Medical

Medical: Highmark

Cards for you and your dependent/s will be mailed to you in a white nondescriptive envelope within 7-10 business days.

Highmark Customer Service: 1-844-946-6259

Highmark website: www.highmarkbcbsde.com

Highmark mobile app: download the Highmark app to access your and your covered dependents’ medical cards and claims.

Transparency in Coverage website: https://mrfdata.hmhs.com/

COVID-19 Information

COVID-19 Vaccine Locations: /covid/

Prescription Benefit Express Scripts allows you to order COVID-19 Test Kits.

To learn more visit: https://www.express-scripts.com/covid-19/resource-center

Which Medical Plan is Right?

Evaluate Your Needs. Consider your prior health care usage and select plans and options that fit your lifestyle and needs.

A little bit of planning will help you select the best plans, coverage levels, and financial programs for your unique situation.

Highmark Open Enrollment Video

Medical Plan Comparison

Medical and Prescription Plan	**EPO Plan	**PPO II Plan
	In Network	In Network	Out-of-Network
Deductibles
Employee Only	$ 500^**	None	$300^**
Employee + One	$1,000^**	None	$600^**
Employee + Family	$1,500^**	None	$900^**

Co-insurance Limits
Employee Only	None	$500^*	$1,500^**
Employee + One	None	$1,000^*	$3,000^**
Family	None	$1,500^*	$4,500^**

Lifetime maximums	Unlimited

Preventive
Annual Exams	100%	100%	Not covered
Annual GYN Exam	100%	100%	Not covered
Mammogram	100%	100%	70%^*
Colonoscopy	100%	100%	70%^*
Pap Smear	100%	100%	70%^*
Well-child Care	100%	100%	Not covered
Immunizations	100%	100%	70%^*
Vision Exams	Not Covered	Not Covered	Not covered
Hearing Exams	100% (PCP office)	100% (PCP office)	Not Covered
Prostate Screening	100%	100%	70%^*

Illness or Injury
Primary Doctor	$30 co-pay	$10 co-pay	70%^*
Specialist	$30 co-pay	$20 co-pay	70%^*
Laboratory Services	100%^*	100%	70%^*
Imaging	100%^*	90%	70%^*
Chiropractic	100%^*	90%	70%^*

In The Hospital
Room and Board	100%^*	90%	70%^*
Physician & Surgeon	100%^*	90%	70%^*
Other Services	100%^*	90%	70%^*

Surgery -- Outpatient	100%^*	90%	70%^*

Maternity	100%^*	90%	70%^*

Emergency
Physician's Office	$30 co-pay	$10 co-pay	70%^*
Medical Aid Units	$30 co-pay	$20 co-pay	70%^*
Hospital ER	$150 co-pay (waived if admitted)	$150 co-pay (waived if admitted)	$150 co-pay (waived if admitted)

Mental Health & Substance Abuse
Inpatient	100%^*	90%	70%^*
Office Visits	$30 co-pay	$10 co-pay	70%^*

Prescription Drugs (Mandatory Generic)
Retail	$10/$20/$35 for a 30 day supply
Mail Order	$20/$40/$70 for a 90 day supply

^* Percentage paid after deductible.
^**Co-Insurance / Deductibles – Out-of-Network (PPO II) ; Network Deductible (EPO)

Note: Please consult plan documents for full benefits, exclusions, and limitations.

There is an opportunity to receive a 2% discount on your medical premium each year. To learn more about our Wellness Discount Program CLICK HERE

City of Wilmington EPO Actives July 2024

City of Wilmington PPO 2 Union Actives 10162727 July.1.2024

City of Wilmington PPO 1 Actives 10162725 July.1.2024

2025 Preventive Schedule, Non-Grandfathered

Transparency in Coverage

Dietician Provider Directory

Clarity 360

Clarity 360: Highmark

Personalized support to help you:

- Make important care decisions and ensure
  you receive the highest quality of care.
- Manage a health condition.
- Improve lifestyle habits.
- Reduce risk for chronic diseases like diabetes
  or heart disease.
- Get preventive care.
- Get answers to your health and coverage
  questions and more.

COVID-19 Information