We understand health care can be confusing. At Highmark, we're listening.
Here is what you're asking right now.
Click on the questions below to reveal their corresponding answers.
In our stores, licensed associates offer personalized assistance to people searching for the right health or dental insurance policy — for themselves or for their families. Since the first Highmark Direct location opened in 2009, more than 160,000 people have visited our stores. We offer a personalized way to shop for health insurance; Here are some of the services that our Highmark Direct stores offer:
Yes. If you would like to do some research prior to your consultation at Highmark Direct, please visit our Product Selector Tool at www.highmark.com. The Product Selector Tool allows you to compare plans, review product summaries, as well as refine your product choices by selecting options that fall under your specific needs. Plus you’ll be able to print out a summary of your results and bring them to your consultation to make the shopping process even easier.
Yes. We offer two convenient options in-store to help answer your customer service questions:
Other convenient ways to access customer service include:
No. Appointments are preferred, but walk-ins are welcome but subject to availability of licensed associates and previously scheduled appointments. Wait times for walk-ins vary.
Yes. We accept cash, check, money order, Visa or MasterCard for in-store payments. We are unable to accept payments over the phone.
Yes. We offer a variety of plans to help cover your needs regardless if you have creditable coverage or not. We have Short Term coverage that can cover you the very next day as long as you can complete a short questionnaire. All of our other plans are available the first of the following month after the application is completed and approved. The benefit of having Creditable Coverage is that pre existing could potentially be waived depending on the creditable coverage you had.
We have eight Highmark Direct stores located throughout western and central Pennsylvania. Our stores are open Monday through Saturday from 9am to 6pm.. Visit our store locator for addresses, phone numbers, and directions.
30 to 60 minutes.
No. We cannot provide quotes over the phone. To receive a quote you must meet with one of our Highmark Direct licensed associates. However, if you wish to receive a quote over the phone, please call 1-800-876-7639.
PPO plans do not require members to receive initial care through a primary care physician. You can decide for yourself where to obtain care. You can use network providers, including specialists, and receive a higher level of coverage, or go to out-of-network providers and receive a lower level of coverage – and pay more -- for covered services. The choice is yours.
Once you enroll, you can review your benefit booklet online at the My Benefits page on the website.
You will receive your new insurance ID cards in 7-10 business days after enrollment. In the future, you’ll receive new ID cards only if changes are made to your plan. If you simply renew the same plan, your current cards are still valid.
Even if you are healthy, one of the smartest things you can do is to protect yourself and your family with the right health care coverage. The cost of medical care is increasing every day -- and getting treatment for an illness or injury could mean thousands of dollars of debt – even bankruptcy – if you don’t have health care coverage.
And what about staying healthy? Regular check-ups, vision care, maternity care and well-child care visits are important ways to take care of yourself and your family. With health care coverage that includes preventive care, you don’t have to think twice about scheduling regular check-ups.
Some individuals get health care coverage for themselves and their families through their employer as part of their benefits package. Other individuals and families purchase coverage directly from a health insurance company.
When you go to a health care provider, your health insurance identification card shows the provider which plan you have and the payment you are expected to make for the service. The provider then sends a claim (a bill for the services provided) to your insurance company, and, if the service is covered, the insurance company pays the provider for the service. You receive an Explanation of Benefits (EOB) statement from the insurance company that tells you the amount the insurance company paid for the service and any remaining amount that you owe the provider. If you did not pay at the time you received care, you will receive a bill from the provider for the amount you owe.
In addition to your premium, which is the series of payments to a health plan for your coverage, you may have to share the costs of the services you receive.
· A deductible is the specified dollar amount you must pay each year for your health care expenses before your plan begins to pay.
· A coinsurance is the specified percentage amount of the provider’s reasonable charge for covered services that you are required to pay for care after you have met your deductible. For example, if the health insurance company pays 80 percent of the cost for a service, you would pay 20 percent coinsurance.
· A copayment is a specific, upfront dollar amount that you pay every time you receive certain services or care, such as $20 for every doctor’s visit. The health insurance company pays the remaining cost. Copayments do not count toward your deductible.
A Preferred-Provider Organization (PPO) gives you access to a network of participating doctors, hospitals and other health care providers. If you receive care from a network provider, you pay a lower share of the cost. You can also choose to go to a doctor or hospital out of the network and pay a higher share of the cost for your care. You do not need to have a primary care physician to coordinate your care.
Some “qualified” PPOs are offered in conjunction with a Health Savings Account (HSA) as defined by the Internal Revenue Service. Your HSA can be used to fund your out-of-pocket medical expenses using tax-free dollars.
A provider is any doctor, specialist, hospital or rehabilitation facility, for example, where you get health care.
