Platinum 2017 Small Group Plans, Q2

Our Platinum plans contain the highest premiums and are designed to include the lowest cost sharing (deductible and copays) compared to other plans. View the plan details below. Please note, all premiums listed represent coverage for dependents up to age 26. 

 

Region 1: Albany, Columbia, Fulton, Greene, Montgomery, Rensselaer, Saratoga, Schenectady, Schohaire, Warren, and Washington.

Region 7: Clinton & Essex

 

If you are an existing group with BlueShield of Northeastern New York, visit BlueConnect to enroll. If you are a new group and would like to enroll in a Platinum plan, please contact your broker or account executive.

Region 1 Platinum Standard Platinum PPO 800 Platinum EPO 5000 Platinum Radius
Monthly Premium        
   Single $640.23 $736.92 $700.55 $618.35
   Employee and child $1,088.39 $1,252.77 $1,190.94 $1,051.19
   Employee and spouse/domestic partner $1,280.46 $1,473.84 $1,401.10 $1,236.70
   Family $1,824.66 $2,100.22 $1,996.57 $1,762.30
Primary Care Doctor/Specialist $15/$35  $15/$20
$0 pediatric PCP visits

$25/$40
$0 pediatric PCP visits
$0 for first three adult PCP visits
$25/$40
$0 pediatric PCP visits
$0 for first three adult PCP visits
Deductible (Single/Family) $0 $0 $0 $0
Inpatient Hospital (per admission) $500 $250 $500 $750
Prescription Drugs:          
   Tier 1/2/3 $10/$30/$60   $10/$35/$70 $4/$35/$70  $4/$35/$70
   Generic Oral Contraceptives Covered in full Covered in full Covered in full Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply 2.5 Copays/90-day supply 2.5 Copays/90-day supply 2.5 Copays/90-day supply
 

Benefits & Coverage

Benefits & Coverage

Benefits & Coverage

Benefits & Coverage

 
 
Region 1  Platinum EX 5000 Platinum HMO  
Monthly Premium      
   Single $667.21 $615.64  
   Employee and child $1,134.26 $1,046.59  
   Employee and spouse/domestic partner $1,334.42 $1,231.28  
   Family $1,901.55 $1,754.57  
Primary Care Doctor/Specialist $25/$40 
$0 pediatric PCP visits (Preferred)
$0 for first three adult PCP visits (Preferred)
$25/$40
$0 pediatric PCP visits 
$0 for first three adult PCP visits
 
Deductible (Single/Family) $0 $0  
Inpatient Hospital (per admission) $500 $1,000  
Prescription Drugs:      
   Tier 1/2/3 $4/$35/$70  $4/$35/$70  
   Generic Oral Contraceptives Covered in full Covered in full  
   Mail Order Drugs 2.5 Copays/90-day supply 2.5 Copays/90-day supply  
 

Benefits & Coverage

Benefits & Coverage

 
Region 7 Platinum Standard Platinum PPO 800 Platinum EPO 5000 Platinum Radius
Monthly Premium        
   Single $766.45 $885.19 $840.53 $739.60
   Employee and child $1,302.96 $1,504.82 $1,428.91 $1,257.32
   Employee and spouse/domestic partner $1,532.90 $1,770.38 $1,681.06 $1,479.20
   Family $2,184.38 $2,522.80 $2,395.51 $2,107.87
Primary Care Doctor/Specialist $15/$35  $15/$20
$0 pediatric PCP visits

$25/$40
$0 pediatric PCP visits
$0 for first three adult PCP visits
$25/$40
$0 pediatric PCP visits
$0 for first three adult PCP visits
Deductible (Single/Family) $0 $0 $0 $0
Inpatient Hospital (per admission) $500 $250 $500 $750
Prescription Drugs:        
   Tier 1/2/3 $10/$30/$60   $10/$35/$70 $4/$35/$70  $4/$35/$70
   Generic Oral Contraceptives Covered in full Covered in full Covered in full Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply 2.5 Copays/90-day supply 2.5 Copays/90-day supply 2.5 Copays/90-day supply
 

Benefits & Coverage

Benefits & Coverage

Benefits & Coverage

Benefits & Coverage

 
 
