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my Blue Access WV EPO Silver 2400 - 2 Free PCP Visits
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my Blue Access WV EPO Silver 2400 - 2 Free PCP Visits

Overview
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my Blue Access WV EPO Silver 2400 - 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 Summers 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
31274WV0500003
Coverage area
Summers 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
$2,400
Out-of-pocket maximum
$7,800
Generic drug co-pay
$5
Preferred brand drug co-pay
$30
Primary care physician visit cost
$40
Specialist doctor visit cost
$90
Doctor Visits
Primary Care Visit $40
Specialist Visit $90
Emergency Room Visit $750 Copay after deductible
Inpatient Facility Visit 30% Coinsurance after deductible
Inpatient Physician Visit 30% 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) $2,400
Medical Maximum Out Of Pocket (Individual) $7,800
Medical Deductible (Family) $4,800
Medical Maximum Out Of Pocket (Family) $15,600
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 0-14 445
Premium Child Age 18 531
Premium Adult Individual Age 21 582
Premium Adult Individual Age 27 610
Premium Adult Individual Age 30 660
Premium Adult Individual Age 40 744
Premium Adult Individual Age 50 1,039
Premium Adult Individual Age 60 1,580
Premium Couple 21 1,164
Premium Couple 30 1,321
Premium Couple 40 1,488
Premium Couple 50 2,079
Premium Couple 60 3,160
Couple+1 child, Age 21 1,609
Couple+1 child, Age 30 1,766
Couple+1 child, Age 40 1,933
Couple+1 child, Age 50 2,524
Couple+2 children, Age 21 2,055
Couple+2 children, Age 30 2,212
Couple+2 children, Age 40 2,378
Couple+2 children, Age 50 2,970
Couple+3 or more Children, Age 21 2,500
Couple+3 or more Children, Age 30 2,657
Couple+3 or more Children, Age 40 2,824
Couple+3 or more Children, Age 50 3,415
Individual+1 child, Age 21 1,027
Individual+1 child, Age 30 1,106
Individual+1 child, Age 40 1,189
Individual+1 child, Age 50 1,485
Individual+2 children, Age 21 1,472
Individual+2 children, Age 30 1,551
Individual+2 children, Age 40 1,634
Individual+2 children, Age 50 1,930
Individual+3 or more children, Age 21 1,918
Individual+3 or more children, Age 30 1,996
Individual+3 or more children, Age 40 2,080
Individual+3 or more children, Age 50 2,375
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