Highmark - Shared Cost Blue EPO Silver 0

Delaware, 2019

  • Plan Type

    EPO

  • Metal Tier

    Silver

  • Out of Pocket Maximum

    $7,800

  • Deductible

    $0

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) $0
Deductible (Family) $0
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,800
Out of Pocket Maximum (Family) $15,600

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility $3900 Copay per day
Inpatient Physician 40% Coinsurance after deductible
Emergency Room Services Data Not Available

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 40% 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 $3900 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) $0
Deductible (Family) $0
Out of Pocket Maximum (Individual) $6,300
Out of Pocket Maximum (Family) $12,600

Doctor Visits

Primary Care Physician
Specialists
Emergency Room
Inpatient Facility $3900 Copay per day
Inpatient Physician 40% 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) $0
Deductible (Family) $0
Out of Pocket Maximum (Individual) $2,400
Out of Pocket Maximum (Family) $4,800

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

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) $0
Deductible (Family) $0
Out of Pocket Maximum (Individual) $1,300
Out of Pocket Maximum (Family) $2,600

Doctor Visits

Primary Care Physician
Specialists
Emergency Room
Inpatient Facility $300 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 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 Gold 1000 - 2 Free PCP Visits Deductible $1,000 Coinsurance Not applicable Out of Pocket $7,000
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) $0
Deductible (Family) $0
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,800
Out of Pocket Maximum (Family) $15,600

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility $3900 Copay per day
Inpatient Physician 40% Coinsurance after deductible
Emergency Room Services Data Not Available

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 40% 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 $3900 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) $0
Deductible (Family) $0
Out of Pocket Maximum (Individual) $6,300
Out of Pocket Maximum (Family) $12,600

Doctor Visits

Primary Care Physician
Specialists
Emergency Room
Inpatient Facility $3900 Copay per day
Inpatient Physician 40% 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) $0
Deductible (Family) $0
Out of Pocket Maximum (Individual) $2,400
Out of Pocket Maximum (Family) $4,800

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

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) $0
Deductible (Family) $0
Out of Pocket Maximum (Individual) $1,300
Out of Pocket Maximum (Family) $2,600

Doctor Visits

Primary Care Physician
Specialists
Emergency Room
Inpatient Facility $300 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 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 Gold 1000 - 2 Free PCP Visits Deductible $1,000 Coinsurance Not applicable Out of Pocket $7,000
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