What you need to know
In general, your medical options work the same way:
- You meet an annual deductible before the plan pays benefits (except with in-network preventive care, which is always 100% covered). Also, the deductible does not apply to the copays in the HMO and PPO plans for things like office visits, specialist visits, and prescription drugs.
- Then, you pay your share with coinsurance.
- If you meet the out-of-pocket maximum (OOPM), the plan pays 100% of eligible expenses for the rest of the year.
Beyond that, plan details vary — such as which providers you can see, how much you pay when you need care, and what you pay each month for coverage.
Your medical plan options (in -network coverage shown)
Highmark CDHP 3750
- Premiums: Lowest
- Deductible (in-network): $3,750 individual/$7,500 family
- Out-of-pocket maximum (in-network): $7,500 individual only plan/$8,500 individual in a family plan/$15,000 family
- Copays: None
- Coinsurance: You pay 30%
- HSA: Yes
- Flexible Spending Account: No
Highmark CDHP 2250 and CDHP 2250 HPN
- Premiums: Medium
- Deductible (in-network): $2,250 individual/$4,500 family
- Out-of-pocket maximum (in-network): $4,500 individual only plan/$8,500 individual in a family plan/$9,000 family
- Copays: None
- Coinsurance: You pay 20%
- HSA: Yes
- Flexible Spending Account: No
IMPORTANT: The CDHP 2250 HPN is only available in certain ZIP codes and does not provide out-of-network coverage except for care at Urgent Care Facilities or the Emergency Department at a Hospital.
Highmark PPO 1000 and PPO 1000 HPN
- Premiums: Highest
- Deductible (in-network): $1,000 individual/$2,000 family
- Out-of-pocket maximum (in-network): $3,500 individual/$7,000 family
- Copays: For office visits, specialist visits, urgent care, emergency room services, and prescription drugs
- Coinsurance: You pay 25%
- HSA: No
- Flexible Spending Account: Yes
IMPORTANT: The PPO 1000 HPN is only available in certain ZIP codes and does not provide out-of-network coverage except for care at Urgent Care Facilities or the Emergency Department at a Hospital.
Kaiser HMO (California Residents)
- Premiums: Highest
- Deductible (in-network): $1,500 individual/$3,000 family
- Out-of-pocket maximum (in-network): $4,000 individual/$8,000 family
- Copays: For office visits, specialist visits, diagnostic tests, urgent care, emergency room services, and prescription drugs
- Coinsurance: You pay 20%
- HSA: No
- Flexible Spending Account: Yes
HMSA PPO (Hawaii Residents)
- Premiums: Low
- Deductible (in-network): No deductible
- Out-of-pocket maximum (in-network): $2,500 individual/$7,500 family (applied to medical coverage; $3,600 individual$4,200 family (applies to prescription drug coverage)
- Copays: For office visits, specialist visits, urgent care, emergency room physician visits, inpatient hospital physician visits, and prescription drugs
- Coinsurance: You pay 20%
- HSA: No
- Flexible Spending Account: Yes
Carrum Health
Carrum Health connects you with leading doctors, surgeons, and cancer specialists nationwide. When you use Carrum Health, most or all of your costs are covered.
Using a Carrum Health Center of Excellence is required for the following procedures:
- Bariatric surgery
- Knee and hip replacement
- Spinal surgery
- CAR-T therapy
Carrum Health is optional for substance use disorder treatment facilities, oncology treatment, and all other surgeries.
Get a personalized recommendation
Use Ask Me, an AI-powered colleague experience, can simplify the benefits decision-making process and recommend benefit options that may be the best fit for you and your family.
Additional medical resources
If you’re enrolled in a Highmark CDHP, PPO or HPN plan, you can access these convenient care solutions.
Treat joint and muscle pain virtually
Use Hinge Health to access virtual physical therapy.
Get help with digestive issues
Use Oshi Health, a virtual digestive care resource, to address your symptoms.
Live better with Livongo
Do you have high blood pressure or diabetes? See how Livongo can help.
Get the care you need in seconds
Connect to a trusted doctor in 60 seconds 24/7/365 through CirrusMD.
FREE beginning January 1, 2026!
Get specialized care
Carrum Centers of Excellence are required for bariatric/joint/spine surgeries and CAR-T therapy and optional for other surgeries and procedures.
Quantum Health Care Coordinators for Highmark plans
Quantum Health Care Coordinators provide personalized, one-on-one support to help you understand your benefits. They can help you find an in-network provider, understand a bill, replace your ID card, and more. Available Monday through Friday, 7:30 a.m. to 9:00 p.m. CT.
Note: Quantum is only available if you’re enrolled in a Highmark medical plan.