Highmark - Health Savings Blue PPO 1700

Pennsylvania, 2017

  • Plan Type

    PPO

  • Metal Tier

    Gold

  • Out of Pocket Maximum

    $3,250

  • Deductible

    $1,700

Enroll Now
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Call (855) 866-5590 to speak with a licensed agent about a new health plan.

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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) $1,700
Deductible (Family) $3,400
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $3,250
Out of Pocket Maximum (Family) $6,500

Doctor Visits

Primary Care Visit 10% Coinsurance after deductible
Specialist Visit 10% Coinsurance after deductible
Inpatient Facility 10% Coinsurance after deductible
Inpatient Physician 10% Coinsurance after deductible
Emergency Room Services 10% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 10% Coinsurance after deductible
Laboratory Outpatient and Professional Services 10% Coinsurance after deductible
X-Ray and Diagnostic Imaging 10% Coinsurance after deductible

Health Management Programs

Asthma Available
Depression Available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Not available
Pain Management Available
Pregnancy Available
Weight Loss Available

Other

Mental / Behavioral Health Inpatient 10% Coinsurance after deductible
Mental / Behavioral Health Outpatient 10% Coinsurance after deductible
Rehabilitative Speech Therapy 10% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 10% Coinsurance after deductible
Outpatient Facility 10% Coinsurance after deductible
Outpatient Surgery 10% Coinsurance after deductible

Prescription Drugs

Generic Rx 10% Coinsurance after deductible
Preferred Brand Rx 10% Coinsurance after deductible
Non Preferred Brand Rx 10% Coinsurance after deductible
Specialty Drugs 10% Coinsurance after deductible

Other Plans in Pennsylvania

Plan my Premier Blue Flex PPO 1700GQ Deductible $1,700 Coinsurance Not applicable Out of Pocket $3,250
Plan my Lehigh Valley Flex Blue PPO 2900S Deductible $2,900 Coinsurance Not applicable Out of Pocket $7,150
Plan Comprehensive Care Flex Blue PPO 500 Deductible $500 Coinsurance Not applicable Out of Pocket $1,900
Plan Alliance Flex Blue PPO 1000 Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,250
Plan my Premier Blue Flex PPO 2700SQE Deductible $2,700 Coinsurance Not applicable Out of Pocket $6,000
Plan my Lehigh Valley Flex Blue PPO 1000G Deductible $1,000 Coinsurance Not applicable Out of Pocket $6,800
Plan my Premier Blue Flex PPO 6000BQE Deductible $6,000 Coinsurance Not applicable Out of Pocket $6,450
Plan Health Savings Blue PPO Embedded 2700 Deductible $2,700 Coinsurance Not applicable Out of Pocket $6,500
Plan my Premier Blue Flex PPO 3200S Deductible $3,200 Coinsurance Not applicable Out of Pocket $6,850
Plan Alliance Flex Blue PPO 2300 Deductible $2,300 Coinsurance Not applicable Out of Pocket $7,150
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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) $1,700
Deductible (Family) $3,400
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $3,250
Out of Pocket Maximum (Family) $6,500

Doctor Visits

Primary Care Visit 10% Coinsurance after deductible
Specialist Visit 10% Coinsurance after deductible
Inpatient Facility 10% Coinsurance after deductible
Inpatient Physician 10% Coinsurance after deductible
Emergency Room Services 10% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 10% Coinsurance after deductible
Laboratory Outpatient and Professional Services 10% Coinsurance after deductible
X-Ray and Diagnostic Imaging 10% Coinsurance after deductible

Health Management Programs

Asthma Available
Depression Available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Not available
Pain Management Available
Pregnancy Available
Weight Loss Available

Other

Mental / Behavioral Health Inpatient 10% Coinsurance after deductible
Mental / Behavioral Health Outpatient 10% Coinsurance after deductible
Rehabilitative Speech Therapy 10% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 10% Coinsurance after deductible
Outpatient Facility 10% Coinsurance after deductible
Outpatient Surgery 10% Coinsurance after deductible

Prescription Drugs

Generic Rx 10% Coinsurance after deductible
Preferred Brand Rx 10% Coinsurance after deductible
Non Preferred Brand Rx 10% Coinsurance after deductible
Specialty Drugs 10% Coinsurance after deductible

Other Plans in Pennsylvania

Plan my Premier Blue Flex PPO 1700GQ Deductible $1,700 Coinsurance Not applicable Out of Pocket $3,250
Plan my Lehigh Valley Flex Blue PPO 2900S Deductible $2,900 Coinsurance Not applicable Out of Pocket $7,150
Plan Comprehensive Care Flex Blue PPO 500 Deductible $500 Coinsurance Not applicable Out of Pocket $1,900
Plan Alliance Flex Blue PPO 1000 Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,250
Plan my Premier Blue Flex PPO 2700SQE Deductible $2,700 Coinsurance Not applicable Out of Pocket $6,000
Plan my Lehigh Valley Flex Blue PPO 1000G Deductible $1,000 Coinsurance Not applicable Out of Pocket $6,800
Plan my Premier Blue Flex PPO 6000BQE Deductible $6,000 Coinsurance Not applicable Out of Pocket $6,450
Plan Health Savings Blue PPO Embedded 2700 Deductible $2,700 Coinsurance Not applicable Out of Pocket $6,500
Plan my Premier Blue Flex PPO 3200S Deductible $3,200 Coinsurance Not applicable Out of Pocket $6,850
Plan Alliance Flex Blue PPO 2300 Deductible $2,300 Coinsurance Not applicable Out of Pocket $7,150