Jump to a Provider by clicking on a Logo.

Excellus Health Plans

CDPHP Plans

 

 

 

 

 

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

Excellus Health Plans

Excellus - Healthy Blue HB-CD-60
PPO policy with in- and out-of-network coverage, no referrals needed. There is a $2,000 (single) $6,000 (family) in-network and out of network deductible with an 80% coinsurance. Coinsurance for out of network is 60% The primary in-network copay is $40 and specialist copay is $60 per visit. With inpatient hospital on both in- and out-of-network you must meet the deductible and coinsurance. Emergency room visits are a $350 copay. Preventive Services are covered in full. The prescription coverage is $5/40%/50% after a $500/$1000 family deductible Full time dependant coverage to age 26.
 

Quarterly

Small Group

Sole Proprietor
Employee

$1,208.88

$1,328.28
Employee + Spouse

$2,402.85

$2,641.62
Employee + Child(ren)

$2,429.37

$2,671.62
Family

$3,345.51

$3,678.54
  Plan Selection Plan Selection
  Instructions Instructions
  Application Application

Excellus - Simply Blue SB-CD-14
PPO policy with in- and out-of-network coverage, no referrals needed. There is a $500 (single) $1,500 (family) in-network and out of network deductible with an 80% coinsurance. Coinsurance for out of network is 60% The primary in-network copay is $25 and specialist copay is $40 per visit. In-patient hospital stays are subject to the deductible and coinsurance. Emergency room visits are a $250 copay. Preventive Services are covered in full. The prescription coverage is $7.00 generic only. Full time dependant coverage to age 26.
 

Quarterly

Small Group

Sole Proprietor
Employee

$1,340.04

$1,472.44
Employee + Spouse

$2,665.17

$2,930.19
Employee + Child(ren)

$2,709.27

$2,978.67
Family

$3,730.17

$4,103.37
  Plan Selection Plan Selection
  Instructions Instructions
  Application Application

Excellus - Simply Blue SB-C-23
This policy is an PPO with both in- and out-of-network coverage, no referrals needed. There are no in-network deductibles or coinsurance. Out of network is $500/$1500 family and 80/20% coinsurance. The primary in-network copay is $30 and specialist copay is $50 per visit. In-patient hospital hospital stays are subject to a $500 copayment in-network and deductibles and coinsurance out of network. Emergency room visits are a $250 copay. The prescription coverage is $7 Generic Only.Dependant coverage to 26. Preventive Services Covered in full.
 

Quarterly

Small Group

Sole Proprietor
Employee

$1,421.61

$1,562.28
Employee + Spouse

$2,828.31

$3,109.65
Employee + Child(ren)

$2,875.44

$3,161.49
Family

$3,960.93

$4,355.20
  Plan Selection Plan Selection
  Instructions Instructions
  Application Application

Excellus - Healthy Blue HB-CD-10E
PPO policy with in- and out-of-network coverage, no referrals needed. There is a $1,000 (single) $3,000 (family) in-network and out of network deductible with an 80% coinsurance. Coinsurance for out of network is 60% The primary in-network copay is $30 and specialist copay is $50 per visit. With inpatient hospital on both in- and out-of-network you must meet the deductible and coinsurance. Emergency room visits are a $250 copay. Preventive Services are covered in full. The prescription coverage is $5/$35/$70 Full time dependant coverage to age 26.
 

Quarterly

Small Group

Sole Proprietor
Employee

$1,468.80

$1,614.21
Employee + Spouse

$2,922.66

$3,213.42
Employee + Child(ren)

$2,949.96

$3,243.48
Family

$4,063.74

$4,468.59
  Plan Selection Plan Selection
  Instructions Instructions
  Application Application

Excellus - Healthy Blue HB-C-48-E
This policy is an PPO with both in- and out-of-network coverage, no referrals needed. In and out of network deductibles of $500 Single and $1,500 Family with 80% coinsurance apply. In-network Copays are $30 Primary, $50 Specialist, $250 Same Day Surgery and ER. All out of network services are subject to deductible and coinsurance. Preventive services are covered in full. $5/$35/$70 Drug. Dependants to 26.
 

Quarterly

Small Group

Sole Proprietor
Employee

$1,556.19

$1,710.36
Employee + Spouse

$3,097.47

$3,405.69
Employee + Child(ren)

$3,127.98

$3,439.26
Family

$4,309.38

$4,738.80
  Plan Selection Plan Selection
  Instructions Instructions
  Application Application

Excellus - Healthy Blue HB-CD-38E
This policy is a PPO. Deductibles are $500 Individual/$1500 family for in and out of network. Copays are $25 Doctor and $40 Specialist. 80/20% coinsurance in network, 60/40% out of network. $250 Copay for emergency room visits Prescription drugs are $5/$35/$70 with no deductibles. Dependants to age 26 and preventive care is covered in full.
 

