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my Blue Access WV EPO Bronze 4000
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my Blue Access WV EPO Bronze 4000

Overview
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my Blue Access WV EPO Bronze 4000 is an individual health health plan issued by Highmark Blue Cross Blue Shield West Virginia and is available for the year 2019. This health plan is offered by the federal government through HealthCare.gov and the Affordable Care Act (ACA).

Where Do I Need to Live to Quality for this Plan?

This plan is available for qualifying individuals who live in Mason county, West Virginia.

What Type of Health Plan Is This?

This plan is an EPO plan, which is also known as an "Exclusive Provider Organization." An EPO is a managed care plan where services are covered so long as the the hospitals, dentists, and other health providers in the plan's network are used.

Where Can I Buy This Plan?

You can purchase this plan at HealthCare.gov.

About
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Issuer
Highmark Blue Cross Blue Shield West Virginia
Plan ID
31274WV0500002
Coverage area
Mason County, West Virginia
Phone
Local Phone: 1-888-601-2109
Toll-Free: 1-888-601-2109
TTY: 1-888-601-2109
Plan type
EPO
Coverage type
Medical deductible
$4,000
Out-of-pocket maximum
$7,900
Generic drug co-pay
30% Coinsurance after deductible
Preferred brand drug co-pay
30% Coinsurance after deductible
Primary care physician visit cost
$60
Specialist doctor visit cost
30% Coinsurance after deductible
Doctor Visits
Primary Care Visit $60
Specialist Visit 30% Coinsurance after deductible
Emergency Room Visit 30% Coinsurance after deductible
Inpatient Facility Visit 30% Coinsurance after deductible
Inpatient Physician Visit 30% Coinsurance after deductible
Prescription Drugs
Generic Drugs 30% Coinsurance after deductible
Preferred Brand Drugs 30% Coinsurance after deductible
Non-preferred Brand Drugs 30% Coinsurance after deductible
Specialty Drugs 30% Coinsurance after deductible
Medical Deductible
Medical Deductible (Individual) $4,000
Medical Maximum Out Of Pocket (Individual) $7,900
Medical Deductible (Family) $8,000
Medical Maximum Out Of Pocket (Family) $15,800
Drug Deductible
Drug Deductible (Individual) Included in Medical
Drug Maximum Out Of Pocket (Individual) Included in Medical
Drug Deductible (Family) Included in Medical
Drug Maximum Out Of Pocket (Family) Included in Medical
Premium Rates
EHB Percent of Total Premium 100.00%
Premium Child Age 0-14 343
Premium Child Age 18 410
Premium Adult Individual Age 21 449
Premium Adult Individual Age 27 470
Premium Adult Individual Age 30 509
Premium Adult Individual Age 40 574
Premium Adult Individual Age 50 802
Premium Adult Individual Age 60 1,219
Premium Couple 21 898
Premium Couple 30 1,019
Premium Couple 40 1,148
Premium Couple 50 1605
Premium Couple 60 2,438
Couple+1 child, Age 21 1,242
Couple+1 child, Age 30 1,363
Couple+1 child, Age 40 1,492
Couple+1 child, Age 50 1,948
Couple+2 children, Age 21 1,586
Couple+2 children, Age 30 1,707
Couple+2 children, Age 40 1,835
Couple+2 children, Age 50 2,292
Couple+3 or more Children, Age 21 1,929
Couple+3 or more Children, Age 30 2,051
Couple+3 or more Children, Age 40 2,179
Couple+3 or more Children, Age 50 2,636
Individual+1 child, Age 21 793
Individual+1 child, Age 30 853
Individual+1 child, Age 40 917
Individual+1 child, Age 50 1,146
Individual+2 children, Age 21 1,136
Individual+2 children, Age 30 1,197
Individual+2 children, Age 40 1,261
Individual+2 children, Age 50 1,489
Individual+3 or more children, Age 21 1,480
Individual+3 or more children, Age 30 1,541
Individual+3 or more children, Age 40 1,605
Individual+3 or more children, Age 50 1,833
Reference
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  • HealthCare.gov. U.S. Centers for Medicare and Medicaid. Accessed June 11, 2019. https://www.healthcare.gov
  • The 'metal' categories: Bronze, Silver, Gold & Platinum. U.S. Centers for Medicare and Medicaid. Accessed June 11, 2019. https://www.healthcare.gov/choose-a-plan/plans-categories
  • Health insurance plan & network types: HMOs, PPOs, and more. U.S. Centers for Medicare and Medicaid. Accessed June 11, 2019. https://www.healthcare.gov/choose-a-plan/plan-types