my Blue Access WV PPO Choice Silver 0

Highmark Blue Cross Blue Shield West Virginia · 2027 plan year

Silver
Ind. deductible
No deductible
Family deductible
$0
Ind. OOP max
$10,700
Family OOP max
$21,400

Compare with other Silver plans in WV

Side by side: deductibles, out-of-pocket limits and copays.

Monthly premiums by age

Rating Area 6 — the lowest-priced of the 11 areas this plan covers. Premiums differ by area.

AgeIndividualIndividual + tobacco
Under 15$666$666
21$870$892
30$988$1,012
40$1,112$1,223
50$1,554$1,904
60$2,361$2,893
64 and over$2,610$3,198

Live premium estimate

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Benefits & cost sharing

Primary Care

BenefitIn-network
Preventive Care/Screening/ImmunizationNo charge
Primary Care Visit to Treat an Injury or Illness$50.00

Specialist

BenefitIn-network
Specialist Visit$50.00

Hospital

BenefitIn-network
Emergency Room Services$1,250.00
Inpatient Hospital Services (e.g., Hospital Stay)$2500.00 Copay per Stay
Outpatient Surgery Physician/Surgical Services$1,000.00
Urgent Care Centers or Facilities$100.00

Pharmacy

BenefitIn-network
Generic Drugs$5.00
Non-Preferred Brand Drugs$250.00
Preferred Brand Drugs$30.00
Specialty Drugs50.00%

Mental Health

BenefitIn-network
Mental Health Other30.00%
Mental/Behavioral Health Inpatient Services$2500.00 Copay per Stay
Mental/Behavioral Health Outpatient Services$50.00

Other

BenefitIn-network
Abortion for Which Public Funding is ProhibitedNot covered
Accidental Dental30.00%
AcupunctureNot covered
Allergy Testing$65.00
Bariatric Surgery30.00%
Basic Dental Care - AdultNot covered
Basic Dental Care - ChildNot covered
Chemotherapy30.00%
Chiropractic Care$50.00
Clinical Trials30.00%
Cosmetic Surgery30.00%
Delivery and All Inpatient Services for Maternity Care$2,500.00
Dental Anesthesia30.00%
Dental Check-Up for ChildrenNot covered
Diabetes Care Management30.00%
Diabetes EducationNo charge
Dialysis30.00%
Durable Medical Equipment30.00%
Emergency Transportation/Ambulance30.00%
Eye Glasses for ChildrenNo charge
Habilitation Services$50.00
Hearing AidsNot covered
Home Health Care Services30.00%
Hospice Services30.00%
Imaging (CT/PET Scans, MRIs)$800.00
Infertility Treatment30.00%
Infusion Therapy30.00%
Inpatient Physician and Surgical ServicesNo charge
Laboratory Outpatient and Professional Services$65.00
Long-Term/Custodial Nursing Home CareNot covered
Major Dental Care - AdultNot covered
Major Dental Care - ChildNot covered
Nutritional CounselingNo charge
Orthodontia - AdultNot covered
Orthodontia - ChildNot covered
Other Practitioner Office Visit (Nurse, Physician Assistant)$50.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)$1,000.00
Outpatient Rehabilitation Services$50.00
Prenatal and Postnatal CareNo charge
Private-Duty Nursing30.00%
Prosthetic Devices30.00%
Radiation30.00%
Reconstructive Surgery30.00%
Rehabilitative Occupational and Rehabilitative Physical Therapy$50.00
Rehabilitative Speech Therapy$50.00
Routine Dental Services (Adult)Not covered
Routine Eye Exam (Adult)Not covered
Routine Eye Exam for ChildrenNo charge
Routine Foot CareNot covered
Skilled Nursing Facility$2500.00 Copay per Stay
Substance Abuse Disorder Inpatient Services$2500.00 Copay per Stay
Substance Abuse Disorder Outpatient Services$50.00
Transplant30.00%
Treatment for Temporomandibular Joint Disorders30.00%
Weight Loss ProgramsNot covered
Well Baby Visits and CareNo charge
X-rays and Diagnostic Imaging$175.00

Plan rules

Service area

This plan covers 1 geographic area.

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