Highmark Flex Blue PPO 1000 a Community Blue Plan PA

Plan Information
Company Highmark Health Services
State PA
Metal Tier Gold
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) $1,000 $4,000
Deductible (Family) $2,000 $8,000
Coinsurance 20% 50%
Out of Pocket Maximum (Individual) $4,000 $8,000
Out of Pocket Maximum (Family) $8,000 $16,000
Services In Network Out of Network
Primary Care Visit $25 50% coinsurance
Specialist Visit $50 50% coinsurance
In Patient Hospital Services $500 Copay per Stay and 20% Coin 50% coinsurance
Emergency Room Services $150 $150 copay
Mental / Behavioral Health $50 copay 50% coinsurance
Imaging (CT/PET Scans, MRIs) $150 copay 50% coinsurance
Rehabilitative Speech Therapy 20% coinsurance 50% coinsurance
Rehabilitative Occupational & Physical Therapy 20% coinsurance 50% coinsurance
Preventative Care $0 50% coinsurance
Laboratory Outpatient and Professional Services $25 copay 50% coinsurance
X-ray and Diagnostic Imaging $25 copay 50% coinsurance
Outpatient Facility 20% coinsurance 50% coinsurance
Outpatient Surgery 20% coinsurance 50% coinsurance
Prescription Drugs In Network Out of Network
Generic Rx $8
Preferred Brand Rx $45
Non Preferred Brand Rx $95
Specialty Drugs 25%

Other Plans

Other plans that are available in the state.

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