Third-Party Administrator: Highmark BCBS WV Plan

Coverage:

The coverage is effective the first day of the month following your date of benefit eligible employment.

  • Dependent children covered to age 26

Deductibles

  • Annual calendar year deductibles
  • Separate deductibles for each Tier
    • Tier I $1,000 individual / $2,000 family
    • Tier II: $1,500 individual / $3,000 family
    • Tier III: $2,500 individual / $5,000 family

Tier I Providers:

  • Ruby Memorial
  • Physician Office Center
  • Chestnut Ridge Center
  • Family Medicine
  • Mary Babb Randolph Cancer Center
  • WVU Cheat Lake Physicians
  • WVU Urgent Care
  • HealthWorks
  • WVUH-East
  • Camden Clark
  • UHA
  • Potomac Valley Hospital

Coverage is dependent on where services are rendered in our three-tier structure (see below).

Tier I:
WVUHS/UHA Network
Tier II:
Other PPO Network
Professional Providers
Tier III:
Non Network and PPO Network Facilities and Non-Network Professional Providers
Inpatient and Outpatient Procedures After Deductible 80% After Deductible 80% – Ancillary Services (x-rays, labs) (of Professional Allowance) After Deductible 60% (of Professional Allowance)
Office Visit After Deductible
$25 co-pay –
Primary Care Physician $40 co-pay –
Specialty Care Physician
After Deductible
$35 co-pay –
Primary Care Physician $60 co-pay –
Specialty Care Physician
After Deductible
60%
Emergency Room $200 copay if true emergency (co-pay waived if admitted, unless for observation) $200 copay if true emergency (co-pay waived if admitted, unless for observation) $200 copay if true emergency (co-pay waived if admitted, unless for observation)
Urgent Care After Deductible

$25 co-pay

After Deductible

$50 co-pay

After Deductible

$60 co-insurance

For detailed information regarding your benefit coverage, please visit the HR website on connect.