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this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $20 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($20 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAPM3_PPO_RX1L98_IDA0_2027_16481PA005010301.pdf"},{"market":"pennie","id":"16481PA0050104-01","standardId":"16481PA0050104","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Gold $1,000/$20 - Premium Network with Adult Dental and Vision","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":533.96,"tobaccoFactor":1.025002},"2":{"base21":709.91,"tobaccoFactor":1.025003},"4":{"base21":533.96,"tobaccoFactor":1.025002},"5":{"base21":575.88,"tobaccoFactor":1.025005}},"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":20,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($50 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 30% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $20 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($20 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAPM3_PPO_RX1L98_IDA0_2027_16481PA005010401.pdf"},{"market":"pennie","id":"16481PA0050105-01","standardId":"16481PA0050105","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Gold $1,000/$20 - Premium Network","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Cumberland","Dauphin","Lackawanna","Lebanon","Luzerne","Lycoming","Perry","Sullivan","Tioga","Wyoming"],"rates":{"3":{"base21":657.92,"tobaccoFactor":1.025003},"9":{"base21":729.77,"tobaccoFactor":1.024994}},"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":20,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($50 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 30% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $20 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($20 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAPN1_PPO_RX1L98_IDA0_2027_16481PA005010501.pdf"},{"market":"pennie","id":"16481PA0050106-01","standardId":"16481PA0050106","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Gold $1,000/$20 - Premium Network with Adult Dental and Vision","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Cumberland","Dauphin","Lackawanna","Lebanon","Luzerne","Lycoming","Perry","Sullivan","Tioga","Wyoming"],"rates":{"3":{"base21":679.18,"tobaccoFactor":1.025001},"9":{"base21":753.36,"tobaccoFactor":1.024995}},"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":20,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($50 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 30% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $20 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($20 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAPN1_PPO_RX1L98_IDA0_2027_16481PA005010601.pdf"},{"market":"pennie","id":"16481PA0050107-01","standardId":"16481PA0050107","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Gold HSA $2,900/10% - Premium Network","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":450.41,"tobaccoFactor":1.024999},"2":{"base21":598.83,"tobaccoFactor":1.024999},"4":{"base21":450.41,"tobaccoFactor":1.024999},"5":{"base21":485.77,"tobaccoFactor":1.024991}},"ded":{"ind":2900,"fam":5800,"embedded":false},"drugDed":null,"oop":{"ind":6000,"fam":12000,"famPerPerson":12000},"rules":{"pcp":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests (10% coinsurance), used for both, and says certain diagnostic services may have additional cost sharing.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy 10% coinsurance; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share (10% coinsurance) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","The SBC says the overall family deductible must be met before the plan begins to pay (a family deductible, not one per person), and the estimate uses the aggregate family deductible.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XASPF_PPO_RX1M58_IDA0_2027_16481PA005010701.pdf"},{"market":"pennie","id":"16481PA0050113-01","standardId":"16481PA0050113","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $7,000/$45 - Premium Network","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":596.77,"tobaccoFactor":1.025001},"2":{"base21":793.42,"tobaccoFactor":1.025006},"4":{"base21":596.77,"tobaccoFactor":1.025001},"5":{"base21":643.62,"tobaccoFactor":1.024999}},"ded":{"ind":7000,"fam":14000,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":45,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($65 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $45 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($45 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAPM9_PPO_RX1N81_IDA0_2027_16481PA005011301.pdf"},{"market":"pennie","id":"16481PA0050113-04","standardId":"16481PA0050113","variant":"csr73","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $7,000/$45 - Premium Network","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":596.77,"tobaccoFactor":1.025001},"2":{"base21":793.42,"tobaccoFactor":1.025006},"4":{"base21":596.77,"tobaccoFactor":1.025001},"5":{"base21":643.62,"tobaccoFactor":1.024999}},"ded":{"ind":2800,"fam":5600,"embedded":true},"drugDed":null,"oop":{"ind":9500,"fam":19000},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":45,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($65 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $45 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($45 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAPM8_PPO_RX1N81_IDA0_2027_16481PA005011304.pdf"},{"market":"pennie","id":"16481PA0050113-05","standardId":"16481PA0050113","variant":"csr87","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $7,000/$45 - Premium Network","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":596.77,"tobaccoFactor":1.025001},"2":{"base21":793.42,"tobaccoFactor":1.025006},"4":{"base21":596.77,"tobaccoFactor":1.025001},"5":{"base21":643.62,"tobaccoFactor":1.024999}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":4000,"fam":8000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":45,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":30,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($45 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $30 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($30 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAPM6_PPO_RX1N83_IDA0_2027_16481PA005011305.pdf"},{"market":"pennie","id":"16481PA0050113-06","standardId":"16481PA0050113","variant":"csr94","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $7,000/$45 - Premium Network","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":596.77,"tobaccoFactor":1.025001},"2":{"base21":793.42,"tobaccoFactor":1.025006},"4":{"base21":596.77,"tobaccoFactor":1.025001},"5":{"base21":643.62,"tobaccoFactor":1.024999}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":2300,"fam":4600},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"free","ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests (no cost), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy no cost; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAPM5_PPO_RX1N83_IDA0_2027_16481PA005011306.pdf"},{"market":"pennie","id":"16481PA0050114-01","standardId":"16481PA0050114","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $7,000/$45 - Premium Network with Adult Dental and Vision","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":613.48,"tobaccoFactor":1.025005},"2":{"base21":815.65,"tobaccoFactor":1.024998},"4":{"base21":613.48,"tobaccoFactor":1.025005},"5":{"base21":661.65,"tobaccoFactor":1.024998}},"ded":{"ind":7000,"fam":14000,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":45,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($65 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $45 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($45 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAPM9_PPO_RX1N81_IDA0_2027_16481PA005011401.pdf"},{"market":"pennie","id":"16481PA0050114-04","standardId":"16481PA0050114","variant":"csr73","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $7,000/$45 - Premium Network with Adult Dental and Vision","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":613.48,"tobaccoFactor":1.025005},"2":{"base21":815.65,"tobaccoFactor":1.024998},"4":{"base21":613.48,"tobaccoFactor":1.025005},"5":{"base21":661.65,"tobaccoFactor":1.024998}},"ded":{"ind":2800,"fam":5600,"embedded":true},"drugDed":null,"oop":{"ind":9500,"fam":19000},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":45,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($65 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $45 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($45 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAPM8_PPO_RX1N81_IDA0_2027_16481PA005011404.pdf"},{"market":"pennie","id":"16481PA0050114-05","standardId":"16481PA0050114","variant":"csr87","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $7,000/$45 - Premium Network with Adult Dental and Vision","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":613.48,"tobaccoFactor":1.025005},"2":{"base21":815.65,"tobaccoFactor":1.024998},"4":{"base21":613.48,"tobaccoFactor":1.025005},"5":{"base21":661.65,"tobaccoFactor":1.024998}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":4000,"fam":8000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":45,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":30,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($45 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $30 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($30 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAPM6_PPO_RX1N83_IDA0_2027_16481PA005011405.pdf"},{"market":"pennie","id":"16481PA0050114-06","standardId":"16481PA0050114","variant":"csr94","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $7,000/$45 - Premium Network with Adult Dental and Vision","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":613.48,"tobaccoFactor":1.025005},"2":{"base21":815.65,"tobaccoFactor":1.024998},"4":{"base21":613.48,"tobaccoFactor":1.025005},"5":{"base21":661.65,"tobaccoFactor":1.024998}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":2300,"fam":4600},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"free","ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests (no cost), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy no cost; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAPM5_PPO_RX1N83_IDA0_2027_16481PA005011406.pdf"},{"market":"pennie","id":"16481PA0050115-01","standardId":"16481PA0050115","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $7,000/$45 - Premium Network","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Cumberland","Dauphin","Lackawanna","Lebanon","Luzerne","Lycoming","Perry","Sullivan","Tioga","Wyoming"],"rates":{"3":{"base21":759.07,"tobaccoFactor":1.025004},"9":{"base21":841.98,"tobaccoFactor":1.025001}},"ded":{"ind":7000,"fam":14000,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":45,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($65 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $45 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($45 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAPM9_PPO_RX1N81_IDA0_2027_16481PA005011501.pdf"},{"market":"pennie","id":"16481PA0050115-04","standardId":"16481PA0050115","variant":"csr73","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $7,000/$45 - Premium Network","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Cumberland","Dauphin","Lackawanna","Lebanon","Luzerne","Lycoming","Perry","Sullivan","Tioga","Wyoming"],"rates":{"3":{"base21":759.07,"tobaccoFactor":1.025004},"9":{"base21":841.98,"tobaccoFactor":1.025001}},"ded":{"ind":2800,"fam":5600,"embedded":true},"drugDed":null,"oop":{"ind":9500,"fam":19000},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":45,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($65 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $45 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($45 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAPM8_PPO_RX1N81_IDA0_2027_16481PA005011504.pdf"},{"market":"pennie","id":"16481PA0050115-05","standardId":"16481PA0050115","variant":"csr87","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $7,000/$45 - Premium Network","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Cumberland","Dauphin","Lackawanna","Lebanon","Luzerne","Lycoming","Perry","Sullivan","Tioga","Wyoming"],"rates":{"3":{"base21":759.07,"tobaccoFactor":1.025004},"9":{"base21":841.98,"tobaccoFactor":1.025001}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":4000,"fam":8000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"xray":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":45,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":30,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}}},"notes":["Pennie plan, cost-sharing variant. UPMC's published SBC for this variant is defective (its drug and ambulatory-surgery-facility cells are printed one row down; upmc.py DEFECTIVE), so its cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134925920, \"2027 IND PPO Standard.xlsx\", variant 05 in-network column). The defective SBC equals that column on page 1 and every other compared row; the column equals, rule for rule, that of the same design's variant 16481PA0050113-05 (rating areas 1, 2, 4, 5), whose SBC equals its own column.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as UPMC's SBCs of the same designs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $30 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $45 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: 40% coinsurance (its other imaging row, used here). Other diagnostic testing: 40% coinsurance.","Mental health: office visits, psychotherapy and counseling $30 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) 40% coinsurance.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134925920/2027 IND PPO Standard.xlsx"},{"market":"pennie","id":"16481PA0050115-06","standardId":"16481PA0050115","variant":"csr94","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $7,000/$45 - Premium Network","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Cumberland","Dauphin","Lackawanna","Lebanon","Luzerne","Lycoming","Perry","Sullivan","Tioga","Wyoming"],"rates":{"3":{"base21":759.07,"tobaccoFactor":1.025004},"9":{"base21":841.98,"tobaccoFactor":1.025001}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":2300,"fam":4600},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"free","ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests (no cost), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy no cost; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAPM5_PPO_RX1N83_IDA0_2027_16481PA005011506.pdf"},{"market":"pennie","id":"16481PA0050116-01","standardId":"16481PA0050116","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $7,000/$45 - Premium Network with Adult Dental and Vision","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Cumberland","Dauphin","Lackawanna","Lebanon","Luzerne","Lycoming","Perry","Sullivan","Tioga","Wyoming"],"rates":{"3":{"base21":780.34,"tobaccoFactor":1.025002},"9":{"base21":865.56,"tobaccoFactor":1.025001}},"ded":{"ind":7000,"fam":14000,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":45,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($65 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $45 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($45 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAPM9_PPO_RX1N81_IDA0_2027_16481PA005011601.pdf"},{"market":"pennie","id":"16481PA0050116-04","standardId":"16481PA0050116","variant":"csr73","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $7,000/$45 - Premium Network with Adult Dental and Vision","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Cumberland","Dauphin","Lackawanna","Lebanon","Luzerne","Lycoming","Perry","Sullivan","Tioga","Wyoming"],"rates":{"3":{"base21":780.34,"tobaccoFactor":1.025002},"9":{"base21":865.56,"tobaccoFactor":1.025001}},"ded":{"ind":2800,"fam":5600,"embedded":true},"drugDed":null,"oop":{"ind":9500,"fam":19000},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":45,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($65 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $45 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($45 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAPM8_PPO_RX1N81_IDA0_2027_16481PA005011604.pdf"},{"market":"pennie","id":"16481PA0050116-05","standardId":"16481PA0050116","variant":"csr87","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $7,000/$45 - Premium Network with Adult Dental and Vision","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Cumberland","Dauphin","Lackawanna","Lebanon","Luzerne","Lycoming","Perry","Sullivan","Tioga","Wyoming"],"rates":{"3":{"base21":780.34,"tobaccoFactor":1.025002},"9":{"base21":865.56,"tobaccoFactor":1.025001}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":4000,"fam":8000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":45,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":30,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($45 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $30 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($30 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAPM6_PPO_RX1N83_IDA0_2027_16481PA005011605.pdf"},{"market":"pennie","id":"16481PA0050116-06","standardId":"16481PA0050116","variant":"csr94","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $7,000/$45 - Premium Network with Adult Dental and Vision","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Cumberland","Dauphin","Lackawanna","Lebanon","Luzerne","Lycoming","Perry","Sullivan","Tioga","Wyoming"],"rates":{"3":{"base21":780.34,"tobaccoFactor":1.025002},"9":{"base21":865.56,"tobaccoFactor":1.025001}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":2300,"fam":4600},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"free","ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests (no cost), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy no cost; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAPM5_PPO_RX1N83_IDA0_2027_16481PA005011606.pdf"},{"market":"pennie","id":"16481PA0050118-01","standardId":"16481PA0050118","variant":"standard","issuer":"UPMC Health Network","name":"UPMC VirtualCare Silver $4,400/$35 - Premium Network","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":597.58,"tobaccoFactor":1.025001},"2":{"base21":794.5,"tobaccoFactor":1.024997},"4":{"base21":597.58,"tobaccoFactor":1.025001},"5":{"base21":644.49,"tobaccoFactor":1.024997}},"ded":{"ind":4400,"fam":8800,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":35,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($50 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $35 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($35 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","The SBC does not say whether the deductible applies to generic drugs; the benefit details Pennie lists for this plan show no deductible, so they are treated as before the deductible.