Highmark Blue Shield PPO-200:
The Highmark Blue Cross (PPO-200) is a Preferred Provider Organization with varying coverage levels depending on the provider, and includes hospitalization and surgical procedures, diagnostic testing, emergency care, and office visits.
In Network:
$20.00 copay for office and therapy visits; $50.00 copay for Emergency Department visits; most other services are covered in full after a $200 deductible per individual (2 per family) is met.
Out of Network:
$400 deductible per person (2 per family); most services are covered at 80% of "Usual Customary Reasonable Charge" (UCR) after the deductible(s) is met. The employee pays 20% coinsurance (in most cases) until the out-of-pocket maximum of $3000 per person (2 per family) is met, then payment is 100% of allowable charges.
The Highmark Blue Shield (PPO-500)
The Highmark Blue Shield (PPO-500) is a Preferred Provider Organization with varying coverage levels depending on the provider, and includes hospitalization and surgical procedures, diagnostic testing, emergency care, and office visits.
In Network:
$20.00 copay for office and therapy visits; $75.00 copay for Emergency Department visits; most other services are covered in full after a $500 deductible per individual (3 per family) is met.
Out of Network:
$1000 deductible per person (3 per family); most services are covered at 70% of "Usual Customary Reasonable Charge" (UCR) after the deductible(s) is met. The employee pays 30% coinsurance (in most cases) until the out-of-pocket maximum of $3,000 per person (3 per family) is met, then payment is 100% of allowable charges.