Highmark Inc.

my Direct Blue Lehigh Valley EPO Silver 2900 + Adult Dental and Vision

Plan Overview

Medical Deductible
  • Individual: 2900
  • Family: 5800
  • Per Person: 2900
Prescription Drug Deductible
  • Individual: 0
  • Family: 0
  • Per Person: 0
Medical Out-of-Pocket Maximum
  • Individual: 7800
  • Family: 15600
  • Per Person: 7800
Drug Out-of-Pocket Maximum
  • Individual: Included in Medical
  • Family: Included in Medical
  • Per Person: Included in Medical

Office Visit

Primary Doctor
  • Standard: $50 Copay
Specialist
  • Standard: $50 Copay

Prescription Drug Information

Preferred Brand Drugs
  • Standard: $30 Copay
Non Preferred Brand Drugs
  • Standard: $150 Copay
Generic Drugs
  • Standard: $0 Copay
Specialty Drugs
  • Standard: 50% Coinsurance

Inpatient Coverage

Hospital Services
  • Standard: 30% Coinsurance after deductible
Inpatient Services
  • Standard: 30% Coinsurance after deductible

Emergency and Urgent Care

Emergency Room
  • Standard: $750 Copay after deductible
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