Pennsylvania Highmark Blue Cross Blue Shield Health insurance policies are available at extremely affordable rates. We offer residents of the state the lowest Pennsylvania rates for Highmark plans. Specific policies are designed for different situations, and we’ll be glad to research and review your options to provide you with the best prices, yet highest-quality policy options. Highmark provides coverage for the 29 counties of Western Pennsylvania.
PPOBlue & DirectBlue
The two most comprehensive Highmark plans are PPOBlue and DirectBlue. Both plans provide comprehensive benefits, preventive care services, prescription coverages and access to the large network of Highmark Blue cross Blue Shield doctors and hospitals. The biggest differences in the two plans are the deductible options. PPOBlue offers individual deductible choices of $1,200, $2,600 and $3,500 and qualifies as an HSA plan. DirectBlue offers lower deductible options of $250 and $500, but rates are generally higher. You can view rates at the bottom of the page.
PPOBlue & DirectBlue Coverages
Pennsylvania Highmark PPOBlue and DirectBlue plans include many preventive care coverages, including routine physicals, pap tests, gynecological exams, mammograms and pediatric examinations. These benefits are not subject to a deductible (Policy pays 90% of covered expense). Additional coverages include office visits, inpatient hospital services, maternity services, diagnostic services and emergency care, which are covered at 90% after the deductible has been met.
PPOBlue pays 90% of prescription drug expenses after the deductible has been met. You must stay “In-Network” to use utilize most benefits. DirectBlue pays 100% of prescription drug expenses after a low $100 deductible has been met. A $10 generic and $20 brand name copay applies to the coverage. If prescriptions are determined to be preventive, then coverage would be 100%.
Additional Benefits
Both Blue Cross Blue Shield plans feature unlimited lifetime policy maximum benefits along with additional coverages of diagnostic services, spinal manipulations, occupational and speech therapy and physical medicine. Mental health services and substance abuse rehabilitation expenses are not covered. Discounts are included on health-related services such as massage therapy, personal trainers, nutritional counseling and fitness centers and spas.
Since Pennsylvania Highmark Blue Cross Blue Shield plans are medically underwritten, when applying for coverage, an application must be submitted, although no physical is required. We’re experienced in helping you with the application process and working to expedite the approval of your policy.You can download an application and fax it to us to begin the process.
There are never any fees for our services and we will continue to provide unlimited support for as long as you own your policy. For additional information including current rates and applying for Highmark coverage, please call us at (888) 513 6446 or contact us (see upper right-hand part of this page).
Highmark PPOBlue & DirectBlue Benefit Details
| Services | ||||
|---|---|---|---|---|
| PPOBlue, An Individual Comprehensive Major Medical Preferred-Provider High-Deductible Health Plan; $1,200 Individual/$2,400 Family Deductible; Medically Underwritten |
DirectBlue, An Individual Comprehensive Major Medical Preferred-Provider Health Plan; $250 Individual/$750 Family Deductible; Medically Underwritten | |||
| Network | Out-of-Network | Network | Out-of-Network | |
| Benefit Period | Contract Year | Contract Year | Contract Year | Contract Year |
| Type of Coverage | Medically Underwritten | Medically Underwritten | Medically Underwritten | Medically Underwritten |
| Deductible - Individual | $1,200 includes out-of-network benefits |
Choice of network deductible applies to out-of-network benefits |
$250 | $500 |
| Deductible - Family | $2,400 Includes out-of-network benefits Family deductible must be met in full before benefits are payable |
Choice of network deductible applies to out-of-network benefits |
$250 per person with a maximum of $750 | $500 per person with a maximum of $1,500 |
| Out of Pocket Limit (does not include deductible) - Individual | $1,000 | $2,000 | $1,500 for network and out-of-network covered services combined | $1,500 for network and out-of-network covered services combined |
| Out of Pocket Limit (does not include deductible) - Family | $2,000 | $4,000 | $4,500 for network and out-of-network covered services combined | $4,500 for network and out-of-network covered services combined |
| Coinsurance (only applied after any applicable deductibles have been met) | 90% | 70% | 90% | 70% |
| Lifetime Policy Maximum | Unlimited | Unlimited | Unlimited | Unlimited |
| Benefit Period Maximum | Unlimited | Unlimited | Unlimited | Unlimited |
| Hospital Facility Expense - Inpatient (includes Maternity) |
90% | 70% Limited to 90 days/benefit period |
90% | 70% |
| Emergency Room Care | 90% | 90% | 90% after $40 copayment (waived if admitted) |
90 % after $40 copayment (waived if admitted) |
| Office/Home Visits | 90% | 70% | 90% | 70% |
| Medical/Surgical Expenses (except office visits) |
90% | 70% | 90% | 70% |
| Preventive Care | Deductible does not apply, 100% for: Adult Care Adult Immunizations Mammogram Pediatric Care Pediatric Immunizations |
Not Covered Except for Pediatric Care, deductible does not apply, 70% |
Deductible does not apply, 100% for: Adult Care Adult Immunizations Mammogram Pediatric Care Pediatric Immunizations |
Not Covered Except for Pediatric Care, deductible does not apply, 70% |
| Diagnostic Services ( X-ray, lab, other tests) |
90% | 70% | 90% | 70% |
| Physical Medicine | 90% 15 visits per contract year |
70% Included as part of network visits |
90% 15 visits per calendar year |
70% Included as part of network visits |
| Occupational and Speech Therapy | 90% Combined 15 visits per contract year |
70% Included as part of network visits |
90% Combined 15 visits per calendar year |
70% Included as part of network visits |
| Spinal Manipulations | 90% 10 visits per contract year |
70% Included as part of network visits |
90% 10 visits per calendar year |
70% Included as part of network visits |
| Mental Health Services | Not Covered | Not Covered | Not Covered | Not Covered |
| Substance Abuse - Rehabilitation | Not Covered | Not Covered | Not Covered | Not Covered |
| Substance Abuse - Detoxification | Not Covered | Not Covered | Not Covered | Not Covered |
| Prescription Drug | 90% | Not Covered | $100 deductible per calendar year $10 generic, $20 brand |
Not Covered |
| Prescription Drug Preventive Medications Certain limited prescription and over-the-counter drugs prescribed for preventative purposes. |
Deductible does not apply, 100% | Not Covered | Deductible does not apply, 100% | Not Covered |
Discounts on Health-Related Services
|
Covered | Covered | Covered | Covered |
| Blues On Call -Health Information and Support Toll-Free Hotline |
Covered | Covered | Covered | Covered |
| Vision* | Not Covered | Not Covered |
|
None |
Toapply for Highmark Blue Cross Blue Shield coverage, please click on the "Download Now" buttonand download the application from the provided link, and fax completedapplication to (888) 513 6446.