Quarterly

Small Group

Sole Proprietor
Employee

$1,587.57

$1,744.86
Employee + Spouse

$3,160.23

$3,474.75
Employee + Child(ren)

$3,191.97

$3,509.67
Family

$4,397.58

$4,835.85
  Plan Selection Plan Selection
  Instructions Instructions
  Application Application

Excellus - Healthy Blue HB-C-42-E
This policy is an PPO with both in- and out-of-network coverage, no referrals needed. There is NO in-network Deductible or coinsurance. Out of Network deductibles of $500 Single and $1,500 Family with 80% coinsurance apply. In-network Copays are $30 Primary, $50 Specialist, $500 Hospital, $250 Same Day Surgery and ER. Preventive services are covered in full. Out of network services are subject to deductibles and coinsurance. $5/$35/$70 Drug. Dependants to 26
 

Quarterly

Small Group

Sole Proprietor
Employee $1,669.14 $1,834.59
Employee + Spouse

$3,232.37

$3,654.21
Employee + Child(ren)

$3,358.14

$3,692.49
Family

$4,626.84

$5,088.00
  Plan Selection Plan Selection
  Instructions Instructions
  Application Application

HMO Blue 30/50
This policy is an HMO with no out-of-network coverage and referrals are required. This plan is has a $30 primary and $50 specialist office visit copay. Inpatient hospital has a $750 copay and an emergency room visit has a $150 copay. The prescription coverage is $10/$30/$50 with no deductible. Full time dependant coverage to age 26.
 

Quarterly

Small Group

Sole Proprietor
Employee

$1,790.73

$1,968.39
Employee + Spouse

$3,566.24

$3,921.48
Employee + Child(ren)

$3,602.55

$3,961.32
Family

$4,963.92

$5,458.80
  Plan Selection Plan Selection
  Instructions Instructions
  Application Application

HMO Blue 25
This policy is an HMO 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 $150 copay. The prescription coverage is $10/$30/$50 with no deductible. Full time dependant coverage to age 26.
 

Quarterly

Small Group

Sole Proprietor
Employee

$1,851.45

$2,035.14
Employee + Spouse

N/A

N/A
Employee + Child(ren)

N/A

N/A
Family

$4,752.18

$5,225.88
  Plan Selection Plan Selection
  Instructions Instructions
  Application Application

Simply Blue - 5500/11000

This policy is an PPO with both in- and out-of-network coverage, no referrals needed. You must meet an individual deductible of $5,500 or a family deductible of $11,000. From then on, the policy pays 100% of covered benefits. All preventive care is covered in full (no deductible applies). Prescription drugs are covered at 100% after you meet the policy deductible.

 

Quarterly

Small Group

Sole Proprietor
Employee

$676.44

$742.59
Employee + Spouse

$1,337.94

$1,470.24
Employee + Child(ren)

$1,363.74

$1,498.62
Family

$1,875.57

$2,061.63
  Plan Selection Plan Selection
  Instructions Instructions
  Application Application

Simply Blue - 2600/5200

This policy is an PPO with both in- and out-of-network coverage, no referrals needed. You must meet an individual deductible of $2,600 or a family deductible of $5,200. From then on, the policy pays 100% of covered benefits. All preventive care is covered in full (no deductible applies). Prescription drugs are covered at $5/$35/$70 after the deductible has been satisfied

 

Quarterly

Small Group

Sole Proprietor
Employee

$963.96

$1,058.85
Employee + Spouse

$1,912.98

$2,102.79
Employee + Child(ren)

$1,950.27

$2,143.80
Family

$2,684.67

$2,951.64
  Plan Selection Plan Selection
  Instructions Instructions
  Application Application

Simply Blue - 1300/2600

This policy is an PPO with both in- and out-of-network coverage, no referrals needed. You must meet an individual deductible of $1,300 or a family deductible of $2,600. coinsurance applies to a maximum out of pocket expense of $3,000 single/$6,000 family. RX is $5/35/70 after deductible

 

Quarterly

Small Group

Sole Proprietor
Employee

$1,115.70

$1,225.77
Employee + Spouse

$2,216.43

$2,436.66
Employee + Child(ren)

$2,257.35

$2,481.60
  Plan Selection Plan Selection
  Instructions Instructions
  Application Application

Home