Highmark Advance Blue individual health insurance is now available in Western Pennsylvania. The Advance Blue plan is a comprehensive policy that offers extensive coverage at an affordable rate for both individuals and families. Covered benefits include coverage that is often found in expensive group plans. However, premiums are very low on this particular plan.
We like this policy because you do not have to meet the deductible to use the office visit and prescription benefits. The Highmark DirectBlue and PPOBlue policies place a deductible on those two coverages. Compared to many other available plans in Pennsylvania, the Advance Blue policy can potentially reduce your total out of pocket cash outlay since most claims are covered with small payments. Whether you have children or no dependents, it is a good choice.
Primary care office visit expenses are covered with a low $20 copay while visits to a specialist require only a $30 copay. No deductible applies so you can freely utilize this benefit. Also, there is no limit on the number of covered office visits per calendar year. We especially like this feature because if you are stricken with a serious illness or injury, there may be a need to visit a specialist quite frequently. And of course, specialist charges can be quite expensive. Many other plans place limitations on this type of benefit...often just two or three allowed visits.
Preventive care expenses are covered without paying the copay or coinsurance. Once the policy is approved and coverage is in effect, you may utilize services such as annual physical exams, OBGYN exams, approved immunizations (both adult and child), mammograms and any medication that is categorized as “preventive.” And that is at no cost to you. And you don't have to wait to use it. Each year, the list of covered items is updated with new additions. Contraceptives and breast-feeding equipment rentals are two of the latest additions to this popular Pittsburgh-area plan.
Highmark Advance Blue prescriptions are not subject to coinsurance. Copays range from $8 to $24 for generic drugs and $40 to $120 for brand drugs. There are also no lifetime maximum limits for these benefits. Unlike many older plans that have an annual prescription cap, this plan removes that restriction. Diagnostic expenses are subject to only a $20 copay which can be a major money-saver. And throughout the year, you may use this benefit many times. There is no upper-limit so if you are scheduled for quarterly tests, you'll like this coverage.
Larger medical expenses, such as inpatient and outpatient treatment, ER, normal hospital charges and ambulance fees are covered once the deductible has been met. The coinsurance is only 10% and the maximum out of pocket cost (not including the deductible) ranges from $1,000 to $3,000, depending on your selected options. We always recommend selecting higher deductibles based upon the potential cost savings. But lower choices can be shown. But you will pay a higher cost.
The free eye exam benefit every 24 months is an added bonus. Typically, most Pennsylvania health insurance plans do not offer this coverage. There is also some chiropractic coverage (subject to policy limitations). When the Exchanges become effective in 2014, more benefits may be added, since the law will require basic minimum essential coverages. This will, of course, cost more, but you may receive a tax break to help pay for the required add-ons.
Rates are calculated by your health status, age, sex, chosen coverages and the number of family members to be insured. For example, a 37 year old male would pay only $101 per month for a policy with a $1,250 deductible. Raising the deductible to $2,600 would reduce the rate to $88. A 37 year old female would pay $170 and $148 respectively.
Family premiums are based on the age of the oldest person to be insured. For example, assuming a family of five (Ages 43,40,16,14 and 10), the $2,400 deductible policy would cost $433 while the $7,000 deductible policy would cost only $348. The family plan has ONE deductible (for everyone) and not individual deductibles. UnitedHealthcare and a few other carriers use this concept and we like it quite a bit. We found these to be very favorable premiums. Again, Exchanges will increase this cost in 2014 but we'll work with you to determine how to keep your premium affordable.
How To Apply
Applying for Highmark coverage is quite easy. The application is attached at the bottom of the page. Simply print and complete the application and fax back to us at (888) 513 6446. You may also email the application (in a PDF file) to email@example.com. And of course, you can call us any time or complete the rate request section.