麻豆村

麻豆村
Human Resources  ›  Benefits and Pay  ›  Health and Welfare Benefits  ›  Medical Plans  ›  Medical Coverage Comparison

2026 Medical Coverage Comparison

PPO Option 1
Highmark or UPMC

PPO Option 2
Highmark or UPMC

EPO / HMO
Highmark / UPMC

High Deductible PPO with HSA
Highmark or UPMC
In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network

Annual Deductibles and Out-of-Pocket Maximums
Deductible (Individual/Family)1 2 $375/$750 $750/$1,500 $750/$1,500 $1,500/$3,000 $250/$500 Not covered $2,000/$4,000 $4,000/$8,000
Out-of-Pocket Maximum (Individual/Family)2 $2,100/$4,200 $4,200/$8,400 $4,500/$9,000 $5,000/$10,000 $1,500/$3,000 Not covered $4,000/$8,000 $8,000/$16,000

Copay/Coinsurance
Plan Coinsurance Responsibility After Deductible 80% 60% fo UCR3 70% 60% of UCR3 90% Not covered 80% 60% of UCR3
Primary Care Physician / Behavioral Health Office Visit (in person/virtual) $30/$5 $35/$5 $25/$5 20%4
Specialist Office Visit (in person/virtual) $50/$5 $60/$5 $40/$5 20%4
Urgent Care Office Visit (in person/virtual) $50/$0 $60/$0 $40/$0 20%4
Preventive Care (per schedule) $0 $0 $0 $0
Emergency Room Visit (waived if admitted) $150 $150 $150 $150 $150 $150 20%4 20%4

1The deductible and copay do not apply when adult or pediatric preventive care is performed according to the plan's schedule. If tests or lab work that are not on the plan's preventive care schedules are performed, the individual's portion of the cost will be applied to the deductible.

2The deductible and out-of-pocket maximum are tracked separately for in- and out-of-network services under all plans. The annual out-of-pocket maximum includes deductible, copays and coinsurance.

3UCR means usual, customary and reasonable charges the carrier has established for medical services. Out-of-network providers may bill you for their charges in excess of the UCR. Expenses in excess of the UCR do not count toward the out-of-pocket maximum.

4Member coinsurance responsibility after the deductible is met.