DE2018 ProductBrochure

BE
READY
FOR
ANYTHING
Learn What You Need to
Know About Your 2018
Highmark Blue Cross
Blue Shield Delaware
Coverage Options
Benefit Period:
January 1 to
December 31, 2018
2018 HEALTH INSURANCE

2
CONNECTING CARE AND COVERAGE
You want to be ready for 2018 with the right health
insurance coverage in place. At Highmark Blue Cross Blue Important Details to Consider Before
Shield Delaware (Highmark Delaware), we’re here to help.
That’s why we’ve been working on new solutions that offer
Choosing a Plan:
high quality, easy-to-access care. • A shorter open enrollment period — only 6 weeks
This guide contains all the information you need to • Prescription drug coverage — check to see if your
understand your health insurance options before you enroll drugs are covered
in a 2018 plan. That means no surprises when you see your • Doctors and hospitals included in the Highmark
doctor, receive care at a hospital, or fill a prescription. So you Delaware network
can feel confident that you are choosing the right plan to fit
your real life—and your budget.
We understand that there is a lot to consider, and that change Choose Highmark Delaware for Your
can feel overwhelming at times. We hope you will use this Coverage in 2018 and You’ll Have:
guide to review details about our 2018 plans and contact us
• Peace of mind from knowing your health plan is
with any questions you have. from a name trusted by generations.
Whatever 2018 has in store for you and your family, or • A network that includes top-rated, providers right in
whatever your health demands, we want you to feel ready your own community.
for anything. That’s why we’re offering you a range of plan
• Benefits including $0 copays for preventive care,
options with easier access to care by:
such as checkups, immunizations, and much more.
• Teaming up with doctors and hospitals in your
• Free tools and resources to help you better manage
community so you don’t have to travel for care your health and get the most from your health
• Providing access to thousands of participating physicians coverage.
and hospitals across the country
• Bringing care to you on your terms with virtual medicine
and direct access to a Blues on CallSM health coach who is
a specially trained registered nurse
We’re here for you if you have questions or need help along the way:
• Call 1- 855-329-7819 (TTY/TDD 711)
• Visit DiscoverHighmark.com
• Talk to your local insurance agent
We can also help you enroll through the Health Insurance Marketplace
(“the Marketplace”). Or you can contact the Marketplace at:
• HealthCare.gov
• 1-800-318-2596 (TTY: 1-855-889-4325)
3
BE READY FOR ANYTHING
BE ON TIME for Open Enrollment P. 5
BE WELL-INFORMED About Your Health Plan Options P. 6
BE PREPARED Before You Choose P. 10
BE KNOWLEDGEABLE
with Base Plan Options & Monthly Rates
Base Plans P. 12
Base Rates P. 20
YOUR HEALTH INSURANCE GLOSSARY P. 23
4
BE ON TIME for Open Enrollment
SHORTER OPEN ENROLLMENT PERIOD: NOVEMBER 1 TO DECEMBER 15, 2017
15
Mark your calendar for this year’s accelerated Open Enrollment Period.
Enroll by December 15, 2017, for coverage beginning January 1, 2018.

DE C
Open Enrollment is the time when you can enroll in health insurance coverage.
Enroll by December 15 or you won’t have coverage on January 1—unless you qualify for a Special Enrollment Period.
If you don’t enroll in a health insurance plan for 2018, you may be charged a fee by the federal government.
To avoid this fee and a lapse in coverage, sign up for a 2018 health insurance plan before Open Enrollment ends.
SPECIAL ENROLLMENT PERIOD

Most people will enroll during Open Enrollment. But you can also change or enroll in coverage through a
Special Enrollment Period if you have a qualifying life event. Some examples are:
A NEW BABY
GETTING MARRIED
LOSING MINIMAL ESSENTIAL

COVERAGE, SUCH AS COVERAGE
THROUGH AN EMPLOYER
MOVING TO A NEW, PERMANENT

RESIDENCE WHERE YOU CAN’T HAVE
ACCESS TO THE SAME HEALTH PLANS
If you think a Special Enrollment Period may apply to you, you can learn more by visiting HealthCare.gov.
You may be asked to submit documents to show that you’re eligible for a Special Enrollment Period.
5
BE WELL-INFORMED About Your Health Plan Options
This year’s plan options are designed with you

in mind. Our 2018 plans focus on offering you
HIGHMARK DELAWARE PLAN OPTIONS
high-quality care, right in your community. It’s A Highmark Delaware Exclusive Provider
easier than ever to prepare—Highmark Delaware Organization (EPO) plan makes it easy to get the
has a variety of 2018 plan options. care you need with network providers. Highmark
Delaware offers plan options with:
To bring you top-quality care, we work with your
• Two visits to your Primary Care Provider (PCP)
local hospitals and providers. This helps to lower
with no out-of-pocket cost
the rising costs of health care, and keeps your
copays and other out-of-pocket costs lower. • Services at NO COST when you choose
in-network health care providers for:
Highmark Delaware has plans where you’ll have > $0 preventive screens and routine
access to a network of community providers for wellness exams
low or no cost services—with one plan offering
> $0 immunizations and vaccinations
two free Primary Care Provider (PCP) office visits—
> $0 contraceptives
plus national access to thousands of providers.
• Lower-cost Silver plan options for members
Along with providing access to care close to who qualify for financial help from the
home, finding a provider isn’t complicated. Marketplace
Doctors, facilities and other providers are either
• Nationwide access to care with BlueCard®
in-network, or out-of-network—it’s that simple.
• No referrals for seeing specialists
6
BE WELL-INFORMED About Your Health Plan Options
Major Events/Catastrophic Coverage

If you are under 30 or meet financial hardship requirements, the low-cost Major Events Blue EPO plan was
designed to provide you with basic coverage at an affordable cost. You get the protection you need in case
of an emergency, serious illness, or accident, and your first three visits to your primary care doctor—and
certain preventive services—are covered at no cost.
Shared Cost Blue EPO

Plans have copays with coverage for some services right from the start. For other services, you need to
meet your deductible before we pay for your care. These plans are offered at three ACA metal levels—
Bronze, Silver, and Gold—to give you a wide range of deductible levels from which to choose. See page 10
for a description of metal levels.
Health Savings Embedded Blue EPO

Plans are qualified high-deductible health plans and may be coupled with a Health Savings Account (HSA)
that offers tax and savings advantages. Other than preventive care, you will pay most costs until your
deductible is met. After that, Highmark Delaware pays most of the plan allowance for covered in-network
care for the remainder of the benefit period. 2018 plans are available in Bronze and Silver levels. See page 10
for a description of metal levels.
Please note: Certain cost-sharing reductions (CSR) or plan variations of this

plan that are offered through the Health Insurance Marketplace are not
intended to be used with an HSA. If you have questions, please check
with your financial advisor.
Highmark Blue Edge Dental

