Medical Plans

ASO Plan

  1. General
  2. Benefit Items
  3. Plan Documents
  4. Rates
  5. Eligibility
Plan Name: ASO Plan
Description: Refer to the Summary Plan Description for benefit questions or call First Niagara 518-324-5335
Employee Instructions: This plan has a PPO network, so coverage is available to any BlueCross BlueShield provider
If any changes are necessary by the member, an application must be completed
Start Date - End Date: 01/01/2014 - 01/01/2015
Group Number: 00962347
Carrier: BlueShield of NENY

POS 298 Class 0003

  1. General
  2. Benefit Items
  3. Plan Documents
  4. Rates
  5. Eligibility
  6. Contacts
Plan Name: POS 298 Class 0003
Description: $0 or $15 or $10 PCP Copay
$20 or $15 or $10 Specialist Copay
$5 / $20 / $40 RX copays
Employee Instructions: This plan has a managed network with very little access to Vermont providers
Start Date - End Date: 01/01/2014 - 01/01/2015
Group Number: 00962347
Carrier: BlueShield of NENY

POS 298 Class 0005

  1. General
  2. Benefit Items
  3. Plan Documents
  4. Rates
  5. Eligibility
  6. Contacts
Plan Name: POS 298 Class 0005
Description: $0 or $15 or $10 PCP Copay
$20 or $15 or $10 Specialist Copay
$5 / $10 / $25 RX copays
Employee Instructions: This plan has a managed network with very little access to Vermont providers
Start date - End date: 01/01/2014 - 01/01/2015
Group Number: 00962347
Carrier: BlueShield of NENY

POS 298 Class 0004

  1. General
  2. Benefit Items
  3. Plan Documents
  4. Rates
  5. Eligibility
  6. Contacts
Plan Name: POS 298 Class 0004
Description: $20 PCP and Specialist Copay
$10 / $20 / $40 RX copays
Employee Instructions: This plan has a managed network with very little access to Vermont providers
Start Date - End Date: 01/01/2014 - 01/01/2015
Group Number: 00962347
Carrier: BlueShield of NENY

POS 298 Class 0007

  1. General
  2. Benefit Items
  3. Plan Documents
  4. Rates
  5. Eligibility
  6. Contacts
Plan Name: POS 298 Class 0007
Description: $20 PCP and Specialist Copay
$5 / $10 / $25 RX copays
Employee Instructions: This plan has a managed network with very little access to Vermont providers
Start Date - End Date: 01/01/2014 - 01/01/2015
Group Number: 00962347
Carrier: BlueShield of NENY
Disclaimer: Every effort has been made to ensure that the information in this summary is accurate; however no warranty of complete accuracy is made. If a discrepancy is found between this summary and the benefits you selected or the Summary Plan Description (SPD), your selections and the provisions of the SPD will govern.