Highmark Shared Cost Blue PPO 1500 PA

Plan Information
Company Highmark Health Insurance Company
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) $1,500 $3,000
Deductible (Family) $3,000 $6,000
Coinsurance 10% 30%
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 $20 30% coinsurance
Specialist Visit $40 30% coinsurance
In Patient Hospital Services 10% Coinsurance after deductible 30% coinsurance
Emergency Room Services 10% Coinsurance after deductible 10% coinsurance
Mental / Behavioral Health $40 copay 30% coinsurance
Imaging (CT/PET Scans, MRIs) 10% coinsurance 30% coinsurance
Rehabilitative Speech Therapy 10% coinsurance 30% coinsurance
Rehabilitative Occupational & Physical Therapy 10% coinsurance 30% coinsurance
Preventative Care $0 30% coinsurance
Laboratory Outpatient and Professional Services $20 copay 30% coinsurance
X-ray and Diagnostic Imaging $20 copay 30% coinsurance
Outpatient Facility 10% coinsurance 30% coinsurance
Outpatient Surgery 10% coinsurance 30% 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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