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAPM1_PPO_RX1N84_IDA0_2027_16481PA005011801.pdf"},{"market":"pennie","id":"16481PA0050118-04","standardId":"16481PA0050118","variant":"csr73","issuer":"UPMC Health Network","name":"UPMC VirtualCare Silver $4,400/$35 - Premium Network","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":597.58,"tobaccoFactor":1.025001},"2":{"base21":794.5,"tobaccoFactor":1.024997},"4":{"base21":597.58,"tobaccoFactor":1.025001},"5":{"base21":644.49,"tobaccoFactor":1.024997}},"ded":{"ind":3400,"fam":6800,"embedded":true},"drugDed":null,"oop":{"ind":8900,"fam":17800},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":35,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($50 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $35 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($35 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","The SBC does not say whether the deductible applies to generic drugs; the benefit details Pennie lists for this plan show no deductible, so they are treated as before the deductible.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAPK7_PPO_RX1N84_IDA0_2027_16481PA005011804.pdf"},{"market":"pennie","id":"16481PA0050118-05","standardId":"16481PA0050118","variant":"csr87","issuer":"UPMC Health Network","name":"UPMC VirtualCare Silver $4,400/$35 - Premium Network","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":597.58,"tobaccoFactor":1.025001},"2":{"base21":794.5,"tobaccoFactor":1.024997},"4":{"base21":597.58,"tobaccoFactor":1.025001},"5":{"base21":644.49,"tobaccoFactor":1.024997}},"ded":{"ind":700,"fam":1400,"embedded":true},"drugDed":null,"oop":{"ind":3000,"fam":6000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":35,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":25,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":30,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($35 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $30 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($30 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","The SBC does not say whether the deductible applies to generic drugs; the benefit details Pennie lists for this plan show no deductible, so they are treated as before the deductible.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAPK9_PPO_RX1M06_IDA0_2027_16481PA005011805.pdf"},{"market":"pennie","id":"16481PA0050118-06","standardId":"16481PA0050118","variant":"csr94","issuer":"UPMC Health Network","name":"UPMC VirtualCare Silver $4,400/$35 - Premium Network","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":597.58,"tobaccoFactor":1.025001},"2":{"base21":794.5,"tobaccoFactor":1.024997},"4":{"base21":597.58,"tobaccoFactor":1.025001},"5":{"base21":644.49,"tobaccoFactor":1.024997}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":2500,"fam":5000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":10,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":10,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($10 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $10 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($10 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAPM2_PPO_RX1N86_IDA0_2027_16481PA005011806.pdf"},{"market":"pennie","id":"16481PA0050119-01","standardId":"16481PA0050119","variant":"standard","issuer":"UPMC Health Network","name":"UPMC VirtualCare Bronze $3,300/$50 - Premium Network","metal":"Bronze","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":413.73,"tobaccoFactor":1.024992},"2":{"base21":550.07,"tobaccoFactor":1.024997},"4":{"base21":413.73,"tobaccoFactor":1.024992},"5":{"base21":446.21,"tobaccoFactor":1.025011}},"ded":{"ind":3300,"fam":6600,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":50,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($80 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $50 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($50 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","The SBC does not say whether the deductible applies to generic drugs; the benefit details Pennie lists for this plan show no deductible, so they are treated as before the deductible.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAPM7_PPO_RX1F33_IDA0_2027_16481PA005011901.pdf"},{"market":"pennie","id":"16481PA0050120-01","standardId":"16481PA0050120","variant":"standard","issuer":"UPMC Health Network","name":"UPMC VirtualCare Bronze $3,300/$50 - Premium Network with Adult Dental and Vision","metal":"Bronze","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":430.45,"tobaccoFactor":1.024997},"2":{"base21":572.29,"tobaccoFactor":1.025005},"4":{"base21":430.45,"tobaccoFactor":1.024997},"5":{"base21":464.24,"tobaccoFactor":1.025009}},"ded":{"ind":3300,"fam":6600,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":50,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($80 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $50 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($50 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","The SBC does not say whether the deductible applies to generic drugs; the benefit details Pennie lists for this plan show no deductible, so they are treated as before the deductible.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAPM7_PPO_RX1F33_IDA0_2027_16481PA005012001.pdf"},{"market":"pennie","id":"16481PA0050121-01","standardId":"16481PA0050121","variant":"standard","issuer":"UPMC Health Network","name":"UPMC First Care Bronze $8,500/$50 - Premium Network","metal":"Bronze","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":369.96,"tobaccoFactor":1.025003},"2":{"base21":491.87,"tobaccoFactor":1.025007},"4":{"base21":369.96,"tobaccoFactor":1.025003},"5":{"base21":399,"tobaccoFactor":1.025013}},"ded":{"ind":8500,"fam":17000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"no_ded"}}},"specialist":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"no_ded"}}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":50,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Primary care visits: the first office or virtual visit is free; later visits are $50 copay per visit.","Specialist visits: the first office or virtual visit is free; later visits are $100 copay per visit. (The benefit details Pennie lists show the specialist visit as a plain copay, without the free first visit; the SBC is used.)","Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($100 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy no cost; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($50 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","The SBC does not say whether the deductible applies to generic drugs; the benefit details Pennie lists for this plan show no deductible, so they are treated as before the deductible.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/X0AP4_PPO_RX1F33_IDA0_2027_16481PA005012101.pdf"},{"market":"pennie","id":"16481PA0050122-01","standardId":"16481PA0050122","variant":"standard","issuer":"UPMC Health Network","name":"UPMC First Care Bronze $8,500/$50 - Premium Network with Adult Dental and Vision","metal":"Bronze","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":386.67,"tobaccoFactor":1.025008},"2":{"base21":514.09,"tobaccoFactor":1.024996},"4":{"base21":386.67,"tobaccoFactor":1.025008},"5":{"base21":417.03,"tobaccoFactor":1.02501}},"ded":{"ind":8500,"fam":17000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"no_ded"}}},"specialist":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"no_ded"}}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":50,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Primary care visits: the first office or virtual visit is free; later visits are $50 copay per visit.","Specialist visits: the first office or virtual visit is free; later visits are $100 copay per visit. (The benefit details Pennie lists show the specialist visit as a plain copay, without the free first visit; the SBC is used.)","Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($100 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy no cost; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($50 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","The SBC does not say whether the deductible applies to generic drugs; the benefit details Pennie lists for this plan show no deductible, so they are treated as before the deductible.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/X0AP4_PPO_RX1F33_IDA0_2027_16481PA005012201.pdf"},{"market":"pennie","id":"16481PA0050123-01","standardId":"16481PA0050123","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Bronze $6,700/$0 - Premium Network","metal":"Bronze","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":364.59,"tobaccoFactor":1.024987},"2":{"base21":484.74,"tobaccoFactor":1.025003},"4":{"base21":364.59,"tobaccoFactor":1.024987},"5":{"base21":393.21,"tobaccoFactor":1.024999}},"ded":{"ind":6700,"fam":13400,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests (40% coinsurance), used for both, and says certain diagnostic services may have additional cost sharing.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy no cost; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","The SBC does not say whether the deductible applies to generic drugs; the benefit details Pennie lists for this plan show no deductible, so they are treated as before the deductible.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAPM4_PPO_RX1F33_IDA0_2027_16481PA005012301.pdf"},{"market":"pennie","id":"16481PA0050124-01","standardId":"16481PA0050124","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Bronze $6,700/$0 - Premium Network with Adult Dental and Vision","metal":"Bronze","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":381.31,"tobaccoFactor":1.024993},"2":{"base21":506.96,"tobaccoFactor":1.024992},"4":{"base21":381.31,"tobaccoFactor":1.024993},"5":{"base21":411.24,"tobaccoFactor":1.024998}},"ded":{"ind":6700,"fam":13400,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests (40% coinsurance), used for both, and says certain diagnostic services may have additional cost sharing.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy no cost; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","The SBC does not say whether the deductible applies to generic drugs; the benefit details Pennie lists for this plan show no deductible, so they are treated as before the deductible.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAPM4_PPO_RX1F33_IDA0_2027_16481PA005012401.pdf"},{"market":"pennie","id":"16481PA0050125-01","standardId":"16481PA0050125","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Bronze $6,700/$0 - Premium Network","metal":"Bronze","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Cumberland","Dauphin","Lackawanna","Lebanon","Luzerne","Lycoming","Sullivan","Tioga","Wyoming"],"rates":{"3":{"base21":463.75,"tobaccoFactor":1.024992},"9":{"base21":514.4,"tobaccoFactor":1.025}},"ded":{"ind":6700,"fam":13400,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests (40% coinsurance), used for both, and says certain diagnostic services may have additional cost sharing.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy no cost; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","The SBC does not say whether the deductible applies to generic drugs; the benefit details Pennie lists for this plan show no deductible, so they are treated as before the deductible.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAPM4_PPO_RX1F33_IDA0_2027_16481PA005012501.pdf"},{"market":"pennie","id":"16481PA0050126-01","standardId":"16481PA0050126","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Bronze $6,700/$0 - Premium Network with Adult Dental and Vision","metal":"Bronze","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Cumberland","Dauphin","Lackawanna","Lebanon","Luzerne","Lycoming","Perry","Sullivan","Tioga","Wyoming"],"rates":{"3":{"base21":485.01,"tobaccoFactor":1.02501},"9":{"base21":537.98,"tobaccoFactor":1.025001}},"ded":{"ind":6700,"fam":13400,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests (40% coinsurance), used for both, and says certain diagnostic services may have additional cost sharing.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy no cost; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","The SBC does not say whether the deductible applies to generic drugs; the benefit details Pennie lists for this plan show no deductible, so they are treated as before the deductible.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAPM4_PPO_RX1F33_IDA0_2027_16481PA005012601.pdf"},{"market":"pennie","id":"16481PA0050127-01","standardId":"16481PA0050127","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Catastrophic $12,000/$0 - Premium Network","metal":"Catastrophic","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":340.58,"tobaccoFactor":1.024987},"2":{"base21":452.81,"tobaccoFactor":1.024999},"4":{"base21":340.58,"tobaccoFactor":1.024987},"5":{"base21":367.32,"tobaccoFactor":1.024992}},"ded":{"ind":12000,"fam":24000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests (no cost), used for both, and says certain diagnostic services may have additional cost sharing.","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy no cost; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAPK8_PPO_RX1D05_IDA1_2027_16481PA005012701.pdf"},{"market":"pennie","id":"16481PA0120001-01","standardId":"16481PA0120001","variant":"standard","issuer":"UPMC Health Network","name":"UPMC First Care Gold $0/$20 - Partner Network","metal":"Gold","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Clinton","Erie","Greene","Lawrence","Lycoming","McKean","Mercer","Potter","Somerset","Tioga","Venango","Washington"],"rates":{"1":{"base21":387.42,"tobaccoFactor":1.025012},"2":{"base21":515.09,"tobaccoFactor":1.025005},"3":{"base21":492.79,"tobaccoFactor":1.025001},"4":{"base21":387.42,"tobaccoFactor":1.025012},"5":{"base21":417.84,"tobaccoFactor":1.02501}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":8750,"fam":17500},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"no_ded"}}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"no_ded"}}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":20,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}}},"notes":["Primary care visits: the first office or virtual visit is free; later visits are $20 copay per visit.","Specialist visits: the first office or virtual visit is free; later visits are $50 copay per visit. (The benefit details Pennie lists show the specialist visit as a plain copay, without the free first visit; the SBC is used.)","Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($50 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 30% coinsurance; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Emergency room: the copay is waived if you are admitted.","Mental health: outpatient office visits and therapy no cost; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($20 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/X0AE6_EPO_RX1L98_IDA0_2027_16481PA012000101.pdf"},{"market":"pennie","id":"16481PA0120002-01","standardId":"16481PA0120002","variant":"standard","issuer":"UPMC Health Network","name":"UPMC First Care Gold $0/$20 - Partner Network with Adult Dental and Vision","metal":"Gold","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Clinton","Erie","Greene","Lawrence","Lycoming","McKean","Mercer","Potter","Somerset","Tioga","Venango","Washington"],"rates":{"1":{"base21":404.14,"tobaccoFactor":1.024991},"2":{"base21":537.31,"tobaccoFactor":1.024995},"3":{"base21":514.05,"tobaccoFactor":1.024998},"4":{"base21":404.14,"tobaccoFactor":1.024991},"5":{"base21":435.86,"tobaccoFactor":1.025008}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":8750,"fam":17500},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"no_ded"}}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"no_ded"}}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":20,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}}},"notes":["Primary care visits: the first office or virtual visit is free; later visits are $20 copay per visit.","Specialist visits: the first office or virtual visit is free; later visits are $50 copay per visit. (The benefit details Pennie lists show the specialist visit as a plain copay, without the free first visit; the SBC is used.)","Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($50 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 30% coinsurance; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Emergency room: the copay is waived if you are admitted.","Mental health: outpatient office visits and therapy no cost; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($20 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/X0AE6_EPO_RX1L98_IDA0_2027_16481PA012000201.pdf"},{"market":"pennie","id":"16481PA0120003-01","standardId":"16481PA0120003","variant":"standard","issuer":"UPMC Health Network","name":"UPMC First Care Gold $0/$20 - Select Network","metal":"Gold","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Fayette","Washington","Westmoreland"],"rates":{"4":{"base21":409.52,"tobaccoFactor":1.025005}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":8750,"fam":17500},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"no_ded"}}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"no_ded"}}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":20,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}}},"notes":["Primary care visits: the first office or virtual visit is