Highmark Shared Cost Blue EPO 1350 (Delaware)

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Company Highmark Blue Cross Blue Shield Delaware
Plan Year 2014
State Delaware
Metal Tier Gold
Plan Type EPO
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Cost Sharing Benefits (In Network)

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductible (Individual) $1,350
Deductible (Family) $2,700
Coinsurance $0
Out of Pocket Maximum (Individual) $2,500
Out of Pocket Maximum (Family) $5,000

Doctors Visits

Primary Care Visit No Charge after deductible
Specialist Visit No Charge after deductible
In Patient Hospital Services No Charge after deductible
Emergency Room Services No Charge after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) $0
Laboratory Outpatient and Professional Services $0
X-ray and Diagnostic Imaging $0


Mental / Behavioral Health $0
Rehabilitative Speech Therapy $0
Rehabilitative Occupational & Physical Therapy $0
Outpatient Facility $0
Outpatient Surgery $0

Prescription Drugs

Generic Rx $8
Preferred Brand Rx $35
Non Preferred Brand Rx $50
Specialty Drugs $50

Other Plans

Other plans that are available in the state.

Plan Name
Blue Cross Blue Shield Shared Cost 3000, a Multi-State Plan
Blue Cross Blue Shield Health Savings 1800, a Multi-State Plan
Major Events Blue EPO 6600
Shared Cost Blue EPO 0
Shared Cost Blue EPO 300
Shared Cost Blue EPO 1000
Shared Cost Blue EPO 3000
Shared Cost Blue EPO 5250
Shared Cost Blue EPO 1350
Shared Cost Blue EPO 750
Health Savings Blue EPO 6300 Rewards
Health Savings Blue EPO 1800
Health Savings Blue EPO 3000
Shared Cost Blue PPO 1500
Shared Cost Blue PPO 1800 Rewards

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