Highmark BlueCross BlueShield – New Castle County Government

Which Medical Plan is Right?

Evaluate Your Needs. Consider your prior health care usage and select plans and options that fit your lifestyle and needs.

Do you take regular prescription medications?
Are you anticipating surgery or non-preventive dental care?
Did you experience a qualifying life event this year?
Review your current plans to ensure you have the coverage you need.

Review this benefits website to learn about your plan options.

A little bit of planning will help you select the best plans, coverage levels, and financial programs for your unique situation.

Medical Plan Comparison

New Castle County will continue to offer medical coverage. The below charts are a brief outline of the plan options for Highmark Blue Cross Blue Shield.

Medical Plan

UNDER 65	Highmark Blue Cross Blue Shield Highmark PPO			Highmark Blue Cross Blue Shield Highmark EPO	Highmark Blue Cross Blue Shield Highmark Passive PPO
	In-Network Benefits	Out-of-Network Benefits	Schedule of Benefits	Schedule of Benefits
Annual Deductible
Individual	$0	$200	$0	$200
Family	$0	$400	$0	$400
Coinsurance	100%	80%	100%	80%

Maximum Out-of-Pocket
Individual	$12,000	N/A	$12,000	$12,000
Family	$24,000	N/A	$24,000	$24,000

Physician Office Visit
Primary Care	$25 copay	80% after deductible	$25 copay	80% after deductible
Specialty Care	$35 copay	80% after deductible	$35 copay	80% after deductible

Preventive Care
Adult Periodic Exams/ Well Child Care	100%	Not covered	100%	100%

Diagnostic Services
X-ray and Lab Tests	100%	80% after deductible	100%	100%
Complex Radiology	100%	80% after deductible	100%	100%
Urgent Care Facility	$25 copay	80% after deductible	$25 copay	80% after deductible
Emergency Room Facility Charges	$100 copay per visit; waived if admitted	$100 copay per visit; waived if admitted	$100 copay per visit; waived if admitted	100%
Inpatient Facility Charges	100%	80% after deductible	100%	100%
Outpatient Facility and Surgical Charges	100%	80% after deductible	100%	100%

Mental Health
Inpatient	100%	80% after deductible	100%	100%
Outpatient	100%	80% after deductible	100%	80% after deductible

Substance Abuse
Inpatient	100%	80% after deductible	100%	100%
Outpatient	100%	80% after deductible	100%	80% after deductible

Retail Pharmacy (30 Day Supply)
Generic	$8 copay	Not covered	$8 copay	20% after deductible
Preferred	$30 copay	Not covered	$30 copay	20% after deductible
Non-Preferred	$50 copay	Not covered	$50 copay	20% after deductible

Mail Order Pharmacy (90 Day Supply)
Generic	$16 copay	Not covered	$16 copay	20% after deductible
Preferred	$60 copay	Not covered	$60 copay	20% after deductible
Non-Preferred	$100 copay	Not covered	$100 copay	20% after deductible

Note: Please consult plan documents for full benefits, exclusions, and limitations.

Highmark Plan Documents

Check out the Health Awareness Series

Each Health Awareness Series episode focuses on a single topic and provides information that has been reviewed by nurses and other health care professionals. Topics range from an explanation of your benefits, to how to talk with your doctor, to documents to have in a health emergency.

When you know more about a topic, you can make better health care choices. Better choices will help you live a better life.

Watch Health Awareness Series