Highmark Comprehensive Care Blue PPO 500 PA

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

Cost Sharing Benefits

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) $500 $1,000
Deductible (Family) $1,000 $2,000
Coinsurance 10% 20%
Out of Pocket Maximum (Individual) $1,650 $3,300
Out of Pocket Maximum (Family) $3,300 $6,600
Services In Network Out of Network
Primary Care Visit 10% Coinsurance after deductible 20% coinsurance
Specialist Visit 10% Coinsurance after deductible 20% coinsurance
In Patient Hospital Services 10% Coinsurance after deductible 20% coinsurance
Emergency Room Services 10% Coinsurance after deductible 10% coinsurance
Mental / Behavioral Health 10% coinsurance 20% coinsurance
Imaging (CT/PET Scans, MRIs) 10% coinsurance 20% coinsurance
Rehabilitative Speech Therapy 10% coinsurance 20% coinsurance
Rehabilitative Occupational & Physical Therapy 10% coinsurance 20% coinsurance
Preventative Care $0 20% coinsurance
Laboratory Outpatient and Professional Services 10% coinsurance 20% coinsurance
X-ray and Diagnostic Imaging 10% coinsurance 20% coinsurance
Outpatient Facility 10% coinsurance 20% coinsurance
Outpatient Surgery 10% coinsurance 20% coinsurance
Prescription Drugs In Network Out of Network
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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