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

Referralsinfo Not required for specialist visits
Deductibleinfo $800 individual/$1,600 family
Out-of-pocket maximuminfo $6,200 individual/$12,400 family
Out-of-networkinfocoverage No coverage for non-emergency services
Primary care physicianinfo 3 free sick visits then $25 before deductible
Preventive carenfo Fully 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