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Highmark - Shared Cost Blue EPO Gold 1000 - 2 Free PCP Visits
Delaware, 2019
Plan Type
EPO
Metal Tier
Gold
Out of Pocket Maximum
$7,000
Deductible
$1,000
Emergency Room Care: $500 Copay after deductible
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) | $1,000 |
|---|---|
| Deductible (Family) | $2,000 |
| Coinsurance | Not applicable |
| Out of Pocket Maximum (Individual) | $7,000 |
| Out of Pocket Maximum (Family) | $14,000 |
Doctor Visits
| Primary Care Visit | Data Not Available |
|---|---|
| Specialist Visit | Data Not Available |
| Inpatient Facility | 20% Coinsurance after deductible |
| Inpatient Physician | 20% Coinsurance after deductible |
| Emergency Room Services | $500 Copay after deductible |
Tests and Imaging
| Imaging (CT/PET Scans, MRIs) | 20% Coinsurance after deductible |
|---|---|
| Laboratory Outpatient and Professional Services | Data Not Available |
| X-Ray and Diagnostic Imaging | Data Not Available |
Health Management Programs
| Asthma | Available |
|---|---|
| Depression | Available |
| Diabetes | Available |
| Heart Disease | Available |
| High Blood Pressure / High Cholesterol | Available |
| Lower Back Pain | Available |
| Pain Management | Available |
| Pregnancy | Available |
| Weight Loss | Available |
Other
| Mental / Behavioral Health Inpatient | 20% Coinsurance after deductible |
|---|---|
| Mental / Behavioral Health Outpatient | Data Not Available |
| Rehabilitative Speech Therapy | Data Not Available |
| Rehabilitative Occupational & Physical Therapy | Data Not Available |
| Outpatient Facility | 20% Coinsurance after deductible |
| Outpatient Surgery | 20% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | Data Not Available |
|---|---|
| Preferred Brand Rx | Data Not Available |
| Non Preferred Brand Rx | Data Not Available |
| Specialty Drugs |
Other Plans in Delaware
| Plan | Deductible | Coinsurance | Out of Pocket |
|---|---|---|---|
| Plan Major Events Blue EPO 7900 | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Health Savings Embedded Blue EPO Silver 4450 HSA | Deductible $4,450 | Coinsurance Not applicable | Out of Pocket $6,650 |
| Plan Shared Cost Blue EPO Bronze 4000 | Deductible $4,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Shared Cost Blue EPO Silver 0 | Deductible $0 | Coinsurance Not applicable | Out of Pocket $7,800 |
| Plan Shared Cost Blue EPO Bronze 7900 | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Shared Cost Blue EPO Silver 2400 - 2 Free PCP Visits | Deductible $2,400 | Coinsurance Not applicable | Out of Pocket $7,800 |
| Plan Shared Cost Blue EPO Platinum 200 - 2 Free PCP Visits | Deductible $200 | Coinsurance Not applicable | Out of Pocket $6,000 |