Do you need adult dental insurance?
Visit HighmarkBlueEdgeDental.com to find out more.
7
BE WELL-INFORMED Choose a Network Primary Care Provider
Get More From Your Highmark Delaware A PCP Can Help You:
Plan – Choose an In-Network Primary Care • Get the most value from your health
Provider (PCP) care dollar
Even when you’re healthy, having an in-network • Achieve health goals

Primary Care Provider (PCP) feels great. A PCP is • Monitor chronic health conditions
the doctor, medical professional, or practice that
• Make sure you receive preventive care,
you visit for your primary and routine health care
like annual exams
services, such as physicals and immunizations.
The Journal of Health Affairs has found that • Coordinate the care you receive from
people with primary care providers enjoy lower other providers, such as specialists, labs,
and imaging centers, to prevent gaps or
overall health care costs and higher satisfaction
overlaps in service
with their care.
• Improve your patient experience
Nationwide Access to Care with BlueCard®

Wherever you go nationwide as a Highmark Delaware member, you have access to
in-network providers.
Just show your Highmark Delaware ID card at the thousands of participating physicians
and hospitals across the country, and you’ll receive in-network access away from home.
How to Find Out if Your Provider Is In-Network: 3 Easy Ways

Doctors, hospitals, and pharmacies in networks often change. That’s why it is very important to make sure
your provider and/or facility are in-network before choosing an insurance plan or going for services. That
way, you’ll avoid surprises—and unexpected costs.
If you go to an out-of-network doctor, pharmacy, hospital, or other provider, you will have to pay 100% of
the cost, except in the case of emergency care. Your services may not be covered by Highmark Delaware.
Find a Doctor or Rx
It’s quick and easy to find an in-network provider or facility. Search online by plan type to make
sure your doctor, specialist, or hospital is in-network. See maps, office hours, quality ratings,
member reviews, and more. Visit HighmarkBCBSDE.com and click Find a Doctor or Rx
to get started.
NEW FOR 2018 It’s now easier to check which prescribed drugs are covered under your 2018
insurance plan. View Highmark Delaware’s online Rx drug listing (or formulary)
at HighmarkBCBSDE.com and click Find a Doctor or Rx.
8
BE WELL-INFORMED Review Your Prescription Drug List
My Care Navigator
Is your doctor in-network? My Care Navigator health advocates make it easy for you to find or
change to an in-network doctor or facility, schedule an appointment, and transfer your medical
records. Call 1-888-BLUE-428 or visit MyCareNavigator.com.
Highmark Delaware Member Service

Already a Highmark Delaware member? You probably know the value of great customer service
from our Member Service area. By calling the number on the back of your Highmark Delaware
ID card, our dedicated team can also help find you an in-network doctor or facility.
IMPORTANT: 2018 Changes to the Prescription Drug List

Changes are made to prescription drug coverage from year to year. As you choose a plan for 2018, be
well-informed and avoid surprises. Be sure to check to see how your prescription drugs will be covered.
Prescription drugs are an important part of your coverage. The list of the drugs that your plan covers is
called a “formulary.”
In 2018, Highmark Delaware plans will include the Progressive

Formulary, which:
• Groups drugs into four levels or “tiers”
• Saves you money when your doctor prescribes
drugs on the lower tiers
• Includes generic and brand-name drugs
It’s easy to check if your prescription drugs are covered —visit HighmarkBCBSDE.com and
click on Find a Doctor or Rx.
Progressive Formulary - 4 Tiers of Drugs

Tier 1 Tier 2 Tier 3 Tier 4
Preferred
Preferred Generics Non-Preferred Generics Non-Preferred Brands
Brands
9
BE PREPARED Before You Choose
Ask yourself these important questions before
choosing a plan!
• Is my doctor in-network?
• Is my hospital in-network?
• At what tier are my prescription drugs
covered and how much will they be?
• Can I get financial help through the Marketplace?
• Would I rather have lower monthly premiums
or lower copays?
• Should I open a Health Savings Account (HSA)
to manage out-of-pocket costs?
Highmark Delaware offers you the support you need to answer
these questions and more. We want you to have the plan that
works best for your needs—so you can be ready for anything.
Metal Levels and Essential Health Benefits

When you are shopping for one of Highmark Delaware’s
Affordable Care Act (ACA) health insurance plans, it’s important
to know about metal levels and essential health benefits.
Metal Levels
Highmark Delaware’s Affordable Care Act health plans are grouped
in metal categories: Bronze, Silver, and Gold. These levels are based
on how you and your health plan split the costs of your health care.
They are simply ways to categorize plan payment levels. They do
not describe the quality of care you receive.
PLAN CATEGORY MONTHLY PREMIUM

BRONZE Lower
SILVER Medium
GOLD Higher
Essential Health Benefits

All Highmark Delaware plans include these essential health benefits:
• Ambulatory services, such as • Pediatric services, including dental • Hospitalization
primary care and specialist visits and vision care
• Laboratory services
• Maternity and newborn care • Mental health and substance
• Preventive and wellness services,
abuse services
• Emergency services and chronic disease management
• Rehabilitative and habilitative
• Prescription drugs, including retail
services and devices
and mail order
10
BE PREPARED Before You Choose
You May Qualify for Financial Help.

It’s Easy to Check.
Most people who buy insurance through the Marketplace are pleased to learn they can get help paying for insurance.
Before you enroll, you should find out if you can get this help to lower the cost of your monthly premium. To start, check
the 2018 Household Income Chart below.
You may qualify for one or both kinds of financial help:
• Advanced Premium Tax Credits (APTC), which may be applied—in advance—to lower what you pay each month for your
premium on any Marketplace metal-level plan.
• Cost-Sharing Reductions (CSR)* will lower out-of-pocket costs that you may pay at the time of service for doctor visits, lab
tests, drugs, and other covered services. You can only get these savings if you enroll in a Marketplace Silver metal-level plan.
Eligibility for financial help can only be determined through the Marketplace at HealthCare.gov.
2018 Household Persons In Family / Household

Income 1 2 3 4 5 6 7 8
Cost-Sharing $12,060 - $16,240 - $20,420 - $24,600 - $28,780 - $32,960 - $37,140 - $41,320 -

