Low-cost Highmark healthcare coverage in Pittsburgh can be purchased by individuals, families, small and large businesses, and self-employed persons. Rates are very attractive compared to other policy options, and approved medical, vision, and dental costs can be paid with tax-deferred deposits. An HDHP (High Deductible Health Plan) is required to accompany the HSA account, and two options (Health Savings Blue PPO Embedded 2700 and Health Savings Blue PPO 1700) are available.
PPOBlue No Longer Available
The PPOBlue policy by Highmark is extremely affordable and popular. PPOBlue is their comprehensive major-medical high deductible plan that is HSA-eligible. This policy is available to individuals and families and you do not have to be self-employed to qualify for coverage. Prices in Allegheny County are typically among the lowest among the major carriers. There are several attractive options and plan designs that will reduce your out of pocket medical expenses and taxes.
We help you find affordable Health Savings Accounts in Pa. The rates we publish are the most competitive contracts offered by each carrier and there are never any fees for our service. We feel it is important to find the health insurance policy that best matches your budget concerns, but that also provides the benefits that you may someday use. And if you wish, we will take the time to review all of the policy options with you since often a high-deductible plan may not be the best choice.
Deductible Choices
The PPOBlue offers three deductible options. They are $1,200, $2,600 and $3,500 for individuals and $2,400, $5,200 and $7,000 for families. Once the deductible has been met, benefits are payable at 90%. Once the designated coinsurance has been met, covered benefits are paid at 100%. Each year, the deductible and coinsurance amounts reset. So if you have a pending elective surgery that can wait until early in the calendar year, consider waiting, if your physician approves.
Preventive services, such as routine physicals, mammograms, gynecological exams, pap tests and adult or pediatric immunizations are not subject to a deductible, copay or coinsurance and are covered immediately. Also, as a result of national health care reform, the lifetime cap has been removed. If in the past, you have not utilized health care benefits very often, a higher deductible might be the best fit. However, beware of maximum out-of-pocket limits.
Some of the additional benefits provided by the PPOBlue plan are occupational and speech therapy, spinal manipulations, and discounts on health related services such as fitness centers and spas, nutritional counseling and personal trainers. Within the next 18 months, additional benefits may be added when the State Exchange starts to operate.
Negotiated Network Discounts
Highmark Blue Cross Blue Shield negotiates lower member rates with doctors, hospitals and other facilities. So when you utilize network facilities, you’ll pay the lower negotiated rate for services and possibly prescriptions. Some of these discounts can be substantial, especially lab tests and x-rays. Highmark’s HSA provider network is one of the largest in Western Pennsylvania and we’ll be happy to find participating providers for you. There’s a high probability that there are many available physicians within a few miles of where you live or work.
Is An HSA Right For You?
An HSA is a low cost policy that favorably compares to a traditional comprehensive health insurance policy. Although it is classified as a savings product, you are able to pay for current and future health care, dental and vision expenses on a tax-free basis. You also have complete control of the money in your account including the type of investments.
Since it’s your money, you can deposit or withdraw funds at any time. In fact, you don’t have to make any deposits at all. Many consumers skip contributions or only occasionally deposit extra funds into the side account. When you have an HDHP (see below), you are not required to establish the savings portion of your policy.
The HSA works with a “High Deductible Health Plan” (HDHP), and the combination of both accounts can provide substantial savings in premium dollars and taxes over many years. The deductible, which is the amount you pay out of pocket before benefits begin, is usually fairly high. Therefore, establishing the account will save you money.
For additional information on the Highmark Blue Cross Blue Shield HSA plans, please feel free to call or email us. We’ll be happy to provide additional specific details regarding how you apply, and set up the optional savings account. You can view HSA rates in Pennsylvania and easily compare the different deductible and coinsurance options.
IMPORTANT NOTE: The plan shown below is no longer available since it does to contain all mandated “Essential Health Benefits” as required by the ACA legislation. However, if you purchased the plan before the “grandfathered” deadline, you can continue to retain coverage.
Benefit Summary listed below for $2,600 Individual/$5,200 Family HSA:
| Services | PPOBlue, An Individual Comprehensive Major Medical Preferred-Provider High-Deductible Health Plan; $2,600 Individual/$5,200 Family Deductible; Medically Underwritten | |
| Network | Out-of-Network | |
| Benefit Period | Contract Year | Contract Year |
| Type of Coverage | Medically Underwritten | Medically Underwritten |
| Deductible – Individual | $2,600 Includes out-of-network benefits | Choice of network deductible applies to out-of-network benefits |
| Deductible – Family | $5,200 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 |
| Out of Pocket Limit (does not include deductible) – Individual | $1,200 | $2,400 |
| Out of Pocket Limit (does not include deductible) – Family | $2,400 | $4,800 |
| Coinsurance (only applied after any applicable deductibles have been met) | 90% | 70% |
| Lifetime Policy Maximum | Unlimited | Unlimited |
| Benefit Period Maximum | Unlimited | Unlimited |
| Hospital Facility Expense – Inpatient (includes Maternity) | 90% | 70% Limited to 90 days/benefit period |
| Emergency Room Care | 90% | 90% |
| Office/Home Visits | 90% | 70% |
| Medical/Surgical Expenses (except office visits) | 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% |
| Diagnostic Services ( X-ray, lab, other tests) | 90% | 70% |
| Physical Medicine | 90% 15 visits per contract 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 |
| Spinal Manipulations | 90% 10 visits per contract year | 70% Included as part of network visits |
| Mental Health Services | Not Covered | Not Covered |
| Substance Abuse – Rehabilitation | Not Covered | Not Covered |
| Substance Abuse – Detoxification | Not Covered | Not Covered |
| Prescription Drug | 90% | 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 |
Discounts on Health-Related Services
| Covered | Covered |
| Blues On Call -Health Information and Support Toll-Free Hotline | Covered | Covered |
| Vision* | Not Covered | Not Covered |