free; later visits are $20 copay per visit.","Specialist visits: the first office or virtual visit is free; later visits are $50 copay per visit. (The benefit details Pennie lists show the specialist visit as a plain copay, without the free first visit; the SBC is used.)","Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($50 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 30% coinsurance; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Emergency room: the copay is waived if you are admitted.","Mental health: outpatient office visits and therapy no cost; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($20 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/X0AE9_EPO_RX1L98_IDA0_2027_16481PA012000301.pdf"},{"market":"pennie","id":"16481PA0120004-01","standardId":"16481PA0120004","variant":"standard","issuer":"UPMC Health Network","name":"UPMC First Care Gold $0/$20 - Select Network with Adult Dental and Vision","metal":"Gold","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Fayette","Washington","Westmoreland"],"rates":{"4":{"base21":426.24,"tobaccoFactor":1.025009}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":8750,"fam":17500},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"no_ded"}}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"no_ded"}}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":20,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}}},"notes":["Primary care visits: the first office or virtual visit is free; later visits are $20 copay per visit.","Specialist visits: the first office or virtual visit is free; later visits are $50 copay per visit. (The benefit details Pennie lists show the specialist visit as a plain copay, without the free first visit; the SBC is used.)","Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($50 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 30% coinsurance; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Emergency room: the copay is waived if you are admitted.","Mental health: outpatient office visits and therapy no cost; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($20 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/X0AE9_EPO_RX1L98_IDA0_2027_16481PA012000401.pdf"},{"market":"pennie","id":"16481PA0120005-01","standardId":"16481PA0120005","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Gold $1,000/$20 - Partner Network","metal":"Gold","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Clinton","Erie","Greene","Lawrence","Lycoming","McKean","Mercer","Potter","Somerset","Tioga","Venango","Washington"],"rates":{"1":{"base21":367.16,"tobaccoFactor":1.025003},"2":{"base21":488.16,"tobaccoFactor":1.024992},"3":{"base21":467.02,"tobaccoFactor":1.02501},"4":{"base21":367.16,"tobaccoFactor":1.025003},"5":{"base21":395.99,"tobaccoFactor":1.025001}},"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":20,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($50 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 30% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $20 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($20 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE2G_EPO_RX1L98_IDA0_2027_16481PA012000501.pdf"},{"market":"pennie","id":"16481PA0120006-01","standardId":"16481PA0120006","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Gold $1,000/$20 - Partner Network with Adult Dental and Vision","metal":"Gold","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Clinton","Erie","Greene","Lawrence","Lycoming","McKean","Mercer","Potter","Somerset","Tioga","Venango","Washington"],"rates":{"1":{"base21":383.88,"tobaccoFactor":1.025008},"2":{"base21":510.38,"tobaccoFactor":1.025001},"3":{"base21":488.28,"tobaccoFactor":1.025006},"4":{"base21":383.88,"tobaccoFactor":1.025008},"5":{"base21":414.02,"tobaccoFactor":1.024999}},"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":20,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($50 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 30% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $20 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($20 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE2G_EPO_RX1L98_IDA0_2027_16481PA012000601.pdf"},{"market":"pennie","id":"16481PA0120007-01","standardId":"16481PA0120007","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Gold $1,000/$20 - Select Network","metal":"Gold","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Fayette","Washington","Westmoreland"],"rates":{"4":{"base21":388.11,"tobaccoFactor":1.024993}},"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":20,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($50 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 30% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $20 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($20 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE1W_EPO_RX1L98_IDA0_2027_16481PA012000701.pdf"},{"market":"pennie","id":"16481PA0120008-01","standardId":"16481PA0120008","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Gold $1,000/$20 - Select Network with Adult Dental and Vision","metal":"Gold","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Fayette","Washington","Westmoreland"],"rates":{"4":{"base21":404.82,"tobaccoFactor":1.024999}},"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":20,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($50 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 30% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $20 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($20 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE1W_EPO_RX1L98_IDA0_2027_16481PA012000801.pdf"},{"market":"pennie","id":"16481PA0120009-01","standardId":"16481PA0120009","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Gold HSA $2,900/10% - Partner Network","metal":"Gold","network":"EPO","hsaEligible":true,"counties":["Allegheny","Bedford","Blair","Butler","Clinton","Erie","Greene","Lawrence","Lycoming","McKean","Mercer","Potter","Somerset","Tioga","Venango","Washington"],"rates":{"1":{"base21":321.86,"tobaccoFactor":1.025011},"2":{"base21":427.93,"tobaccoFactor":1.025004},"3":{"base21":409.4,"tobaccoFactor":1.025012},"4":{"base21":321.86,"tobaccoFactor":1.025011},"5":{"base21":347.13,"tobaccoFactor":1.025005}},"ded":{"ind":2900,"fam":5800,"embedded":false},"drugDed":null,"oop":{"ind":6000,"fam":12000,"famPerPerson":12000},"rules":{"pcp":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests (10% coinsurance), used for both, and says certain diagnostic services may have additional cost sharing.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy 10% coinsurance; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share (10% coinsurance) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","The SBC says the overall family deductible must be met before the plan begins to pay (a family deductible, not one per person), and the estimate uses the aggregate family deductible.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XASEN_EPO_RX1M58_IDA0_2027_16481PA012000901.pdf"},{"market":"pennie","id":"16481PA0120010-01","standardId":"16481PA0120010","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Gold HSA $2,900/10% - Select Network","metal":"Gold","network":"EPO","hsaEligible":true,"counties":["Allegheny","Beaver","Butler","Fayette","Washington","Westmoreland"],"rates":{"4":{"base21":340.23,"tobaccoFactor":1.025012}},"ded":{"ind":2900,"fam":5800,"embedded":false},"drugDed":null,"oop":{"ind":6000,"fam":12000,"famPerPerson":12000},"rules":{"pcp":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests (10% coinsurance), used for both, and says certain diagnostic services may have additional cost sharing.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy 10% coinsurance; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share (10% coinsurance) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","The SBC says the overall family deductible must be met before the plan begins to pay (a family deductible, not one per person), and the estimate uses the aggregate family deductible.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XASEO_EPO_RX1M58_IDA0_2027_16481PA012001001.pdf"},{"market":"pennie","id":"16481PA0120017-01","standardId":"16481PA0120017","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $7,000/$45 - Partner Network","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Clinton","Erie","Greene","Lawrence","Lycoming","McKean","Mercer","Potter","Somerset","Tioga","Venango","Washington"],"rates":{"1":{"base21":423.9,"tobaccoFactor":1.025006},"2":{"base21":563.59,"tobaccoFactor":1.025},"3":{"base21":539.2,"tobaccoFactor":1.025},"4":{"base21":423.9,"tobaccoFactor":1.025006},"5":{"base21":457.18,"tobaccoFactor":1.025001}},"ded":{"ind":7000,"fam":14000,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":45,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($65 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $45 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($45 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE2C_EPO_RX1N81_IDA0_2027_16481PA012001701.pdf"},{"market":"pennie","id":"16481PA0120017-04","standardId":"16481PA0120017","variant":"csr73","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $7,000/$45 - Partner Network","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Clinton","Erie","Greene","Lawrence","Lycoming","McKean","Mercer","Potter","Somerset","Tioga","Venango","Washington"],"rates":{"1":{"base21":423.9,"tobaccoFactor":1.025006},"2":{"base21":563.59,"tobaccoFactor":1.025},"3":{"base21":539.2,"tobaccoFactor":1.025},"4":{"base21":423.9,"tobaccoFactor":1.025006},"5":{"base21":457.18,"tobaccoFactor":1.025001}},"ded":{"ind":2800,"fam":5600,"embedded":true},"drugDed":null,"oop":{"ind":9500,"fam":19000},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":45,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($65 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $45 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($45 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE2B_EPO_RX1N81_IDA0_2027_16481PA012001704.pdf"},{"market":"pennie","id":"16481PA0120017-05","standardId":"16481PA0120017","variant":"csr87","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $7,000/$45 - Partner Network","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Clinton","Erie","Greene","Lawrence","Lycoming","McKean","Mercer","Potter","Somerset","Tioga","Venango","Washington"],"rates":{"1":{"base21":423.9,"tobaccoFactor":1.025006},"2":{"base21":563.59,"tobaccoFactor":1.025},"3":{"base21":539.2,"tobaccoFactor":1.025},"4":{"base21":423.9,"tobaccoFactor":1.025006},"5":{"base21":457.18,"tobaccoFactor":1.025001}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":4000,"fam":8000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":45,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":30,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($45 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $30 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($30 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE2A_EPO_RX1N83_IDA0_2027_16481PA012001705.pdf"},{"market":"pennie","id":"16481PA0120017-06","standardId":"16481PA0120017","variant":"csr94","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $7,000/$45 - Partner Network","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Clinton","Erie","Greene","Lawrence","Lycoming","McKean","Mercer","Potter","Somerset","Tioga","Venango","Washington"],"rates":{"1":{"base21":423.9,"tobaccoFactor":1.025006},"2":{"base21":563.59,"tobaccoFactor":1.025},"3":{"base21":539.2,"tobaccoFactor":1.025},"4":{"base21":423.9,"tobaccoFactor":1.025006},"5":{"base21":457.18,"tobaccoFactor":1.025001}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":2300,"fam":4600},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"free","ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests (no cost), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy no cost; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE2K_EPO_RX1N83_IDA0_2027_16481PA012001706.pdf"},{"market":"pennie","id":"16481PA0120018-01","standardId":"16481PA0120018","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $7,000/$45 - Partner Network with Adult Dental and Vision","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Clinton","Erie","Greene","Lawrence","Lycoming","McKean","Mercer","Potter","Somerset","Tioga","Venango","Washington"],"rates":{"1":{"base21":440.62,"tobaccoFactor":1.02501},"2":{"base21":585.82,"tobaccoFactor":1.025008},"3":{"base21":560.46,"tobaccoFactor":1.024997},"4":{"base21":440.62,"tobaccoFactor":1.02501},"5":{"base21":475.21,"tobaccoFactor":1.024999}},"ded":{"ind":7000,"fam":14000,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":45,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($65 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $45 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($45 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE2C_EPO_RX1N81_IDA0_2027_16481PA012001801.pdf"},{"market":"pennie","id":"16481PA0120018-04","standardId":"16481PA0120018","variant":"csr73","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $7,000/$45 - Partner Network with Adult Dental and Vision","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Clinton","Erie","Greene","Lawrence","Lycoming","McKean","Mercer","Potter","Somerset","Tioga","Venango","Washington"],"rates":{"1":{"base21":440.62,"tobaccoFactor":1.02501},"2":{"base21":585.82,"tobaccoFactor":1.025008},"3":{"base21":560.46,"tobaccoFactor":1.024997},"4":{"base21":440.62,"tobaccoFactor":1.02501},"5":{"base21":475.21,"tobaccoFactor":1.024999}},"ded":{"ind":2800,"fam":5600,"embedded":true},"drugDed":null,"oop":{"ind":9500,"fam":19000},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":45,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($65 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $45 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($45 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE2B_EPO_RX1N81_IDA0_2027_16481PA012001804.pdf"},{"market":"pennie","id":"16481PA0120018-05","standardId":"16481PA0120018","variant":"csr87","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $7,000/$45 - Partner Network with Adult Dental and Vision","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Clinton","Erie","Greene","Lawrence","Lycoming","McKean","Mercer","Potter","Somerset","Tioga","Venango","Washington"],"rates":{"1":{"base21":440.62,"tobaccoFactor":1.02501},"2":{"base21":585.82,"tobaccoFactor":1.025008},"3":{"base21":560.46,"tobaccoFactor":1.024997},"4":{"base21":440.62,"tobaccoFactor":1.02501},"5":{"base21":475.21,"tobaccoFactor":1.024999}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":4000,"fam":8000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":45,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":30,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($45 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $30 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($30 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE2A_EPO_RX1N83_IDA0_2027_16481PA012001805.pdf"},{"market":"pennie","id":"16481PA0120018-06","standardId":"16481PA0120018","variant":"csr94","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $7,000/$45 - Partner Network with Adult Dental and Vision","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Clinton","Erie","Greene","Lawrence","Lycoming","McKean","Mercer","Potter","Somerset","Tioga","Venango","Washington"],"rates":{"1":{"base21":440.62,"tobaccoFactor":1.02501},"2":{"base21":585.82,"tobaccoFactor":1.025008},"3":{"base21":560.46,"tobaccoFactor":1.024997},"4":{"base21":440.62,"tobaccoFactor":1.02501},"5":{"base21":475.21,"tobaccoFactor":1.024999}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":2300,"fam":4600},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"free","ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests (no cost), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy no cost; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE2K_EPO_RX1N83_IDA0_2027_16481PA012001806.pdf"},{"market":"pennie","id":"16481PA0120019-01","standardId":"16481PA0120019","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $7,000/$45 - Select Network","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Fayette","Washington","Westmoreland"],"rates":{"4":{"base21":448.09,"tobaccoFactor":1.024995}},"ded":{"ind":7000,"fam":14000,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":45,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($65 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $45 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($45 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE2I_EPO_RX1N81_IDA0_2027_16481PA012001901.pdf"},{"market":"pennie","id":"16481PA0120019-04","standardId":"16481PA0120019","variant":"csr73","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $7,000/$45 - Select Network","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Fayette","Washington","Westmoreland"],"rates":{"4":{"base21":448.09,"tobaccoFactor":1.024995}},"ded":{"ind":2800,"fam":5600,"embedded":true},"drugDed":null,"oop":{"ind":9500,"fam":19000},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":45,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($65 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $45 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($45 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE2E_EPO_RX1N81_IDA0_2027_16481PA012001904.pdf"},{"market":"pennie","id":"16481PA0120019-05","standardId":"16481PA0120019","variant":"csr87","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $7,000/$45 - Select Network","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Fayette","Washington","Westmoreland"],"rates":{"4":{"base21":448.09,"tobaccoFactor":1.024995}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":4000,"fam":8000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":45,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":30,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($45 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $30 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($30 