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

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) $1,000
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 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
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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) $1,000
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 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