Third-Party Administrator: Highmark BCBS WV

Coverage:

  • Begins your first day of benefit eligibility
  • Dependent children covered to age 26
  • Three Tiers of coverage
  • Premiums paid bi-weekly (per pay)
  • Rates available in Ultimate

Deductibles

  • Annual, calendar year deductibles
    • Single: one individual meets deductible
    • Family: one individual must meet the single deductible and family members can make up the balance
  • Separate deductibles for each Tier
    • Tier I: $150 individual / $300 family
    • Tier II: $300 individual / $600 family
    • Tier III: $500 individual / $1,000 family

 For union-specific information, please refer to CONNECT which is viewable from any WVU Medicine computer. Union members are automatically enrolled in the Standard Medical Plan as an individual.

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
  • United Hospital Center
Tier I:
WVUHS/UHA Network
Tier II:
Other PPO Network
Professional and Facility
Providers
Tier III:
Non-Network and PPO Network Competitor Facilities and Non-Network Professional Providers
Inpatient & Outpatient Procedures After Deductible $100% After Deductible
80% – Ancillary Services (x-rays, labs)
(of Professional Allowance)
After Deductible
60% (of Professional Allowance)
Office Visit After Deductible
$15 co-pay –
Primary Care Physician
$35 co-pay –
Specialty Care Physician
After Deductible
$25 co-pay –
Primary Care Physician
$50 co-pay –
Specialty Care Physician
After Deductible 60%
Out of Pocket Maximums Single: $1,500
Family: $3,000
Single: $3,000
Family: $6,000
Single: $5,000
Family: $10,000
Emergency
Room
$100 co-pay if true emergency (co-pay waived if admitted, unless for observation) $100 co-pay if true emergency (co-pay waived if admitted, unless for observation) $100 co-pay 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 Union-specific information, please refer to the HR site on CONNECT.

Coverage is dependent upon where services are rendered in the three Tier chart above

Emergency services: Must be true emergency for coverage in this plan

Preventative Services: Tier I and Tier II only, (no Tier III coverage for these services)

  • One per calendar year
  • No deductible or co-pay for these visits
  • Covers annual pap smears, mammograms, routine exams, prostate screenings, well child visits

Specialist Services: Referrals not required

Prior Authorization: Some tests and procedures require a pre-certification before services are rendered

  • MRI, CT scan, etc.

Other Important Things to Note:

  • Once you enroll in Medical Insurance and receive your ID cards, there are many self-service options on Highmark’s website: www.highmarkbcbswv.com

You can:

  • Look up physicians in the Highmark Network
  • Check claims status
  • Elect to receive your Explanation of Benefits (EOBs) online
  • Access a wealth of information on health and wellness topics
  • Request additional insurance cards

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