Pasar a contenido principal

Gold Premier (with Family Dental and Vision)

Who's eligible: Individuals and families living within the 28 New York counties. Children and young adults can stay on a parent’s plan until age 26. 

 

Financial assistance: Tax credits available for qualified individuals to help with premiums and out-of-pocket costs when enrolling on the NY State of Health Marketplace.

  • DENTAL
  • VISION
  • ACUPUNCTURE
  • TELEMEDICINE

Benefits Summary

ReferralsinfoNot required for specialist visits
Deductibleinfo$800 individual/$1,600 family
Out-of-pocket maximuminfo$6,200 individual/$12,400 family
Out-of-networkinfocoverageNo coverage for non-emergency services
Primary care physicianinfo3 free sick visits then $25 before deductible
Preventive carenfoFully covered
Specialist$45 before deductible
Urgent care$75 before deductible
Pharmacy              $0 generic drugs before deductible
Telemedicineinfo              Fully covered
Acupuncture              Fully covered
Gym       Reimbursement up to $400 per calendar year if qualified
Dental              Adult and pediatric dental care 
Vision              Adult and pediatric vision benefits
 

Plan Documents