Major Medical/Rx Plans

Clario offers two medical plans through Highmark BCBS: a High Deductible Health Plan with a Health Savings Account and a PPO plan. Both plans utilize the national PPO network of physicians, hospitals, and other health care providers. With both plans, you have the freedom to seek services from providers who do not participate in the PPO network; however, you will typically have more out-of-pocket costs for covered services, and you will need to file claims for reimbursement. These plans have differing levels of In-Network/Out-of-Network out-of-pocket costs (e.g., deductibles, coinsurance, copays) so that you can select the plan that best meets the needs of you and your family.

A comparison chart of the plans is shown below.

Medical Plan Benefits

Medical Plans - Highmark BCBS
Highmark BCBS HDHP ⊕
Highmark BCBS Core PPO ⊕
Annual Deductible
Individual / Family
In Network: $2,000 / $4,000
Out-of-Network: $2,500 / $5,000
In-Network: $1,000 / $2,000
Out-of-Network: $2,500 / $5,000
Annual Out-of-Pocket Maximum
Individual / Family / Individual within Family
In Network: $3,000 / $6,000 / $4,000
Out-of-Network: $6,000 / $12,000 / $6,000
In-Network: $3,500 / $7,000 / $7,000
Out-of-Network: $10,000 / $20,000 / $20,000
Office Visit
In Network: 90% covered*
Out-of-Network: 80% covered*
In-Network: $20 copay
Out-of-Network: 50% covered*

Specialist Office Visit

In Network: 90% covered*

Out-of-Network: 80% covered*

In-Network: $35 copay
Out-of-Network: 50% covered*
Preventive Services
In Network: 100% covered
Out-of-Network: 80% covered*
In-Network: 100% covered
Out-of-Network: 50% covered*
Diagnostic Testing (x-rays/blood work):**
  • Basic Diagnostic Services
  • Standard Imaging
  • Lab/Pathology
  • Allergy Testing

Basic Diagnostic Services: ECG, EEG, echocardiogram, pulmonary study, stress test, audiology test, etc.

In Network: 90% covered*
Out-of-Network: 80% covered*
In-Network:
  • Basic Diagnostic Services: 20% after deductible
  • Standard Imaging: 100% covered after $30 copay
  • Lab/Pathology: 100% (deductible does not apply) outpatient facility or freestanding lab
  • Allergy Testing: 100% after office visit copay Out-of-Network: 50% covered*
Advanced Imaging (CT scans, PET scans, MRIs, etc.):
  • Basic Diagnostic Services
  • Standard Imaging
  • Lab/Pathology
  • Allergy Testing
  • Inpatient Facility
In Network: 90% covered*
Out-of-Network: 80% covered*
In-Network:
  • Advanced Imaging: $50 per scan copay, plus office visit copay then 100%
  • Advanced Imaging: $50 copay per type of scan per day at outpatient facility, deductible does not apply
  • Basic Diagnostic Services: 20% after deductible
  • Standard Imaging: 100% after $30 copay
  • Lab/Pathology: 100% (deductible does not apply) outpatient facility or freestanding lab
  • Allergy Testing: 100% after office visit copay
  • Inpatient Facility: 20% after deductible
Out-of-Network: 50% covered*
Emergency Room
90% covered*
$150 copay (waived if admitted)
Urgent Care

In Network: 90% covered*

Out-of-Network: 80% covered*

In-Network: $70 copay Out-of-Network: 50% covered*
Inpatient Hospitalization
In Network: 90% covered*
Out-of-Network: 80% covered*

In-Network: 80% covered* Out-of-Network: 50% covered*

Outpatient Surgery
In Network: 90% covered*
Out-of-Network: 80% covered*
In-Network: 80% covered*
Out-of-Network: 50% covered*

There is an aggregate deductible for family coverage on each plan. The entire family deductible must be met before copayments or coinsurance are applied for an individual member.

*After deductible **Your cost share for Diagnostic Testing is dependent on the place of service. Diagnostic Testing for Professional Provider's Offices are only covered at 100% after office visit copay, if billed in conjunction with an office visit code, on the same date of service. If you go to an independent lab (Labcorp, Quest, etc), then you will be charged deductible and 80% coinsurance.

Please contact Quantum Health for coordination and full details of your benefits coverage.

Prescription Drug Benefits ⊕

Pharmacy - CVS Caremark
Highmark HDHP
Highmark Core PPO
Retail | 30 day supply
(Generic / Preferred Brand / Non-Preferred Brand / Specialty)
In-Network: $8 / $30 / $55 / $55 (after medical deductible)
Out-of-Network: 20% reimbursement (after medical deductible)
In-Network: $10 / $25 / $40 / $40
Out-of-Network: 30% reimbursement
Mail Order | 90 day supply
(Generic / Preferred Brand / Non-Preferred Brand)
In-Network: $16 / $60 / $110 (after medical deductible)
Out-of-Network: Not covered
In-Network: $20 / $50 / $80
Out-of-Network: Not covered

Consider a Participating Provider Organization (PPO) plan if:

  • You want access to both in-and out-of-network providers
  • You want a lower deductible and out-of-pocket maximums
  • You are willing to pay more in premiums

Consider a High Deductible Health Plan (HDHP) if:

  • You want to be able to see any provider, even a specialist, without a referral
  • You want tax-free savings on your healthcare costs
  • You want to build a savings account for future healthcare costs for you and your eligible family members
  • You want an extra way to add to your retirement savings

Still unsure which plan to pick? Click the link below for help:

ALEX
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