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
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.

Plan Name
Blue Cross Blue Shield Shared Cost 1500, a Multi-State Plan
Blue Cross Blue Shield Shared Cost 3200, a Multi-State Plan
Blue Shield Shared Cost 1500, a Multi-State Plan
Blue Shield Shared Cost 3200, a Multi-State Plan
Comprehensive Care Blue PPO 1500
Comprehensive Care Blue PPO 500
Health Savings Blue PPO 1300
Health Savings Blue PPO 2500
Health Savings Blue PPO 3400
Shared Cost Blue PPO 1500
Shared Cost Blue PPO 3200
Shared Cost Blue PPO 5500
Flex Blue PPO 1000 a Community Blue Plan
Flex Blue PPO 1200 a Community Blue Plan
Flex Blue PPO 2100 a Community Blue Plan
Flex Blue PPO 2650 a Community Blue Plan
Flex Blue PPO 4000 a Community Blue Plan
Health Savings Blue PPO 1700 a Community Blue Plan
Health Savings Blue PPO 2750 a Community Blue Plan
Major Events Blue PPO 6350
Major Events Blue PPO 6350 a Community Blue plan
Shared Cost Blue PPO 1000 a Community Blue Plan
Shared Cost Blue PPO 1200 a Community Blue Plan
Shared Cost Blue PPO 2100 a Community Blue Plan
Shared Cost Blue PPO 2650 a Community Blue Plan
Shared Cost Blue PPO 5500 a Community Blue Plan
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This tool is for research purposes only. The numbers shown are estimates based on the information you have provided and our best efforts to provide accurate data. We try to keep the information up to date however we cannot make warranties about the accuracy of our information. We advise that users confirm any research with the respective health insurance companies and health exchanges.