Compare medical plans

Here’s what the plans cover and what you pay when you need care.

What you need to know

All medical plans cover:

  • Many of the same services, like doctor’s visits and hospital stays
  • Free in-network preventive care with no deductible for annual physicals, pediatric exams, well-woman exams, immunizations, and diagnostic tests

The Highmark CDHP, PPO, and HPN plans also give you access to CirrusMD, Hinge Health, Oshi Health, and Livongo by Teladoc Health. These services are free. 

Hawaii residents have access to the HMSA plan only. Most California residents have access to Highmark plans and Kaiser Permanente based on your zip code. All continental U.S. states will have access to the Highmark PPO 1000, CDHP 2250, and CDHP 3750 plans. Based on zip code, continental US colleagues may have access to the Highmark PPO 1000 HPN and CDHP 2250 HPN plans.

The medical plans differ in how much you pay when you receive care. Take a look at the differences below or check out Ask Me, an AI-powered colleague experience.

Note: For the best experience using Ask Me, use the Chrome web browser and make sure you are logged in to Okta on your device. 

What you pay when you need care

Click through the tabs below to view what you’ll pay for care in 2026. You can use the toggles to view in- and out-of-network coverage and individual and family coverage.

Highmark CDHP 3750 benefit summary
Cost
In-network
Out-of-network
Preventive care
Covered at 100%
50%
(after deductible)
Annual deductible
Individual: $3,750
Family: $7,500
Individual: $7,500
Family: $15,000
Annual out-of-pocket maximum 1
Individual only plan: $7,500
Individual in Family plan: $8,500
Family: $15,000
Individual: $15,000
individual in a Family plan: $17,000
Family: $30,000
Coinsurance
30%
(after deductible)
50%
(after deductible)
Doctor’s office visit
30%
(after deductible)
50%
(after deductible)
Telemedicine (CirrusMD)
(effective January 1, 2026)
$0
Not covered
Specialist office visit
30%
(after deductible)
50%
(after deductible)
Urgent care
30%
(after deductible)
50%
(after deductible)
Emergency room visit
30%
(after deductible)
30%
(after deductible)

1 Coinsurance applies toward annual out-of-pocket maximum.

Cost
In-network
Out-of-network
Note: HPNs do not offer out-of-network coverage.
Preventive care
Covered at 100%
40%
(after deductible)
Annual deductible
Individual: $2,250
Family: $4,500
Individual: $4,500
Family: $9,000
Annual out-of-pocket maximum 1
Individual: $4,500
Individual in family plan: $8,500
Family: $9,000
Individual: $9,000
Individual in a family plan: $17,000
Family: $18,000
Coinsurance
20%
(after deductible)
40%
(after deductible)
Doctor’s office visit
20%
(after deductible)
40%
(after deductible)
Telemedicine (CirrusMD)
(effective January 1, 2026)
$0
Not covered
Specialist office visit
20%
(after deductible)
40%
(after deductible)
Urgent care
20%
(after deductible)
40%
(after deductible)
Emergency room visit
20%
(after deductible)
20%
(after deductible)

1 Coinsurance applies toward annual out-of-pocket maximum.

Cost
In-network
Out-of-network
Note: HPNs do not offer out-of-network coverage.
Preventive care
Covered at 100%
50%
(after deductible)
Annual deductible
Individual: $1,000
Family: $2,000
Individual: $2,000
Family: $4,000
Annual out-of-pocket maximum 1
Individual: $3,500
Family: $7,000
Individual: $7,000
Family: $14,000
Coinsurance
25%
(after deductible)
50%
(after deductible)
Doctor’s office visit
$40
(copay)
50%
(after deductible)
Telemedicine (CirrusMD)
(effective January 1, 2026)
$0
Not covered
Specialist office visit
$50
(copay)
50%
(after deductible)
Urgent care
$50
(copay)
50%
(after deductible)
Emergency room visit
$400 copay2
$400 copay2

1 Copays apply toward annual out-of-pocket maximum.
2 Emergency room copay is waived if the patient is admitted to the hospital.

Cost
In-network
Out-of-network
Preventive care
Covered at 100%
n/a
Annual deductible
Individual: $1,500
Family: $3,000
n/a
Annual out-of-pocket maximum 1
Individual: $4,000
Family: $8,000
n/a
Coinsurance
20%
(after deductible)
n/a
Doctor’s office visit
$30
(copay)
n/a
Telehealth Visits
(effective January 1, 2026)
$0
n/a
Specialist office visit
$40
(copay)
n/a
Urgent care
$30
(copay)
n/a
Emergency room visit
20%
(after deductible)
n/a

1 Copays apply toward annual out-of-pocket maximum.
3 Emergency room coinsurance is waived if the patient is admitted to the hospital.

Cost
In-network
Out-of-network
Preventive care
Covered at 100%
30% (after deductible)
Annual deductible
Individual: $0
Family: $0
Individual: $1001
Family: Up to $300/family1
Annual out-of-pocket maximum 1
Individual: $2,500
Family: $7,500
Individual: $2,500
Family: $7,500
Coinsurance
Individual: 20%
Family: n/a
n/a
Doctor’s office visit
$12
(copay)
30%
(after deductible)
Telehealth Services
(effective January 1, 2026)
Matches the copay or coinsurance for the service received
Individual: 30%
(after deductible)
Family: n/a
Specialist office visit
$12
(copay)
30%
(after deductible)
Urgent care
$12
(copay)
30%
(after deductible)
Emergency room visit
20%
(after deductible)
0%
(deductible does not apply)

1 Copays apply toward annual out-of-pocket maximum.
3 Emergency room coinsurance is waived if the patient is admitted to the hospital.

Important note about out-of-network coverage

You may be eligible for the CDHP 2250 HPN, PPO 1000 HPN, and Kaiser Permanente plan (available to California residents only) based on the ZIP code of your home address. If any of these plans are available to you, they will show as options when completing your benefits enrollment. With these plans, you’re only covered for in-network care — there’s no out-of-network coverage except in emergency situations.

If you live in California and would like to enroll in Kaiser Permanente coverage, you must accept the Kaiser Foundation Health Plan Arbitration Agreement. If you’re unwilling to do so, you will need to select a different plan option.

Quantum Health Care Coordinators for Highmark CDHP and PPO 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.

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Additional medical resources

If you’re enrolled in a Highmark CDHP or PPO 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.