UPDATED: Nov 30, 2018
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Highmark was formed out of the merger of two older Pennsylvania insurance companies in 1996. Those two companies were Blue Cross of Western Pennsylvania and Pennsylvania Blue Shield, both of which trace their history back to the 1930s. With the formation of Highmark, Inc., the merged company became the largest health insurance provider in the state.
Further expansion through acquisition of other insurance companies brought Highmark into West Virginia and eventually into Delaware as well. The company still operates under the Blue Cross and Blue Shield names as a licensed insurer. They continue to stand as the largest health insurance company in Pennsylvania, approaching 5 million members.
Highmark offers a wide array of individual and family health insurance plans at every level, both EPO and PPO. They also offer supplemental coverage, including Medicare, which we have covered separately in our Medicare review. This review focuses specifically on the Highmark health insurance plans.
Highmark’s headquarters is located in Pittsburgh, PA. They offer their plans through their website, over the phone, and via the health insurance marketplace.
Highmark Health Insurance Plans
Highmark’s plans vary based on the city and county in which you reside. We chose to use the company’s headquarters as the zip code for plans; offerings will differ depending on where you live.
Plans are offered in both PPO and EPO formats, with bronze, silver, and gold levels of coverage, and additional sub-categories of coverage.
Gold Plans – EPO
MyConnect Blue EPO 250G offers three levels of coverage: standard, enhanced, and preferred. Each Tier has a lower deductible and lower co pay amounts. At the standard level, the deductible is $2,250 individual and $4,500 family, and all doctor visits are covered with a 50% coinsurance charge after the deductible is met.
The Enhanced level has a lower deductible of $750 individual and $1,500 family, and co pays of $40 for an office visit and $85 for a specialist.
The lowest deductible is available with the Preferred plan, at $250 individual and $500 family. Co pays on this plan are $10 for primary care and $60 for a specialist. Prescription drugs start at 15% coinsurance for Tier 1 and go up at each Tier thereafter.
MyConnect Blue EPO 1000 has higher deductibles and lower co pays in some areas. There are again three levels of coverage. Standard has a $2,500 individual and $5,000 family deductible with 50% coinsurance after deductible like the 250G plan level.
Enhanced has a $1,500 individual deductible and $3,000 family, and co pays are $40 for primary care and $55 for specialists.
Finally, the Preferred plan has deductibles of $1,000 individual and $2,000 family, with co pays at $10 for primary care and $30 for specialists. Prescription drugs coverage is the same as the other Gold plan.
Silver Plans – EPO
Like the Gold plans, there are two separate plans with three levels of coverage. Deductibles are higher across the board.
The MyConnect Blue EPO 1750S starts at the Standard level with deductibles of $6,000 individual and $12,000 family. Most covered services have a 60% coinsurance after the deductible is met.
The Enhanced level has deductibles of $4,500 individual and $9,000 family, and co pays are $90 for primary care and $140 for specialist visits.
The third level, Preferred, has an individual deductible of $1,750 and a family deductible of $3,500. Co pays with this plan are still quite high at $60 for primary care and $100 for a specialist. Prescription drugs at all levels have a 10% coinsurance after the deductible is met.
The MyConnect Blue EPO 2500S plans again have three levels, and the Standard has the same co pays as the 1750S, but with a slightly lower coinsurance of 50% after the deductible is met.
The Enhanced plan brings deductibles down to $4,000 individual and $8,000 family, with co pays of $75 for primary care and $120 for specialist.
The Preferred plan has the lowest deductibles at $2,500 individual and $5,000 family. Co pays are $55 for primary care and $70 for specialists.
Bronze Plans – EPO
There is only one Bronze level plan among the EPO plans, but again it has three options for levels of coverage and deductibles. There is not as much difference between the levels in terms of deductible amounts, and all are relatively high. Co pays are not far off from the Silver options.
The MyConnect Blue EPO 6500B at the Standard level offers 60% coinsurance after the deductible is met. Deductibles are $7,000 individual and $14,000 family.
The enhanced level has deductibles that are only slightly lower, at $6,800 individual and $13,600 family. Co pays are $130 for primary care and $180 for specialist visits.
