximum (Individual) $5,500
Out of Pocket Maximum (Family) $11,000

Doctors Visits

Primary Care Visit $30 copay
Specialist Visit $50 copay
In Patient Hospital Services $1,500 copay
Emergency Room Services $150 copay

Tests and Imaging

Imaging (CT/PET Scans, MRIs) $50 copay
Laboratory Outpatient and Professional Services $50 copay
X-ray and Diagnostic Imaging $50 copay


Mental / Behavioral Health $30 copay
Rehabilitative Speech Therapy $30 copay
Rehabilitative Occupational & Physical Therapy $30 copay
Outpatient Facility $100 copay
Outpatient Surgery $100 copay

Prescription Drugs

Generic Rx $10 copay
Preferred Brand Rx $35 copay
Non Preferred Brand Rx $70 copay
Specialty Drugs 70

Other Plans

Other plans that are available in the state.

Plan Name
Standard Platinum
Standard Platinum Child Only
Standard Platinum Age 29 Rider
Standard Gold
Standard Gold Child Only
Standard Gold Age 29 Rider
Standard Silver
Standard Silver Child Only
Standard Silver Age 29 Rider
Standard Bronze
Standard Bronze Child Only
Standard Bronze Age 29 Rider
Catastrophic Coverage

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