Highmark Blue Shield

my Blue Access PPO Premier Silver 0

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: $8,350
  • Family: $16,700
  • Per Person: $8,350
Drug Out-of-Pocket Maximum
  • Individual: Included in Medical
  • Family: Included in Medical
  • Per Person: Included in Medical

Office Visit

Primary Doctor
  • Standard: $70 Copay
Specialist
  • Standard: $70 Copay

Prescription Drug Information

Preferred Brand Drugs
  • Standard: $30 Copay
Non Preferred Brand Drugs
  • Standard: $150 Copay
Generic Drugs
  • Standard: $0 Copay
Specialty Drugs
  • Standard: 50% Coinsurance

Inpatient Coverage

Hospital Services
  • Standard: $2500 Copay per stay
Inpatient Services
  • Standard: No Charge

Emergency and Urgent Care

Emergency Room
  • Standard: $1250 Copay