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.
Will benefits or insurance coverage change after the PHE expires?
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*:
*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.
Will Highmark continue to pay out-of-network claims as in-network for Medicare Advantage members?
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.
Will Highmark continue to cover inpatient COVID-19 treatment?
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.
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.
Can 90-day prescriptions be delivered to a home?
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.
Are prescription refills available early?
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.
Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. Highmark Western and Northeastern New York Inc., serves eight counties in Western New York under the trade name Highmark Blue Cross Blue Shield of Western New York and serves 13 counties in Northeastern New York under the trade name Highmark Blue Shield of Northeastern New York. Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. Blue Cross, Blue Shield and the Blue Cross and Blue Shield symbols are registered marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration.
This website is operated by Highmark, Inc. and is not the Health Insurance Marketplace website. This website does not display all Qualified Health Plans available through the Health Insurance Marketplace website. To see all available Qualified Health Plan options, go to the Health Insurance Marketplace website at HealthCare.gov.
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