Reductions (CSR) $30,150 $40,600 $51,050 $61,500 $71,950 $82,400 $92,850 $103,300
Advanced
$12,060 - $16,240 - $20,420 - $24,600 - $28,780 - $32,960 - $37,140 - $41,320 -
Premium Tax
$48,240 $64,960 $81,680 $98,400 $115,120 $131,840 $148,560 $165,280
Credits (APTC)
Medicaid
Eligible Range $12,060 - $16,240 - $20,420 - $24,600 - $28,780 - $32,960 - $37,140 - $41,320 -
(100-138% or $16,643 $22,411 $28,180 $33,948 $39,716 $45,485 $51,253 $57,022
less FPL)
This chart is only applicable for coverage in 2018 and in the 48 contiguous states and the District of Columbia. For families/households with more than 8 persons, add $4,180 for
each additional person. HHS Poverty Guidelines for 2017 (January 31, 2017). Retrieved from https://aspe.hhs.gov/poverty-guidelines 8-30-17
*American Indians and Alaska Natives who are members of federally recognized tribes are eligible for cost-sharing reductions at alternative dollar thresholds.
You’ll need these documents for yourself and every family member you want to enroll:
• Social Security numbers (or documents for legal immigrants)
• Birth dates
• Pay stubs, W-2 forms, or wage and tax statements—to determine your income
• Policy numbers for any current health insurance
• Information about any health insurance you or your family could get from your job
11
BE KNOWLEDGEABLE With Base Plan Options by County
2018 PLAN BENEFIT GRIDS

There's a lot to know and do when it comes to picking the right plan for you and your family.
If you are looking for more medical plan details, visit HighmarkBCBSDE-SBC.com
to find each plan’s Summary of Benefits and Coverage. If you do not have online
access, you can get a paper copy of any Summary of Benefits free of charge by
calling Highmark Delaware toll-free at 1- 855-329-7819 (TTY/TDD 711).
12

Major Events Blue EPO 7350 CATASTROPHIC
On Exchange Base Plan ID: 76168DE0400001-‐01; Off Exchange Base Plan ID: 76168DE0460001-‐00
The chart below shows in-‐network costs for all categories as a member.
Benefit Network
Deductible/Coinsurance and Out of Pocket Costs
Deductible (Individual) $7,350
1
Deductible Aggregate (Family) $14,700
Coinsurance 0% after deductible
2
Out of Pocket Maximum (Individual) $7,350
2
Out of Pocket Maximum Aggregate (Family) $14,700
Office/Clinic/Urgent Care Visits
Retail Clinic Visits 0% after deductible
0% after deductible
Primary Care Provider Office Visits (Eligible For 3 Visits Prior To Deductible At Zero Cost)
Specialist Office & Virtual Visits 0% after deductible
Urgent Care Center Visits 0% after deductible
Telemedicine Service 0% after deductible
Pediatric Dental and Vision
9,10
Pediatric Vision Exam 0% after deductible
Pediatric Vision Frame selection/Standard eyeglass
9,10
lenses 0% after deductible
10
Pediatric Dental Exam and Cleanings 0% after deductible
10
Pediatric Dental Basic Restorative Services 0% after deductible
Hospital and Medical/Surgical Expenses (including maternity)
Hospital Inpatient 0% after deductible
Hospital Outpatient 0% after deductible
Inpatient Hospital Maternity 0% after deductible
Medical Care (including inpatient visits and
consultations)/Surgical Expenses and Maternity 0% after deductible
Emergency Services
Emergency Room Services 0% after deductible
Ambulance 0% after deductible
Therapy, Rehabilitative and Habilitative Services
6
Physical Medicine 0% after deductible
(Rehabilitative and Habilitative) Physical therapy and occupational therapy are a combined 30 visit limit per benefit period
each for Rehabilitative and Habilitative services (60 visits total per benefit period).
6
Speech & Occupational Therapy 0% after deductible
(Rehabilitative and Habilitative) Speech therapy is limited to 30 visits per benefit period each for Rehabilitative and
Habilitative services (60 visits total per benefit period)
0% after deductible
7
Chiropractor Services 30 Visits per Benefit Period; DE State Mandate: Member cost sharing cannot exceed 25%
(deductible may apply)
Mental Health/Substance Abuse
Inpatient 0% after deductible
Inpatient Detoxification/Rehabilitation 0% after deductible
Outpatient 0% after deductible
Other Services
Diagnostic Services
5
Advanced Imaging (MRI, CAT, PET scan, etc.) 0% after deductible
Basic Diagnostic Services (standard imaging, diagnostic
4
medical, allergy testing) 0% after deductible
3
Lab/Pathology 0% after deductible
8
Skilled Nursing Facility Care 0% after deductible
120 days per confinement; benefits renew after 180 days without care

Prescription Drugs11
Formulary (Drug List) -‐ Progressive
Tiers Tier 1 Tier 2 Tier 3 Tier 4
Prescription Drug Coverage Retail (34 days supply) 0% after deductible 0% after deductible 0% after deductible 0% after deductible
Prescription Drug Coverage Mail (90 days supply) 0% after deductible 0% after deductible 0% after deductible 0% after deductible
13
Health Savings Embedded Blue EPO 6550 BRONZE
Benefit Network
1
Deductible Embedded (Family) $13,100
2
2
Out of Pocket Maximum Embedded (Family) $13,100
Primary Care Provider Office Visits 0% after deductible
9,10
Pediatric Vision Exam 0% deductible does not apply
9,10
Pediatric Vision Frame selection/Standard eyeglass lenses 0% after deductible
10
Pediatric Dental Exam and Cleanings 0% deductible does not apply
10
Emergency Services
6
6
0% after deductible
7
Other Services
Diagnostic Services
5
4
3
8

14
Shared Cost Blue EPO 6950 BRONZE
Benefit Network
1
2
2
Retail Clinic Visits $50 copay
Primary Care Provider Office Visits $50 copay
9,10
9,10
lenses 0% deductible does not apply
10
10
Pediatric Dental Basic Restorative Services 50% deductible does not apply
Emergency Services
6
6
0% after deductible
7
Other Services
Diagnostic Services
5
4
3
8

11
Prescription Drugs
15
Health Savings Embedded Blue EPO 3500 SILVER
Benefit Network
1
Deductible Embedded (Family) $7,000
2
2
Out of Pocket Maximum Embedded (Family) $13,100
Primary Care Provider Office Visits 10% after deductible
9,10
9,10
Pediatric Vision Frame selection/Standard eyeglass lenses 0% after deductible
10
10
Emergency Services
6
6
10% after deductible
7
Other Services
Diagnostic Services
5
4
3
8