 
Region 7 Platinum EX 5000 Platinum HMO  
Monthly Premium      
   Single $794.67 $736.26  
   Employee and child $1,350.94 $1,251.64  
   Employee and spouse/domestic partner $1,589.34 $1,472.52  
   Family $2,264.81 $2,098.35  
Primary Care Doctor/Specialist $25/$40 
$0 pediatric PCP visits (Preferred)
$0 for first three adult PCP visits (Preferred)
$25/$40
$0 pediatric PCP visits 
$0 for first three adult PCP visits
 
Deductible (Single/Family) $0 $0  
Inpatient Hospital (per admission) $500 $1,000  
Prescription Drugs:      
   Tier 1/2/3 $4/$35/$70  $4/$35/$70  
   Generic Oral Contraceptives Covered in full Covered in full  
   Mail Order Drugs 2.5 Copays/90-day supply 2.5 Copays/90-day supply
 

Benefits & Coverage

Benefits & Coverage

 
Platinum Standard
Region 1  
Monthly Premium  
   Single $640.23
   Employee and child $1,088.39
   Employee and spouse/domestic
partner
$1,280.46
   Family $1,824.66
Primary Care
Doctor/Specialist
$15/$35
Deductible (Single/Family) $0
Inpatient Hospital
(per admission)
$500
Prescription Drugs:  
   Tier 1/2/3 $10/$30/$60 
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Platinum Standard
Region 7  
Monthly Premium  
   Single $766.45
   Employee and child $1,302.96
   Employee and spouse/domestic
partner
$1,532.90
   Family $2,184.38
Primary Care
Doctor/Specialist
$15/$35
Deductible (Single/Family) $0
Inpatient Hospital
(per admission)
$500
Prescription Drugs:  
   Tier 1/2/3 $10/$30/$60 
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Platinum PPO 800
Region 1  
Monthly Premium  
   Single $736.92
   Employee and child $1,252.77
   Employee and spouse/domestic
partner
$1,473.84
   Family $2,100.22
Primary Care
Doctor/Specialist
$15/$20
$0 pediatric PCP visits
Deductible (Single/Family) $0
Inpatient Hospital
(per admission)
$250
Prescription Drugs:  
   Tier 1/2/3 $10/$35/$70 
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Platinum PPO 800
Region 7  
Monthly Premium  
   Single $885.19
   Employee and child $1,504.82
   Employee and spouse/domestic
partner
$1,770.38
   Family $2,522.80
Primary Care
Doctor/Specialist
$25/$40
$0 pediatric PCP visits
Deductible (Single/Family) $0
Inpatient Hospital
(per admission)
$250
Prescription Drugs:  
   Tier 1/2/3 $10/$35/$70 
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Platinum EPO 5000
Region 1  
Monthly Premium  
   Single $700.55
   Employee and child $1,190.94
   Employee and spouse/domestic
partner
$1,401.10
   Family $1,996.57
Primary Care
Doctor/Specialist
$25 / $40
$0 pediatric PCP visits
$0 for first three adult PCP visits
Deductible (Single/Family) $0
Inpatient Hospital
(per admission)
$500
Prescription Drugs:  
   Tier 1/2/3 $4/$35/$70 
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Platinum EPO 5000
Region 7  
Monthly Premium  
   Single $840.53
   Single & Child $1,428.91
   Person $1,681.06
   Family $2,395.51
Primary Care
Doctor/Specialist
$25 / $40
$0 pediatric PCP visits
$0 for first three adult PCP visits
Deductible (Single/Family) $0
Inpatient Hospital
(per admission)
$500
Prescription Drugs:  
   Tier 1/2/3 $4/$35/$70 
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Platinum  Radius
Region 1
Monthly Premium
 
   Single $618.35
   Employee and child $1,051.19
   Employee and spouse/domestic
partner
$1,236.70
   Family $1,762.30
Primary Care
Doctor/Specialist
$25 / $40
$0 pediatric PCP visits 
$0 for first three adult PCP visits 
Deductible (Single/Family) $0
Inpatient Hospital
(per admission)
$750
Prescription Drugs:  
   Tier 1/2/3 $4/$35/$70 
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Platinum  Radius
Region 7
Monthly Premium
 
   Single $739.60
   Employee and child $1,257.32
   Employee and spouse/domestic
partner
$1,479.20
   Family $2,107.87
Primary Care
Doctor/Specialist
$25/$40
$0 pediatric PCP visits 
$0 for first three adult PCP visits 
Deductible (Single/Family) $0
Inpatient Hospital
(per admission)
$750
Prescription Drugs:  
   Tier 1/2/3 $4/$35/$70 
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Platinum  EX 5000
Region 1
Monthly Premium
 
