MEDICAL
Choose from three plan options, all administered through Highmark.
WHO IS ELIGIBLE?
All active, full-time employees working 30 or more hours per week are eligible.
ARE THERE ANY CHANGES TO THE PLAN DESIGNS?
There have been a few changes with each PPO Option as shown below.
- PPO Option 1: Increased in-network deductible to $1,500 single / $3,000 family
- PPO Option 2: Increased in-network deductible to $2,500 single / $5,000 family and presciption drug costs now apply to the deductible
- PPO Option 3: Increased in-network deductible to $4,000 single / $8,000 family and is remaining as a Qualified High Deductible Health Plan that can be paired with a Health Savings Account
HIGHLIGHTS
There are no cost increases to employee contributions for 2025!
All three PPO plans give you the option to see both in-network and out-of-network providers for covered services. However, you will see greater savings when you utilize in-network providers.
PPO Option 3 is Health Savings Account (HSA) eligible! See the Spending Accounts page to learn more about the HSA and its benefits.
HIGHMARK PPO OPTION 1
PPO Option 1 offers you direct access to any network provider for covered services. Under this plan, an in-network deductible of $1,500 single / $3,000 family will apply. There is a $20 copay for primary care visits and a $30 copay for specialists visits under this plan. Prescription drugs will have copays regardless of your deductible being met. This plan will cost you the most amount from your paycheck.
To learn more about the covered services of PPO Option 1, click below.
HIGHMARK PPO OPTION 2
PPO Option 2 offers you direct access to any network provider for covered services. Under this plan, an in-network deductible of $2,500 single / $5,000 family will apply. There is a $30 copay for primary care visits and a $50 copay for specialists visits under this plan. Prescription drugs will have copays, but those copays only apply after the medical deductible has been met. This plan is a middle-cost plan in terms of the amount that will be deducted from your paycheck.
To learn more about the covered services of PPO Option 2, click below.
HIGHMARK PPO OPTION 3 (HSA)
PPO Option 3 (HSA) offers you direct access to any network provider for covered services. However this plan is considered a Qualified High Deductible Plan and can be paired with a Health Savings Account (HSA). This plan has an in-network deductible of $4,000 single / $8,000 family. This plan will pay 80% coinsurance after the deductible has been met. Prescription drugs will have copays, but those copays only apply after the medical deductible has been met. This plan is the least amount that will be deducted from your paycheck.
To learn more about the covered services of PPO Option 3, click below.
NEED HELP FINDING A PARTICIPATING PROVIDER?
For all three medical plans, you are going to save the most money by utilizing an in-network provider. All three plans give you the ability to see an out-of-network provider as well, however you are going to end up paying more out of your own pocket if you decide to do so. To find a Highmark in-network provider, click below.
COPAY ARMOR
For any employees currently prescribed specialty drugs, we're sure you understand the immense cost that comes with those drugs. That is why we've implemented Highmark's Copay Armor program to help battle the costs of specialty drugs for our employees. This program will help to lower the cost of specialty medications for members, oftentimes to as low as $0 copay.
WEll360- VIRTUAL VISITS
Access to healthcare is now even easier with Highmark through Well360
When your primary doctor isn't available, Highmark's Well360 benefit is available 24/7/365 for treatment of acute conditions.
Virtual Visits are available to all Highmark medical enrollees (including enrolled dependents). You can access virtual visits through Well360 in your My Highmark portal/app under the Get Care section.
The doctor can call in prescriptions to your local pharmacy when appropriate. You and your enrolled dependents can avoid unnecessary visits to the ER and/or Urgent Care and long waits for doctor appointments by utilizing virtual visits.
For PPO Options 1 & 2, the cost of the visit is a $10 copay.
For PPO Option 3, the cost of the visit will be roughly $50-$60 until your deductible has been met. Keep in mind, that the cost of a PCP visit will be roughly $90-$100 until your deductible has been met.
The doctor will provide a diagnosis and advice for many common medical conditions such as:
- Respiratory Infections
- Sinus Infections
- Stomachache/Diarrhea
- Urinary Tract Infections
- Allergies
- Bronchitis
- Cold/Flu
- Headaches/Migraines
- Eye/Ear Infections
- Rash/Skin Irritations
- Many other conditions
