Medical

Medical Insurance: Highmark Blue Cross Blue Shield of Delaware

The City of Wilmington offers medical insurance through Highmark Blue Cross Blue Shield of Delaware. The below chart is a brief outline of the plan options.

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/

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

Check out your Blue 365 Deals: Home Page | Blue365 Deals

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

	Highmark Blue Cross Blue Shield PPO Plan 1			Highmark Blue Cross Blue Shield PPO Plan 2		Highmark Blue Cross Blue Shield EPO Plan
	PPO In-Network	PPO Out-of-Network	PPO In-Network	PPO Out-of-Network	Schedule of Benefits
Annual Deductible
Individual	$0	$300	$0	$300	$500
Family	$0	$900	$0	$900	$1,500
Coinsurance	100%	80%	90%	70%	100%
Total Maximum Out-of-Pocket
Individual	$3,300	N/A	$3,300	N/A	$3,300
Family	$6,600	N/A	$6,600	N/A	$6,600
Physician Office Visit
Primary Care	100% after $5 copay	80% after deductible	100% after $10 copay	70% after deductible	100% after $30 copay
Specialty Care	100% after $10 copay	80% after deductible	100% after $20 copay	70% after deductible	100% after $30 copay
Preventive Care
Adult/Well-Child Preventive	100%	80% after deductible	100%	70% after deductible	100%
Diagnostic Services
X-ray and Lab Tests	100% after deductible	80% after deductible	90% after deductible	70% after deductible	100% after deductible
Complex Radiology	100% after deductible	80% after deductible	90% after deductible	70% after deductible	100% after deductible
Urgent Care Facility	100% after $10 copay	80% after deductible	100% after $20 copay	70% after deductible	100% after $30 copay
Emergency Room Facility Charges	100% after $150 copay waived if admitted	100% after $150 copay waived if admitted	100% after $50 copay; waived if admitted	100% after $50 copay; waived if admitted	100% after $150 copay; waived if admitted
Inpatient/Outpatient Facility & Surgical Charges	100% after deductible	80% after deductible	90% after deductible	70% after deductible	100% after deductible
Mental Health/Substance Health
Inpatient	100% after deductible	80% after deductible	90% after deductible	70% after deductible	100% after deductible
Outpatient	100% after deductible	80% after deductible	100% after $10 copay	70% after deductible	100% after $30 copay
Retail Pharmacy (30 Day Supply)
Generic	$10 copay	Not covered	$10 copay	Not covered	$10 copay
Preferred	$20 copay	Not covered	$20 copay	Not covered	$20 copay
Non-Preferred	$35 copay	Not covered	$35 copay	Not covered	$35 copay
Mail Order Pharmacy (90 Day Supply)
Generic	$20 copay	Not covered	$20 copay	Not covered	$20 copay
Preferred	$40 copay	Not covered	$40 copay	Not covered	$40 copay
Non-Preferred	$70 copay	Not covered	$70 copay	Not covered	$70 copay

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

City of Wilmington EPO Actives July 2025

City of Wilmington PPO 2 Union Actives July 2025

City of Wilmington PPO 1 Actives July 2025

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.