   Single $667.21
   Employee and child $1,134.26
   Employee and spouse/domestic
partner
$1,334.42
   Family $1,901.55
Primary Care
Doctor/Specialist
$25 / $40
$0 pediatric PCP visits (Preferred)
$0 for first three adult PCP visits (Preferred)
Deductible (Single/Family) $0
Inpatient Hospital
(per admission)
$500
Prescription Drugs:  
   Tier 1/2/3 $4/$35/$70 
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Platinum  EX 5000
Region 7
Monthly Premium
 
   Single $794.67
   Employee and child $1,350.94
   Employee and spouse/domestic
partner
$1,589.34
   Family $2,264.81
Primary Care
Doctor/Specialist
$25 / $40
$0 pediatric PCP visits (Preferred)
$0 for first three adult PCP visits (Preferred)
Deductible (Single/Family) $0
Inpatient Hospital
(per admission)
$500
Prescription Drugs:  
   Tier 1/2/3 $4/$35/$70 
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Platinum HMO*
Region 1  
Monthly Premium  
   Single $615.64
   Employee and child $1,046.59
   Employee and spouse/
domestic partner
$1,231.28
   Family $1,754.57
Primary Care
Doctor/Specialist
$25 / $40
$0 pediatric PCP visits
$0 for first three adult PCP visits
Deductible (Single/Family) $0
Inpatient Hospital
(per admission)
$1,000
Prescription Drugs:  
   Tier 1/2/3 $4/$35/$70 
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Platinum HMO*
Region 7  
Monthly Premium  
   Single $736.26
   Employee and child $1,251.64
   Employee and spouse/
domestic partner
$1,472.52
   Family $2,098.35
Primary Care
Doctor/Specialist
$25 / $40
$0 pediatric PCP visits
$0 for first three adult PCP visits
Deductible (Single/Family) $0
Inpatient Hospital
(per admission)
$1,000
Prescription Drugs:  
   Tier 1/2/3 $4/$35/$70 
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Visit BlueConnect to enroll. If you are a new group and would like to enroll in a Platinum plan, please contact your broker or account executive.

Region 1 Platinum Standard Platinum PPO 800
Platinum EPO 5000 Platinum Radius Platinum HMO
Monthly Premium          
   Single $583.50 $692.17 $654.52 $569.45 $561.57
   Employee and child $991.95 $1,176.69 $1,112.68 $968.06 $954.67
   Employee and spouse/
   domestic partner
$1,167.00 $1,384.34 $1,309.04 $1,138.90 $1,123.14
   Family $1,662.98 $1,972.68 $1,865.38 $1,622.93 $1,600.47
Primary Care Doctor/Specialist $15/$35  $15/$20 
$0 pediatric PCP visits
$0 for first three adult PCP visits
$25/$40 
$0 pediatric PCP visits
$0 for first three adult PCP visits
$25/$40
$0 pediatric PCP visits
$0 for first three adult PCP visits
$30/$540
$0 pediatric PCP visits
$0 for first three adult PCP visits
Deductible (Single/Family) $0 $0 $0 $0 $0
Inpatient Hospital (per admission) $500 $250 $500 $750 $1,000
Prescription Drugs:          
   Tier 1/2/3 $10/$30/$60  $4/$35/$70  $4/$35/$70 $4/$35/$70  $4/$35/$70
   Generic Oral Contraceptives Covered in full Covered in full Covered in full Covered in full Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply 2.5 Copays/90-day supply 2.5 Copays/90-day supply 2.5 Copays/90-day supply 2.5 Copays/90-day supply
 

Benefits & Coverage

Benefits & Coverage

Benefits & Coverage

Benefits & Coverage

Benefits & Coverage

 
Region 7 Platinum Standard Platinum EPO 5000 Platinum HMO
Monthly Premium      
   Single $693.57 $780.24 $666.83
   Employee and child $1,179.07 $1,326.41 $1,133.61
   Employee and spouse/domestic partner $1,387.14 $1,560.48 $1,333.66
   Family $1,976.67 $2,223.69 $1,900.47
Primary Care Doctor/Specialist $15/$35  $25/$40
$0 pediatric PCP visits
$0 for first three adult PCP visits
$30/$50
$0 pediatric PCP visits
$0 for first three adult PCP visits
Deductible (Single/Family) $0 $0 $0
Inpatient Hospital (per admission) $500 $500 $1,000
Prescription Drugs:      
   Tier 1/2/3 $10/$30/$60   $4/$35/$70  $4/$35/$70
   Generic Oral Contraceptives Covered in full Covered in full Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply 2.5 Copays/90-day supply 2.5 Copays/90-day supply
 

