Highmark Benefits Group Inc.

my Priority Blue Flex EPO Premier Gold 0 + Adult Dental and Vision

Plan Overview

Medical Deductible
  • Individual: 0
  • Family: 0
  • Per Person: 0
Prescription Drug Deductible
  • Individual: 0
  • Family: 0
  • Per Person: 0
Medical Out-of-Pocket Maximum
  • Individual: 6500
  • Family: 13000
  • Per Person: 6500
Drug Out-of-Pocket Maximum
  • Individual: Included in Medical
  • Family: Included in Medical
  • Per Person: Included in Medical

Office Visit

Primary Doctor
  • Standard: $15 Copay
  • Standard: $15 Copay

Prescription Drug Information

Preferred Brand Drugs
  • Standard: $25 Copay
Non Preferred Brand Drugs
  • Standard: $75 Copay
Generic Drugs
  • Standard: $0 Copay
Specialty Drugs
  • Standard: 50% Coinsurance

Inpatient Coverage

Hospital Services
  • Standard: $375 Copay per stay
Inpatient Services
  • Standard: 20% Coinsurance

Emergency and Urgent Care

Emergency Room
  • Standard: $250 Copay
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3. Premium subsidies vary by address and subject to eligibility. Those with incomes between 100% and 150% of the federal poverty level (FPL) may qualify for a zero-dollar premium silver plan (after tax credits). They may also qualify for a zero-dollar premium bronze plan (after tax credits). Cost sharing (deductibles and coinsurance) may be higher.
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