my Blue Access WV Major Events PPO Catastrophic 10600 - 3 Free PCP Visits

Highmark Blue Cross Blue Shield West Virginia

CatastrophicHSA eligible

Ind. deductible: $10,600
Family deductible: $10,600
Ind. OOP max: $10,600
Family OOP max: $10,600

Other cost-sharing reduction variants for this plan:

Monthly premiums by age

Age	Individual	Individual + tobacco
21	$467	—
30	$530	—
40	$597	—
50	$834	—
60	$1,267	—

Live premium estimate

Benefits & cost sharing

Primary Care

Benefit	In-network
Preventive Care/Screening/Immunization	No charge
Primary Care Visit to Treat an Injury or Illness	No Charge after deductible

Specialist

Benefit	In-network
Specialist Visit	No Charge after deductible

Hospital

Benefit	In-network
Emergency Room Services	No Charge after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	No Charge after deductible
Outpatient Surgery Physician/Surgical Services	No Charge after deductible
Urgent Care Centers or Facilities	No Charge after deductible

Pharmacy

Benefit	In-network
Generic Drugs	No Charge after deductible
Non-Preferred Brand Drugs	No Charge after deductible
Preferred Brand Drugs	No Charge after deductible
Specialty Drugs	No Charge after deductible

Mental Health

Benefit	In-network
Mental Health Other	No Charge after deductible
Mental/Behavioral Health Inpatient Services	No Charge after deductible
Mental/Behavioral Health Outpatient Services	No Charge after deductible

Other

Benefit	In-network
Basic Dental Care - Adult	Not covered
Abortion for Which Public Funding is Prohibited	Not covered
Accidental Dental	No Charge after deductible
Acupuncture	Not covered
Allergy Testing	No Charge after deductible
Bariatric Surgery	No Charge after deductible
Basic Dental Care - Child	No Charge after deductible
Chemotherapy	No Charge after deductible
Chiropractic Care	No Charge after deductible
Clinical Trials	No Charge after deductible
Cosmetic Surgery	No Charge after deductible
Delivery and All Inpatient Services for Maternity Care	No Charge after deductible
Dental Anesthesia	No Charge after deductible
Dental Check-Up for Children	No Charge after deductible
Diabetes Care Management	No Charge after deductible
Diabetes Education	No charge
Dialysis	No Charge after deductible
Durable Medical Equipment	No Charge after deductible
Emergency Transportation/Ambulance	No Charge after deductible
Eye Glasses for Children	No Charge after deductible
Habilitation Services	No Charge after deductible
Hearing Aids	Not covered
Home Health Care Services	No Charge after deductible
Hospice Services	No Charge after deductible
Imaging (CT/PET Scans, MRIs)	No Charge after deductible
Infertility Treatment	No Charge after deductible
Infusion Therapy	No Charge after deductible
Inpatient Physician and Surgical Services	No Charge after deductible
Laboratory Outpatient and Professional Services	No Charge after deductible
Long-Term/Custodial Nursing Home Care	Not covered
Major Dental Care - Adult	Not covered
Major Dental Care - Child	No Charge after deductible
Nutritional Counseling	No charge
Orthodontia - Adult	Not covered
Orthodontia - Child	No Charge after deductible
Other Practitioner Office Visit (Nurse, Physician Assistant)	No Charge after deductible
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)	No Charge after deductible
Outpatient Rehabilitation Services	No Charge after deductible
Prenatal and Postnatal Care	No Charge after deductible
Private-Duty Nursing	No Charge after deductible
Prosthetic Devices	No Charge after deductible
Radiation	No Charge after deductible
Reconstructive Surgery	No Charge after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy	No Charge after deductible
Rehabilitative Speech Therapy	No Charge after deductible
Routine Dental Services (Adult)	Not covered
Routine Eye Exam (Adult)	Not covered
Routine Eye Exam for Children	No Charge after deductible
Routine Foot Care	Not covered
Skilled Nursing Facility	No Charge after deductible
Substance Abuse Disorder Inpatient Services	No Charge after deductible
Substance Abuse Disorder Outpatient Services	No Charge after deductible
Transplant	No Charge after deductible
Treatment for Temporomandibular Joint Disorders	No Charge after deductible
Weight Loss Programs	Not covered
Well Baby Visits and Care	No charge
X-rays and Diagnostic Imaging	No Charge after deductible

Plan rules

Service area

This plan covers 1 geographic area.