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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 Roane 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
Roane 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 0-14 369
Premium Child Age 18 441
Premium Adult Individual Age 21 483
Premium Adult Individual Age 27 506
Premium Adult Individual Age 30 548
Premium Adult Individual Age 40 617
Premium Adult Individual Age 50 862
Premium Adult Individual Age 60 1,311
Premium Couple 21 966
Premium Couple 30 1,096
Premium Couple 40 1,234
Premium Couple 50 1,725
Premium Couple 60 2,622
Couple+1 child, Age 21 1,335
Couple+1 child, Age 30 1,466
Couple+1 child, Age 40 1,604
Couple+1 child, Age 50 2,095
Couple+2 children, Age 21 1,705
Couple+2 children, Age 30 1,835
Couple+2 children, Age 40 1,974
Couple+2 children, Age 50 2,465
Couple+3 or more Children, Age 21 2,075
Couple+3 or more Children, Age 30 2,205
Couple+3 or more Children, Age 40 2,343
Couple+3 or more Children, Age 50 2,834
Individual+1 child, Age 21 852
Individual+1 child, Age 30 917
Individual+1 child, Age 40 987
Individual+1 child, Age 50 1,232
Individual+2 children, Age 21 1,222
Individual+2 children, Age 30 1,287
Individual+2 children, Age 40 1,356
Individual+2 children, Age 50 1,602
Individual+3 or more children, Age 21 1,591
Individual+3 or more children, Age 30 1,657
Individual+3 or more children, Age 40 1,726
Individual+3 or more children, Age 50 1,971
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