Highmark - my Direct Blue Erie HMO Silver 2400 - 2 Free PCP Visits

Pennsylvania, 2019

  • Plan Type

    HMO

  • Metal Tier

    Silver

  • Out of Pocket Maximum

    $7,800

  • Deductible

    $2,400

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) $2,400
Deductible (Family) $4,800
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 30% Coinsurance after deductible
Inpatient Physician 30% Coinsurance after deductible
Emergency Room Services $750 Copay after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 30% 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 30% 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 30% Coinsurance after deductible
Outpatient Surgery 30% 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

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) $2,300
Deductible (Family) $4,600
Out of Pocket Maximum (Individual) $6,300
Out of Pocket Maximum (Family) $12,600

Doctor Visits

Primary Care Physician
Specialists
Emergency Room $570 Copay after deductible
Inpatient Facility 30% Coinsurance after deductible
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) $2,200
Out of Pocket Maximum (Family) $4,400

Doctor Visits

Primary Care Physician
Specialists
Emergency Room $500 Copay after deductible
Inpatient Facility 10% Coinsurance after deductible
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) $100
Deductible (Family) $200
Out of Pocket Maximum (Individual) $1,100
Out of Pocket Maximum (Family) $2,200

Doctor Visits

Primary Care Physician
Specialists
Emergency Room $150 Copay after deductible
Inpatient Facility 10% Coinsurance after deductible
Inpatient Physician 10% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

Other Plans in Pennsylvania

Plan my Direct Blue Erie HMO Silver 4450 HSA Deductible $4,450 Coinsurance Not applicable Out of Pocket $6,650
Plan my Direct Blue Erie HMO Gold 1000 - 2 Free PCP Visits Deductible $1,000 Coinsurance Not applicable Out of Pocket $7,000
Plan my Direct Blue HMO Silver 4450 HSA Deductible $4,450 Coinsurance Not applicable Out of Pocket $6,650
Plan my Direct Blue HMO Bronze 4000 Deductible $4,000 Coinsurance Not applicable Out of Pocket $7,900
Plan my Direct Blue HMO Gold 1000 - 2 Free PCP Visits Deductible $1,000 Coinsurance Not applicable Out of Pocket $7,000
Plan my Direct Blue Erie HMO Bronze 4000 Deductible $4,000 Coinsurance Not applicable Out of Pocket $7,900
Plan my Direct Blue HMO Silver 0 Deductible $0 Coinsurance Not applicable Out of Pocket $7,800
Plan my Direct Blue HMO Silver 2400 - 2 Free PCP Visits Deductible $2,400 Coinsurance Not applicable Out of Pocket $7,800
Plan my Direct Blue Erie HMO Silver 0 Deductible $0 Coinsurance Not applicable Out of Pocket $7,800
Plan my Direct Blue Erie HMO Bronze 7900 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan my Direct Blue HMO Bronze 7900 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
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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) $2,400
Deductible (Family) $4,800
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 30% Coinsurance after deductible
Inpatient Physician 30% Coinsurance after deductible
Emergency Room Services $750 Copay after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 30% 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 30% 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 30% Coinsurance after deductible
Outpatient Surgery 30% 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

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) $2,300
Deductible (Family) $4,600
Out of Pocket Maximum (Individual) $6,300
Out of Pocket Maximum (Family) $12,600

Doctor Visits

Primary Care Physician
Specialists
Emergency Room $570 Copay after deductible
Inpatient Facility 30% Coinsurance after deductible
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) $2,200
Out of Pocket Maximum (Family) $4,400

Doctor Visits

Primary Care Physician
Specialists
Emergency Room $500 Copay after deductible
Inpatient Facility 10% Coinsurance after deductible
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) $100
Deductible (Family) $200
Out of Pocket Maximum (Individual) $1,100
Out of Pocket Maximum (Family) $2,200

Doctor Visits

Primary Care Physician
Specialists
Emergency Room $150 Copay after deductible
Inpatient Facility 10% Coinsurance after deductible
Inpatient Physician 10% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

Other Plans in Pennsylvania

Plan my Direct Blue Erie HMO Silver 4450 HSA Deductible $4,450 Coinsurance Not applicable Out of Pocket $6,650
Plan my Direct Blue Erie HMO Gold 1000 - 2 Free PCP Visits Deductible $1,000 Coinsurance Not applicable Out of Pocket $7,000
Plan my Direct Blue HMO Silver 4450 HSA Deductible $4,450 Coinsurance Not applicable Out of Pocket $6,650
Plan my Direct Blue HMO Bronze 4000 Deductible $4,000 Coinsurance Not applicable Out of Pocket $7,900
Plan my Direct Blue HMO Gold 1000 - 2 Free PCP Visits Deductible $1,000 Coinsurance Not applicable Out of Pocket $7,000
Plan my Direct Blue Erie HMO Bronze 4000 Deductible $4,000 Coinsurance Not applicable Out of Pocket $7,900
Plan my Direct Blue HMO Silver 0 Deductible $0 Coinsurance Not applicable Out of Pocket $7,800
Plan my Direct Blue HMO Silver 2400 - 2 Free PCP Visits Deductible $2,400 Coinsurance Not applicable Out of Pocket $7,800
Plan my Direct Blue Erie HMO Silver 0 Deductible $0 Coinsurance Not applicable Out of Pocket $7,800
Plan my Direct Blue Erie HMO Bronze 7900 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan my Direct Blue HMO Bronze 7900 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900