Together Blue EPO Bronze 8900 – EPO
Network type: EPO
Coverage tier: Bronze
Primary care visit: No charge after deductible
Specialist visit: No charge after deductible
Urgent care visit: No charge after deductible
Description
Health Care Plan Details
Network type | EPO |
Deductible | $8,900 per person $8,900 per person |
Out-of-pocket max | $8,900 per person $17,800 per family |
Metal tier | Bronze |
Visit Copay
Primary care visit | No charge after deductible |
Specialist visit | No charge after deductible |
Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
Urgent care | No charge after deductible |
Emergency room | No charge after deductible |
Ambulance | No charge after deductible |
Hospital stay (facility) | No charge after deductible |
Hospital stay (physician) | No charge after deductible |
Outpatient procedure (facility) | No charge after deductible |
Outpatient procedure (physician) | No charge after deductible |
Physical rehabilitation | No charge after deductible |
Maternitowny and Pregnancy
Well baby care | No charge |
Labor, delivery, hospital stay | No charge after deductible |
Pharmacy, Drugs, and Medication
Generic | No charge after deductible |
Brand | No charge after deductible |
Non-preferred Brand | No charge after deductible |
Specialty | No charge after deductible |
Lab Tests and Diagnostic Procedures
X-rays | No charge after deductible |
Imaging (CT/PET/MRI) | No charge after deductible |
Blood work | No charge after deductible |
Mental and Psychiatric Health Care
Mental Health outpatient services | No charge after deductible |
Psychiatric hospital stay | No charge after deductible |
Health Plan Provider Information
Health Plan Benefits | https://shop.highmark.com/content/dam/highmark/en/healthco/shopx/plan-documents/2024/sbcs/wpa/individual/I_79279PA0080011-01_20240101_SBC.pdf |
Drug and medication plan formulary | http://client.formularynavigator.com/Search.aspx?siteCode=6571849149 |
Search doctor list | https://highmark.sapphirecareselect.com/?ci=bcbswpanepa&network_id=190 |