Network providers are doctors, hospitals and other health care professionals and suppliers that have signed an agreement with a health plan to accept the amount that the company will pay for covered services as payment in full less any cost-sharing you’re responsible for. They also file claims for you.
Out-of-network providers do not have an agreement with a health plan. If you are treated by an out-of-network provider or facility, you’ll have to pay a greater share of the costs for your care. You may also be responsible for paying any difference between the amount your plan pays and the provider’s charge for the service, and you may have to file your own claims.
When selecting a health care coverage plan, you will want to research specific details about the plans you are considering, including:
Covered services – Most plans cover doctor visits, hospital stays, surgery and emergency care. But if you want coverage for prescription drugs, vision or behavioral health, make sure the plan offers it.
Pre-existing condition limitations - Some plans do not pay in the first year for services related to a condition you had before you enrolled. If a plan has these limits, they apply to applicants age 19 or older.
Deductible – How much of your health care expenses are you responsible for paying before the plan begins to cover your care? If you are covering family members too, do you need to meet more than one deductible? Or do expenses for all covered family members count toward a single deductible?
Cost-sharing – What portion of the cost for services is paid by the plan and how much will you be responsible for? Are those costs within your budget?
Network – Does the plan’s provider network include the doctors and hospitals you want? If you use providers outside of the network, how much more will you pay for care?
Preventive care – This usually includes yearly check-ups, mammograms, Pap tests, prostate exams, immunizations and well-child visits. What kind of preventive care is covered? Are there limitations on that care, such as the number of visits per year?
Maximums – Are there limits on how much the plan will pay for your care?
Health Savings Account – To enjoy the tax advantages of a Health Savings Account, should you consider enrolling in a qualified high-deductible health plan?
There are lots of things you can do to improve your health, become an educated health care consumer and help control health care costs.
With more providers than competitive plans, chances are good that your current physician and hospital are part of our extensive provider network. Find a Doctor, Hospital or Medical Provider to see if your provider is in our network.
In case of emergency, you’re covered at the higher level of benefits for emergency care received in or outside the PPO provider network.
Your PPO Plan has you covered no matter where you are. You can locate thousands of participating Blue Plan providers by calling BlueCard Access at 1-800-810-BLUE.
Your PPO Plan is a Blue Plan. That means you enjoy all the services of BlueCard Worldwide. Your coverage travels with you through a worldwide network of care providers.
Your premium depends on the plan you select. View premium options by completing the 3 simple steps to finding the right insurance.
Your deductible or coinsurance depends on the plan you select. View the deductible or coinsurance by completing the 3 simple steps to finding the right insurance.
Your copay, if any, depends on the plan you select and if you are seeing your primary care physician or a specialist. Compare benefits including copays by completing the 3 simple steps to find the right insurance.
If your plan does not have set copays, services will be subject to your in-network deductible. Once the deductible has been met, services will then be considered at a set percentage of the allowance (80% for example). You will be responsible for the remaining 20% until you have reached your out-of-pocket maximum for the calendar year. Once the out-of-pocket maximum has been met, services will then be considered at 100% of the allowed amount for the rest of the calendar year.
If you have prescription coverage, your medication cost depends on your selected plan. See your medication costs by completing the 3 simple steps to finding the right insurance. Select the More Details button and the link Find your Prescription under Prescription Drugs in the benefit grid to see if your medication is covered.
In order to obtain this information, we will need the following information: the procedure code, the in-network provider’s tax ID and provider’s charge. Once you have this information, you can contact member service for the medical procedure cost.
We offer a Standalone Dental policy through United Concordia*. Our Dental plans take effect the first of the following month after the application is completed and first month’s premium is received. At this time we do not offer a Standalone Vision plan, however vision is included in most of our policies.
Yes. We offer guaranteed issue plans, where we can guarantee you coverage regardless of your health history or pre existing conditions. Depending on what previous coverage you may have had, pre existing could be waived so you would be covered from day one for any ongoing health care needs.
There are many services that are eligible as part of your preventive benefits package. Eligibility of services will be based on age, gender, and when the last service date was. It is best to contact member service at the time of your visit with a list of services that your health care provider will be performingor check the Preventive Schedule on our website.
The prohibition on pre-existing condition exclusions applied to children under age 19 means that all health plans — individual, group, self-funded, and grandfathered plans — may not deny coverage or benefits to children under age 19 who have a pre-existing condition. The prohibition on pre-existing condition exclusions extends to adults in 2014.
Under the new health care reform law, health plans must provide coverage for adult dependents under-age 26 on their parents policies.
Your number of visits depends on your selected plan. View available plans and compare benefits including physical therapy visitsby completing the 3 simple steps to finding the right insurance and selecting the More Details button.
Gym memberships are not a covered benefit under the terms of your health insurance policy. However, you may be entitled to receive a discount through our member wellness discount program.