Highmark Comprehensive Care Blue PPO 1500 PA

Plan Information
Company Highmark Health Insurance Company
State PA
Metal Tier Silver
Plan Type PPO

Cost Sharing Benefits

These details are for the standard Silver plan. For reduced Cost Sharing versions scroll down below

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.

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $1,500 $3,000
Deductible (Family) $3,000 $6,000
Coinsurance 20% 40%
Out of Pocket Maximum (Individual) $6,350 $12,700
Out of Pocket Maximum (Family) $12,700 $25,400
Services In Network Out of Network
Primary Care Visit $35 Copay after deductible 40% coinsurance
Specialist Visit $70 Copay after deductible 40% coinsurance
In Patient Hospital Services 20% Coinsurance after deductible 40% coinsurance
Emergency Room Services 20% Coinsurance after deductible 20% coinsurance
Mental / Behavioral Health $70 copay 40% coinsurance
Imaging (CT/PET Scans, MRIs) 20% coinsurance 40% coinsurance
Rehabilitative Speech Therapy 20% coinsurance 40% coinsurance
Rehabilitative Occupational & Physical Therapy 20% coinsurance 40% coinsurance
Preventative Care $0 40% coinsurance
Laboratory Outpatient and Professional Services $40 copay 40% coinsurance
X-ray and Diagnostic Imaging $40 copay 40% coinsurance
Prescription Drugs In Network Out of Network
Generic Rx $8
Preferred Brand Rx $45
Non Preferred Brand Rx $95
Specialty Drugs 25%

73% Cost Sharing Benefits

Households with incomes between 200% to 250% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $1,500.00
Deductible (Family) $3,000.00
Out of Pocket Maximum (Individual) $3,500.00
Out of Pocket Maximum (Family) $7,000.00
Services In Network Out of Network
Primary Care Physician $35 Copay after deductible
Specialists $70 Copay after deductible
Emergency Room 20% Coinsurance after deductible
Inpatient Facility 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible
Prescription Drugs In Network Out of Network
Generic Rx $8.00
Preferred Brand Rx $45
Non Preferred Brand Rx $95
Specialty Drugs 25%

87% Cost Sharing Benefits

Households with incomes between 150% to 200% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $500.00
Deductible (Family) $1,000.00
Out of Pocket Maximum (Individual) $1,000.00
Out of Pocket Maximum (Family) $2,000.00
Services In Network Out of Network
Primary Care Physician $20 Copay after deductible
Specialists $30 Copay after deductible
Emergency Room 10% Coinsurance after deductible
Inpatient Facility 10% Coinsurance after deductible
Inpatient Physician 10% Coinsurance after deductible
Prescription Drugs In Network Out of Network
Generic Rx $8.00
Preferred Brand Rx $45
Non Preferred Brand Rx $95
Specialty Drugs 25%

94% Cost Sharing Benefits

Households with incomes between 138% to 150% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $100.00
Deductible (Family) $200.00
Out of Pocket Maximum (Individual) $500.00
Out of Pocket Maximum (Family) $1,000.00
Services In Network Out of Network
Primary Care Physician $5 Copay after deductible
Specialists $10 Copay after deductible
Emergency Room 10% Coinsurance after deductible
Inpatient Facility 10% Coinsurance after deductible
Inpatient Physician 10% Coinsurance after deductible
Prescription Drugs In Network Out of Network
Generic Rx $8.00
Preferred Brand Rx $45
Non Preferred Brand Rx $95
Specialty Drugs 25%

Other Plans

Other plans that are available in the state.

Plan Name
Blue Cross Blue Shield Shared Cost 1500, a Multi-State Plan
Blue Cross Blue Shield Shared Cost 3200, a Multi-State Plan
Blue Shield Shared Cost 1500, a Multi-State Plan
Blue Shield Shared Cost 3200, a Multi-State Plan
Comprehensive Care Blue PPO 1500
Comprehensive Care Blue PPO 500
Health Savings Blue PPO 1300
Health Savings Blue PPO 2500
Health Savings Blue PPO 3400
Shared Cost Blue PPO 1500
Shared Cost Blue PPO 3200
Shared Cost Blue PPO 5500
Flex Blue PPO 1000 a Community Blue Plan
Flex Blue PPO 1200 a Community Blue Plan
Flex Blue PPO 2100 a Community Blue Plan
Flex Blue PPO 2650 a Community Blue Plan
Flex Blue PPO 4000 a Community Blue Plan
Health Savings Blue PPO 1700 a Community Blue Plan
Health Savings Blue PPO 2750 a Community Blue Plan
Major Events Blue PPO 6350
Major Events Blue PPO 6350 a Community Blue plan
Shared Cost Blue PPO 1000 a Community Blue Plan
Shared Cost Blue PPO 1200 a Community Blue Plan
Shared Cost Blue PPO 2100 a Community Blue Plan
Shared Cost Blue PPO 2650 a Community Blue Plan
Shared Cost Blue PPO 5500 a Community Blue Plan
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