Benefits & Coverage

Benefits & Coverage

Benefits & Coverage

 
Platinum Standard
Region 1  
Monthly Premium  
   Single $583.50
   Employee and child $991.95
   Employee and spouse/
domestic partner
$1,167.00
   Family $1,662.98
Primary Care
Doctor/Specialist
$15/$35
Deductible (Single/Family) $0
Inpatient Hospital
(per admission)
$500
Prescription Drugs:  
   Tier 1/2/3 $10/$30/$60 
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Platinum Standard 
Region 7  
Monthly Premium  
   Single $693.57
   Employee and child $1,179.07
   Employee and spouse/
domestic partner
$1,387.14
   Family $1,976.67
Primary Care
Doctor/Specialist
$15/$35
Deductible (Single/Family) $0
Inpatient Hospital
(per admission)
$500
Prescription Drugs:  
   Tier 1/2/3 $10/$30/$60 
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Platinum PPO 800
Region 1  
Monthly Premium  
   Single $692.17
   Employee and child $1,176.69
   Employee and spouse/
domestic partner
$1,384.34
   Family $1,972.68
Primary Care
Doctor/Specialist
$15/$20
$0 pediatric PCP visits
$0 for first three adult PCP visits
Deductible (Single/Family) $0
Inpatient Hospital
(per admission)
$250
Prescription Drugs:  
   Tier 1/2/3 $4/$35/$70 
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Platinum EPO 5000
Region 1  
Monthly Premium  
   Single $654.52
   Employee and child $1,112.68
   Employee and spouse/
domestic partner
$1,309.04
   Family $1,865.38
Primary Care
Doctor/Specialist
$25/$40
$0 pediatric PCP visits
$0 for first three adult PCP visits
Deductible (Single/Family) $0
Inpatient Hospital
(per admission)
$500
Prescription Drugs:  
   Tier 1/2/3 $4/$35/$70 
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Platinum EPO 5000
Region 7  
Monthly Premium  
   Single $780.24
   Employee and child $1,326.41
   Employee and spouse/
domestic partner
$1,560.48
   Family $2,223.69
Primary Care
Doctor/Specialist
$25/$40
$0 pediatric PCP visits
$0 for first three adult PCP visits
Deductible (Single/Family) $0
Inpatient Hospital
(per admission)
$500
Prescription Drugs:  
   Tier 1/2/3 $4/$35/$70 
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Platinum Radius
Region 1  
Monthly Premium  
   Single $569.45
   Employee and child $968.06
   Employee and spouse/
domestic partner
$1,138.90
   Family $1,622.93
Primary Care
Doctor/Specialist
$25/$40
$0 pediatric PCP visits
$0 for first three adult PCP visits
Deductible (Single/Family) $0
Inpatient Hospital
(per admission)
$750
Prescription Drugs:  
   Tier 1/2/3 $4/$35/$70 
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Platinum HMO
Region 1  
Monthly Premium  
   Single $561.57
   Employee and child $954.67
   Employee and spouse/
domestic partner
$1,123.14
   Family $1,600.47
Primary Care
Doctor/Specialist
$30/$50
$0 pediatric PCP visits
$0 for first three adult PCP visits
Deductible (Single/Family) $0
Inpatient Hospital
(per admission)
$1,000
Prescription Drugs:  
   Tier 1/2/3 $4/$35/$70 
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

Platinum HMO
Region 7  
Monthly Premium  
   Single $666.83
   Employee and child $1,133.61
   Employee and spouse/
domestic partner
$1,333.66
   Family $1,900.47
Primary Care
Doctor/Specialist
$30/$50
$0 pediatric PCP visits
$0 for first three adult PCP visits
Deductible (Single/Family) $0
Inpatient Hospital
(per admission)
$1,000
Prescription Drugs:  
   Tier 1/2/3 $4/$35/$70 
   Generic Oral
Contraceptives
Covered in full
   Mail Order Drugs 2.5 Copays/90-day supply
 

Benefits & Coverage

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