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE1Y_EPO_RX1N83_IDA0_2027_16481PA012001905.pdf"},{"market":"pennie","id":"16481PA0120019-06","standardId":"16481PA0120019","variant":"csr94","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $7,000/$45 - Select Network","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Fayette","Washington","Westmoreland"],"rates":{"4":{"base21":448.09,"tobaccoFactor":1.024995}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":2300,"fam":4600},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"free","ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests (no cost), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy no cost; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE2H_EPO_RX1N83_IDA0_2027_16481PA012001906.pdf"},{"market":"pennie","id":"16481PA0120020-01","standardId":"16481PA0120020","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $7,000/$45 - Select Network with Adult Dental and Vision","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Fayette","Washington","Westmoreland"],"rates":{"4":{"base21":464.8,"tobaccoFactor":1.025}},"ded":{"ind":7000,"fam":14000,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":45,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($65 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $45 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($45 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE2I_EPO_RX1N81_IDA0_2027_16481PA012002001.pdf"},{"market":"pennie","id":"16481PA0120020-04","standardId":"16481PA0120020","variant":"csr73","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $7,000/$45 - Select Network with Adult Dental and Vision","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Fayette","Washington","Westmoreland"],"rates":{"4":{"base21":464.8,"tobaccoFactor":1.025}},"ded":{"ind":2800,"fam":5600,"embedded":true},"drugDed":null,"oop":{"ind":9500,"fam":19000},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":45,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($65 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $45 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($45 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE2E_EPO_RX1N81_IDA0_2027_16481PA012002004.pdf"},{"market":"pennie","id":"16481PA0120020-05","standardId":"16481PA0120020","variant":"csr87","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $7,000/$45 - Select Network with Adult Dental and Vision","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Fayette","Washington","Westmoreland"],"rates":{"4":{"base21":464.8,"tobaccoFactor":1.025}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":4000,"fam":8000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":45,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":30,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($45 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $30 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($30 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE1Y_EPO_RX1N83_IDA0_2027_16481PA012002005.pdf"},{"market":"pennie","id":"16481PA0120020-06","standardId":"16481PA0120020","variant":"csr94","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $7,000/$45 - Select Network with Adult Dental and Vision","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Fayette","Washington","Westmoreland"],"rates":{"4":{"base21":464.8,"tobaccoFactor":1.025}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":2300,"fam":4600},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"free","ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests (no cost), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy no cost; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE2H_EPO_RX1N83_IDA0_2027_16481PA012002006.pdf"},{"market":"pennie","id":"16481PA0120023-01","standardId":"16481PA0120023","variant":"standard","issuer":"UPMC Health Network","name":"UPMC VirtualCare Silver $4,400/$35 - Partner Network","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Clinton","Erie","Greene","Lawrence","Lycoming","McKean","Mercer","Potter","Somerset","Tioga","Venango","Washington"],"rates":{"1":{"base21":423.31,"tobaccoFactor":1.024994},"2":{"base21":562.8,"tobaccoFactor":1.025},"3":{"base21":538.44,"tobaccoFactor":1.024998},"4":{"base21":423.31,"tobaccoFactor":1.024994},"5":{"base21":456.54,"tobaccoFactor":1.024992}},"ded":{"ind":4400,"fam":8800,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":35,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($50 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $35 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($35 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","The SBC does not say whether the deductible applies to generic drugs; the benefit details Pennie lists for this plan show no deductible, so they are treated as before the deductible.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE1R_EPO_RX1N84_IDA0_2027_16481PA012002301.pdf"},{"market":"pennie","id":"16481PA0120023-04","standardId":"16481PA0120023","variant":"csr73","issuer":"UPMC Health Network","name":"UPMC VirtualCare Silver $4,400/$35 - Partner Network","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Clinton","Erie","Greene","Lawrence","Lycoming","McKean","Mercer","Potter","Somerset","Tioga","Venango","Washington"],"rates":{"1":{"base21":423.31,"tobaccoFactor":1.024994},"2":{"base21":562.8,"tobaccoFactor":1.025},"3":{"base21":538.44,"tobaccoFactor":1.024998},"4":{"base21":423.31,"tobaccoFactor":1.024994},"5":{"base21":456.54,"tobaccoFactor":1.024992}},"ded":{"ind":3400,"fam":6800,"embedded":true},"drugDed":null,"oop":{"ind":8900,"fam":17800},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":35,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($50 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $35 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($35 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","The SBC does not say whether the deductible applies to generic drugs; the benefit details Pennie lists for this plan show no deductible, so they are treated as before the deductible.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE1V_EPO_RX1N84_IDA0_2027_16481PA012002304.pdf"},{"market":"pennie","id":"16481PA0120023-05","standardId":"16481PA0120023","variant":"csr87","issuer":"UPMC Health Network","name":"UPMC VirtualCare Silver $4,400/$35 - Partner Network","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Clinton","Erie","Greene","Lawrence","Lycoming","McKean","Mercer","Potter","Somerset","Tioga","Venango","Washington"],"rates":{"1":{"base21":423.31,"tobaccoFactor":1.024994},"2":{"base21":562.8,"tobaccoFactor":1.025},"3":{"base21":538.44,"tobaccoFactor":1.024998},"4":{"base21":423.31,"tobaccoFactor":1.024994},"5":{"base21":456.54,"tobaccoFactor":1.024992}},"ded":{"ind":700,"fam":1400,"embedded":true},"drugDed":null,"oop":{"ind":3000,"fam":6000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":35,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":25,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":30,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($35 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $30 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($30 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","The SBC does not say whether the deductible applies to generic drugs; the benefit details Pennie lists for this plan show no deductible, so they are treated as before the deductible.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE1S_EPO_RX1M06_IDA0_2027_16481PA012002305.pdf"},{"market":"pennie","id":"16481PA0120023-06","standardId":"16481PA0120023","variant":"csr94","issuer":"UPMC Health Network","name":"UPMC VirtualCare Silver $4,400/$35 - Partner Network","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Clinton","Erie","Greene","Lawrence","Lycoming","McKean","Mercer","Potter","Somerset","Tioga","Venango","Washington"],"rates":{"1":{"base21":423.31,"tobaccoFactor":1.024994},"2":{"base21":562.8,"tobaccoFactor":1.025},"3":{"base21":538.44,"tobaccoFactor":1.024998},"4":{"base21":423.31,"tobaccoFactor":1.024994},"5":{"base21":456.54,"tobaccoFactor":1.024992}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":2500,"fam":5000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":10,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":10,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($10 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $10 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($10 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE1N_EPO_RX1N86_IDA0_2027_16481PA012002306.pdf"},{"market":"pennie","id":"16481PA0120024-01","standardId":"16481PA0120024","variant":"standard","issuer":"UPMC Health Network","name":"UPMC VirtualCare Silver $4,400/$35 - Select Network","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Fayette","Washington","Westmoreland"],"rates":{"4":{"base21":447.46,"tobaccoFactor":1.025008}},"ded":{"ind":4400,"fam":8800,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":35,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($50 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $35 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($35 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","The SBC does not say whether the deductible applies to generic drugs; the benefit details Pennie lists for this plan show no deductible, so they are treated as before the deductible.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE1M_EPO_RX1N84_IDA0_2027_16481PA012002401.pdf"},{"market":"pennie","id":"16481PA0120024-04","standardId":"16481PA0120024","variant":"csr73","issuer":"UPMC Health Network","name":"UPMC VirtualCare Silver $4,400/$35 - Select Network","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Fayette","Washington","Westmoreland"],"rates":{"4":{"base21":447.46,"tobaccoFactor":1.025008}},"ded":{"ind":3400,"fam":6800,"embedded":true},"drugDed":null,"oop":{"ind":8900,"fam":17800},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":35,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($50 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $35 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($35 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","The SBC does not say whether the deductible applies to generic drugs; the benefit details Pennie lists for this plan show no deductible, so they are treated as before the deductible.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE1P_EPO_RX1N84_IDA0_2027_16481PA012002404.pdf"},{"market":"pennie","id":"16481PA0120024-05","standardId":"16481PA0120024","variant":"csr87","issuer":"UPMC Health Network","name":"UPMC VirtualCare Silver $4,400/$35 - Select Network","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Fayette","Washington","Westmoreland"],"rates":{"4":{"base21":447.46,"tobaccoFactor":1.025008}},"ded":{"ind":700,"fam":1400,"embedded":true},"drugDed":null,"oop":{"ind":3000,"fam":6000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":35,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":25,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":30,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($35 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $30 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($30 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","The SBC does not say whether the deductible applies to generic drugs; the benefit details Pennie lists for this plan show no deductible, so they are treated as before the deductible.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE1Q_EPO_RX1M06_IDA0_2027_16481PA012002405.pdf"},{"market":"pennie","id":"16481PA0120024-06","standardId":"16481PA0120024","variant":"csr94","issuer":"UPMC Health Network","name":"UPMC VirtualCare Silver $4,400/$35 - Select Network","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Fayette","Washington","Westmoreland"],"rates":{"4":{"base21":447.46,"tobaccoFactor":1.025008}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":2500,"fam":5000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":10,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":10,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($10 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $10 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($10 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE1O_EPO_RX1N86_IDA0_2027_16481PA012002406.pdf"},{"market":"pennie","id":"16481PA0120025-01","standardId":"16481PA0120025","variant":"standard","issuer":"UPMC Health Network","name":"UPMC VirtualCare Bronze $3,300/$50 - Partner Network","metal":"Bronze","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Clinton","Erie","Greene","Lawrence","Lycoming","McKean","Mercer","Potter","Somerset","Tioga","Venango","Washington"],"rates":{"1":{"base21":294.71,"tobaccoFactor":1.025008},"2":{"base21":391.83,"tobaccoFactor":1.025011},"3":{"base21":374.87,"tobaccoFactor":1.024995},"4":{"base21":294.71,"tobaccoFactor":1.025008},"5":{"base21":317.85,"tobaccoFactor":1.025012}},"ded":{"ind":3300,"fam":6600,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":50,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($80 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $50 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($50 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","The SBC does not say whether the deductible applies to generic drugs; the benefit details Pennie lists for this plan show no deductible, so they are treated as before the deductible.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE2F_EPO_RX1F33_IDA0_2027_16481PA012002501.pdf"},{"market":"pennie","id":"16481PA0120026-01","standardId":"16481PA0120026","variant":"standard","issuer":"UPMC Health Network","name":"UPMC VirtualCare Bronze $3,300/$50 - Partner Network with Adult Dental and Vision","metal":"Bronze","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Clinton","Erie","Greene","Lawrence","Lycoming","McKean","Mercer","Potter","Somerset","Tioga","Venango","Washington"],"rates":{"1":{"base21":311.43,"tobaccoFactor":1.025014},"2":{"base21":414.05,"tobaccoFactor":1.024997},"3":{"base21":396.13,"tobaccoFactor":1.024992},"4":{"base21":311.43,"tobaccoFactor":1.025014},"5":{"base21":335.88,"tobaccoFactor":1.025009}},"ded":{"ind":3300,"fam":6600,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":50,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($80 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $50 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($50 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","The SBC does not say whether the deductible applies to generic drugs; the benefit details Pennie lists for this plan show no deductible, so they are treated as before the deductible.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE2F_EPO_RX1F33_IDA0_2027_16481PA012002601.pdf"},{"market":"pennie","id":"16481PA0120027-01","standardId":"16481PA0120027","variant":"standard","issuer":"UPMC Health Network","name":"UPMC VirtualCare Bronze $3,300/$50 - Select Network","metal":"Bronze","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Fayette","Washington","Westmoreland"],"rates":{"4":{"base21":311.52,"tobaccoFactor":1.025006}},"ded":{"ind":3300,"fam":6600,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":50,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($80 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $50 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($50 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","The SBC does not say whether the deductible applies to generic drugs; the benefit details Pennie lists for this plan show no deductible, so they are treated as before the deductible.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE2J_EPO_RX1F33_IDA0_2027_16481PA012002701.pdf"},{"market":"pennie","id":"16481PA0120028-01","standardId":"16481PA0120028","variant":"standard","issuer":"UPMC Health Network","name":"UPMC VirtualCare Bronze $3,300/$50 - Select Network with Adult Dental and Vision","metal":"Bronze","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Fayette","Washington","Westmoreland"],"rates":{"4":{"base21":328.24,"tobaccoFactor":1.025012}},"ded":{"ind":3300,"fam":6600,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":50,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($80 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $50 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($50 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","The SBC does not say whether the deductible applies to generic drugs; the benefit details Pennie lists for this plan show no deductible, so they are treated as before the deductible.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE2J_EPO_RX1F33_IDA0_2027_16481PA012002801.pdf"},{"market":"pennie","id":"16481PA0120029-01","standardId":"16481PA0120029","variant":"standard","issuer":"UPMC Health Network","name":"UPMC First Care Bronze $8,500/$50 - Partner Network","metal":"Bronze","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Clinton","Erie","Greene","Lawrence","Lycoming","McKean","Mercer","Potter","Somerset","Tioga","Venango","Washington"],"rates":{"1":{"base21":263.8,"tobaccoFactor":1.025019},"2":{"base21":350.74,"tobaccoFactor":1.025004},"3":{"base21":335.55,"tobaccoFactor":1.025004},"4":{"base21":263.8,"tobaccoFactor":1.025019},"5":{"base21":284.52,"tobaccoFactor":1.024989}},"ded":{"ind":8500,"fam":17000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"no_ded"}}},"specialist":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"no_ded"}}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":50,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Primary care visits: the first office or virtual visit is free; later visits are $50 copay per visit.","Specialist visits: the first office or virtual visit is free; later visits are $100 copay per visit. (The benefit details Pennie lists show the specialist visit as a plain copay, without the free first visit; the SBC is used.)","Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($100 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy no cost; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($50 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","The SBC does not say whether the deductible applies to generic drugs; the benefit details Pennie lists for this plan show no deductible, so they are treated as before the deductible.