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my Blue Access EX Destination 65 Silver + Adult Dental and Vision, Silver, NS, INN, Blue Marketplace, Dep29, Family Dental, Family Vision, WP
Health Insurance Plan Details (2026 Plan)
by Highmark Western and Northeastern New York
Monthly Premium
EPO
$ubsidy
Silver
- Deductible
- $0 /yr
- Max Out-of-Pocket
- $9,700 /yr
Details
| Deductible (per individual) | $0 /yr |
| Deductible (per family) | $0 /yr |
| Max Out-of-Pocket (per individual) | $9,700 /yr |
| Max Out-of-Pocket (per family) | $19,400 /yr |
| Drug Deductible (per individual) | |
| Drug Deductible (per family) | |
| Drug Max Out-of-Pocket (per individual) | |
| Drug Max Out-of-Pocket (per family) | |
| Plan Type | EPO |
| Includes Child Dental? | Yes |
| Includes Adult Dental? | Yes |
Out-of-Pocket Costs
| Preventive Care | No Charge |
| Primary Care Visit | $0 Copay |
| Specialist Visit | $50 Copay |
| Emergency Room | $1000 Copay |
| Inpatient Facility | $2000 Copay per Stay |
| Inpatient Physician | $500 Copay |
| Generic Drugs | $15 Copay |
| Preferred Brand Drugs | 50.00% Coinsurance |
| Non-preferred Brand Drugs | 50.00% Coinsurance |
| Specialty Drugs | Not Applicable |
Plan Documents
| Summary of Benefits and Coverage | SBC doc |
| Provider Directory | Doctor lookup |
| Drug Formulary List | n/a |
* Figures shown are only for in-network medical costs
** Please check with insurance company if Copay and Coinsurance rates are before or after the deductible
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