Highmark Flex Blue PPO 2100 a Community Blue Plan PA

Plan Information
Company Highmark Health Services
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) $2,100 $8,400
Deductible (Family) $4,200 $16,800
Coinsurance 30% 60%
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 $45 60% coinsurance
Specialist Visit $90 60% coinsurance
In Patient Hospital Services $950 Copay per Stay and 30% Coin 60% coinsurance
Emergency Room Services 30% Coinsurance after deductible 30% coinsurance
Mental / Behavioral Health $90 copay 60% coinsurance
Imaging (CT/PET Scans, MRIs) $250 copay 60% coinsurance
Rehabilitative Speech Therapy 30% coinsurance 60% coinsurance
Rehabilitative Occupational & Physical Therapy 30% coinsurance 60% coinsurance
Preventative Care $0 60% coinsurance
Laboratory Outpatient and Professional Services $50 copay 60% coinsurance
X-ray and Diagnostic Imaging $50 copay 60% coinsurance
Outpatient Facility 30% coinsurance 60% coinsurance
Outpatient Surgery 30% coinsurance 60% 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. To understand how cost sharing reductions work and how they work for you see our article about Obamacare Cost Sharing Reduction Discounts

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $1,750.00
Deductible (Family) $3,500.00
Out of Pocket Maximum (Individual) $4,500.00
Out of Pocket Maximum (Family) $9,000.00
Services In Network Out of Network
Primary Care Physician $45
Specialists $90
Emergency Room 30% Coinsurance after deductible
Inpatient Facility $950 Copay per Stay and 30% Coin
Inpatient Physician 30% 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) $1,500.00
Out of Pocket Maximum (Family) $3,000.00
Services In Network Out of Network
Primary Care Physician $20
Specialists $40
Emergency Room 20% Coinsurance after deductible
Inpatient Facility $500 Copay per Stay and 20% Coin
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%

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
Specialists $10
Emergency Room 10% Coinsurance after deductible
Inpatient Facility $100 Copay per Stay and 10% Coin
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.

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