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my Blue Access WV EPO Gold 1000 - 2 Free PCP Visits
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my Blue Access WV EPO Gold 1000 - 2 Free PCP Visits

Overview
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my Blue Access WV EPO Gold 1000 - 2 Free PCP Visits 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 Pendleton 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
31274WV0500006
Coverage area
Pendleton 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
$1,000
Out-of-pocket maximum
$7,000
Generic drug co-pay
$5
Preferred brand drug co-pay
$30
Primary care physician visit cost
$20
Specialist doctor visit cost
$45
Doctor Visits
Primary Care Visit $20
Specialist Visit $45
Emergency Room Visit $500 Copay after deductible
Inpatient Facility Visit 20% Coinsurance after deductible
Inpatient Physician Visit 20% Coinsurance after deductible
Prescription Drugs
Generic Drugs $5
Preferred Brand Drugs $30
Non-preferred Brand Drugs 35%
Specialty Drugs 50%
Medical Deductible
Medical Deductible (Individual) $1,000
Medical Maximum Out Of Pocket (Individual) $7,000
Medical Deductible (Family) $2,000
Medical Maximum Out Of Pocket (Family) $14,000
Drug Deductible
Drug Deductible (Individual) $0
Drug Maximum Out Of Pocket (Individual) Included in Medical
Drug Deductible (Family) $0
Drug Maximum Out Of Pocket (Family) Included in Medical
Premium Rates
EHB Percent of Total Premium 100.00%
Premium Child Age 0-14 432
Premium Child Age 18 515
Premium Adult Individual Age 21 564
Premium Adult Individual Age 27 592
Premium Adult Individual Age 30 641
Premium Adult Individual Age 40 721
Premium Adult Individual Age 50 1,008
Premium Adult Individual Age 60 1,533
Premium Couple 21 1,129
Premium Couple 30 1,282
Premium Couple 40 1,443
Premium Couple 50 2,017
Premium Couple 60 3,066
Couple+1 child, Age 21 1,562
Couple+1 child, Age 30 1,714
Couple+1 child, Age 40 1,876
Couple+1 child, Age 50 2,450
Couple+2 children, Age 21 1,994
Couple+2 children, Age 30 2,146
Couple+2 children, Age 40 2,308
Couple+2 children, Age 50 2,882
Couple+3 or more Children, Age 21 2,426
Couple+3 or more Children, Age 30 2,578
Couple+3 or more Children, Age 40 2,740
Couple+3 or more Children, Age 50 3,314
Individual+1 child, Age 21 997
Individual+1 child, Age 30 1,073
Individual+1 child, Age 40 1,154
Individual+1 child, Age 50 1,441
Individual+2 children, Age 21 1,429
Individual+2 children, Age 30 1,505
Individual+2 children, Age 40 1,586
Individual+2 children, Age 50 1,873
Individual+3 or more children, Age 21 1,861
Individual+3 or more children, Age 30 1,937
Individual+3 or more children, Age 40 2,018
Individual+3 or more children, Age 50 2,305
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