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/X0AE7_EPO_RX1F33_IDA0_2027_16481PA012002901.pdf"},{"market":"pennie","id":"16481PA0120030-01","standardId":"16481PA0120030","variant":"standard","issuer":"UPMC Health Network","name":"UPMC First Care Bronze $8,500/$50 - Partner Network with Adult Dental and Vision","metal":"Bronze","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Clinton","Erie","Greene","Lawrence","Lycoming","McKean","Mercer","Potter","Somerset","Tioga","Venango","Washington"],"rates":{"1":{"base21":280.52,"tobaccoFactor":1.024989},"2":{"base21":372.96,"tobaccoFactor":1.024989},"3":{"base21":356.81,"tobaccoFactor":1.024999},"4":{"base21":280.52,"tobaccoFactor":1.024989},"5":{"base21":302.54,"tobaccoFactor":1.024988}},"ded":{"ind":8500,"fam":17000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"no_ded"}}},"specialist":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"no_ded"}}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":50,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Primary care visits: the first office or virtual visit is free; later visits are $50 copay per visit.","Specialist visits: the first office or virtual visit is free; later visits are $100 copay per visit. (The benefit details Pennie lists show the specialist visit as a plain copay, without the free first visit; the SBC is used.)","Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($100 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy no cost; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($50 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","The SBC does not say whether the deductible applies to generic drugs; the benefit details Pennie lists for this plan show no deductible, so they are treated as before the deductible.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/X0AE7_EPO_RX1F33_IDA0_2027_16481PA012003001.pdf"},{"market":"pennie","id":"16481PA0120031-01","standardId":"16481PA0120031","variant":"standard","issuer":"UPMC Health Network","name":"UPMC First Care Bronze $8,500/$50 - Select Network","metal":"Bronze","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Fayette","Washington","Westmoreland"],"rates":{"4":{"base21":278.85,"tobaccoFactor":1.024996}},"ded":{"ind":8500,"fam":17000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"no_ded"}}},"specialist":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"no_ded"}}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":50,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Primary care visits: the first office or virtual visit is free; later visits are $50 copay per visit.","Specialist visits: the first office or virtual visit is free; later visits are $100 copay per visit. (The benefit details Pennie lists show the specialist visit as a plain copay, without the free first visit; the SBC is used.)","Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($100 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy no cost; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($50 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","The SBC does not say whether the deductible applies to generic drugs; the benefit details Pennie lists for this plan show no deductible, so they are treated as before the deductible.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/X0AE8_EPO_RX1F33_IDA0_2027_16481PA012003101.pdf"},{"market":"pennie","id":"16481PA0120032-01","standardId":"16481PA0120032","variant":"standard","issuer":"UPMC Health Network","name":"UPMC First Care Bronze $8,500/$50 - Select Network with Adult Dental and Vision","metal":"Bronze","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Fayette","Washington","Westmoreland"],"rates":{"4":{"base21":295.57,"tobaccoFactor":1.025003}},"ded":{"ind":8500,"fam":17000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"no_ded"}}},"specialist":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"no_ded"}}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":50,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Primary care visits: the first office or virtual visit is free; later visits are $50 copay per visit.","Specialist visits: the first office or virtual visit is free; later visits are $100 copay per visit. (The benefit details Pennie lists show the specialist visit as a plain copay, without the free first visit; the SBC is used.)","Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($100 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy no cost; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($50 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","The SBC does not say whether the deductible applies to generic drugs; the benefit details Pennie lists for this plan show no deductible, so they are treated as before the deductible.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/X0AE8_EPO_RX1F33_IDA0_2027_16481PA012003201.pdf"},{"market":"pennie","id":"16481PA0120033-01","standardId":"16481PA0120033","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Bronze $6,700/$0 - Partner Network","metal":"Bronze","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Clinton","Erie","Greene","Lawrence","Lycoming","McKean","Mercer","Potter","Somerset","Tioga","Venango","Washington"],"rates":{"1":{"base21":260.1,"tobaccoFactor":1.02499},"2":{"base21":345.81,"tobaccoFactor":1.025014},"3":{"base21":330.84,"tobaccoFactor":1.024997},"4":{"base21":260.1,"tobaccoFactor":1.02499},"5":{"base21":280.52,"tobaccoFactor":1.024989}},"ded":{"ind":6700,"fam":13400,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests (40% coinsurance), used for both, and says certain diagnostic services may have additional cost sharing.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy no cost; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","The SBC does not say whether the deductible applies to generic drugs; the benefit details Pennie lists for this plan show no deductible, so they are treated as before the deductible.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE1X_EPO_RX1F33_IDA0_2027_16481PA012003301.pdf"},{"market":"pennie","id":"16481PA0120034-01","standardId":"16481PA0120034","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Bronze $6,700/$0 - Partner Network with Adult Dental and Vision","metal":"Bronze","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Clinton","Erie","Greene","Lawrence","Lycoming","McKean","Mercer","Potter","Somerset","Tioga","Venango","Washington"],"rates":{"1":{"base21":276.81,"tobaccoFactor":1.024999},"2":{"base21":368.03,"tobaccoFactor":1.024998},"3":{"base21":352.1,"tobaccoFactor":1.024993},"4":{"base21":276.81,"tobaccoFactor":1.024999},"5":{"base21":298.54,"tobaccoFactor":1.024988}},"ded":{"ind":6700,"fam":13400,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests (40% coinsurance), used for both, and says certain diagnostic services may have additional cost sharing.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy no cost; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","The SBC does not say whether the deductible applies to generic drugs; the benefit details Pennie lists for this plan show no deductible, so they are treated as before the deductible.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE1X_EPO_RX1F33_IDA0_2027_16481PA012003401.pdf"},{"market":"pennie","id":"16481PA0120035-01","standardId":"16481PA0120035","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Bronze $6,700/$0 - Select Network","metal":"Bronze","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Fayette","Washington","Westmoreland"],"rates":{"4":{"base21":274.94,"tobaccoFactor":1.024987}},"ded":{"ind":6700,"fam":13400,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests (40% coinsurance), used for both, and says certain diagnostic services may have additional cost sharing.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy no cost; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","The SBC does not say whether the deductible applies to generic drugs; the benefit details Pennie lists for this plan show no deductible, so they are treated as before the deductible.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE2D_EPO_RX1F33_IDA0_2027_16481PA012003501.pdf"},{"market":"pennie","id":"16481PA0120036-01","standardId":"16481PA0120036","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Bronze $6,700/$0 - Select Network with Adult Dental and Vision","metal":"Bronze","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Fayette","Washington","Westmoreland"],"rates":{"4":{"base21":291.65,"tobaccoFactor":1.024996}},"ded":{"ind":6700,"fam":13400,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests (40% coinsurance), used for both, and says certain diagnostic services may have additional cost sharing.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy no cost; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","The SBC does not say whether the deductible applies to generic drugs; the benefit details Pennie lists for this plan show no deductible, so they are treated as before the deductible.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE2D_EPO_RX1F33_IDA0_2027_16481PA012003601.pdf"},{"market":"pennie","id":"16481PA0120037-01","standardId":"16481PA0120037","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Catastrophic $12,000/$0 - Partner Network","metal":"Catastrophic","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Clinton","Erie","Greene","Lawrence","Lycoming","McKean","Mercer","Potter","Somerset","Tioga","Venango","Washington"],"rates":{"1":{"base21":243.68,"tobaccoFactor":1.024992},"2":{"base21":323.98,"tobaccoFactor":1.025002},"3":{"base21":309.95,"tobaccoFactor":1.025004},"4":{"base21":243.68,"tobaccoFactor":1.024992},"5":{"base21":262.81,"tobaccoFactor":1.024999}},"ded":{"ind":12000,"fam":24000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests (no cost), used for both, and says certain diagnostic services may have additional cost sharing.","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy no cost; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE1T_EPO_RX1D05_IDA1_2027_16481PA012003701.pdf"},{"market":"pennie","id":"16481PA0120038-01","standardId":"16481PA0120038","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Catastrophic $12,000/$0 - Select Network","metal":"Catastrophic","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Fayette","Washington","Westmoreland"],"rates":{"4":{"base21":257.58,"tobaccoFactor":1.025002}},"ded":{"ind":12000,"fam":24000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests (no cost), used for both, and says certain diagnostic services may have additional cost sharing.","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy no cost; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAE1U_EPO_RX1D05_IDA1_2027_16481PA012003801.pdf"},{"market":"pennie","id":"19702PA0010001-01","standardId":"19702PA0010001","variant":"standard","issuer":"Jefferson Health Plans (Partners Insurance Company)","name":"Jefferson Health Plans + $0 Deductible + Bronze + PPO","metal":"Bronze","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bucks","Carbon","Delaware","Lehigh","Monroe","Montgomery","Northampton","Philadelphia","Schuylkill"],"rates":{"3":{"base21":413.18,"tobaccoFactor":1.100005},"6":{"base21":422.7,"tobaccoFactor":1.1},"8":{"base21":373.08,"tobaccoFactor":1.100005}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":{"ind":5000,"fam":10000,"embedded":true},"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":1500,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":600,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":150,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":2000,"ded":"no_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"prenatal":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":2000,"ded":"no_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}}},"notes":["Physical and occupational therapy: limited to 30 visits per benefit period combined; visits above the limit are priced in full here.","Separate prescription drug deductible: $5,000 individual / $10,000 family. It applies to preferred brand drugs, non-preferred brand drugs, specialty drugs; the other drug tiers are charged their copay from the first fill.","Out-of-network care is covered at a lower level (mostly 50% after a separate out-of-network deductible); these prices are for in-network providers.","Lab work: $100 copay. X-rays: $250 copay.","Mental health: the outpatient services price (an office visit) is used.","Hospital stay and delivery facility fees are a copay per day for up to 5 days per admission.","Visits with Jefferson designated telemedicine providers are covered in full (the prices above are for in-person visits).","The medical deductible is $0, so these prices (which the SBC does not tag either way) are charged from the first dollar: primary care visits, specialist visits, lab work, x-rays, imaging, outpatient surgery facility fee, outpatient surgeon fees, emergency room care, urgent care, hospital stay facility fee, hospital stay physician fees, mental health visits, prenatal office visits, delivery physician fees, delivery facility fee and physical therapy."],"sbcUrl":"https://www.jeffersonhealthplans.com/content/dam/jeffersonhealthplans/documents/sbc/2027/jefferson-health-plans-zero-deductible-bronze-ppo-on-exchange-pa.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":321.57,"tobaccoFactor":1.100009},"6":{"base21":337.03,"tobaccoFactor":1.099991},"8":{"base21":299.21,"tobaccoFactor":1.099997}}}},{"market":"pennie","id":"19702PA0010002-01","standardId":"19702PA0010002","variant":"standard","issuer":"Jefferson Health Plans (Partners Insurance Company)","name":"Jefferson Health Plans + Total + Bronze + PPO","metal":"Bronze","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bucks","Carbon","Delaware","Lehigh","Monroe","Montgomery","Northampton","Philadelphia","Schuylkill"],"rates":{"3":{"base21":379.6,"tobaccoFactor":1.1},"6":{"base21":388.34,"tobaccoFactor":1.09999},"8":{"base21":342.75,"tobaccoFactor":1.100015}},"ded":{"ind":9000,"fam":18000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":450,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":0,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":0,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":0,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":125,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 visits per benefit period combined; visits above the limit are priced in full here.","The SBC has no separate drug deductible, so drug tiers marked as subject to the Rx deductible are charged after the plan deductible: preferred brand drugs, non-preferred brand drugs, specialty drugs.","Out-of-network care is covered at a lower level (mostly 50% after a separate out-of-network deductible); these prices are for in-network providers.","Lab work: $0 copay after the deductible. X-rays: $0 copay after the deductible.","Mental health: the outpatient services price (an office visit) is used.","Visits with Jefferson designated telemedicine providers are covered in full (the prices above are for in-person visits).","Page 1 of the SBC lists primary care visits and specialist visits as covered before you meet your deductible, so they are charged from the first dollar (the chart cell does not repeat it).","For urgent care, mental health visits and prenatal office visits, the SBC cell does not say whether the deductible applies. Jefferson marks the cells that are subject to the deductible (\"after deductible\", \"Deductible does apply\") and leaves the others unmarked, and the HMO version of the same plan design says the deductible does not apply to these services, so they are read as charged from the first dollar. This is a reading, not something the SBC states.","For physical therapy the SBC cell does not say whether the deductible applies and the evidence is mixed, so it is read as after the deductible. This is a reading, not something the SBC states."],"sbcUrl":"https://www.jeffersonhealthplans.com/content/dam/jeffersonhealthplans/documents/sbc/2027/jefferson-health-plans-total-bronze-ppo-on-exchange-pa.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":310.23,"tobaccoFactor":1.09999},"6":{"base21":325.14,"tobaccoFactor":1.099988},"8":{"base21":288.65,"tobaccoFactor":1.100017}}}},{"market":"pennie","id":"19702PA0010003-01","standardId":"19702PA0010003","variant":"standard","issuer":"Jefferson Health Plans (Partners Insurance Company)","name":"Jefferson Health Plans + Value + Bronze + PPO","metal":"Bronze","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bucks","Carbon","Delaware","Lehigh","Monroe","Montgomery","Northampton","Philadelphia","Schuylkill"],"rates":{"3":{"base21":378.32,"tobaccoFactor":1.099995},"6":{"base21":387.04,"tobaccoFactor":1.09999},"8":{"base21":341.6,"tobaccoFactor":1.1}},"ded":{"ind":10000,"fam":20000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"specialist":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 visits per benefit period combined; visits above the limit are priced in full here.","The SBC has no separate drug deductible, so drug tiers marked as subject to the Rx deductible are charged after the plan deductible: preferred brand drugs, non-preferred brand drugs, specialty drugs.","Out-of-network care is covered at a lower level (mostly 50% after a separate out-of-network deductible); these prices are for in-network providers.","Mental health: the outpatient services price (an office visit) is used.","Visits with Jefferson designated telemedicine providers are covered in full (the prices above are for in-person visits).","For generic drugs, the SBC cell does not say whether the deductible applies; other drug tiers of the same plan are marked as subject to the drug deductible, or page 1 lists these as covered before the deductible, so they are charged from the first dollar.","Page 1 of the SBC lists primary care visits as covered before you meet your deductible, so they are charged from the first dollar (the chart cell does not repeat it)."],"sbcUrl":"https://www.jeffersonhealthplans.com/content/dam/jeffersonhealthplans/documents/sbc/2027/jefferson-health-plans-value-bronze-ppo-on-exchange-pa.