Highmark Shared Cost Blue PPO 5500 a Community Blue Plan (Pennsylvania)

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Company Highmark Health Services
Plan Year 2014
State Pennsylvania
Metal Tier Bronze
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) $5,500
Deductible (Family) $11,000
Coinsurance 40%
Out of Pocket Maximum (Individual) $6,350
Out of Pocket Maximum (Family) $12,700

Doctors Visits

Primary Care Visit $50
Specialist Visit $90
In Patient Hospital Services 40% Coinsurance after deductible
Emergency Room Services 40% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 40% coinsurance
Laboratory Outpatient and Professional Services $50 copay
X-ray and Diagnostic Imaging $50 copay


Mental / Behavioral Health $90 copay
Rehabilitative Speech Therapy 40% coinsurance
Rehabilitative Occupational & Physical Therapy 40% coinsurance
Outpatient Facility 40% coinsurance
Outpatient Surgery 40% coinsurance

Prescription Drugs

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

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