Finally, the Preferred level has slightly lower deductibles once more, $6,500 individual and $13,000 family. Co pays are $90 for individuals and $120 for families. Prescription drug coverage starts at 15% coinsurance for Tier 1.
Like the EPO plans, PPO plans come in Gold, Silver, and Bronze, and have subcategories for each level as well. These plans, however, have only two sub-levels: Standard and Enhanced.
Gold Plans – PPO
The only Gold level plan is the My Community Blue Flex PPO 1700GQ. Deductibles are the same at both levels, with a $1,700 individual deductible and $3,400 family deductible.
The Standard level has 30% coinsurance for all doctor visits, while the Enhanced level has 10% coinsurance for all doctor visits. These include urgent care and emergency room visits. Prescription drug coverage is 10% coinsurance after the deductible.
Silver Plans – PPO
There are two Silver level plans, each with two levels of coverage.
The My Community Blue Flex PPO 2100S Standard level has deductibles of $4,500 individual and $9,000 family. Coinsurance is 40% after the deductible is met.
The Enhanced plan has lower deductibles, at $2,100 individual and $4,200 family. Co pays are $60 for an office visit and $80 for a specialist visit. Prescription drug coverage starts at 15% coinsurance.
The My Community Blue Flex PPO 2800S plan has the same deductible for both levels, $2,800 individual and $5,600 family. Coinsurance is at 40% after deductible for the Standard plan and 20% after deductible for the Enhanced plan. Prescription drugs are covered with 20% coinsurance across the board after the deductible is met.
Bronze Plans – PPO
Again, there is only one plan at the Bronze level. Both the Standard and Enhanced levels of the Blue Flex PPO 6800B plan have the same deductible at $6,800 individual and $13,600 family. The Standard level has co pays of $130 for primary care and $160 for specialist visits. The Enhanced has co pays of $95 for primary care and $130 for specialist care. Prescription drug coverage starts at 15% coinsurance for Tier 1.
At the time of this review, quotes were not available online for any of the Highmark plans, nor do they offer coverage in our usual comparison area. Rates for health insurance can vary and plans offer very different levels of coverage, so comparison can be difficult across companies.
In general, Highmark’s plans have high deductibles and high co pays/coinsurance amounts compared to what we have seen from other companies. In most cases, premiums are lower when deductibles and co pays are higher, but without a rate quote we are unable to say that for sure.
As a health insurance company, Highmark’s claims are handled directly between the insurer and the provider in most cases. Not surprisingly, no claims section is available on the website.
Ratings and Consumer Reviews
Highmark currently has an A+ rating with the Better Business Bureau (BBB), and the complaint volume is down a little from when we reviewed this company’s Medicare plans. Previously at 88 complaints in the past three years, the company now shows a total of 79 complaints, with 14 closed in the past 12 months. This indicates that as time passes, complaints are falling off and there does not appear to have been many new complaints to replace them. Overall, the complaint volume is low for a company with as many members as Highmark has.
Highmark has several companies under the main parent company, with a variety of ratings from the National Committee for Quality Assurance. These ratings range from 3.5 to 4.0 overall. The main company situated in Pittsburgh, Highmark, Inc., carries a 3.5 rating overall. This is the result of a 4.0 rating in Consumer Satisfaction, but only 3.0 ratings for Treatment and Prevention.
There are 16 reviews on Consumer Affairs, and several of them are positive. Not only is the complaint volume here low considering Highmark’s 4.7 million members, but also positive reviews are always a good thing.
Pissed Consumer also has a low volume of complaints for this company, with only 9 reviews, although they all appear to be negative. Most of the negative reviews appear to be related to billing or renewal issues.
The general impression of Highmark is a positive one, given that they are a very big company and have a relatively low number of complaints filed.
The Bottom Line
Highmark’s insurance plans are worth a look, particularly for those who don’t mind higher out of pocket costs on their plan, in return for what we would hope is a lower premium – although we are unable to confirm premium costs. They are not likely to appeal to those who would rather pay more monthly and have very low deductibles and co pays. They have a solid reputation, and as plans can vary in different locations, are well worth further investigation when shopping for health insurance.
For a list of companies that we recommend, visit our Best Insurance Companies page.