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Pennsylvania Highmark Blue Cross Blue Shield Health insurance policies are available at extremely affordable rates. We offer residents of the state the lowest 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. We help you find 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  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. The lower deductible options are attractive when maternity benefits are used.

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 or co-payment. 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%. And annual caps have also been removed, as part of the Patent Protection and Affordable Care Act passed by the US Congress.

Highmark is in the process of purchasing West Penn Allegheny Health System, a network that will help compete with the larger UPMC in the area. Many doctors and surgeons have been recently hired as the trendof buying independent practices continues. This process is part of the recent shift towards emphasis of compensating physicians to keep patients healthy as well as the typical treatment when needed.

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 the 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. We can also email the needed questions to you. If help is needed, we'll be available.

Apply for Highmark BC/BS online and save money. We provide the lowest Highmark rates and make it easy to purchase coverage.

Beginning in 2014, (Open Enrollment begins in October of 2013), medical questions will not have to be answered as plan availability changes. We will keep you updated on benefit changes. It is expected that policies will be grouped into four categories with tax subsidies available to lower premiums (based upon your income).

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
  • Fitness Centers & Spas
  • Massage Therapy
  • Nutritional Counseling
  • Personal Trainers
Covered Covered Covered Covered
Blues On Call
-Health Information and Support Toll-Free Hotline
Covered Covered Covered Covered
Vision* Not Covered Not Covered
  • Eye exam every two years
  • Discounts on lenses and frames, non-prescription sunglasses & Laser Vision Correction
  • Davis Vision Provider Network Only
  • Benefit does not apply towards deductible
None
     

 

And don't forget the new Advance Blue plan that has become very popular.

 

UPDATE: January 29 2014 - A bill that will attempt to get Highmark and UPMC to start negotiating again has been sponsored by Rep Tony Deluca. If the legislation passes, it would give the DOI more authority to settle disputes between healthcare providers.

The bill would allow the Commissioner to extend expiring contracts an additional six months, which would avoid coverage disruption for existing policyholders. Highmarl and UPMC have been battling for years over a contract that will expire at the end of 2014.

UPDATE: February 19 2014 - A proposed merger between Highmark and Blue Cross of Northeastern Pennsylvania has been filed. If approved, more than 500,000 new customers will be added, and Highmark would gain market share in an additional 13 counties.

UPDATE:April 4 2014 - Highmark will lose about $3 million on its Marketplace plans in the first year of the ACA. As expected, far too fewer healthy young persons enrolled, while also as expected, older new customers are submitting many new claims.