Medical
Medical plans
Find the right fit
Choosing the right plan depends on how you and your family use healthcare. Some plans have higher payroll costs but lower costs when you need care, while others keep payroll costs lower but may cost more when you use services. Most associates receive medical coverage through Highmark and use Collective Health to access and manage their benefits in one place. If you live in California, you also have the option of medical coverage through Kaiser Permanente.
overview
Plans at a glance
Some plans cost more each month but cover more when you need care—others have lower monthly costs but you’ll pay more out of pocket when you use them. Have a look.
Complete
(PPO)
Essentials
(PPO)
Balanced*
(CDHP + HSA)
Northern and Southern California
COMPARISON TABLE
See how the plans stack up
Compare plans side by side—see what they cover, what they cost, and what sets them apart.
Plan overview
Higher paycheck contributions, less when you seek care
Lower paycheck contributions, fixed costs for visits
A balance of cost for care and paycheck contributions
Plan style
The type of medical insurance plan, such as PPO, HDHP, or HMO, which determines provider access and cost-sharing rules.
PPO
PPO
CDHP with HSA
Spending accounts
Tax-advantaged accounts to set aside pre-tax dollars for medical needs, including:
Flexible Spending Account (FSA) - for eligible healthcare or dependent care expenses. HSA (Health Savings Account) - for qualified medical expenses if enrolled in an HDHP.
HSA (Health Savings Account) - for qualified medical expenses if enrolled in an HDHP. HRA (Health Reimbursement Arrangement) - an employer-funded account that reimburses you for qualified medical expenses.
Limited Purpose FSA (LPFSA) - can be used alongside an HSA (limited to covering eligible dental and vision expenses.)
Flexible Spending Account (FSA) - for eligible healthcare or dependent care expenses. HSA (Health Savings Account) - for qualified medical expenses if enrolled in an HDHP.
HSA (Health Savings Account) - for qualified medical expenses if enrolled in an HDHP. HRA (Health Reimbursement Arrangement) - an employer-funded account that reimburses you for qualified medical expenses.
Limited Purpose FSA (LPFSA) - can be used alongside an HSA (limited to covering eligible dental and vision expenses.)
FSA
FSA
HSA (associate funded) and Limited Purpose FSA
Deductible
The amount you pay out-of-pocket for covered services before your plan starts sharing costs. An embedded deductible means that each person on the family plan only needs to meet their own individual deductible before the insurance starts covering their costs – even if the family deductible hasn’t been met yet.
In-network (single/ family)
$1,000/ $2,000
$2,500/ $5,000
$4,000/ $8,000
Annual OOP max
The most you’ll pay in a plan year for covered services, including deductibles, copays, and coinsurance. After reaching this limit, the plan pays 100% of in-network covered costs.
In-network (single/ family)
$2,000/ $4,000
$5,000/ $10,000
$8,000/ $12,000
In-network benefits
Preventive care
Routine health services, like checkups and screenings, aimed at preventing illness, usually covered at 100% in-network.
In-network
Covered at 100%
(no deductible)
(no deductible)
Covered at 100%
(no deductible)
(no deductible)
Covered at 100%
(no deductible)
(no deductible)
Co-insurance
The percentage of costs you pay for a covered health service after you’ve met your deductible.
In-network
20% after deductible
20% after deductible
20% after deductible
Office visit
(PCP/ specialist)
(PCP/ specialist)
A scheduled appointment with a primary care provider or specialist for diagnosis or treatment
$25/ $50 copay
$25/ $50 copay
20% after deductible
Emergency room
Care provided in a hospital ER for sudden, serious medical conditions.
$200 copay
$150 copay, then 20%
20% after deductible
Urgent care
Immediate treatment for non-life-threatening conditions when your regular doctor isn’t available.
$50 copay
$100 copay
20% after deductible
Inpatient hospital care
Services provided when you’re admitted to a hospital for overnight care.
20% after deductible
20% after deductible
20% after deductible
Prescription drug coverage | 31-day retail supply listed below, 90-day mail order also available**
Generic
Lower-cost medications that contain the same active ingredients as brand-name drugs.
$12
$12
20% after deductible
Preferred brand
Brand-name drugs on your plan’s preferred list, typically costing more than generics but less than non-preferred brands.
20% coinsurance up to $60
20% coinsurance up to $60
20% after deductible
Non-preferred brand
Brand-name drugs not on your plan’s preferred list, usually at the highest cost for brand-name prescriptions.
20% coinsurance up to $120
20% coinsurance up to $120
20% after deductible
Speciality
High-cost medications, often for complex conditions, that may require special handling or administration.
20% coinsurance up to $200
20% up to $200
20% after deductible
* Associates enrolling in this plan will receive an employer-paid Critical Illness benefit from MetLife.
**90-day mail order out-of-pocket amounts can be found through ExpressScripts by Evernorth (ESI). Specialty medications not covered by mail order.
*** Kaiser (CA only) plan designs have slight variations from the plans outlined above. Click here for more information.
**90-day mail order out-of-pocket amounts can be found through ExpressScripts by Evernorth (ESI). Specialty medications not covered by mail order.
*** Kaiser (CA only) plan designs have slight variations from the plans outlined above. Click here for more information.
Collective Health makes your benefits easier to use
Collective Health is your benefits platform for managing your Highmark BCBS coverage in one place. It helps you understand your benefits, find care, and navigate your plan with support when you need it.
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