Prescription Drug Coverage Retail (34 days supply) 10% after 10% after 10% after 10% after
deductible deductible deductible deductible
Prescription Drug Coverage Mail (90 days supply) 10% after 10% after 10% after 10% after
deductible deductible deductible deductible
16
Shared Cost Blue EPO 3500 SILVER
Benefit Network
1
2
2
Primary Care Provider Office Visits $0 copay (Visits 1-‐2); $40 copay (Thereafter)
Specialist Office & Virtual Visits $90 copay
Urgent Care Center Visits $110 copay
Telemedicine Service $20 copay
9,10
9,10
10
10
Emergency Services
Emergency Room Services $500 copay (waived if admitted)
6
Physical Medicine $90 copay
(Rehabilitative and Habilitative) Physical therapy and occupational therapy are a combined 30 visit limit per benefit
period each for Rehabilitative and Habilitative services (60 visits total per benefit period).
6
Speech & Occupational Therapy $90 copay
7
Outpatient 0% after $90 copay
Other Services
Diagnostic Services
5
4
medical, allergy testing) $90 copay
3
Lab/Pathology $20 copay (Non-‐Hospital); $80 copay (Hospital)
8

10% after $250 drug 15% after $250 drug 20% after $250 30% after $250 drug
Prescription Drug Coverage Retail (34 days supply)
deductible* deductible* drug deductible* deductible*
10% after $250 drug 15% after $250 drug 20% after $250 30% after $250 drug
Prescription Drug Coverage Mail (90 days supply)
after deductible* after deductible* drug deductible* deductible*
* Drug deductible is per member
17
Shared Cost Blue EPO 7150 SILVER
Benefit Network
9,10
Pediatric Vision Frame selection/Standard
9,10
eyeglass lenses 0% deductible does not apply
10
10
Emergency Services
6
(Rehabilitative and Habilitative) Physical therapy and occupational therapy are a combined 30 visit limit per benefit period each
for Rehabilitative and Habilitative services (60 visits total per benefit period).
6
(Rehabilitative and Habilitative) Speech therapy is limited to 30 visits per benefit period each for Rehabilitative and Habilitative
services (60 visits total per benefit period)
7
Outpatient $80 copay
Other Services
Diagnostic Services
5
Basic Diagnostic Services (standard imaging,
4
diagnostic medical, allergy testing) $90 copay
$20 copay (Non-‐Hospital)
3
Lab/Pathology $90 copay (Hospital)
8
Prescription Drug Coverage Retail (34 days supply) 10% 15% 20% 30%
Prescription Drug Coverage Mail (90 days supply) 10% 15% 20% 30%
18
Shared Cost Blue EPO 1400 GOLD
Benefit Network
1
2
2
9,10
9,10
10
10
Emergency Services
Emergency Room Services $500 copay after deductible
6
6
7
Outpatient $45 copay
Other Services
Diagnostic Services
5
4
medical, allergy testing) $50 copay
3
Lab/Pathology $10 copay (Non-‐Hospital); $35 copay (Hospital)
8

Prescription Drugs Prescription Drugs11
10% after $100 drug 15% after $100 20% after $100 drug 30% after $100 drug
Prescription Drug Coverage Retail (34 days supply) deductible* drug deductible* deductible* deductible*
10% after $100 drug 15% after $100 20% after $100 drug 30% after $100 drug
Prescription Drug Coverage Mail (90 days supply) deductible* drug deductible* deductible* deductible*
19
BE KNOWLEDGEABLE with Base Monthly Rates
Understand How Your Monthly Premium Find Your Rate By:

Rate Is Calculated • The Highmark Delaware plan you wish
At Highmark Delaware, we want you to trust to purchase
in the value of your health care coverage. To • Your age—and the age of each dependent
help you understand how we calculate the on your plan
price you pay, we have included a guide to
• Your tobacco use—and the tobacco use of
base rates on pages 21-22. The base
each dependent on your plan
premium rate listed is the most a person*
will pay for their premium each month.
If You Have More Than Three Children Under Age 21:

Only include rates for you, your spouse/domestic partner, children between ages 21—26, and/or
the three oldest children under age 21. Your policy will also cover your remaining children. Please
include them as eligible dependents when you enroll.
*If you are also enrolling family members, you will need to get the base rate for each member of your family. Add these
base rates together to get the rate that covers the family members on your plan.
20
BASE RATE
PLANS CATASTROPHIC BRONZE BRONZE SILVER
Health Savings Embedded Blue Health Savings Embedded Blue
Major Events Blue EPO 7350 Shared Cost Blue EPO 6950B
(Use the Plan EPO 6550BQE EPO 3500SQE
ID to find your PLAN ID