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":309.74,"tobaccoFactor":1.099987},"6":{"base21":324.63,"tobaccoFactor":1.099991},"8":{"base21":288.2,"tobaccoFactor":1.1}}}},{"market":"pennie","id":"19702PA0010005-01","standardId":"19702PA0010005","variant":"standard","issuer":"Jefferson Health Plans (Partners Insurance Company)","name":"Jefferson Health Plans + Balanced + Silver + PPO","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bucks","Carbon","Delaware","Lehigh","Monroe","Montgomery","Northampton","Philadelphia","Schuylkill"],"rates":{"3":{"base21":519.73,"tobaccoFactor":1.099994},"6":{"base21":531.7,"tobaccoFactor":1.1},"8":{"base21":469.28,"tobaccoFactor":1.100004}},"ded":{"ind":3500,"fam":7000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":325,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":95,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":450,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":650,"ded":"after_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":650,"ded":"after_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 visits per benefit period combined; visits above the limit are priced in full here.","Separate prescription drug deductible: $500 individual / $1,000 family. It applies to preferred brand drugs, non-preferred brand drugs, specialty drugs; the other drug tiers are charged their copay from the first fill.","Out-of-network care is covered at a lower level (mostly 50% after a separate out-of-network deductible); these prices are for in-network providers.","Generic drugs: tier 1 generics $5 copay (used here); tier 2 generics $25 copay.","Lab work: $50 copay after the deductible. X-rays: $100 copay after the deductible.","Mental health: the outpatient services price (an office visit) is used.","Hospital stay and delivery facility fees are a copay per day for up to 5 days per admission.","Visits with Jefferson designated telemedicine providers are covered in full (the prices above are for in-person visits).","Page 1 of the SBC lists primary care visits and specialist visits as covered before you meet your deductible, so they are charged from the first dollar (the chart cell does not repeat it).","For emergency room care, urgent care, mental health visits and prenatal office visits, the SBC cell does not say whether the deductible applies. Jefferson marks the cells that are subject to the deductible (\"after deductible\", \"Deductible does apply\") and leaves the others unmarked, and the HMO version of the same plan design says the deductible does not apply to these services, so they are read as charged from the first dollar. This is a reading, not something the SBC states.","Lab work and x-rays: the SBC cell reads \"$50/Visit (lab work) $100/Visit (X-Ray) Deductible does apply.\", with the deductible sentence closing the whole cell, so both are read as after the deductible (the higher cost). The other versions of this plan design tag only the x-ray amount \"after deductible\"."],"sbcUrl":"https://www.jeffersonhealthplans.com/content/dam/jeffersonhealthplans/documents/sbc/2027/jefferson-health-plans-balanced-silver-ppo-on-exchange-pa.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":433.87,"tobaccoFactor":1.100007},"6":{"base21":454.73,"tobaccoFactor":1.099993},"8":{"base21":403.7,"tobaccoFactor":1.1}}}},{"market":"pennie","id":"19702PA0010005-04","standardId":"19702PA0010005","variant":"csr73","issuer":"Jefferson Health Plans (Partners Insurance Company)","name":"Jefferson Health Plans + Balanced + Silver + PPO","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bucks","Carbon","Delaware","Lehigh","Monroe","Montgomery","Northampton","Philadelphia","Schuylkill"],"rates":{"3":{"base21":519.73,"tobaccoFactor":1.099994},"6":{"base21":531.7,"tobaccoFactor":1.1},"8":{"base21":469.28,"tobaccoFactor":1.100004}},"ded":{"ind":3500,"fam":7000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":9600,"fam":19200},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":325,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":95,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":450,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":650,"ded":"after_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":650,"ded":"after_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 visits per benefit period combined; visits above the limit are priced in full here.","Separate prescription drug deductible: $500 individual / $1,000 family. It applies to preferred brand drugs, non-preferred brand drugs, specialty drugs; the other drug tiers are charged their copay from the first fill.","Out-of-network care is covered at a lower level (mostly 50% after a separate out-of-network deductible); these prices are for in-network providers.","Generic drugs: tier 1 generics $5 copay (used here); tier 2 generics $25 copay.","Lab work: $50 copay. X-rays: $100 copay after the deductible.","Mental health: the outpatient services price (an office visit) is used.","Hospital stay and delivery facility fees are a copay per day for up to 5 days per admission.","Visits with Jefferson designated telemedicine providers are covered in full (the prices above are for in-person visits).","Page 1 of the SBC lists primary care visits and specialist visits as covered before you meet your deductible, so they are charged from the first dollar (the chart cell does not repeat it).","For lab work, emergency room care, urgent care, mental health visits and prenatal office visits, the SBC cell does not say whether the deductible applies. Jefferson marks the cells that are subject to the deductible (\"after deductible\", \"Deductible does apply\") and leaves the others unmarked, and the HMO version of the same plan design says the deductible does not apply to these services, so they are read as charged from the first dollar. This is a reading, not something the SBC states."],"sbcUrl":"https://www.jeffersonhealthplans.com/content/dam/jeffersonhealthplans/documents/sbc/2027/jefferson-health-plans-balanced-silver-ppo-73-pa.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":433.87,"tobaccoFactor":1.100007},"6":{"base21":454.73,"tobaccoFactor":1.099993},"8":{"base21":403.7,"tobaccoFactor":1.1}}}},{"market":"pennie","id":"19702PA0010005-05","standardId":"19702PA0010005","variant":"csr87","issuer":"Jefferson Health Plans (Partners Insurance Company)","name":"Jefferson Health Plans + Balanced + Silver + PPO","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bucks","Carbon","Delaware","Lehigh","Monroe","Montgomery","Northampton","Philadelphia","Schuylkill"],"rates":{"3":{"base21":519.73,"tobaccoFactor":1.099994},"6":{"base21":531.7,"tobaccoFactor":1.1},"8":{"base21":469.28,"tobaccoFactor":1.100004}},"ded":{"ind":500,"fam":1000,"embedded":true},"drugDed":{"ind":250,"fam":500,"embedded":true},"oop":{"ind":4000,"fam":8000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":0,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":550,"ded":"after_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":550,"ded":"after_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 visits per benefit period combined; visits above the limit are priced in full here.","Separate prescription drug deductible: $250 individual / $500 family. It applies to non-preferred brand drugs, specialty drugs; the other drug tiers are charged their copay from the first fill.","Out-of-network care is covered at a lower level (mostly 50% after a separate out-of-network deductible); these prices are for in-network providers.","Generic drugs: tier 1 generics $0 copay (used here); tier 2 generics $10 copay.","Lab work: $20 copay. X-rays: $75 copay.","Mental health: the outpatient services price (an office visit) is used.","Hospital stay and delivery facility fees are a copay per day for up to 5 days per admission.","Visits with Jefferson designated telemedicine providers are covered in full (the prices above are for in-person visits).","Page 1 of the SBC lists primary care visits and specialist visits as covered before you meet your deductible, so they are charged from the first dollar (the chart cell does not repeat it).","For lab work, x-rays, emergency room care, urgent care, mental health visits and prenatal office visits, the SBC cell does not say whether the deductible applies. Jefferson marks the cells that are subject to the deductible (\"after deductible\", \"Deductible does apply\") and leaves the others unmarked, and the HMO version of the same plan design says the deductible does not apply to these services, so they are read as charged from the first dollar. This is a reading, not something the SBC states.","For outpatient surgeon fees, hospital stay physician fees and delivery physician fees, the SBC cell does not say whether the deductible applies; the sibling plans of the same design tag these same cells \"after deductible\", so they are read as after the deductible. This is a reading based on those sibling plans, not something the SBC states.","For physical therapy the SBC cell does not say whether the deductible applies and the evidence is mixed, so it is read as after the deductible. This is a reading, not something the SBC states."],"sbcUrl":"https://www.jeffersonhealthplans.com/content/dam/jeffersonhealthplans/documents/sbc/2027/jefferson-health-plans-balanced-silver-ppo-87-pa.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":433.87,"tobaccoFactor":1.100007},"6":{"base21":454.73,"tobaccoFactor":1.099993},"8":{"base21":403.7,"tobaccoFactor":1.1}}}},{"market":"pennie","id":"19702PA0010005-06","standardId":"19702PA0010005","variant":"csr94","issuer":"Jefferson Health Plans (Partners Insurance Company)","name":"Jefferson Health Plans + Balanced + Silver + PPO","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bucks","Carbon","Delaware","Lehigh","Monroe","Montgomery","Northampton","Philadelphia","Schuylkill"],"rates":{"3":{"base21":519.73,"tobaccoFactor":1.099994},"6":{"base21":531.7,"tobaccoFactor":1.1},"8":{"base21":469.28,"tobaccoFactor":1.100004}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":{"ind":250,"fam":500,"embedded":true},"oop":{"ind":4000,"fam":8000},"rules":{"pcp":{"base":{"kind":"copay","amount":0,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":0,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":15,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":0,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":0,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.15,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":400,"ded":"no_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"no_ded"}},"prenatal":{"base":{"kind":"copay","amount":0,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":400,"ded":"no_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"coins","rate":0,"ded":"no_ded"}}},"notes":["Physical and occupational therapy: limited to 30 visits per benefit period combined; visits above the limit are priced in full here.","Separate prescription drug deductible: $250 individual / $500 family. It applies to specialty drugs; the other drug tiers are charged their copay from the first fill.","Out-of-network care is covered at a lower level (mostly 50% after a separate out-of-network deductible); these prices are for in-network providers.","Generic drugs: tier 1 generics $0 copay (used here); tier 2 generics $0 copay.","Lab work: $0 copay. X-rays: $15 copay.","Mental health: the outpatient services price (an office visit) is used.","Hospital stay and delivery facility fees are a copay per day for up to 5 days per admission.","Visits with Jefferson designated telemedicine providers are covered in full (the prices above are for in-person visits).","The medical deductible is $0, so these prices (which the SBC does not tag either way) are charged from the first dollar: primary care visits, specialist visits, lab work, x-rays, imaging, outpatient surgery facility fee, outpatient surgeon fees, emergency room care, urgent care, hospital stay facility fee, hospital stay physician fees, mental health visits, prenatal office visits, delivery physician fees, delivery facility fee and physical therapy.","The SBC coverage examples show $250 of deductible paid in all three examples although the medical deductible is $0 (the plan has a $250 drug deductible); the grid cells do not explain it. These rules follow the grid cells."],"sbcUrl":"https://www.jeffersonhealthplans.com/content/dam/jeffersonhealthplans/documents/sbc/2027/jefferson-health-plans-balanced-silver-ppo-94-pa.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":433.87,"tobaccoFactor":1.100007},"6":{"base21":454.73,"tobaccoFactor":1.099993},"8":{"base21":403.7,"tobaccoFactor":1.1}}}},{"market":"pennie","id":"19702PA0010006-01","standardId":"19702PA0010006","variant":"standard","issuer":"Jefferson Health Plans (Partners Insurance Company)","name":"Jefferson Health Plans + Total + Silver + PPO","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bucks","Carbon","Delaware","Lehigh","Monroe","Montgomery","Northampton","Philadelphia","Schuylkill"],"rates":{"3":{"base21":510.44,"tobaccoFactor":1.099992},"6":{"base21":522.2,"tobaccoFactor":1.1},"8":{"base21":460.89,"tobaccoFactor":1.100002}},"ded":{"ind":5500,"fam":11000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":85,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":600,"ded":"after_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":600,"ded":"after_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 visits per benefit period combined; visits above the limit are priced in full here.","Separate prescription drug deductible: $500 individual / $1,000 family. It applies to preferred brand drugs, non-preferred brand drugs, specialty drugs; the other drug tiers are charged their copay from the first fill.","Out-of-network care is covered at a lower level (mostly 50% after a separate out-of-network deductible); these prices are for in-network providers.","Generic drugs: tier 1 generics $5 copay (used here); tier 2 generics $25 copay.","Lab work: $50 copay. X-rays: $100 copay after the deductible.","Mental health: the outpatient services price (an office visit) is used.","Hospital stay and delivery facility fees are a copay per day for up to 5 days per admission.","Visits with Jefferson designated telemedicine providers are covered in full (the prices above are for in-person visits).","For generic drugs, the SBC cell does not say whether the deductible applies; other drug tiers of the same plan are marked as subject to the drug deductible, or page 1 lists these as covered before the deductible, so they are charged from the first dollar.","Page 1 of the SBC lists primary care visits and specialist visits as covered before you meet your deductible, so they are charged from the first dollar (the chart cell does not repeat it).","For lab work, emergency room care, urgent care, mental health visits and prenatal office visits, the SBC cell does not say whether the deductible applies. Jefferson marks the cells that are subject to the deductible (\"after deductible\", \"Deductible does apply\") and leaves the others unmarked, and the HMO version of the same plan design says the deductible does not apply to these services, so they are read as charged from the first dollar. This is a reading, not something the SBC states."],"sbcUrl":"https://www.jeffersonhealthplans.com/content/dam/jeffersonhealthplans/documents/sbc/2027/jefferson-health-plans-total-silver-ppo-on-exchange-pa.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":427.89,"tobaccoFactor":1.100002},"6":{"base21":448.46,"tobaccoFactor":1.100009},"8":{"base21":398.13,"tobaccoFactor":1.099992}}}},{"market":"pennie","id":"19702PA0010006-04","standardId":"19702PA0010006","variant":"csr73","issuer":"Jefferson Health Plans (Partners Insurance Company)","name":"Jefferson Health Plans + Total + Silver + PPO","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bucks","Carbon","Delaware","Lehigh","Monroe","Montgomery","Northampton","Philadelphia","Schuylkill"],"rates":{"3":{"base21":510.44,"tobaccoFactor":1.099992},"6":{"base21":522.2,"tobaccoFactor":1.1},"8":{"base21":460.89,"tobaccoFactor":1.100002}},"ded":{"ind":5500,"fam":11000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":9600,"fam":19200},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":85,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":600,"ded":"after_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":600,"ded":"after_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 visits per benefit period combined; visits above the limit are priced in full here.","Separate prescription drug deductible: $500 individual / $1,000 family. It applies to preferred brand drugs, non-preferred brand drugs, specialty drugs; the other drug tiers are charged their copay from the first fill.","Out-of-network care is covered at a lower level (mostly 50% after a separate out-of-network deductible); these prices are for in-network providers.","Generic drugs: tier 1 generics $5 copay (used here); tier 2 generics $25 copay.","Lab work: $50 copay. X-rays: $100 copay after the deductible.","Mental health: the outpatient services price (an office visit) is used.","Hospital stay and delivery facility fees are a copay per day for up to 5 days per admission.","Visits with Jefferson designated telemedicine providers are covered in full (the prices above are for in-person visits).","Page 1 of the SBC lists primary care visits and specialist visits as covered before you meet your deductible, so they are charged from the first dollar (the chart cell does not repeat it).","For lab work, emergency room care, urgent care, mental health visits and prenatal office visits, the SBC cell does not say whether the deductible applies. Jefferson marks the cells that are subject to the deductible (\"after deductible\", \"Deductible does apply\") and leaves the others unmarked, and the HMO version of the same plan design says the deductible does not apply to these services, so they are read as charged from the first dollar. This is a reading, not something the SBC states."],"sbcUrl":"https://www.jeffersonhealthplans.com/content/dam/jeffersonhealthplans/documents/sbc/2027/jefferson-health-plans-total-silver-ppo-73-pa.