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Complete Blue PPO

Main

 Additional Information WPA_CPA_NEPA_SEPA_CBPPO_AddInfo.pdf

 Annual Notice of Changes CMP_PPOD_Premier_H3916-044-003_ANOC.pdf

 Annual Notice of Changes CMP_PPOD_Premier_H3916-044-002_ANOC.pdf

 Annual Notice of Changes CMP_PPOD_Premier_H3916-044-001_ANOC.pdf

 Annual Notice of Changes CMP_PPOD_Distinct_H3916-035-001_ANOC.pdf

 Annual Notice of Changes CMP_PPOD_Signature_H3916-041-001_ANOC.pdf

 Annual Notice of Changes CMP_PPOD_Distinct_H3916-035-002_ANOC.pdf

 Annual Notice of Changes CMP_PPOD_Distinct_H3916-035-004_ANOC.pdf

 Annual Notice of Changes CMP_PPOD_Signature_H3916-038_ANOC.pdf

 Annual Notice of Changes CMP_PPOD_Signature_H3916-041-002_ANOC.pdf

 Evidence of Coverage CMP_PPOD_Choice_Deluxe_H3916-047-001_EOC.pdf

 Evidence of Coverage CMP_PPOD_Choice_H3916-048-001_2_3_EOC.pdf

 Evidence of Coverage CMP_PPOD_Choice_Deluxe_H3916-047-002_3_EOC.pdf

 Evidence of Coverage CMP_PPO_Premier_H3916-044-003_EOC.pdf

 Evidence of Coverage CMP_PPO_Premier_H3916-044-002_EOC.pdf

 Evidence of Coverage CMP_PPO_Premier_H3916-044-001_EOC.pdf

 Evidence of Coverage CMP_PPOD_Signature_H3916-041-002_EOC.pdf

 Evidence of Coverage CMP_PPOD_Signature_H3916-041-001_EOC.pdf

 Evidence of Coverage CMP_PPOD_Merit_H3916-049-001_2_3_EOC.pdf

 Evidence of Coverage CMP_PPOD_Distinct_H3916-035_EOC.pdf

 Evidence of Coverage CMP_PPOD_Signature_H3916-038_EOC.pdf

 Medicare Star Ratings

 Plan Availability Map WPA_CBPPO_Counties.pdf

 Provider/Pharmacy Directory WPA_CPA_NEPA_SEPA_CBPPO_PD.pdf

 Summary of Benefits wpa-cb-ppo-wc-b-sob.pdf

 Summary of Benefits wpa-cb-ppo-sw-sob.pdf

 Summary of Benefits wpa-cb-ppo-wc-a-sob.pdf

 Paper Application WPA_EnrollApp.pdf

 WPA Application Tagged WPA Application.pdf

 Notice of Nondiscrimination bcbs-notice-of-nondiscrimination.pdf

Community Blue Medicare PPO

Main

 Additional Information CPA_NEPA_CBMPPO_AddInfo.pdf

 Annual Notice of Changes CB_PPOD_Distinct_H3916-034-001_ANOC.pdf

 Annual Notice of Changes CB_PPOD_Distinct_H3916-034-003_ANOC.pdf

 Annual Notice of Changes CB_PPOD_Distinct_H3916-034-004_ANOC.pdf

 Annual Notice of Changes CB_PPOD_Distinct_H3916-034-005_ANOC.pdf

 Annual Notice of Changes CB_PPOD_Premier_H3916-045-001_ANOC.pdf

 Annual Notice of Changes CB_PPOD_Premier_H3916-045-002_ANOC.pdf

 Annual Notice of Changes CB_PPOD_Premier_H3916-045-003_ANOC.pdf

 Annual Notice of Changes CB_PPOD_Premier_H3916-045-004_ANOC.pdf

 Annual Notice of Changes CB_PPOD_Signature_H3916-037-001_ANOC.pdf

 Annual Notice of Changes CB_PPOD_Signature_H3916-037-002_ANOC.pdf

 Annual Notice of Changes CB_PPOD_Signature_H3916-037-003_ANOC.pdf

 Annual Notice of Changes CB_PPOD_Signature_H3916-037-004_ANOC.pdf

 Evidence of Coverage CB_PPO_Premier_H3916-045-001_2_3_4_EOC.pdf

 Evidence of Coverage CB_PPOD_Distinct_H3916-034-001_3_EOC.pdf

 Evidence of Coverage CB_PPOD_Distinct_H3916-034-004_EOC.pdf

 Evidence of Coverage CB_PPOD_Distinct_H3916-034-005_EOC.pdf

 Evidence of Coverage CB_PPOD_Signature_H3916-037-001_2_EOC.pdf

 Evidence of Coverage CB_PPOD_Signature_H3916-037-003_EOC.pdf

 Evidence of Coverage CB_PPOD_Signature_H3916-037-004_EOC.pdf

 Medicare Star Ratings

 Plan Availability Map CPA_NEPA_CBMPPO_Counties.pdf

 Provider/Pharmacy Directory CPA_NEPA_CBMPPO_PD.pdf

 Summary of Benefits cpa-cbm-ppo-a-sob.pdf

 Summary of Benefits cpa-cbm-ppo-b-sob.pdf

 Summary of Benefits cpa-nepa-cbm-ppo-a-sob.pdf

 Summary of Benefits cpa-nepa-cbm-ppo-b-sob.pdf

 Summary of Benefits cpa-nepa-cbm-ppo-c-sob.pdf

 Summary of Benefits cpa-nepa-cbm-ppo-d-sob.pdf

 Notice of Nondiscrimination bs-notice-of-nondiscrimination.pdf

 Paper Application CPA_EnrollApp.pdf

Freedom Blue PPO

Main

 Additional Information WV_FBPPO_AddInfo.pdf

 Annual Notice of Changes FB_PPOD_Distinct_H5106-029-001_ANOC.pdf

 Annual Notice of Changes FB_PPOD_Distinct_H5106-029-002_ANOC.pdf

 Annual Notice of Changes FB_PPOD_Signature_H5106-030-001_ANOC.pdf

 Annual Notice of Changes FB_PPOD_Signature_H5106-030-002_ANOC.pdf

 Annual Notice of Changes FB_PPOD_Standard_H5106-013_ANOC.pdf

 Annual Notice of Changes wv-fb-ppo-merit-031-001-anoc.pdf

 Annual Notice of Changes wv-fb-ppo-merit-031-002-anoc.pdf

 Annual Notice of Changes wv-fb-ppo-prestige-032-001-anoc.pdf

 Annual Notice of Changes wv-fb-ppo-prestige-032-002-anoc.pdf