AGE
76168DE0400001
No Tobacco Tobacco
76168DE0420001
No Tobacco Tobacco
76168DE0410010
No Tobacco Tobacco
76168DE0420004
No Tobacco Tobacco
plan on the 0-14 $253.48 $253.48 $285.80 $285.80 $283.25 $283.25 $353.64 $353.64
Marketplace.) 15
16
$276.01
$284.62
$276.01
$284.62
$311.20
$320.91
$311.20
$320.91
$308.43
$318.05
$308.43
$318.05
$385.07
$397.09
$385.07
$397.09
17 $293.24 $293.24 $330.63 $330.63 $327.68 $327.68 $409.11 $409.11
18 $302.51 $302.51 $341.09 $341.09 $338.05 $338.05 $422.05 $422.05
19 $311.79 $311.79 $351.55 $351.55 $348.41 $348.41 $435.00 $435.00
20 $321.40 $321.40 $362.38 $362.38 $359.15 $359.15 $448.40 $448.40
21 $331.34 $339.62 $373.59 $382.93 $370.26 $379.52 $462.27 $473.83
22 $331.34 $339.62 $373.59 $382.93 $370.26 $379.52 $462.27 $473.83
23 $331.34 $339.62 $373.59 $382.93 $370.26 $379.52 $462.27 $473.83
24 $331.34 $339.62 $373.59 $382.93 $370.26 $379.52 $462.27 $473.83
25 $332.67 $340.99 $375.08 $384.46 $371.74 $381.03 $464.12 $475.72
26 $339.29 $347.77 $382.56 $392.12 $379.15 $388.63 $473.36 $485.19
27 $347.24 $355.92 $391.52 $401.31 $388.03 $397.73 $484.46 $496.57
28 $360.17 $369.17 $406.09 $416.24 $402.47 $412.53 $502.49 $515.05
29 $370.77 $380.04 $418.05 $428.50 $414.32 $424.68 $517.28 $530.21
30 $376.07 $385.47 $424.02 $434.62 $420.25 $430.76 $524.68 $537.80
31 $384.02 $393.62 $432.99 $443.81 $429.13 $439.86 $535.77 $549.16
32 $391.98 $401.78 $441.96 $453.01 $438.02 $448.97 $546.87 $560.54
33 $396.95 $406.87 $447.56 $458.75 $443.57 $454.66 $553.80 $567.65
34 $402.25 $412.31 $453.54 $464.88 $449.50 $460.74 $561.20 $575.23
35 $404.90 $415.02 $456.53 $467.94 $452.46 $463.77 $564.89 $579.01
36 $407.55 $417.74 $459.52 $471.01 $455.42 $466.81 $568.59 $582.80
37 $410.20 $420.46 $462.50 $474.06 $458.38 $469.84 $572.29 $586.60
38 $412.85 $423.17 $465.49 $477.13 $461.34 $472.87 $575.99 $590.39
39 $418.15 $428.60 $471.47 $483.26 $467.27 $478.95 $583.38 $597.96
40 $423.45 $465.80 $477.45 $525.20 $473.19 $520.51 $590.78 $649.86
41 $431.40 $476.70 $486.41 $537.48 $482.08 $532.70 $601.88 $665.08
42 $439.03 $488.20 $495.01 $550.45 $490.59 $545.54 $612.51 $681.11
43 $449.63 $504.04 $506.96 $568.30 $502.44 $563.24 $627.30 $703.20
44 $462.88 $523.98 $521.91 $590.80 $517.25 $585.53 $645.79 $731.03
45 $478.45 $547.83 $539.46 $617.68 $534.66 $612.19 $667.52 $764.31
46 $497.01 $576.53 $560.39 $650.05 $555.39 $644.25 $693.41 $804.36
47 $517.88 $609.54 $583.92 $687.27 $578.72 $681.15 $722.53 $850.42
48 $541.74 $647.92 $610.82 $730.54 $605.38 $724.03 $755.81 $903.95
49 $565.27 $687.93 $637.34 $775.64 $631.66 $768.73 $788.63 $959.76
50 $591.77 $724.92 $667.23 $817.36 $661.28 $810.07 $825.61 $1,011.37
51 $617.95 $756.99 $696.75 $853.52 $690.53 $845.90 $862.13 $1,056.11
52 $646.78 $792.31 $729.25 $893.33 $722.75 $885.37 $902.35 $1,105.38
53 $675.93 $828.01 $762.12 $933.60 $755.33 $925.28 $943.03 $1,155.21
54 $707.41 $866.58 $797.61 $977.07 $790.51 $968.37 $986.95 $1,209.01
55 $738.89 $905.14 $833.11 $1,020.56 $825.68 $1,011.46 $1,030.86 $1,262.80
56 $773.02 $946.95 $871.59 $1,067.70 $863.82 $1,058.18 $1,078.48 $1,321.14
57 $807.48 $989.16 $910.44 $1,115.29 $902.32 $1,105.34 $1,126.55 $1,380.02
58 $844.25 $1,034.21 $951.91 $1,166.09 $943.42 $1,155.69 $1,177.86 $1,442.88
59 $862.48 $1,056.54 $972.45 $1,191.25 $963.79 $1,180.64 $1,203.29 $1,474.03
60 $899.26 $1,101.59 $1,013.92 $1,242.05 $1,004.89 $1,230.99 $1,254.60 $1,536.89
61 $931.07 $1,140.56 $1,049.79 $1,285.99 $1,040.43 $1,274.53 $1,298.98 $1,591.25
62 $951.94 $1,166.13 $1,073.32 $1,314.82 $1,063.76 $1,303.11 $1,328.10 $1,626.92
63 $978.12 $1,198.20 $1,102.84 $1,350.98 $1,093.01 $1,338.94 $1,364.62 $1,671.66
64 $994.02 $1,217.67 $1,120.77 $1,372.94 $1,110.78 $1,360.71 $1,386.81 $1,698.84
65+ $994.02 $1,217.67 $1,120.77 $1,372.94 $1,110.78 $1,360.71 $1,386.81 $1,698.84
21
BASE RATE
PLANS SILVER
CATASTROPHIC SILVER
BRONZE GOLD
BRONZE SILVER
Health Savings Embedded Blue Health Savings Embe
Shared Cost Blue
Major Events BlueEPO
EPO3500S
7350 Shared Cost Blue EPO 7150S Shared
SharedCost
CostBlue
BlueEPO
EPO1400G
6950B
(Use the Plan ID to EPO 6550BQE EPO 3500SQ
find your plan on PLAN ID

