Frequently Asked Questions
Health insurance questions and answers. Learn about Highmark products and services and how to choose health insurance.
Read questions about health insurance including ACA, COVID, Highmark Healthy Kids, home delivery prescriptions and more. Learn how to choose health insurance, find options to get care and read health insurance definitions in the glossary.
Popular health insurance questions and answers
Public Health Emergency
Given our ongoing commitment to support our members, clients and providers throughout the COVID-19 pandemic, Highmark will extend the following waivers to Highmark members with employer-sponsored or individual health insurance coverage until June 1, 2023*:
- $0 in-network and out-of-network COVID-19 vaccines
- $0 in-network and out-of-network COVID-19 diagnostic and antibody testing
- $0 over-the-counter (OTC) COVID-19 testing
- $0 Prescription antiviral treatment
- $0 in-network and out-of-network related services to diagnose COVID-19 - office visit (in-person or telehealth), emergency room or urgent care
For Medicare Advantage members, Highmark will extend the following waivers with Highmark Medicare Advantage insurance coverage until June 1, 2023*:
- $0 in-network and out-of-network COVID-19 vaccines
- $0 in-network and out-of-network COVID-19 diagnostic and antibody testing
- $0 in-network and out-of-network related services to diagnose COVID-19. Includes office visits (in-person or telehealth), emergency room visits or urgent care visits.
- $0 inpatient COVID-19 treatment – covered through 12/31/23 for Medicare Advantage members
*While this coverage applies to most Highmark members, every plan is a little different. If you have any questions, please login to your member portal and send a message using the message center to Member Service. You can also call Member Service using the number on the back of your insurance card.
** West Virginia Members: Please note that WV State mandates may continue to be in place and extend coverage of these services after 6/1/2023. Please continue to check back here for updates.
After June 1, 2023, the services above may have out-of-pocket costs based on your plan coverage.
No, due to government regulations all out-of-network claims will be processed according to your Medicare Advantage plan benefits beginning on June 11, 2023.
If you choose to see an out-of-network provider on or after June 11th, and your plan has out-of-network benefits, you may see a change in the amount you owe. If you choose to see an out-of-network provider on or after June 11th, and your plan does not have out-of-network benefits, you will have to pay the full amount owed (except for urgent or emergency care).
Please check your Summary of Benefits to find out if your Medicare Advantage plan has out-of-network benefits.
For members with Highmark employer-sponsored or individual health insurance coverage, Highmark will continue to cover inpatient COVID-19 treatment based on the member’s plan coverage for in-patient services. This may mean there will be out-of-pocket costs based on your plan.
For Highmark Medicare Advantage members, inpatient COVID-19 treatment will be fully covered through December 31, 2023.
CHIP - Highmark Healthy Kids FAQ
There are no income limits for CHIP. Your child can be covered on CHIP regardless of household income or employment status.
There aren't any pre-existing condition limits to qualify for CHIP.
You can enroll in CHIP anytime throughout the year.
Home Delivery Prescriptions FAQ
It’s quick and easy to get your prescription delivered right to your home. And, you’ll likely save money. To set up your prescription delivery, grab your Highmark card and call Express Scripts at (800) 282-2881. They are available 24/7 to help switch your prescriptions to home delivery. Or, log in to your Highmark member website and select “Prescriptions.” On the next screen, click “Mail Order Savings” to go to the Express Scripts website. Follow the on-screen prompts to set up your prescription delivery.
Yes, if the prescription is for a 90-day supply. Talk to your doctor to find out if they can change your prescription to a three-month supply.
Depending on your situation, you may be able to get a home delivery of a prescription refill early. Call the Member Services team — the number is on the back of your Highmark Blue Cross Blue Shield card — to learn more.
