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Shopping for Health Care Coverage

A Health Plan That’s Dedicated to You

Why choose CDPHP? Because when we say we care about your health and well-being, we mean it. With a variety of wellness initiatives, classes, and support programs at your disposal, you can take a proactive role in your health. Couple this with comprehensive benefit plans designed with your budget and lifestyle in mind and top-notch customer service, you can feel confident that your health care, and your health, are in excellent hands.

Find the Plan That’s Right for You
Shopping for a health plan that fits your needs and budget shouldn’t be difficult or time-consuming, and with CDPHP it isn’t. Use these tools to explore your options and help get a clear picture of your health care costs.

You may be eligible to enroll in a health savings account (HSA)offered by HealthEquity®. If your silver or bronze individual plan qualifies, simply fill out the Individual Enrollment/Application form* and check the HealthEquity HSA enrollment box.

*Please note, you will only need to fill in your name and address in section C – Subscriber Info, and sign the form at the end. HealthEquity will contact you with your Custodial Agreement separately.

Have Questions?
As always, we’re here to help. If you need assistance, please visit one of our local CDPHP Customer Connect service locations, email your question or call 1-800-777-2273 Monday through Friday from 8 a.m. to 8 p.m. 

Estimating Your Ultimate Cost

Your health care costs can vary depending on a number of factors. It is important to look at all of the different options available to you, and select the plan that best fits your needs. If you select a high deductible, your premium will be lower. A low-cost plan may be the best option for a person in good health, but can result in higher uncovered costs for someone who needs a lot of services. You need to consider your own budget and health status. The resources on this page can help you compare your choices.

  • Our individual health plans are tiered in “metal levels” based on the percentage of the cost they cover: Bronze, Silver, Gold, and Platinum.

  • Benefit levels are spelled out clearly and simply in the Summaries of Benefits and Coverage.

Estimating Your Costs

  • Select a metal level and review the Summaries of Benefits and Coverage (SBCs) to see how various services are covered.

  • Where a straightforward copayment is listed for a service (example: $25 for a primary care doctor visit), you can count on paying that amount for that service (after meeting the deductible, if any).

  • If the plan you are interested in has a deductible, or entails a coinsurance (example: 20% cost-sharing), use the FAIR Health calculator to get a sense of what health care providers in your area are charging for common procedures.

    • Tip: CDPHP high deductible health plan members also get access to CDPHP Price Check, allowing them to call and speak with a live, local representative to determine the costs of almost 20 common health care services BEFORE they’re scheduled.
  • Based on those cost estimates you can then calculate how quickly you might meet your deductible and what your share of the cost would be for services after the health plan pays.

Group Coverage: In Network Versus Out of Network

  • When viewing your options, note the difference between in-network and out-of-network cost-sharing levels. You will save by using our network!

  • Like other health plans, CDPHP has an “allowed amount” or maximum that we will pay for covered health care services delivered by a non-network provider. If a non-participating provider charges more than the allowed amount you may have to pay the difference between the allowed amount and the provider’s charge, in addition to any cost-sharing requirements.

These tools can guide you as you plan and compare costs. They do not constitute a guarantee of charges or authorization of any particular health service.

Questions?CDPHP can help! Make an appointment to speak to a knowledgeable member services representative at one of our CDPHP Customer Connect™ locations. You can also send us an email or call 1-855-236-7113.

2018 Insurance Options for Individuals and Families

What Will The Plan Cost?

Monthly premium rates vary by region, based on the county in which you live: Albany Region Rates, Mid-Hudson Region Rates, Syracuse Region Rates, Utica Region Rates

What Will Be Covered?

Below are the Summaries of Benefits and Coverage (SBCs) for the Individual plans offered by CDPHP. The Glossary of Terms will help you understand some of the language used in the SBCs.

Platinum Plans

Your out-of-pocket share of overall costs for covered services is approximately 10%. No cost-sharing applies to preventive care services.*

Gold Plans

Your out-of-pocket share for covered services is approximately 20%. Prescription drugs will not apply toward the overall medical deductible. No cost-sharing applies to preventive care services.*

Silver Plans

Your out-of-pocket share for covered services is approximately 30%. Prescription drugs will not apply toward the overall medical deductible. No cost-sharing applies to preventive care services.*

Bronze Plans

Your out-of-pocket share for covered services is approximately 40%. Prescription drug costs apply to the deductible.  No cost-sharing applies to preventive care services.*

Cost-Share Reduction Plans

Within the Cost-Share Reduction (CSR) category, purchasers must meet certain income requirements, with premium subsidies based on their income level. Out-of-pocket costs are less for those with lower incomes.

Catastrophic Plans

The Catastrophic Plan is available only to purchasers younger than 30 who meet a certain income requirement. It will provide basic preventive care services* and three other primary care doctor visits per year not subject to the deductible. Once the deductible is met, the member has no cost-share for covered benefits for the rest of the year.

 

2017 Insurance Options for Individuals and Families

What Will The Plan Cost?

Monthly premium rates vary by region, based on the county in which you live: Albany Region Rates, Mid-Hudson Region Rates, Syracuse Region Rates, Utica Region Rates

What Will Be Covered?

Below are the Summaries of Benefits and Coverage (SBCs) for the Individual plans offered by CDPHP. The Glossary of Terms will help you understand some of the language used in the SBCs.

Platinum Plans

Your out-of-pocket share of overall costs for covered services is approximately 10%. No cost-sharing applies to preventive care services.*

Gold Plans

Your out-of-pocket share for covered services is approximately 20%. Prescription drugs will not apply toward the overall medical deductible. No cost-sharing applies to preventive care services.*

Silver Plans

Your out-of-pocket share for covered services is approximately 30%. Prescription drugs will not apply toward the overall medical deductible. No cost-sharing applies to preventive care services.*

Bronze Plans

Your out-of-pocket share for covered services is approximately 40%. Prescription drug costs apply to the deductible.  No cost-sharing applies to preventive care services.*

Cost-Share Reduction Plans

Within the Cost-Share Reduction (CSR) category, purchasers must meet certain income requirements, with premium subsidies based on their income level. Out-of-pocket costs are less for those with lower incomes.

Catastrophic Plans

The Catastrophic Plan is available only to purchasers younger than 30 who meet a certain income requirement. It will provide basic preventive care services* and three other primary care doctor visits per year not subject to the deductible. Once the deductible is met, the member has no cost-share for covered benefits for the rest of the year.

 

Small Business Coverage 2017

Small business owners: Review the Summaries of Benefits and Coverage (SBCs) for the Small Group plans offered by CDPHP.

Platinum Plan

Gold Plans

The member’s out-of-pocket share of overall costs is 10%. No cost-sharing applies to preventive care services.*

The member’s out-of-pocket share for covered services is approximately 20%. Prescription drugs will not apply toward the overall medical deductible. No cost-sharing applies to preventive care services.*

 

Silver Plans

Bronze Plans

The member’s out-of-pocket share for covered services is approximately 30%. Prescription drugs will not apply toward the overall medical deductible, although the Rx benefit may have its own deductible. No cost-sharing applies to preventive care services.*

The member’s out-of-pocket share for covered services is approximately 40%. Prescription drug costs apply to the deductible.  No cost-sharing applies to preventive care services.*