AGE No
76168DE0410013
76168DE0400001
NoTobacco
Tobacco Tobacco
Tobacco No
76168DE0410017
76168DE0420001
NoTobacco
Tobacco Tobacco
Tobacco No
76168DE0410012
76168DE0410010
NoTobacco
Tobacco Tobacco
Tobacco
76168DE0420
No Tobacco T
the Marketplace.) 0-14 $357.48
$253.48 $357.48
$253.48 $342.87
$285.80 $342.87
$285.80 $422.67
$283.25 $422.67
$283.25 $353.64 $
15 $389.25
$276.01 $389.25
$276.01 $373.34
$311.20 $373.34
$311.20 $460.24
$308.43 $460.24
$308.43 $385.07 $
16 $401.40
$284.62 $401.40
$284.62 $385.00
$320.91 $385.00
$320.91 $474.61
$318.05 $474.61
$318.05 $397.09 $
17 $413.55
$293.24 $413.55
$293.24 $396.65
$330.63 $396.65
$330.63 $488.97
$327.68 $488.97
$327.68 $409.11 $
18 $426.64
$302.51 $426.64
$302.51 $409.20
$341.09 $409.20
$341.09 $504.44
$338.05 $504.44
$338.05 $422.05 $
19 $439.72
$311.79 $439.72
$311.79 $421.75
$351.55 $421.75
$351.55 $519.91
$348.41 $519.91
$348.41 $435.00 $
20 $453.27
$321.40 $453.27
$321.40 $434.74
$362.38 $434.74
$362.38 $535.93
$359.15 $535.93
$359.15 $448.40 $
21 $467.29
$331.34 $478.97
$339.62 $448.19
$373.59 $459.39
$382.93 $552.51
$370.26 $566.32
$379.52 $462.27 $
22 $467.29
$331.34 $478.97
$339.62 $448.19
$373.59 $459.39
$382.93 $552.51
$370.26 $566.32
$379.52 $462.27 $
23 $467.29
$331.34 $478.97
$339.62 $448.19
$373.59 $459.39
$382.93 $552.51
$370.26 $566.32
$379.52 $462.27 $
24 $467.29
$331.34 $478.97
$339.62 $448.19
$373.59 $459.39
$382.93 $552.51
$370.26 $566.32
$379.52 $462.27 $
25 $469.16
$332.67 $480.89
$340.99 $449.98
$375.08 $461.23
$384.46 $554.72
$371.74 $568.59
$381.03 $464.12 $
26 $478.50
$339.29 $490.46
$347.77 $458.95
$382.56 $470.42
$392.12 $565.77
$379.15 $579.91
$388.63 $473.36 $
27 $489.72
$347.24 $501.96
$355.92 $469.70
$391.52 $481.44
$401.31 $579.03
$388.03 $593.51
$397.73 $484.46 $
28 $507.94
$360.17 $520.64
$369.17 $487.18
$406.09 $499.36
$416.24 $600.58
$402.47 $615.59
$412.53 $502.49 $
29 $522.90
$370.77 $535.97
$380.04 $501.52
$418.05 $514.06
$428.50 $618.26
$414.32 $633.72
$424.68 $517.28 $
30 $530.37
$376.07 $543.63
$385.47 $508.70
$424.02 $521.42
$434.62 $627.10
$420.25 $642.78
$430.76 $524.68 $
31 $541.59
$384.02 $555.13
$393.62 $519.45
$432.99 $532.44
$443.81 $640.36
$429.13 $656.37
$439.86 $535.77 $
32 $552.80
$391.98 $566.62
$401.78 $530.21
$441.96 $543.47
$453.01 $653.62
$438.02 $669.96
$448.97 $546.87 $
33 $559.81
$396.95 $573.81
$406.87 $536.93
$447.56 $550.35
$458.75 $661.91
$443.57 $678.46
$454.66 $553.80 $
34 $567.29
$402.25 $581.47
$412.31 $544.10
$453.54 $557.70
$464.88 $670.75
$449.50 $687.52
$460.74 $561.20 $
35 $571.03
$404.90 $585.31
$415.02 $547.69
$456.53 $561.38
$467.94 $675.17
$452.46 $692.05
$463.77 $564.89 $
36 $574.77
$407.55 $589.14
$417.74 $551.27
$459.52 $565.05
$471.01 $679.59
$455.42 $696.58
$466.81 $568.59 $
37 $410.20
$578.51 $420.46
$592.97 $462.50
$554.86 $474.06
$568.73 $458.38
$684.01 $469.84
$701.11 $572.29 $
38 $412.85
$582.24 $423.17
$596.80 $465.49
$558.44 $477.13
$572.40 $461.34
$688.43 $472.87
$705.64 $575.99 $
39 $418.15
$589.72 $428.60
$604.46 $471.47
$565.62 $483.26
$579.76 $467.27
$697.27 $478.95
$714.70 $583.38 $
40 $423.45
$597.20 $465.80
$656.92 $477.45
$572.79 $525.20
$630.07 $473.19
$706.11 $520.51
$776.72 $590.78 $
41 $431.40
$608.41 $476.70
$672.29 $486.41
$583.54 $537.48
$644.81 $482.08
$719.37 $532.70
$794.90 $601.88 $
42 $439.03
$619.16 $488.20
$688.51 $495.01
$593.85 $550.45
$660.36 $490.59
$732.08 $545.54
$814.07 $612.51 $
43 $449.63
$634.11 $504.04
$710.84 $506.96
$608.19 $568.30
$681.78 $502.44
$749.76 $563.24
$840.48 $627.30 $
44 $462.88
$652.80 $523.98
$738.97 $521.91
$626.12 $590.80
$708.77 $517.25
$771.86 $585.53
$873.75 $645.79 $
45 $478.45
$674.77 $547.83
$772.61 $539.46
$647.19 $617.68
$741.03 $534.66
$797.82 $612.19
$913.50 $667.52 $
46 $497.01
$700.94 $576.53
$813.09 $560.39
$672.29 $650.05
$779.86 $555.39
$828.77 $644.25
$961.37 $693.41 $
47 $517.88
$730.37 $609.54
$859.65 $583.92
$700.52 $687.27
$824.51 $578.72
$863.57 $681.15
$1,016.42 $722.53 $
48 $541.74
$764.02 $647.92
$913.77 $610.82
$732.79 $730.54
$876.42 $605.38
$903.35 $724.03
$1,080.41 $755.81 $
49 $565.27
$797.20 $687.93
$970.19 $637.34
$764.61 $775.64
$930.53 $631.66
$942.58 $768.73
$1,147.12 $788.63 $
50 $591.77
$834.58 $724.92
$1,022.36 $667.23
$800.47 $817.36
$980.58 $661.28
$986.78 $810.07
$1,208.81 $825.61 $
51 $617.95
$871.50 $756.99
$1,067.59 $696.75
$835.87 $853.52
$1,023.94 $690.53
$1,030.43 $845.90
$1,262.28 $862.13 $
52 $646.78
$912.15 $792.31
$1,117.38 $729.25
$874.87 $893.33
$1,071.72 $722.75
$1,078.50 $885.37
$1,321.16 $902.35 $
53 $675.93
$953.27 $828.01
$1,167.76 $762.12
$914.31 $933.60
$1,120.03 $755.33
$1,127.12 $925.28
$1,380.72 $943.03 $
54 $707.41
$997.66 $866.58
$1,222.13 $797.61
$956.89 $977.07
$1,172.19 $790.51
$1,179.61 $968.37
$1,445.02 $986.95 $
55 $738.89
$1,042.06 $905.14
$1,276.52 $833.11
$999.46 $1,020.56
$1,224.34 $825.68
$1,232.10 $1,011.46
$1,509.32 $1,030.86 $
56 $773.02
$1,090.19 $946.95
$1,335.48 $871.59
$1,045.63 $1,067.70
$1,280.90 $863.82
$1,289.01 $1,058.18
$1,579.04 $1,078.48 $
57 $807.48
$1,138.79 $989.16
$1,395.02 $910.44
$1,092.24 $1,115.29
$1,337.99 $902.32
$1,346.47 $1,105.34
$1,649.43 $1,126.55 $
58 $844.25
$1,190.65 $1,034.21
$1,458.55 $951.91
$1,141.99 $1,166.09
$1,398.94 $943.42
$1,407.80 $1,155.69
$1,724.56 $1,177.86 $
59 $862.48
$1,216.36 $1,056.54
$1,490.04 $972.45
$1,166.64 $1,191.25
$1,429.13 $963.79
$1,438.18 $1,180.64
$1,761.77 $1,203.29 $
60 $899.26
$1,268.23 $1,101.59
$1,553.58 $1,013.92
$1,216.39 $1,242.05
$1,490.08 $1,004.89
$1,499.51 $1,230.99
$1,836.90 $1,254.60 $
61 $931.07
$1,313.08 $1,140.56
$1,608.52 $1,049.79
$1,259.41 $1,285.99
$1,542.78 $1,040.43
$1,552.55 $1,274.53
$1,901.87 $1,298.98 $
62 $951.94
$1,342.52 $1,166.13
$1,644.59 $1,073.32
$1,287.65 $1,314.82
$1,577.37 $1,063.76
$1,587.36 $1,303.11
$1,944.52 $1,328.10 $
63 $978.12
$1,379.44 $1,198.20
$1,689.81 $1,102.84
$1,323.06 $1,350.98
$1,620.75 $1,093.01
$1,631.01 $1,338.94
$1,997.99 $1,364.62 $
64 $994.02
$1,401.87 $1,217.67
$1,717.29 $1,120.77
$1,344.57 $1,372.94
$1,647.10 $1,110.78
$1,657.53 $1,360.71
$2,030.47 $1,386.81 $
65+ $994.02
$1,401.87 $1,217.67
$1,717.29 $1,120.77
$1,344.57 $1,372.94
$1,647.10 $1,110.78
$1,657.53 $1,360.71
$2,030.47 $1,386.81 $
22
YOUR HEALTH INSURANCE GLOSSARY
Here are some commonly used health insurance plan terms to help you.
Coinsurance – The costs of your care are shared between you and Out-Of-Network Provider – Health care providers with whom
the insurance company. Coinsurance is the part of your medical bill Highmark Delaware does not have a contract are considered to
that you pay after reaching your deductible. So if your medical bill be “out of network.” Highmark Delaware EPO plans do not cover
for covered, in-network services is $100 and your coinsurance is services performed by Out of network providers (except in the
20%, you pay $20. The insurance company pays $80. case of emergency).
Copay or Copayment – A fixed dollar amount (like $25) that you Out-of-Pocket Costs – The copayments, coinsurance, and
pay each time you receive certain covered health care services. deductible amounts you have to pay.
Deductible – The amount of money you must pay for health care Out-of-Pocket Maximum – The most you have to pay out of
services before your health plan starts to pay. your own pocket each benefit period (usually a year). After that,
your health insurance company pays 100% of the cost for
• An embedded or aggregate deductible has two parts: an
covered services.
individual deductible and a family deductible. Each family
member can meet but not exceed his/her own deductible Premium – The amount of money you pay each month for your
before the family deductible is met. (Individual deductibles health insurance. You must pay this amount every month — even if
add up to meet the family deductible.) you don’t use services that month.
Emergency Medical Condition – An illness, injury, symptom, or Preventive Care Services – Routine health care, like screenings,
condition so serious that a reasonable person would seek care right well visits and checkups — to help prevent illnesses, disease, or
away to avoid severe harm. other health problems.
Emergency Room Care – Emergency services you receive in an Primary Care Provider (PCP) – The doctor or medical professional
emergency room. who provides most of your basic care, such as yearly preventive
visits and screenings. In most cases, your PCP will coordinate your
Emergency Services – Evaluation of an emergency medical
care with specialists, health care facilities, and other providers.
condition and treatment to keep the condition from getting worse.
Qualified Health Plan (QHP) – An insurance plan certified
EPO (Exclusive Provider Organization) – A health plan that
by the Marketplace. It must provide the 10 essential health
provides benefits when care is received from network providers.
benefits, follow established limits on cost-sharing (like
Out-of-network care is not covered (except in an emergency).
deductibles, copayments, and out-of-pocket maximum
Formulary – A list of prescription drugs covered by your health amounts), and meet other requirements.
plan. In a tiered drug formulary, drugs are assigned a level or tier.
Telemedicine/Virtual Medicine – Contacting and receiving
Each tier has a different copay or coinsurance. You usually pay less
health care guidance from a doctor in real time by using a
when your doctor prescribes drugs in the lower tiers.
smartphone, tablet, or computer.
High Deductible Health Plan (HDHP) – These plans have higher
Urgent Care Center – A walk-in center that you can use when your
deductibles than traditional health plans. Qualified HDHPs may
doctor is unavailable, or when you have an illness or injury serious
be combined with a health savings account (HSA) that you can
enough that you need care right away, but not serious enough for
fund with tax-deductible contributions up to annual limits
a trip to the emergency room. Urgent care visits are usually less
published by the IRS. You can use the HSA to pay for unreimbursed
costly than going to the emergency room, but more costly than
“qualified” medical expenses. Please note that not all HDHP plans
a PCP visit.
are Qualified HDHPs. Certain Cost-Sharing Reductions (CSR) or plan
variations of this plan that are offered through the Health Insurance
Marketplace are not intended to be used with an HSA.
In-Network/Network Providers – Highmark Delaware contracts
with doctors, hospitals, clinics, labs, and other providers to provide
health services to its members as a network participant. (In certain
circumstances, a plan may have a contract with an out-of-network
provider.) These providers form a network. Highmark Delaware
EPO plans cover services performed by in-network providers.
23
HIGHMARK BLUE CROSS BLUE SHIELD DELAWARE DISCLOSURES
Important Benefit Details