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":427.89,"tobaccoFactor":1.100002},"6":{"base21":448.46,"tobaccoFactor":1.100009},"8":{"base21":398.13,"tobaccoFactor":1.099992}}}},{"market":"pennie","id":"19702PA0010006-05","standardId":"19702PA0010006","variant":"csr87","issuer":"Jefferson Health Plans (Partners Insurance Company)","name":"Jefferson Health Plans + Total + Silver + PPO","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bucks","Carbon","Delaware","Lehigh","Monroe","Montgomery","Northampton","Philadelphia","Schuylkill"],"rates":{"3":{"base21":510.44,"tobaccoFactor":1.099992},"6":{"base21":522.2,"tobaccoFactor":1.1},"8":{"base21":460.89,"tobaccoFactor":1.100002}},"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":{"ind":250,"fam":500,"embedded":true},"oop":{"ind":4000,"fam":8000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":55,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":0,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":20,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 visits per benefit period combined; visits above the limit are priced in full here.","Separate prescription drug deductible: $250 individual / $500 family. It applies to preferred brand drugs, non-preferred brand drugs, specialty drugs; the other drug tiers are charged their copay from the first fill.","Out-of-network care is covered at a lower level (mostly 50% after a separate out-of-network deductible); these prices are for in-network providers.","Generic drugs: tier 1 generics $0 copay (used here); tier 2 generics $10 copay.","Lab work: $15 copay. X-rays: $65 copay.","Mental health: the outpatient services price (an office visit) is used.","Hospital stay and delivery facility fees are a copay per day for up to 5 days per admission.","Visits with Jefferson designated telemedicine providers are covered in full (the prices above are for in-person visits).","Page 1 of the SBC lists primary care visits and specialist visits as covered before you meet your deductible, so they are charged from the first dollar (the chart cell does not repeat it).","For lab work, x-rays, emergency room care, urgent care and mental health visits, the SBC cell does not say whether the deductible applies. Jefferson marks the cells that are subject to the deductible (\"after deductible\", \"Deductible does apply\") and leaves the others unmarked, and the HMO version of the same plan design says the deductible does not apply to these services, so they are read as charged from the first dollar. This is a reading, not something the SBC states.","For hospital stay physician fees and delivery physician fees, the SBC cell does not say whether the deductible applies; the sibling plans of the same design tag these same cells \"after deductible\", so they are read as after the deductible. This is a reading based on those sibling plans, not something the SBC states.","For physical therapy the SBC cell does not say whether the deductible applies and the evidence is mixed, so it is read as after the deductible. This is a reading, not something the SBC states."],"sbcUrl":"https://www.jeffersonhealthplans.com/content/dam/jeffersonhealthplans/documents/sbc/2027/jefferson-health-plans-total-silver-ppo-87-pa.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":427.89,"tobaccoFactor":1.100002},"6":{"base21":448.46,"tobaccoFactor":1.100009},"8":{"base21":398.13,"tobaccoFactor":1.099992}}}},{"market":"pennie","id":"19702PA0010006-06","standardId":"19702PA0010006","variant":"csr94","issuer":"Jefferson Health Plans (Partners Insurance Company)","name":"Jefferson Health Plans + Total + Silver + PPO","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bucks","Carbon","Delaware","Lehigh","Monroe","Montgomery","Northampton","Philadelphia","Schuylkill"],"rates":{"3":{"base21":510.44,"tobaccoFactor":1.099992},"6":{"base21":522.2,"tobaccoFactor":1.1},"8":{"base21":460.89,"tobaccoFactor":1.100002}},"ded":{"ind":250,"fam":500,"embedded":true},"drugDed":null,"oop":{"ind":4000,"fam":8000},"rules":{"pcp":{"base":{"kind":"copay","amount":0,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":0,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":0,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":0,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":15,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":0,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":0,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.15,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":400,"ded":"after_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":0,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":400,"ded":"after_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 visits per benefit period combined; visits above the limit are priced in full here.","The SBC has no separate drug deductible, so drug tiers marked as subject to the Rx deductible are charged after the plan deductible: non-preferred brand drugs, specialty drugs.","Out-of-network care is covered at a lower level (mostly 50% after a separate out-of-network deductible); these prices are for in-network providers.","Generic drugs: tier 1 generics $0 copay after the deductible (used here); tier 2 generics $0 copay after the deductible.","Lab work: $0 copay. X-rays: $25 copay.","Mental health: the outpatient services price (an office visit) is used.","Hospital stay and delivery facility fees are a copay per day for up to 5 days per admission.","Visits with Jefferson designated telemedicine providers are covered in full (the prices above are for in-person visits).","Page 1 of the SBC lists primary care visits and specialist visits as covered before you meet your deductible, so they are charged from the first dollar (the chart cell does not repeat it).","For lab work, x-rays, emergency room care, urgent care, mental health visits and prenatal office visits, the SBC cell does not say whether the deductible applies. Jefferson marks the cells that are subject to the deductible (\"after deductible\", \"Deductible does apply\") and leaves the others unmarked, and the HMO version of the same plan design says the deductible does not apply to these services, so they are read as charged from the first dollar. This is a reading, not something the SBC states.","For imaging, outpatient surgery facility fee, outpatient surgeon fees, hospital stay facility fee, hospital stay physician fees, delivery physician fees and delivery facility fee, the SBC cell does not say whether the deductible applies; the sibling plans of the same design tag these same cells \"after deductible\", so they are read as after the deductible. This is a reading based on those sibling plans, not something the SBC states.","For physical therapy the SBC cell does not say whether the deductible applies and the evidence is mixed, so it is read as after the deductible. This is a reading, not something the SBC states.","Generic drugs ($0 a fill) and preferred brand drugs (15% coinsurance): the SBC cells do not say whether the $250 deductible applies, the plan has no separate drug deductible, and page 1 does not list drugs as covered before the deductible, so they are read as after the deductible (the other two drug tiers say \"Subject to deductible\"). This is a reading, not something the SBC states.","The SBC's \"having a baby\" coverage example shows $0 of deductible paid although this plan has a $250 deductible; if that example is right, the delivery and hospital cells are not subject to the deductible. These rules follow the reading from the sibling plans (after the deductible), the higher cost."],"sbcUrl":"https://www.jeffersonhealthplans.com/content/dam/jeffersonhealthplans/documents/sbc/2027/jefferson-health-plans-total-silver-ppo-94-pa.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":427.89,"tobaccoFactor":1.100002},"6":{"base21":448.46,"tobaccoFactor":1.100009},"8":{"base21":398.13,"tobaccoFactor":1.099992}}}},{"market":"pennie","id":"19702PA0010007-01","standardId":"19702PA0010007","variant":"standard","issuer":"Jefferson Health Plans (Partners Insurance Company)","name":"Jefferson Health Plans + $0 Deductible + Gold + PPO","metal":"Gold","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bucks","Carbon","Delaware","Lehigh","Monroe","Montgomery","Northampton","Philadelphia","Schuylkill"],"rates":{"3":{"base21":486.04,"tobaccoFactor":1.099992},"6":{"base21":497.23,"tobaccoFactor":1.099994},"8":{"base21":438.86,"tobaccoFactor":1.100009}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":75,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":0,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":600,"ded":"no_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"no_ded"}},"prenatal":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":600,"ded":"no_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"coins","rate":0,"ded":"no_ded"}}},"notes":["Physical and occupational therapy: limited to 30 visits per benefit period combined; visits above the limit are priced in full here.","Out-of-network care is covered at a lower level (mostly 50% after a separate out-of-network deductible); these prices are for in-network providers.","Generic drugs: tier 1 generics $0 copay (used here); tier 2 generics $20 copay.","Lab work: $25 copay. X-rays: $75 copay.","Mental health: the outpatient services price (an office visit) is used.","Hospital stay and delivery facility fees are a copay per day for up to 5 days per admission.","Visits with Jefferson designated telemedicine providers are covered in full (the prices above are for in-person visits).","The medical deductible is $0, so these prices (which the SBC does not tag either way) are charged from the first dollar: primary care visits, specialist visits, lab work, x-rays, imaging, generic drugs, preferred brand drugs, non-preferred brand drugs, specialty drugs, outpatient surgery facility fee, outpatient surgeon fees, emergency room care, urgent care, hospital stay facility fee, hospital stay physician fees, mental health visits, prenatal office visits, delivery physician fees, delivery facility fee and physical therapy."],"sbcUrl":"https://www.jeffersonhealthplans.com/content/dam/jeffersonhealthplans/documents/sbc/2027/jefferson-health-plans-zero-deductible-gold-ppo-on-exchange-pa.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":405.27,"tobaccoFactor":1.100007},"6":{"base21":424.75,"tobaccoFactor":1.100012},"8":{"base21":377.08,"tobaccoFactor":1.100005}}}},{"market":"pennie","id":"19702PA0010008-01","standardId":"19702PA0010008","variant":"standard","issuer":"Jefferson Health Plans (Partners Insurance Company)","name":"Jefferson Health Plans + Total + Gold + PPO","metal":"Gold","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bucks","Carbon","Delaware","Lehigh","Monroe","Montgomery","Northampton","Philadelphia","Schuylkill"],"rates":{"3":{"base21":467.01,"tobaccoFactor":1.099998},"6":{"base21":477.77,"tobaccoFactor":1.100006},"8":{"base21":421.68,"tobaccoFactor":1.100005}},"ded":{"ind":500,"fam":1000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":0,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 visits per benefit period combined; visits above the limit are priced in full here.","Separate prescription drug deductible: $500 individual / $1,000 family. It applies to non-preferred brand drugs, specialty drugs; the other drug tiers are charged their copay from the first fill.","Out-of-network care is covered at a lower level (mostly 50% after a separate out-of-network deductible); these prices are for in-network providers.","Generic drugs: tier 1 generics $0 copay (used here); tier 2 generics $20 copay.","Lab work: $20 copay. X-rays: $60 copay.","Mental health: the outpatient services price (an office visit) is used.","Hospital stay and delivery facility fees are a copay per day for up to 5 days per admission.","Visits with Jefferson designated telemedicine providers are covered in full (the prices above are for in-person visits).","For generic drugs and preferred brand drugs, the SBC cell does not say whether the deductible applies; other drug tiers of the same plan are marked as subject to the drug deductible, or page 1 lists these as covered before the deductible, so they are charged from the first dollar.","Page 1 of the SBC lists primary care visits and specialist visits as covered before you meet your deductible, so they are charged from the first dollar (the chart cell does not repeat it).","For lab work, x-rays, emergency room care, urgent care, mental health visits and prenatal office visits, the SBC cell does not say whether the deductible applies. Jefferson marks the cells that are subject to the deductible (\"after deductible\", \"Deductible does apply\") and leaves the others unmarked, and the HMO version of the same plan design says the deductible does not apply to these services, so they are read as charged from the first dollar. This is a reading, not something the SBC states.","For physical therapy the SBC cell does not say whether the deductible applies and the evidence is mixed, so it is read as after the deductible. This is a reading, not something the SBC states."],"sbcUrl":"https://www.jeffersonhealthplans.com/content/dam/jeffersonhealthplans/documents/sbc/2027/jefferson-health-plans-total-gold-ppo-on-exchange-pa.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":385.95,"tobaccoFactor":1.100013},"6":{"base21":404.51,"tobaccoFactor":1.099998},"8":{"base21":359.11,"tobaccoFactor":1.099997}}}},{"market":"pennie","id":"19702PA0010009-01","standardId":"19702PA0010009","variant":"standard","issuer":"Jefferson Health Plans (Partners Insurance Company)","name":"Jefferson Health Plans + Value + Gold + PPO","metal":"Gold","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bucks","Carbon","Delaware","Lehigh","Monroe","Montgomery","Northampton","Philadelphia","Schuylkill"],"rates":{"3":{"base21":457.79,"tobaccoFactor":1.100002},"6":{"base21":468.34,"tobaccoFactor":1.099991},"8":{"base21":413.35,"tobaccoFactor":1.100012}},"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":55,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":0,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":400,"ded":"after_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":20,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":450,"ded":"after_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 visits per benefit period combined; visits above the limit are priced in full here.","Separate prescription drug deductible: $500 individual / $1,000 family. It applies to non-preferred brand drugs, specialty drugs; the other drug tiers are charged their copay from the first fill.","Out-of-network care is covered at a lower level (mostly 50% after a separate out-of-network deductible); these prices are for in-network providers.","Generic drugs: tier 1 generics $0 copay (used here); tier 2 generics $20 copay.","Lab work: $15 copay. X-rays: $50 copay.","Mental health: the outpatient services price (an office visit) is used.","Hospital stay and delivery facility fees are a copay per day for up to 5 days per admission.","Visits with Jefferson designated telemedicine providers are covered in full (the prices above are for in-person visits).","For generic drugs and preferred brand drugs, the SBC cell does not say whether the deductible applies; other drug tiers of the same plan are marked as subject to the drug deductible, or page 1 lists these as covered before the deductible, so they are charged from the first dollar.","Page 1 of the SBC lists primary care visits and specialist visits as covered before you meet your deductible, so they are charged from the first dollar (the chart cell does not repeat it).","For lab work, x-rays, emergency room care, urgent care and mental health visits, the SBC cell does not say whether the deductible applies. Jefferson marks the cells that are subject to the deductible (\"after deductible\", \"Deductible does apply\") and leaves the others unmarked, and the HMO version of the same plan design says the deductible does not apply to these services, so they are read as charged from the first dollar. This is a reading, not something the SBC states.","For physical therapy the SBC cell does not say whether the deductible applies and the evidence is mixed, so it is read as after the deductible. This is a reading, not something the SBC states."],"sbcUrl":"https://www.jeffersonhealthplans.com/content/dam/jeffersonhealthplans/documents/sbc/2027/jefferson-health-plans-value-gold-ppo-on-exchange-pa.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":379.95,"tobaccoFactor":1.100013},"6":{"base21":398.22,"tobaccoFactor":1.099995},"8":{"base21":353.53,"tobaccoFactor":1.099992}}}},{"market":"pennie","id":"22444PA0010035-01","standardId":"22444PA0010035","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 20/50/3250","metal":"Gold","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bradford","Carbon","Centre","Clinton","Columbia","Juniata","Lackawanna","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northumberland","Pike","Schuylkill","Snyder","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming"],"rates":{"3":{"base21":588.91,"tobaccoFactor":1.100015},"6":{"base21":619.91,"tobaccoFactor":1.099998},"9":{"base21":743.89,"tobaccoFactor":1.100001}},"ded":{"ind":3250,"fam":6500,"embedded":true},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Access HMO 20 50 3250\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010082, 22444PA0010042, 22444PA0010036 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $15 copay.","Specialty drugs: 40% coinsurance up to $150 per fill (the cap is modelled here)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"3":{"base21":540.92,"tobaccoFactor":1.099996},"6":{"base21":569.39,"tobaccoFactor":1.100002},"9":{"base21":683.27,"tobaccoFactor":1.09999}}}},{"market":"pennie","id":"22444PA0010036-01","standardId":"22444PA0010036","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 20/50/3250","metal":"Gold","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Lehigh","Northampton"],"rates":{"6":{"base21":619.91,"tobaccoFactor":1.099998}},"ded":{"ind":3250,"fam":6500,"embedded":true},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Access HMO 20 50 3250\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010082, 22444PA0010035, 22444PA0010042 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $15 copay.","Specialty drugs: 40% coinsurance up to $150 per fill (the cap is modelled here)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"6":{"base21":569.39,"tobaccoFactor":1.100002}}}},{"market":"pennie","id":"22444PA0010038-01","standardId":"22444PA0010038","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 30/60/4900","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bradford","Carbon","Centre","Clinton","Columbia","Juniata","Lackawanna","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northumberland","Pike","Schuylkill","Snyder","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming"],"rates":{"3":{"base21":654.99,"tobaccoFactor":1.100002},"6":{"base21":689.47,"tobaccoFactor":1.09999},"9":{"base21":827.36,"tobaccoFactor":1.100005}},"ded":{"ind":4900,"fam":9800,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family. Drug rows that say \"Deductible does not apply\" (generic drugs) are charged from the first fill; the others (preferred brand drugs, non-preferred brand drugs, specialty drugs) do not say, so they are read as after the drug deductible.","Geisinger has not published its 2027 SBCs yet; this is the 2027 SBC it filed with the PA Insurance Department in SERFF form filing GSHP-134794457 (\"2027 - 22444PA0010098 -  All-Access HMO (Silver) 30_60_4900.pdf\") for 22444PA0010098-01. The filing's benefit summary (PY2027_Individual_6.3.2026.xlsx, sheet \"All-Access HMO 30 60 4900\") lists this plan in one design with 22444PA0010098, 22444PA0010039, 22444PA0010040; they differ only in service area, and Geisinger's SBCs print no plan ID.","The SBC equals the filing's benefit summary (sheet \"All-Access HMO 30 60 4900\") on the deductible, out-of-pocket limit, drug deductible, coverage examples and every cost used here, and the rate decision's rate pages on the deductible, coinsurance, primary care and specialist copays and out-of-pocket maximum."