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Excellus Health Plans

CDPHP Plans

 

 

 

 

 


If you have any questions about any of the plans,
please feel free to contact us directly.

CDPHP Plans

CDPHP EPO - EPOS1811
EPO (Exclusive Provider Organization) with no out-of-network coverage and no referrals needed. There is a $1,250 (single) $3,125 (family) in-network deductible with an 80% coinsurance. It has a $35 primary and specialist office visit copay. Deductible and coinsurance apply to in-patient Hospital, same day Surgery and ER visits. PREVENTIVE SERVICES ARE COVERED IN FULL. This policy come with a $10 Generic, $50 Preferred anSd 50% non-preferred drug rider.
 

Quarterly

Sole Proprietor

Small Group
Employee

$1,347.81

$1,184.13
Employee + One $2,680.65 $2,353.29
Family $3,546.69 $3,113.22
  Plan Selection Plan Selection
  Instructions Instructions
  Application Application

CDPHP EPO - EPOS0512
This plan is an EPO (Exclusive Provider Organization) with no out-of-network coverage and no referrals needed. There is a $500 (single) $1,250 (family) in-network deductible with an 80% coinsurance. It has a $25 primary and specialist office visit copay. With in-patient hospital and emergency room visits you must meet the deductible and coinsurance. The prescription coverage is $10/$50/50% with no deductible but has a $2,000 maximum. Full time dependant coverage to age 25.
 

Quarterly

Sole Proprietor

Small Group
Employee

$1,566.54

$1,367.01
Employee + One $3,118.14 $2,734.05
Family $4,126.65 $3,612.69
  Plan Selection Plan Selection
  Instructions Instructions
  Application Application

CDPHP HMO- HA6S12
This plan option is a HMO with no out-of-network coverage and referrals are required. There is a $25 primary and specialist office visit copay. Inpatient hospital is a $500 copay and an emergency room visit is a $100 copay. The prescription coverage is $4 generic/$50 preferred/50% no preferred.
 

Quarterly

Small Group

Sole Proprietor
Employee

$1,597.86

$1,819.44
Employee + One $3,180.72 $3,623.91
Family $4,209.39 $4,796.82
  Plan Selection Plan Selection
  Instructions Instructions
  Application Application

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