Highmark Blue Shield health insurance plans are available through our website at the lowest available rates for residents in the 21 counties of Central Pennsylvania and the Lehigh Valley. Easily compare affordable individual and family policies and apply for quality Highmark Blue Shield coverage.
Four low cost plans are available. They are Simply Blue, PPO Blue, Advance Blue and Direct Blue. Each plan offers 100% preventive benefits, unlimited major medical coverage with no lifetime maximums, and access to the Highmark Network, one of the largest of its kind in Pennsylvania.
Highmark Simply Blue is the newest of the plans and was just introduced in 2012. Primary care office visits are covered with a $35 copay (Specialists and Urgent Care at $50) without having to satisfy a deductible. All preventive visits including annual physicals and preventive-related prescriptions are covered a 100% and basic diagnostic services have only a $25 copay.
Many prescriptions (Formulary) are covered with an $8 copay on generic and $45 copay on brand. Additional specifics can be found in the brochure we attached below the article. Naturally, non-generic RX will have higher out of pocket costs to you. Emergency room visits must meet a $150 copay, which is comparable to most other Pennsylvania health insurance plans.
The two individual deductible options are $500 and $750 ($1,000 and $1,500 for a family). The maximum additional out of pocket cost is $4,000 for an individual policy and $8,000 for a family, which includes the most common coinsurance of 20%. Other benefits include a bi-annual eye exam for all covered applicants, chiropractor coverage and home health or skilled nursing facility coverage.
Rates can be viewed at the bottom of the page.
Highmark PPO Blue HDHP is an HSA-eligible plan that features very affordable premiums. Individual Deductible options are $1,200, $2,600 and $3,500. The family deductible options are two times the individual deductible and of course would only apply if there are two or more persons that are insured. Coinsurance after the deductible is only 10% instead of 20% on other Highmark plans.
Since the PPO Blue is a “High Deductible” plan, the deductible must be met before any non-preventive benefits are paid. However, a discount on prescriptions and the bi-annual eye exam are included. A Health Savings Account can be set up with a bank of your choice so that you can tax-deduct qualified health care, dental and vision costs.
Highmark Advance Blue features very affordable out of pocket costs. Primary care physician and specialist visits are subject to low copays of $20 and $30. Basic diagnostic services receive a low $20 copay while all preventive services are covered at 100% (as are all four Highmark plans). Prescription is fairly similar to the Simply Blue plan with some minor differences.
This plan features the identical deductible options as the PPO Blue HDHP plan although it is not an HSA-eligible plan. It is also one of Highmark’s newest plans and has become a very popular family plan.
Highmark Direct Blue offers some of the lowest-deductible plan options in Central Pennsylvania. An individual $250 or $500 ($750 and $1,500 Family deductible) deductible are the two choices. So if you have a major claim, your coverage will begin much quicker with this policy than most other medical insurance plans in Pennsylvania. The individual out of pocket (after the deductible) is also only $1,500 per person (maximum three per family).
Prescription benefits are fairly similar to the other Highmark Blue Shield plans with the exception of the $100 deductible. Preventive benefits, vision coverage and most other major medical coverages are the same as the other three plans.
So…which one is best for you? Of course, there is no right answer, but generally, if you like a copay plan, the Advance Blue plan may be your best choice. If you like Health savings Accounts, the PPO Blue HDHP is the best choice. If you’re not sure…call or contact us and we’ll help you decide which policy fits your needs the best.
Highmark Blue Shield Simply Blue Information
Highmark Blue Shield Pennsylvania Plan Comparisons