Highmark Health Insurance Company

Highmark Health Insurance Company, as an independent licensee of the Blue Cross and Blue Shield Association, is one of the largest health insurance companies in the United States. Although its predecessors began in Pennsylvania in the 1930s, Highmark Health Insurance Company actually came out of a consolidation in 1996 of Pennsylvania Blue Shield and of Blue Cross of Western Pennsylvania. With 4.6 million members in Pennsylvania and West Virginia, Highmark Health Insurance Company is able to offer its members access to worldwide provider networks through the BlueCard program.

In western Pennsylvania, central Pennsylvania, and the Lehigh Valley, Highmark offers indemnity and managed care health insurance, consumer driven health plans, and Medicare supplemental products. It is able to offer health insurance products in northeastern Pennsylvania and southeastern Pennsylvania through joint operating agreements with BlueCross of Northeastern Pennsylvania. Coverage is available in West Virginia through Highmark’s affiliation with Mountain State Blue Cross Blue Shield.

Find some useful information by reading through this Highmark review, read through the reviews of Highmark Health Insurance left by customers at the bottom of this page, and then use the free tool on the side of this page to compare quotes from top health insurance providers online.

Highmark Medicare Advantage Plans

Highmark has one of the largest Medicare Advantage plans in the country, handling both Medicare Part A and Medicare Part B in Delaware, the District of Columbia metropolitan area, Maryland, New Jersey, and Pennsylvania. Through its relationship with various Blue Cross and Blue Shield plans (click here to read the Blue Cross Blue Shield Health Insurance review), Highmark is also able to handle the processing of Medicare Part D across the country.

Highmark Ratings

In addition to its “A” rating from both Standard and Poor and A.M. Best, Highmark receives numerous awards every year. Some of its most recent recognitions include the Brand Excellence Award for member retention from the Blue Cross and Blue Shield Association, a Workplace Fitness Innovation Award from the American Heart Association, a Leadership Award from America’s Health Insurance Plan (AHIP) for its PALS (People Able to Lend Support) program, and the Good Neighbor Award from the Greater Lehigh Valley Red Cross.

Highmark Charitable Contributions

Highmark contributes many dollars and employee volunteered hours to multiple charitable organizations. One of its more recent significant contributions is $100 million dollars given to the Highmark Foundation to fund the Highmark Healthy High 5 program for the next five years. The Highmark Healthy High 5 program was created to promote lifestyle awareness for lifelong healthy habits through education and support in five health issues considered critical for children aged six to eighteen. The five issues are bullying, grieving, nutrition, physical activity, and self-esteem.

Highmark Individual Health Insurance

Individual and family health insurance is available in 29 counties of Western Pennsylvania. Most plans are medically underwritten and vary in premiums and deductibles.

Temporary coverage is available through ShortTermBlue with three different deductible choices of $250, $500, or $1000.

For low monthly premiums there is Complete Care with a deductible of $500, or $1,000 or PPOBlue with higher deductibles of $1200, $2600, or $3500. DirectBlue offers a greater choice in doctors and has two plans, one deductible of $250 and another deductible of $500.

The Keystone Blue HMO plan has no deductible except for prescription coverage and the co-payments are relatively low. Guaranteed insurance is available for broad benefits with the Preferred Blue plan that has two different deductible options, one for $500 and one for $1,000.

Low income coverage is available if certain eligibility requirements are met and include CHIP (Pennsylvania’s Children’s Health Insurance Program), adultBasic for Pennsylvania residents, and SpecialCare, which is guaranteed limited indemnity for hospital and medical expenses.

Highmark Group Health Insurance

Group insurance is available with many plans from which to choose, including PPOBlue, EPOBlue, ClassicBlue, KeystoneBlue, BlueWorldwide Expat, SecurityBlue, FreedomBlue, BlueRx, Signature 65, and Vision Benefit.

There is also the option of BlueChoice, which gives employees the choice of their own health care plan. For federal employees, the Federal Employee Program Service Benefit Plan offers a choice between two Blue Cross Blue Shield PPO plans.

The Standard Option PPO allows the member to select a health care provider and costs will vary depending on in-network or out-of-network services.

The Basic Option PPO carries a lower premium than the Standard and does not have any deductibles, but with this plan the member must use a preferred provider.

COBRA coverage is offered to all eligible employees who lose their group health insurance, and a conversion policy may also be applicable in specific cases.

Highmark Options For Pre-existing Conditions

A pre-existing condition is typically defined as a medical condition that was diagnosed at a time prior to obtaining health insurance. Since insurance is purchased to cover future illnesses and accidents, not to pay for previous injury, there is oftentimes a waiting period of anywhere between nine and twelve months before you can receive coverage for a pre-existing condition. However, just because you have a pre-existing condition does not automatically mean you are excluded from obtaining health insurance coverage.

Highmark offers health care coverage to individuals who meet the HIPAA (Health Insurance Portability and Accountability Act) requirements of 1996. In order to be eligible, you must have had continuous health care coverage with a group, government, or church plan for a minimum of 18 months prior to the application, with no breaks in-between greater than 65 days each. Note, due to this same 65 day rule, you must apply for coverage within 65 days of your previous insurance ending. All COBRA coverage must be used first and you must have no other health insurance coverage. In order to be eligible for HIPAA coverage, you must not be eligible for or enrolled in Medicare, Medicaid, or any other group, government, or church plan.

If you meet the eligibility requirements, you can apply for the PreferredBlue plan, choosing between a $500 deductible or a $1,000 deductible. An example of the benefits for the $500 deductible plan is as follows. If you stay in the network, there is an 80% coinsurance applied once all deductibles have been met. Other benefits that are at 80% include inpatient hospital facilities, emergency room care, office and home visits, medical and surgical expenses, preventive care, diagnostic services, and various therapies. Prescription drugs have a $100 deductible with a cost of $10 for generic drugs and $20 for brand name drugs. Eye exams and vision correction discounts are available as well as discounts on fitness centers, spas, massage therapy, nutrition counseling, and personal trainers. Mental health services, substance abuse rehabilitation, and substance abuse detoxification are not covered at all under the PreferredBlue plan. The individual maximum out of pocket for in-network services is $2,500.

If you go out of the network for the same $500 deductible PreferredBlue plan as described above, the out of pocket maximum for an individual increases to $5,000 and your coinsurance drops to 70% after all deductibles have been satisfied. Although emergency care stays at 80%, hospital facility expenses have a coinsurance of only 70% and are limited to 90 days per benefit period at the out-of-network level. Furthermore, office and home visits, medical and surgical expenses, diagnostics, and select therapies also drop to 70%.

There is no benefit applied to preventive care, prescription drugs, or vision care. Although the choice to go out of network is an optional benefit as part of the plan, it is recommended for you to confirm that your selected providers and services are in the network in order to obtain the most cost effective benefit from your health insurance plan.

Compare Highmark Health Insurance Quotes

Whether you have a pre-existing condition or you are simply seeking individual insurance due to a change in your family or lifestyle, there are many health care choices available to you. Be sure to compare Highmark health insurance quotes with quotes from many different health insurance providers. To start shopping for health care insurance right away, just enter your zip code above!