Highmark Flex Blue PPO 1000 a Community Blue Plan (Pennsylvania)

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Company Highmark Health Services
Plan Year 2014
State Pennsylvania
Metal Tier Gold
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) $1,000
Deductible (Family) $2,000
Coinsurance 20%
Out of Pocket Maximum (Individual) $4,000
Out of Pocket Maximum (Family) $8,000

Doctors Visits

Primary Care Visit $25
Specialist Visit $50
In Patient Hospital Services $500 Copay per Stay and 20% Coin
Emergency Room Services $150

Tests and Imaging

Imaging (CT/PET Scans, MRIs) $150 copay
Laboratory Outpatient and Professional Services $25 copay
X-ray and Diagnostic Imaging $25 copay


Mental / Behavioral Health $50 copay
Rehabilitative Speech Therapy 20% coinsurance
Rehabilitative Occupational & Physical Therapy 20% coinsurance
Outpatient Facility 20% coinsurance
Outpatient Surgery 20% coinsurance

Prescription Drugs

Generic Rx $8
Preferred Brand Rx $45
Non Preferred Brand Rx $95
Specialty Drugs 25%

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