Highmark - my Connect Blue WV PPO 750S

West Virginia, 2017

  • Plan Type

    PPO

  • Metal Tier

    Silver

  • Out of Pocket Maximum

    $7,150

  • Deductible

    $750

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) $750
Deductible (Family) $1,500
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,150
Out of Pocket Maximum (Family) $14,300

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility $1000 Copay per day
Inpatient Physician 30% Coinsurance after deductible
Emergency Room Services Data Not Available

Tests and Imaging

Imaging (CT/PET Scans, MRIs) Data Not Available
Laboratory Outpatient and Professional Services Data Not Available
X-Ray and Diagnostic Imaging Data Not Available

Health Management Programs

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

Other

Mental / Behavioral Health Inpatient $1000 Copay per day
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy Data Not Available
Rehabilitative Occupational & Physical Therapy Data Not Available
Outpatient Facility Data Not Available
Outpatient Surgery Data Not Available

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx Data Not Available
Non Preferred Brand Rx Data Not Available
Specialty Drugs

73% Cost Sharing Benefits

Households with incomes between 200% to 250% of FPL qualify for the following cost sharing benefits for this silver plan. To understand how cost sharing reductions work and how they work for you see our article about Obamacare Cost Sharing Reduction Discounts

Deductibles and Cost Sharing

Deductible (Individual) $750
Deductible (Family) $1,500
Out of Pocket Maximum (Individual) $4,900
Out of Pocket Maximum (Family) $9,800

Doctor Visits

Primary Care Physician
Specialists
Emergency Room
Inpatient Facility $1000 Copay per day
Inpatient Physician 30% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

87% Cost Sharing Benefits

Households with incomes between 150% to 200% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $600
Deductible (Family) $1,200
Out of Pocket Maximum (Individual) $1,200
Out of Pocket Maximum (Family) $2,400

Doctor Visits

Primary Care Physician
Specialists
Emergency Room
Inpatient Facility $500 Copay per day
Inpatient Physician 10% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

94% Cost Sharing Benefits

Households with incomes between 138% to 150% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $200
Deductible (Family) $400
Out of Pocket Maximum (Individual) $400
Out of Pocket Maximum (Family) $800

Doctor Visits

Primary Care Physician
Specialists
Emergency Room
Inpatient Facility $500 Copay per day
Inpatient Physician 10% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

Other Plans in West Virginia

Plan my Connect Blue WV PPO 1000G Deductible $1,000 Coinsurance Not applicable Out of Pocket $4,500
Plan my Connect Blue WV PPO 6500B Deductible $6,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Major Events Blue PPO 7150 Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan my Connect Blue WV PPO 1500G Deductible $1,500 Coinsurance Not applicable Out of Pocket $4,200
Plan my Connect Blue WV PPO 2800SQE Deductible $2,800 Coinsurance Not applicable Out of Pocket $5,700
Plan my Connect Blue WV PPO 4750S Deductible $4,750 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) $750
Deductible (Family) $1,500
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,150
Out of Pocket Maximum (Family) $14,300

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility $1000 Copay per day
Inpatient Physician 30% Coinsurance after deductible
Emergency Room Services Data Not Available

Tests and Imaging

Imaging (CT/PET Scans, MRIs) Data Not Available
Laboratory Outpatient and Professional Services Data Not Available
X-Ray and Diagnostic Imaging Data Not Available

Health Management Programs

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

Other

Mental / Behavioral Health Inpatient $1000 Copay per day
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy Data Not Available
Rehabilitative Occupational & Physical Therapy Data Not Available
Outpatient Facility Data Not Available
Outpatient Surgery Data Not Available

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx Data Not Available
Non Preferred Brand Rx Data Not Available
Specialty Drugs

73% Cost Sharing Benefits

Households with incomes between 200% to 250% of FPL qualify for the following cost sharing benefits for this silver plan. To understand how cost sharing reductions work and how they work for you see our article about Obamacare Cost Sharing Reduction Discounts

Deductibles and Cost Sharing

Deductible (Individual) $750
Deductible (Family) $1,500
Out of Pocket Maximum (Individual) $4,900
Out of Pocket Maximum (Family) $9,800

Doctor Visits

Primary Care Physician
Specialists
Emergency Room
Inpatient Facility $1000 Copay per day
Inpatient Physician 30% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

87% Cost Sharing Benefits

Households with incomes between 150% to 200% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $600
Deductible (Family) $1,200
Out of Pocket Maximum (Individual) $1,200
Out of Pocket Maximum (Family) $2,400

Doctor Visits

Primary Care Physician
Specialists
Emergency Room
Inpatient Facility $500 Copay per day
Inpatient Physician 10% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

94% Cost Sharing Benefits

Households with incomes between 138% to 150% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $200
Deductible (Family) $400
Out of Pocket Maximum (Individual) $400
Out of Pocket Maximum (Family) $800

Doctor Visits

Primary Care Physician
Specialists
Emergency Room
Inpatient Facility $500 Copay per day
Inpatient Physician 10% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

Other Plans in West Virginia

Plan my Connect Blue WV PPO 1000G Deductible $1,000 Coinsurance Not applicable Out of Pocket $4,500
Plan my Connect Blue WV PPO 6500B Deductible $6,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Major Events Blue PPO 7150 Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan my Connect Blue WV PPO 1500G Deductible $1,500 Coinsurance Not applicable Out of Pocket $4,200
Plan my Connect Blue WV PPO 2800SQE Deductible $2,800 Coinsurance Not applicable Out of Pocket $5,700
Plan my Connect Blue WV PPO 4750S Deductible $4,750 Coinsurance Not applicable Out of Pocket $7,150