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my Blue Access WV EPO Silver 4450 HSA
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my Blue Access WV EPO Silver 4450 HSA

Overview
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my Blue Access WV EPO Silver 4450 HSA 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 Tucker 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
31274WV0510001
Coverage area
Tucker 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
$4,450
Out-of-pocket maximum
$6,650
Generic drug co-pay
10% Coinsurance after deductible
Preferred brand drug co-pay
10% Coinsurance after deductible
Primary care physician visit cost
10% Coinsurance after deductible
Specialist doctor visit cost
10% Coinsurance after deductible
Doctor Visits
Primary Care Visit 10% Coinsurance after deductible
Specialist Visit 10% Coinsurance after deductible
Emergency Room Visit 10% Coinsurance after deductible
Inpatient Facility Visit 10% Coinsurance after deductible
Inpatient Physician Visit 10% Coinsurance after deductible
Prescription Drugs
Generic Drugs 10% Coinsurance after deductible
Preferred Brand Drugs 10% Coinsurance after deductible
Non-preferred Brand Drugs 10% Coinsurance after deductible
Specialty Drugs 10% Coinsurance after deductible
Medical Deductible
Medical Deductible (Individual) $4,450
Medical Maximum Out Of Pocket (Individual) $6,650
Medical Deductible (Family) $8,900
Medical Maximum Out Of Pocket (Family) $13,300
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 0-14 388
Premium Child Age 18 463
Premium Adult Individual Age 21 507
Premium Adult Individual Age 27 531
Premium Adult Individual Age 30 576
Premium Adult Individual Age 40 648
Premium Adult Individual Age 50 906
Premium Adult Individual Age 60 1,377
Premium Couple 21 1,015
Premium Couple 30 1,152
Premium Couple 40 1,297
Premium Couple 50 1,813
Premium Couple 60 2,755
Couple+1 child, Age 21 1,403
Couple+1 child, Age 30 1,540
Couple+1 child, Age 40 1,685
Couple+1 child, Age 50 2,201
Couple+2 children, Age 21 1,791
Couple+2 children, Age 30 1,928
Couple+2 children, Age 40 2,074
Couple+2 children, Age 50 2,589
Couple+3 or more Children, Age 21 2,180
Couple+3 or more Children, Age 30 2,317
Couple+3 or more Children, Age 40 2,462
Couple+3 or more Children, Age 50 2,978
Individual+1 child, Age 21 895
Individual+1 child, Age 30 964
Individual+1 child, Age 40 1,037
Individual+1 child, Age 50 1,294
Individual+2 children, Age 21 1,284
Individual+2 children, Age 30 1,352
Individual+2 children, Age 40 1,425
Individual+2 children, Age 50 1,683
Individual+3 or more children, Age 21 1,672
Individual+3 or more children, Age 30 1,741
Individual+3 or more children, Age 40 1,813
Individual+3 or more children, Age 50 2,071
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