Highmark Shared Cost Blue PPO 5500 a Community Blue Plan PA

Plan Information
Company Highmark Health Services
State PA
Metal Tier Bronze
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) $5,500 $11,000
Deductible (Family) $11,000 $22,000
Coinsurance 40% 50%
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 $50 50% coinsurance
Specialist Visit $90 50% coinsurance
In Patient Hospital Services 40% Coinsurance after deductible 50% coinsurance
Emergency Room Services 40% Coinsurance after deductible 40% coinsurance
Mental / Behavioral Health $90 copay 50% coinsurance
Imaging (CT/PET Scans, MRIs) 40% coinsurance 50% coinsurance
Rehabilitative Speech Therapy 40% coinsurance 50% coinsurance
Rehabilitative Occupational & Physical Therapy 40% coinsurance 50% coinsurance
Preventative Care $0 50% coinsurance
Laboratory Outpatient and Professional Services $50 copay 50% coinsurance
X-ray and Diagnostic Imaging $50 copay 50% coinsurance
Outpatient Facility 40% coinsurance 50% coinsurance
Outpatient Surgery 40% coinsurance 50% coinsurance
Prescription Drugs In Network Out of Network
Generic Rx 40% Coinsurance after deductible
Preferred Brand Rx 40% Coinsurance after deductible
Non Preferred Brand Rx 40% Coinsurance after deductible
Specialty Drugs 40% Coinsurance after deductible

Other Plans

Other plans that are available in the state.

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