1 Embedded/Aggregate Family Deductible: For an agreement covering more than one (1) family member, as each member satisfies their individual deductible,
the plan will begin to pay benefits for covered services for that member for the remainder of the benefit period (January 1, 2018– December 31, 2018),
whether or not the entire family deductible has been satisfied. When the family deductible has been satisfied, the family deductible will be considered to
have been satisfied for all remaining covered family members. No individual member may satisfy the entire family deductible.
2 You are responsible for out-of-pocket costs each benefit period (January 1, 2018 – December 31, 2018) up to the maximum amount shown. Thereafter,
the plan pays 100% of the Provider’s Allowable Charge during the remainder of the benefit period. This amount does not include amounts in excess of the
provider’s allowable charge.
3 Diagnostic Lab services include Laboratory, Pathology and Allergy Testing. Diagnostic Lab services require one copay/coinsurance per date of service and
type of service.
4 Basic Diagnostic Services include diagnostic X-ray and diagnostic medical. Basic diagnostic services require one copay/coinsurance per date of service and
type of service.
5 Advanced Imaging services include, but are not limited to, CAT Scan, CTA, MRI, MRA, PET Scan and PET/CT Scan. Advanced Imaging services require one
copay/coinsurance per date of service and type of service.
6 Therapy and Rehab Services (Rehabilitative & Habilitative) - Therapy visit limits include in and out-of-network visits. Speech therapy is limited to 30 visits per
contract year each for Rehabilitative and Habilitative service (60 visits total per contract year). Physical therapy and occupational therapy are a combined 30
visit limit per contract year each for Rehabilitative and Habilitative service (60 visits total per contract year).
7 Chiropractor Services - Benefit Maximum: 30 visits per Benefit Period.
8 Skilled Nursing Facility Care - Benefit Maximum: 120 days per confinement; benefits renew after 180 days without care.
9 Pediatric Routine Vision Exam - Benefit Maximum: One pediatric exam every 12 months for members under the age of 19.
10 Pediatric Vision Services - Vision benefits utilize the Davis Vision-Health Care Reform Network. Pediatric Dental Benefits utilize Advantage Plus 2.0 Network.
11 All Highmark Delaware plans provide the HCR Progressive Formulary on the National Plus network.
All Highmark Delaware Health Savings base plans are Qualified High Deductible Health Plans and may be coupled with a Health Savings Account (HSA). However,
certain Cost-Sharing Reductions (CSR) or plan variations of this plan that are offered through the Health Insurance Marketplace are not intended to be used with
an HSA. If you have questions, please check with your financial advisor.
Highmark Blue Cross Blue Shield Delaware is a Qualified Health Plan issuer in the Health Insurance Marketplace.
Highmark Blue Cross Blue Shield Delaware is an independent licensee of the Blue Cross and Blue Shield Association.
Please note that information regarding the Patient Protection and Affordable Care Act of 2010 (a.k.a. “PPACA”, “Affordable Care Act”, “ACA”, and/or “Health Care
Reform”), as amended, and/or any other law, does not constitute legal or tax advice and is subject to change based upon the issuance of new guidance and/or
change in laws. This information is intended to provide general information only and does not attempt to give you advice that relates to your specific
circumstances. The information regarding any health plan will be subject to the terms of the applicable health plan benefit agreement. Any review of materials,
request for information, or application does not obligate you to enroll for coverage. Please request the Outline of Coverage for details on benefits, conditions
and exclusions. Providing your information is voluntary.
To find more information about Highmark’s benefits and operating procedures, such as accessing the drug formulary or using network providers, please go to
DiscoverHighmark.com/QualityAssurance; or for a paper copy, call (855) 329-0694 (TTY/TDD 711).
BlueCard® is a registered mark of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.
Davis Vision is a separate company that administers the Plan’s vision benefits. United Concordia is a separate company that administers the Plan’s pediatric
dental benefits.
Blues on Call is a registered service mark of the Blue Cross and Blue Shield Association.
24
Discrimination is Against the Law
The Claims Administrator/Insurer complies with applicable Federal civil rights
laws and does not discriminate on the basis of race, color, national origin, age,
disability, or sex, including sex stereotypes and gender identity. The Claims
Administrator/Insurer does not exclude people or treat them differently because
of race, color, national origin, age, disability, or sex assigned at birth, gender
identity or recorded gender. Furthermore, the Claims Administrator/Insurer
will not deny or limit coverage to any health service based on the fact that an
individual’s sex assigned at birth, gender identity, or recorded gender is different
from the one to which such health service is ordinarily available. The Claims
Administrator/Insurer will not deny or limit coverage for a specific health service
related to gender transition if such denial or limitation results in discriminating
against a transgender individual. The Claims Administrator/Insurer:
• Provides free aids and services to people with disabilities to communicate
effectively with us, such as:
– Qualified sign language interpreters
– Written information in other formats (large print, audio, accessible
electronic formats, other formats)
• Provides free language services to people whose primary language is not
English, such as:
– Qualified interpreters
– Information written in other languages
If you need these services, contact the Civil Rights Coordinator.
If you believe that the Claims Administrator/Insurer has failed to provide
these services or discriminated in another way on the basis of race, color,
national origin, age, disability, or sex, including sex stereotypes and gender
identity, you can file a grievance with: Civil Rights Coordinator, P.O. Box 22492,
Pittsburgh, PA 15222, Phone: 1-866-286-8295, TTY: 711, Fax: 412-544-2475,
email: CivilRightsCoordinator@highmarkhealth.org. You can file a grievance in
person or by mail, fax, or email. If you need help filing a grievance, the Civil Rights
Coordinator is available to help you. You can also file a civil rights complaint
with the U.S. Department of Health and Human Services, Office for Civil Rights
electronically through the Office for Civil Rights Complaint Portal, available at
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
U65_DE_G_M_2Col_8pt_blk_NL
25
26
27
BE CONFIDENT in your choice of health plan.
Complete the checklist below to make sure you’ve answered the most important questions, before
choosing a plan.
[ ] I have reviewed the hospitals that will be in-network and out-of-network for my plan.
[ ] I’ve checked to see if my doctor is in-network by calling 1-888-BLUE-428 or visiting

