Highmark direct blue providers

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Launch a virtual tour of our location. Individual and family plans: Highmark offers a variety of health insurance plans for individuals and families. Dental: Blue Edge Dental covers cleanings, exams and other dental services.

Travel insurance: GeoBlue provides trip protection and medical coverage for Americans traveling outside the U. Services We Offer: Personalized Services and Appointments: Our store associates meet one-on- one with you to answer your questions and address your health insurance needs.

Free health assessments: Visit the health evaluation area at your local store to check your weight, body mass index BMI and blood pressure. Free wellness programs and seminars: Our stores regularly host a variety of free healthy living programs and Medicare seminars. Bill Payment: Stop in anytime to pay your monthly premium or look into charges for medical services. Shop and Compare Plans: Explore health insurance plans for individuals and families. Translation services: Our in-store customer phone line offers translation services [in many spoken languages].

We also have sign language interpreters who can meet with you at a store. Member Login Contact Us Privacy. Cancel Submit. The ZIP code you entered is outside the service areas of the states in which we operate. TTY call The ZIP code you entered is outside the service areas of the states in which we offer plans. Coinsurance The specific percentage of the provider's reasonable charge for covered services that is the member's financial responsibility.

The member may be required to pay any applicable coinsurance at the time of service. Consolidated Omnibus Budget Reconciliation Act COBRA A federal act which requires health plans to allow their members and covered dependents to continue their health coverage for a stated period of time following a qualifying event that causes the loss of their coverage. Qualifying events include reduced work hours, death or divorce of a covered employee, and termination of employment.

Copayment Copay A specific, upfront dollar amount a member pays for certain covered services. A member may be responsible for multiple copayments per visit and also to pay at the time of service.

A copayment may not apply toward deductibles or coinsurance, and may not accumulate toward the out-of-pocket limit. Deductibles, coinsurance, and copayments are examples of member cost sharing.

Covered Service Benefit A service or supply for which health care coverage will be provided by the health plan. D Deductible A specified dollar amount a member must pay out of their own pocket before the health plan begins to pay for any covered services some services may be exempt from the deductible.

The member may be required to pay any applicable deductible at the time of service. E Exclusive Provider Organization EPO A health care plan which provides benefits when care is received from network providers, and for emergency care when received at either network or out-of-network providers.

Explanation of Benefits EOB Statement sent by a health plan that details the charges for the service s received, the plan's allowable charge s for the covered service s , the amount the health plan pays for the service s , and the amount s the member is responsible for paying. F Fee-for-Service A payment system where the care provider is paid for each service rendered rather than a pre-negotiated amount for each patient. Fee Schedule A complete listing of fees used by health plans to pay doctors or other providers.

Flexible Spending Account FSA A health savings account that allows people to contribute a specified amount from their paycheck to help pay for health care services. Contributions are tax-exempt. Formulary A listing of prescription drugs selected by the health plan based on clinical analysis, unique value, and safety. This listing is subject to periodic review and modification by the health plan or a designated committee of physicians and pharmacists.

G Group Health Plan A health plan offered by an employer that provides health coverage to employees and their dependents. Guaranteed Issue Under guaranteed issue, a health insurer must provide coverage to an applicant regardless of prior medical history. HIPAA helps plan members continue their health coverage and establishes equality between individual and group health coverage. Health Maintenance Organization HMO Health care coverage that requires all members to select a primary care provider PCP who is responsible for supervising, coordinating and providing basic medical services.

All non-emergency covered services must be obtained from network providers unless pre-authorized by the health plan. Funds remaining in the account at year-end go back to the employer. Account contributions are not taxed. Treasury Department. These guidelines require 1. A member must be enrolled in a qualified HDHP to establish and contribute to a health savings account. I Indemnity Traditional fee-for-service health coverage in which covered health care services received from participating providers are paid-in-full after any applied deductibles, copayments or coinsurance costs have been met.

M Maintenance Drugs A prescription drug prescribed for the control of a chronic disease or illness, or to alleviate the pain and discomfort associated with a chronic disease or illness. Managed Care Health care coverage offered by health plans where there is an organized way for contracting with providers, and processes in place to manage costs, use of services and the quality of the delivery of health care.

Maximum The greatest amount of benefits that the health plan will provide for covered services within a prescribed period of time. This could be expressed in dollars, number of days or number of services. Medically Underwritten Plans that base acceptance for enrollment on health status, determined by the answers given on a medical questionnaire.

N Network Group of physicians, hospitals and other health care providers and suppliers contracted with the health plan to offer health care services at negotiated rates. O Open Enrollment A period each year when a member has the opportunity to change or elect their health care coverage.

Out-Of-Network Provider Physicians, hospitals or other health care providers who do not contract with a health plan. Out-of-Pocket Maximum The maximum dollar amount a member is required to contribute towards the cost of covered services in a benefit period. This limit protects a member from very high costs by capping the total amount they will have to pay for covered health care services.

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