Highmark Blue Cross Blue Shield
New York • EPO, HMO, High-Deductible Health Plan (HDHP)
This is an Exclusive Provider Organization (EPO) prefix. EPO plans do not cover out-of-network care except in genuine emergencies. Members can see any in-network specialist without a referral from their primary care physician. Claims for out-of-network non-emergency services will be denied.
This is a Health Maintenance Organization (HMO) prefix. HMO plans have stricter routing requirements than PPO plans. Members select a PCP who manages their care and issues referrals. Claims for specialist services should include the referral number. Out-of-network claims will typically be denied unless emergency criteria are met.
HDHP coverage under this prefix means the member carries a higher annual deductible in exchange for lower monthly premiums. Claims are processed normally but the member's cost-sharing will be higher than standard plans until the deductible is met. Preventive services are typically the exception and are covered at no cost to the member.
Highmark Inc. providing commercial, Medicare and Medicaid plans in Pennsylvania.