Platinum 2018 Small Group Plans, Q1

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, Schoharie, 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 Radius Platinum EX Platinum PPO
Monthly Premium        
   Single $695.38 $697.21 $725.80 $784.85
   Employee and child $1,182.15
$1,185.26 $1,233.87 $1,334.25
   Employee and spouse/domestic partner $1,390.76 $1,394.42 $1,451.60 $1,569.70
   Family $1,981.83 $1,987.05 $2,068.53 $2,236.83
Primary Care Doctor/Specialist $15/$35  $0 pediatric PCP visits
$0 for first three adult visits
$15/$20
$0 pediatric PCP visits
$0 for first three adult visits
$15/$20
$0 pediatric PCP visits
$0 for first three adult visits
$15/$20
Deductible (Single/Family) $0 $0 $0 $0
Inpatient Hospital (per admission) $500 $250 $250 $250
Prescription Drugs:          
   Tier 1/2/3 $10/$30/$60   $10/$35/$70 $10/$35/$70  $10/$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 Standard Platinum Radius Platinum EX Platinum PPO
Monthly Premium        
   Single $840.82 $834.07 $878.04 $950.29
   Employee and child $1,429.40 $1,433.22 $1,492.67 $1,615.49
   Employee and spouse/domestic partner $1,681.64 $1,686.14 $1,756.08 $1,900.58
   Family $2,396.33 $2,402.75 $2,502.41 $2,708.33
Primary Care Doctor/Specialist $15/$35  $0 pediatric PCP visits
$0 for first three adult visits
$15/$20
$0 pediatric PCP visits
$0 for first three adult visits
$15/$20
$0 pediatric PCP visits
$0 for first three adult visits
$15/$20
Deductible (Single/Family) $0 $0 $0 $0
Inpatient Hospital (per admission) $500 $250 $250 $250
Prescription Drugs:          
   Tier 1/2/3 $10/$30/$60   $10/$35/$70 $10/$35/$70  $10/$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

 
Platinum Standard
Region 1  
Monthly Premium  
   Single $695.38
   Employee and child $1,182.15
   Employee and spouse/domestic
partner
$1,390.76
   Family $1,981.83
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 $840.82
   Employee and child $1,429.40
   Employee and spouse/domestic
partner
$1,681.64
   Family $2,396.33
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  Radius
Region 1
Monthly Premium
 
   Single $697.21
   Employee and child $1,185.26
   Employee and spouse/domestic
partner
$1,394.42
   Family $1,987.05
Primary Care
Doctor/Specialist
$0 pediatric PCP visits
$0 for first three adult visits
$15/$20
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  Radius
Region 7
Monthly Premium
 
   Single $843.07
   Employee and child $1,433.22
   Employee and spouse/domestic
partner
$1,686.14
   Family $2,402.75
Primary Care
Doctor/Specialist
$0 pediatric PCP visits
$0 for first three adult PCP visits
$15/$20
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 EX
Region 1  
Monthly Premium  
   Single $725.80
   Employee and child $1,233.87
   Employee and spouse/domestic
partner
$1,451.60
   Family $2,068.53
Primary Care
Doctor/Specialist
$0 pediatric PCP visits
$0 for first three adult visits
$15/$20
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 EX
Region 7  
Monthly Premium  
   Single $878.04
   Single & Child $1,492.67
   Person $1,756.08
   Family $2,502.41
Primary Care
Doctor/Specialist
$0 pediatric PCP visits
$0 for first three adult visits
$15/$20
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
Region 1  
Monthly Premium  
   Single $784.85
   Employee and child $1,334.25
   Employee and spouse/domestic
partner
$1,569.70
   Family $2,236.83
Primary Care
Doctor/Specialist
$0 pediatric PCP visits
$0 for first three adult visits
$15/$20
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
Region 7  
Monthly Premium  
   Single $950.29
   Employee and child $1,615.49
   Employee and spouse/domestic
partner
$1,900.58
   Family $2,708.33
Primary Care
Doctor/Specialist
$0 pediatric PCP visits
$0 for first three adult visits
$15/$20
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

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 Radius*    
Monthly Premium          
   Single $661.53 $761.44 $638.92    
   Employee and child $1,124.61 $1,294.45 $1,086.17    
   Employee and spouse/
   domestic partner
$1,323.06 $1,522.88 $1,277.84    
   Family $1,885.36 $2,170.10 $1,820.92    
Primary Care Doctor/Specialist $15/$35  $0 pediatric PCP visits
$15/$20
$0 pediatric PCP visits
$0 for first three adult PCP visits
$25/$40
   
Deductible (Single/Family) $0 $0 $0    
Inpatient Hospital (per admission) $500 $250 $750    
Prescription Drugs:          
   Tier 1/2/3 $10/$30/$60  $10/$30/$60  $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

 

 

 
Region 1     Platinum EPO 5000 Platinum EX 5000 Platinum HMO*
Monthly Premium          
   Single     $723.86 $689.41 $636.13
   Employee and child     $1,230.57 $1,172.00 $1,081.42
   Employee and spouse/
   domestic partner
    $1,447.72 $1,378.82 $1,272.26
   Family     $2,063.00 $1,964.82 $1,812.97
Primary Care Doctor/Specialist     $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, preferred

