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

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Excellus - Healthy
Blue 500 408607002 -
Click here for the detailed plan summary. |
| This policy
is an PPO (Preferred Provider Organization) with both
in- and out-of-network coverage, no referrals needed.
There is a $500 (single) $1,500 (family) in-network
deductible with an 80% coinsurance. This plan also has a
$500 (single) $1,500 (family) out-of-network deductible
with an 60% coinsurance. The primary in-network copay is
$15 and specialist copay is $25 per visit. With
inpatient hospital on both in and out-of-network you
must meet the deductible and coinsurance. Emergency room
visits are a $150 copay. The prescription coverage is
$5/$25/$50 with no deductible. Full time dependant
coverage to age 26. |
| |
Quarterly |
|
Sole Proprietor |
Small
Group |
| Employee
|
$1,498.68 |
$1,363.77 |
| Employee
+ Spouse |
$2,982.36 |
$2,712.54 |
| Employee
+ Child(ren) |
$3,101.71 |
$2,738.34 |
| Family |
$4,147.59 |
$3,771.81 |
| |
Plan
Selection |
Plan
Selection |
| |
Instructions |
Instructions |
| |
Application |
Application |
|
Excellus - Healthy
Blue 1000 408608002 -
Click here for the detailed plan summary. |
| This policy
is an PPO (Preferred Provider Organization) with both
in- and out-of-network coverage, no referrals needed.
There is a $1,000 (single) $3,000 (family) in-network
deductible with an 80% coinsurance. This plan also has a
$1,000 (single) $3,000 (family) out-of-network
deductible with an 60% coinsurance. The primary
in-network copay is $15 and specialist copay is $25 per
visit. With inpatient hospital on both in- and
out-of-network you must meet the deductible and
coinsurance. Emergency room visits are a $150 co-pay.
The prescription coverage is $5/$25/$50 with no
deductible. Full time dependant coverage to age 26. |
| |
Quarterly |
|
Sole Proprietor |
Small
Group |
| Employee
|
$1,413.45 |
$1,286.31 |
| Employee
+ Spouse |
$2,811.90 |
$2,557.62 |
| Employee
+ Child(ren) |
$2,837.10 |
$2,580.51 |
| Family |
$3,908.07 |
$3,554.10 |
| |
Plan Selection |
Plan
Selection |
| |
Instructions |
Instructions |
| |
Application |
Application |
|
Excellus - EPO Balance
404999002 -
Click here for the detailed plan summary. |
| This policy
is an EPO (Exclusive Provider Organization) with no out-of-network coverage
and no referrals needed. There is a
$500 (single) $1,500 (family) in network deductible with
an 85% coinsurance. A primary and specialist office visit
has a $15 copay. With the inpatient hospital you must
meet the deductible and coinsurance. Emergency room visits
have a $50 copay. The prescription coverage is
$10/$30/$50 with no deductible. Full time dependant
coverage to age 23. |
| |
Quarterly |
|
Sole Proprietor |
Small Group |
| Employee
|
$1,556.46 |
$1,416.30 |
| Employee
+ Spouse |
N/A |
N/A |
| Employee
+ Child(ren) |
N/A |
N/A |
| Family |
$3,931.56 |
$3,575.49 |
| |
Plan
Selection |
Plan Selection |
| |
Instructions |
Instructions |
| |
Application |
Application |
|
Excellus - HMO Blue
25 - Click here for the detailed plan summary. |
| This policy
is an HMO (Health Maintenance Organization) with no out-of-network coverage
and referrals
are required. This plan is has a $25 primary and $40
specialist office visit copay. Inpatient hospital has a
$500 copay and an emergency room visit has a $100 copay.
The prescription coverage is $10/$30/$50 with no
deductible. Full time dependant coverage to age 23. |
| |
Quarterly |
|
Sole Proprietor |
Small Group |
| Employee
|
$1,613.49 |
$1,468.14 |
| Employee
+ Spouse |
N/A |
N/A |
| Employee
+ Child(ren) |
N/A |
N/A |
| Family |
$4,075.86 |
$3,706.68 |
| |
Plan Selection |
Plan Selection |
| |
Instructions |
Instructions |
| |
Application |
Application |
|
Excellus - BCBS
MEDICARE - Click here for the detailed plan summary. |
|
Please
click here to read the
Medicare Supplement Plan C Benefit
Summary |
| |
Quarterly |
|
|
| Employee
|
$1,016.55 |
| Employee
+ Spouse |
N/A |
| Employee
+ Child(ren) |
N/A |
| Family |
N/A |
| |
Plan Selection |
| |
Instructions |
| |
Application |
|
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