MyCareNavigator.com OR Find a Doctor or Rx at HighmarkBCBSDE.com.
[ ] I understand that if I go to an out-of-network doctor, pharmacy, hospital or other provider, I will have
to pay 100% of the cost, except in the case of emergency care.
[ ] I have checked how my prescriptions are covered at Find a Doctor or Rx at HighmarkBCBSDE.com.
There’s a lot to know and do when it comes to picking the right plan for you and your family.
We are here to help!
• Call us at 1-855-329-7819 (TTY/TDD 711)

• Visit DiscoverHighmark.com
• Talk to your local insurance agent
You can also visit the Health Insurance Marketplace (“the Marketplace”) at HealthCare.gov,
or call the Marketplace at 1-800-318-2596 (TTY: 1-855-889-4325).
DE -27615
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DE2018 ProductBrochure

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DE2018 ProductBrochure

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BE

2018 HEALTH INSURANCE

BE ON TIME for Open Enrollment P. 5

BE WELL-INFORMED About Your Health Plan Options P. 6

BE PREPARED Before You Choose P. 10

YOUR HEALTH INSURANCE GLOSSARY P. 23

SHORTER OPEN ENROLLMENT PERIOD: NOVEMBER 1 TO DECEMBER 15, 2017

Enroll by December 15, 2017, for coverage beginning January 1, 2018.

SPECIAL ENROLLMENT PERIOD

LOSING MINIMAL ESSENTIAL

MOVING TO A NEW, PERMANENT

This year’s plan options are designed with you

Major Events/Catastrophic Coverage

Shared Cost Blue EPO

Health Savings Embedded Blue EPO

Please note: Certain cost-sharing reductions (CSR) or plan variations of this

Highmark Blue Edge Dental

Even when you’re healthy, having an in-network • Achieve health goals

Nationwide Access to Care with BlueCard®

How to Find Out if Your Provider Is In-Network: 3 Easy Ways

Highmark Delaware Member Service

IMPORTANT: 2018 Changes to the Prescription Drug List

In 2018, Highmark Delaware plans will include the Progressive

Progressive Formulary - 4 Tiers of Drugs

Metal Levels and Essential Health Benefits

PLAN CATEGORY MONTHLY PREMIUM

Essential Health Benefits

You May Qualify for Financial Help.

2018 Household Persons In Family / Household

Cost-Sharing $12,060 - $16,240 - $20,420 - $24,600 - $28,780 - $32,960 - $37,140 - $41,320 -

2018 PLAN BENEFIT GRIDS

Understand How Your Monthly Premium Find Your Rate By:

If You Have More Than Three Children Under Age 21:

ID to find your PLAN ID

find your plan on PLAN ID

Important Benefit Details

[ ] I’ve checked to see if my doctor is in-network by calling 1-888-BLUE-428 or visiting

[ ] I have checked how my prescriptions are covered at Find a Doctor or Rx at HighmarkBCBSDE.com.

• Call us at 1-855-329-7819 (TTY/TDD 711)

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