$25/$40, participating
$0 pediatric PCP visits
$0 for first three adult PCP visits
$25/$40
Deductible (Single/Family)     $0 $0 $0
Inpatient Hospital (per admission)     $500 $500 $1,000
Prescription Drugs:          
   Tier 1/2/3      $4/$35/$70 $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

 
Region 7 Platinum Standard Platinum PPO 800
Platinum Radius*    
Monthly Premium          
   Single $791.95 $914.64 $764.21    
   Employee and child $1,346.31 $1,554.89 $1,299.16    
   Employee and spouse/
   domestic partner
$1,583.90 $1,829.28 $1,528.42    
   Family $2,257.06 $2,606.72 $2,178.00    
Primary Care Doctor/Specialist $15/$35  $0 pediatric PCP visits
$15/$20
$0 pediatric PCP visits
$0 for first three adult PCP visits
$25/$40
   
Deductible (Single/Family) $0 $0 $0    
Inpatient Hospital (per admission) $500 $250 $750    
Prescription Drugs:          
   Tier 1/2/3 $10/$30/$60  $10/$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

 

 

 
Region 7     Platinum EPO 5000 Platinum EX 5000 Platinum HMO*
Monthly Premium          
   Single     $868.49 $821.11 $760.76
   Employee and child     $1,476.43 $1,395.88 $1,293.30
   Employee and spouse/
   domestic partner
    $1,736.98 $1,642.22 $1,521.52
   Family     $2,475.20 $2,340.16 $2,168.17
Primary Care Doctor/Specialist     $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, preferred

$25/$40, participating
$0 pediatric PCP visits
$0 for first three adult PCP visits
$25/$40
Deductible (Single/Family)     $0 $0 $0
Inpatient Hospital (per admission)     $500 $500 $1,000
Prescription Drugs:          
   Tier 1/2/3      $4/$35/$70 $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 $661.53
   Employee and child $1,124.61
   Employee and spouse/
domestic partner
$1,323.06
   Family $1,885.36
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 $791.95
   Employee and child $1,346.31
   Employee and spouse/
domestic partner
$1,583.90
   Family $2,257.06
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 $761.44
   Employee and child $1,294.45
   Employee and spouse/
domestic partner
$1,552.88
   Family $2,170.10
Primary Care
Doctor/Specialist
$0 pediatric PCP visits
$15/$20
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 $914.64
   Employee and child $1,554.89
   Employee and spouse/
domestic partner
$1,829.28
   Family $2,606.72
Primary Care
Doctor/Specialist
$0 pediatric PCP visits
$15/$20
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 Radius
Region 1  
Monthly Premium  
   Single $638.92
   Employee and child $1,086.17
   Employee and spouse/
domestic partner
$1,277.84
   Family $1,820.92
Primary Care
Doctor/Specialist
$0 pediatric PCP visits
$0 for first three adult PCP visits
$25/$40
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 $764.21
   Employee and child $1,299.16
   Employee and spouse/
domestic partner
$1,528.42
   Family $2,178.00
Primary Care
Doctor/Specialist
$0 pediatric PCP visits
$0 for first three adult PCP visits
$25/$40
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 EPO 5000
Region 1  
Monthly Premium  
   Single $723.86
   Employee and child $1,230.57
   Employee and spouse/
domestic partner
$1,447.72
   Family $2,063.00
Primary Care
Doctor/Specialist
$0 pediatric PCP visits
$0 for first three adult PCP visits
$25/$40
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 $868.49
   Employee and child $1,476.43
   Employee and spouse/
domestic partner
$1,736.98
   Family $2,475.20
Primary Care
Doctor/Specialist
$0 pediatric PCP visits
$0 for first three adult PCP visits
$25/$40
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 1  
Monthly Premium  
   Single $689.41
   Employee and child $1,172.00
   Employee and spouse/
domestic partner
$1,378.82
   Family $1,964.82
Primary Care
Doctor/Specialist
$0 pediatric PCP visits
$0 for first three adult PCP visits
$25/$40, Preferred

$25/$40, Participating
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 $821.11
   Employee and child $1,395.88
   Employee and spouse/
domestic partner
$1,642.22
   Family $2,340.16
Primary Care
Doctor/Specialist
$0 pediatric PCP visits
$0 for first three adult PCP visits
$25/$40, Preferred

$25/$40, Participating
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 $636.13
   Employee and child $1,081.42
   Employee and spouse/
domestic partner
$1,272.26
   Family $1,812.97
Primary Care
Doctor/Specialist
$0 pediatric PCP visits
$0 for first three adult PCP visits
$25/$40
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 $760.76
   Employee and child $1,293.30
   Employee and spouse/
domestic partner
$1,521.52
   Family $2,168.17
Primary Care
Doctor/Specialist
$0 pediatric PCP visits
$0 for first three adult PCP visits
$25/$40
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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Preventive Services

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