Highmark Comprehensive Care Blue PPO 500 (Pennsylvania)

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Company Highmark Health Insurance Company
Plan Year 2014
State Pennsylvania
Metal Tier Platinum
Plan Type PPO
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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) $500
Deductible (Family) $1,000
Coinsurance 10%
Out of Pocket Maximum (Individual) $1,650
Out of Pocket Maximum (Family) $3,300

Doctors Visits

Primary Care Visit 10% Coinsurance after deductible
Specialist Visit 10% Coinsurance after deductible
In Patient Hospital Services 10% Coinsurance after deductible
Emergency Room Services 10% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 10% coinsurance
Laboratory Outpatient and Professional Services 10% coinsurance
X-ray and Diagnostic Imaging 10% coinsurance


Mental / Behavioral Health 10% coinsurance
Rehabilitative Speech Therapy 10% coinsurance
Rehabilitative Occupational & Physical Therapy 10% coinsurance
Outpatient Facility 10% coinsurance
Outpatient Surgery 10% coinsurance

Prescription Drugs

Generic Rx $5
Preferred Brand Rx $20
Non Preferred Brand Rx $45
Specialty Drugs $45

Other Plans

Other plans that are available in the state.

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