 Annual Notice of Changes wv-fb-ppo-valor-033-001-anoc.pdf

 Annual Notice of Changes wv-fb-ppo-valor-033-002-anoc.pdf

 Evidence of Coverage FB_PPO_Valor_H5106-033-001_2_EOC.pdf

 Evidence of Coverage FB_PPOD_Distinct_H5106-029-001_EOC.pdf

 Evidence of Coverage FB_PPOD_Distinct_H5106-029-002_EOC.pdf

 Evidence of Coverage FB_PPOD_Merit_H5106-031-001_EOC.pdf

 Evidence of Coverage FB_PPOD_Merit_H5106-031-002_EOC.pdf

 Evidence of Coverage FB_PPOD_Prestige_H5106-032-001_2_EOC.pdf

 Evidence of Coverage FB_PPOD_Signature_H5106-030-001_EOC.pdf

 Evidence of Coverage FB_PPOD_Signature_H5106-030-002_EOC.pdf

 Evidence of Coverage FB_PPOD_Standard_H5106-013_EOC.pdf

 Medicare Star Ratings

 Plan Availability Map WV_FBPPO_Counties.pdf

 Provider/Pharmacy Directory WV_FBPPO_PD.pdf

 Summary of Benefits wv-fb-ppo-a-sob.pdf

 Summary of Benefits wv-fb-ppo-b-sob.pdf

 Summary of Benefits wv-fb-ppo-c-sob.pdf

 Notice of Nondiscrimination bcbs-notice-of-nondiscrimination.pdf

 Tagged WV Application.pdf

 Paper Application WV_EnrollApp.pdf

Terms of Service     Legal and Policies    Non-Discrimination Policy    Mental Health Parity

 

®Highmark is a registered mark of Highmark Inc. 2024 Highmark Inc. All Rights Reserved. ®Blue Cross, Blue Shield and the Cross and Shield symbols are registered service marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans.

Benefits and/or benefit administration may be provided by or through the following entities, which are independent licensees of the Blue Cross Blue Shield Association:

Western and Northeastern Pennsylvania: Highmark Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Health Insurance Company, Highmark Coverage Advantage Inc., Highmark Benefits Group Inc., First Priority Health, First Priority Life, Highmark Senior Health Company or Highmark Wholecare.

Central and Southeastern Pennsylvania: Highmark Inc. d/b/a Highmark Blue Shield, Highmark Benefits Group Inc., Highmark Health Insurance Company, Highmark Choice Company, Highmark Senior Health Company or Highmark Wholecare.

Pennsylvania: Your plan may not cover all your health care expenses. Read your plan materials carefully to determine which health care services are covered. For more information, call the number on the back of your member ID card or, if not a member, call 866-459-4418.

Delaware: Highmark BCBSD Inc. d/b/a Highmark Blue Cross Blue Shield.

West Virginia:  Highmark West Virginia Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Health Insurance Company or Highmark Senior Solutions Company. Visit https://www.highmarkbcbswv.com/networkaccessplan to view the Access Plan required by the Health Benefit Plan Network Access and Adequacy Act. You may also request a copy by contacting us at the number on the back of your ID card.

Western New York: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Cross Blue Shield. 

Northeastern New York: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Shield. 

Highmark Blue Cross Blue Shield and Highmark Blue Shield are Medicare Advantage HMO, PPO, and/or Part D plans with a Medicare contract. Enrollment in these plans depends on contract renewal.

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 and/or to one or more of its affiliated Blue companies.

United Concordia is a separate company that provides the provider network for Blue Edge Dental and administers dental benefits.

Attention:  This website is operated by Highmark and not the Insurance Exchanges relative to your state.  This website does not display all Qualified Health Plans (“QHPs”) that may be available to you.  To see all available QHP options in West Virginia & Delaware, go to the Health Insurance Marketplace® website at HealthCare.gov. To see all available QHP options in Pennsylvania, go to the Pennsylvania Health Insurance Exchange website at https://pennie.com/. To see all available QHP options in New York, go to the New York State Office of Health website at https://nystateofhealth.ny.gov/"

We are committed to providing outstanding services to our applicants and members. If you require special assistance, including accommodations for disabilities or limited English proficiency, please call us at 1-800-876-7639 or TTY at #711 to receive assistance free of charge.

Highmark Inc. is a Qualified Health Plan issuer on the Health Insurance Marketplace.

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