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/2027 - 22444PA0010098 -  All-Access HMO (Silver) 30_60_4900.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":617.13,"tobaccoFactor":1.099995},"6":{"base21":649.61,"tobaccoFactor":1.099998},"9":{"base21":779.53,"tobaccoFactor":1.099996}}}},{"market":"pennie","id":"22444PA0010038-04","standardId":"22444PA0010038","variant":"csr73","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 30/60/4900","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bradford","Carbon","Centre","Clinton","Columbia","Juniata","Lackawanna","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northumberland","Pike","Schuylkill","Snyder","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming"],"rates":{"3":{"base21":654.99,"tobaccoFactor":1.100002},"6":{"base21":689.47,"tobaccoFactor":1.09999},"9":{"base21":827.36,"tobaccoFactor":1.100005}},"ded":{"ind":4000,"fam":8000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":9000,"fam":18000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"HMO 30 60 4900 (.73)\", in-network column; each rule's page is the sheet row); the rate decision prints no cost-sharing reduction amounts.","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with the same cost-sharing version of 22444PA0010098, 22444PA0010039, 22444PA0010040 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family; it applies to preferred brand drugs, non-preferred brand drugs, specialty drugs (the filed summary says \"after deductible\" there)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"3":{"base21":617.13,"tobaccoFactor":1.099995},"6":{"base21":649.61,"tobaccoFactor":1.099998},"9":{"base21":779.53,"tobaccoFactor":1.099996}}}},{"market":"pennie","id":"22444PA0010038-05","standardId":"22444PA0010038","variant":"csr87","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 30/60/4900","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bradford","Carbon","Centre","Clinton","Columbia","Juniata","Lackawanna","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northumberland","Pike","Schuylkill","Snyder","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming"],"rates":{"3":{"base21":654.99,"tobaccoFactor":1.100002},"6":{"base21":689.47,"tobaccoFactor":1.09999},"9":{"base21":827.36,"tobaccoFactor":1.100005}},"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":null,"oop":{"ind":4000,"fam":8000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"HMO 30 60 4900 (.87)\", in-network column; each rule's page is the sheet row); the rate decision prints no cost-sharing reduction amounts.","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with the same cost-sharing version of 22444PA0010098, 22444PA0010039, 22444PA0010040 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $15 copay.","Specialty drugs: 40% coinsurance up to $150 per fill (the cap is modelled here)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"3":{"base21":617.13,"tobaccoFactor":1.099995},"6":{"base21":649.61,"tobaccoFactor":1.099998},"9":{"base21":779.53,"tobaccoFactor":1.099996}}}},{"market":"pennie","id":"22444PA0010038-06","standardId":"22444PA0010038","variant":"csr94","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 30/60/4900","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bradford","Carbon","Centre","Clinton","Columbia","Juniata","Lackawanna","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northumberland","Pike","Schuylkill","Snyder","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming"],"rates":{"3":{"base21":654.99,"tobaccoFactor":1.100002},"6":{"base21":689.47,"tobaccoFactor":1.09999},"9":{"base21":827.36,"tobaccoFactor":1.100005}},"ded":{"ind":800,"fam":1600,"embedded":true},"drugDed":null,"oop":{"ind":3000,"fam":6000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":7,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":75}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"HMO 30 60 4900 (.94)\", in-network column; each rule's page is the sheet row); the rate decision prints no cost-sharing reduction amounts.","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with the same cost-sharing version of 22444PA0010098, 22444PA0010039, 22444PA0010040 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $1 copay.","Specialty drugs: 20% coinsurance up to $75 per fill (the cap is modelled here)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"3":{"base21":617.13,"tobaccoFactor":1.099995},"6":{"base21":649.61,"tobaccoFactor":1.099998},"9":{"base21":779.53,"tobaccoFactor":1.099996}}}},{"market":"pennie","id":"22444PA0010039-01","standardId":"22444PA0010039","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 30/60/4900","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Adams","Berks","Cumberland","Dauphin","Franklin","Fulton","Lancaster","Lebanon","Perry","York"],"rates":{"7":{"base21":861.83,"tobaccoFactor":1.100008},"9":{"base21":827.36,"tobaccoFactor":1.100005}},"ded":{"ind":4900,"fam":9800,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family. Drug rows that say \"Deductible does not apply\" (generic drugs) are charged from the first fill; the others (preferred brand drugs, non-preferred brand drugs, specialty drugs) do not say, so they are read as after the drug deductible.","Geisinger has not published its 2027 SBCs yet; this is the 2027 SBC it filed with the PA Insurance Department in SERFF form filing GSHP-134794457 (\"2027 - 22444PA0010098 -  All-Access HMO (Silver) 30_60_4900.pdf\") for 22444PA0010098-01. The filing's benefit summary (PY2027_Individual_6.3.2026.xlsx, sheet \"All-Access HMO 30 60 4900\") lists this plan in one design with 22444PA0010098, 22444PA0010038, 22444PA0010040; they differ only in service area, and Geisinger's SBCs print no plan ID.","The SBC equals the filing's benefit summary (sheet \"All-Access HMO 30 60 4900\") on the deductible, out-of-pocket limit, drug deductible, coverage examples and every cost used here, and the rate decision's rate pages on the deductible, coinsurance, primary care and specialist copays and out-of-pocket maximum."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/2027 - 22444PA0010098 -  All-Access HMO (Silver) 30_60_4900.pdf","prev":{"planYear":2026,"rates":{"7":{"base21":812.01,"tobaccoFactor":1.099999},"9":{"base21":779.53,"tobaccoFactor":1.099996}}}},{"market":"pennie","id":"22444PA0010039-04","standardId":"22444PA0010039","variant":"csr73","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 30/60/4900","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Adams","Berks","Cumberland","Dauphin","Franklin","Fulton","Lancaster","Lebanon","Perry","York"],"rates":{"7":{"base21":861.83,"tobaccoFactor":1.100008},"9":{"base21":827.36,"tobaccoFactor":1.100005}},"ded":{"ind":4000,"fam":8000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":9000,"fam":18000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"HMO 30 60 4900 (.73)\", in-network column; each rule's page is the sheet row); the rate decision prints no cost-sharing reduction amounts.","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with the same cost-sharing version of 22444PA0010098, 22444PA0010038, 22444PA0010040 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family; it applies to preferred brand drugs, non-preferred brand drugs, specialty drugs (the filed summary says \"after deductible\" there)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"7":{"base21":812.01,"tobaccoFactor":1.099999},"9":{"base21":779.53,"tobaccoFactor":1.099996}}}},{"market":"pennie","id":"22444PA0010039-05","standardId":"22444PA0010039","variant":"csr87","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 30/60/4900","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Adams","Berks","Cumberland","Dauphin","Franklin","Fulton","Lancaster","Lebanon","Perry","York"],"rates":{"7":{"base21":861.83,"tobaccoFactor":1.100008},"9":{"base21":827.36,"tobaccoFactor":1.100005}},"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":null,"oop":{"ind":4000,"fam":8000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"HMO 30 60 4900 (.87)\", in-network column; each rule's page is the sheet row); the rate decision prints no cost-sharing reduction amounts.","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with the same cost-sharing version of 22444PA0010098, 22444PA0010038, 22444PA0010040 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $15 copay.","Specialty drugs: 40% coinsurance up to $150 per fill (the cap is modelled here)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"7":{"base21":812.01,"tobaccoFactor":1.099999},"9":{"base21":779.53,"tobaccoFactor":1.099996}}}},{"market":"pennie","id":"22444PA0010039-06","standardId":"22444PA0010039","variant":"csr94","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 30/60/4900","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Adams","Berks","Cumberland","Dauphin","Franklin","Fulton","Lancaster","Lebanon","Perry","York"],"rates":{"7":{"base21":861.83,"tobaccoFactor":1.100008},"9":{"base21":827.36,"tobaccoFactor":1.100005}},"ded":{"ind":800,"fam":1600,"embedded":true},"drugDed":null,"oop":{"ind":3000,"fam":6000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":7,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":75}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"HMO 30 60 4900 (.94)\", in-network column; each rule's page is the sheet row); the rate decision prints no cost-sharing reduction amounts.","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with the same cost-sharing version of 22444PA0010098, 22444PA0010038, 22444PA0010040 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $1 copay.","Specialty drugs: 20% coinsurance up to $75 per fill (the cap is modelled here)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"7":{"base21":812.01,"tobaccoFactor":1.099999},"9":{"base21":779.53,"tobaccoFactor":1.099996}}}},{"market":"pennie","id":"22444PA0010040-01","standardId":"22444PA0010040","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 30/60/4900","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Lehigh","Northampton"],"rates":{"6":{"base21":689.47,"tobaccoFactor":1.09999}},"ded":{"ind":4900,"fam":9800,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family. Drug rows that say \"Deductible does not apply\" (generic drugs) are charged from the first fill; the others (preferred brand drugs, non-preferred brand drugs, specialty drugs) do not say, so they are read as after the drug deductible.","Geisinger has not published its 2027 SBCs yet; this is the 2027 SBC it filed with the PA Insurance Department in SERFF form filing GSHP-134794457 (\"2027 - 22444PA0010098 -  All-Access HMO (Silver) 30_60_4900.pdf\") for 22444PA0010098-01. The filing's benefit summary (PY2027_Individual_6.3.2026.xlsx, sheet \"All-Access HMO 30 60 4900\") lists this plan in one design with 22444PA0010098, 22444PA0010038, 22444PA0010039; they differ only in service area, and Geisinger's SBCs print no plan ID.","The SBC equals the filing's benefit summary (sheet \"All-Access HMO 30 60 4900\") on the deductible, out-of-pocket limit, drug deductible, coverage examples and every cost used here, and the rate decision's rate pages on the deductible, coinsurance, primary care and specialist copays and out-of-pocket maximum."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/2027 - 22444PA0010098 -  All-Access HMO (Silver) 30_60_4900.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":649.61,"tobaccoFactor":1.099998}}}},{"market":"pennie","id":"22444PA0010040-04","standardId":"22444PA0010040","variant":"csr73","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 30/60/4900","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Lehigh","Northampton"],"rates":{"6":{"base21":689.47,"tobaccoFactor":1.09999}},"ded":{"ind":4000,"fam":8000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":9000,"fam":18000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"HMO 30 60 4900 (.73)\", in-network column; each rule's page is the sheet row); the rate decision prints no cost-sharing reduction amounts.","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with the same cost-sharing version of 22444PA0010098, 22444PA0010038, 22444PA0010039 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family; it applies to preferred brand drugs, non-preferred brand drugs, specialty drugs (the filed summary says \"after deductible\" there)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"6":{"base21":649.61,"tobaccoFactor":1.099998}}}},{"market":"pennie","id":"22444PA0010040-05","standardId":"22444PA0010040","variant":"csr87","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 30/60/4900","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Lehigh","Northampton"],"rates":{"6":{"base21":689.47,"tobaccoFactor":1.09999}},"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":null,"oop":{"ind":4000,"fam":8000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"HMO 30 60 4900 (.87)\", in-network column; each rule's page is the sheet row); the rate decision prints no cost-sharing reduction amounts.","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with the same cost-sharing version of 22444PA0010098, 22444PA0010038, 22444PA0010039 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $15 copay.","Specialty drugs: 40% coinsurance up to $150 per fill (the cap is modelled here)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"6":{"base21":649.61,"tobaccoFactor":1.099998}}}},{"market":"pennie","id":"22444PA0010040-06","standardId":"22444PA0010040","variant":"csr94","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 30/60/4900","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Lehigh","Northampton"],"rates":{"6":{"base21":689.47,"tobaccoFactor":1.09999}},"ded":{"ind":800,"fam":1600,"embedded":true},"drugDed":null,"oop":{"ind":3000,"fam":6000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":7,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":75}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"HMO 30 60 4900 (.94)\", in-network column; each rule's page is the sheet row); the rate decision prints no cost-sharing reduction amounts.","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with the same cost-sharing version of 22444PA0010098, 22444PA0010038, 22444PA0010039 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $1 copay.","Specialty drugs: 20% coinsurance up to $75 per fill (the cap is modelled here)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"6":{"base21":649.61,"tobaccoFactor":1.099998}}}},{"market":"pennie","id":"22444PA0010042-01","standardId":"22444PA0010042","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 20/50/3250","metal":"Gold","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Adams","Berks","Cumberland","Dauphin","Franklin","Fulton","Lancaster","Lebanon","Perry","York"],"rates":{"7":{"base21":774.89,"tobaccoFactor":1.099988},"9":{"base21":743.89,"tobaccoFactor":1.100001}},"ded":{"ind":3250,"fam":6500,"embedded":true},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Access HMO 20 50 3250\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010082, 22444PA0010035, 22444PA0010036 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $15 copay.","Specialty drugs: 40% coinsurance up to $150 per fill (the cap is modelled here)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"7":{"base21":711.74,"tobaccoFactor":1.099994},"9":{"base21":683.27,"tobaccoFactor":1.09999}}}},{"market":"pennie","id":"22444PA0010045-01","standardId":"22444PA0010045","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access Extra HMO 10/50/500","metal":"Gold","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":true,"counties":["Carbon","Centre","Clinton","Cumberland","Dauphin","Juniata","Lackawanna","Luzerne","Lycoming","Monroe","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Susquehanna","Union","Wayne","Wyoming"],"rates":{"3":{"base21":578.37,"tobaccoFactor":1.100005},"6":{"base21":608.81,"tobaccoFactor":1.099998},"9":{"base21":730.57,"tobaccoFactor":1.100004}},"ded":{"ind":500,"fam":1000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Primary care visits: $50 copay (used here); $10 copay only at a primary care site designated as an \"Extra\" or ProvenHealth Navigator site.","Diagnostic tests: x-rays $50 copay per day of service (charged once per x-ray here); laboratory tests 20% coinsurance.","Separate prescription drug deductible: $500 individual / $1,000 family. Drug rows that say \"Deductible does not apply\" (generic drugs) are charged from the first fill; the others (preferred brand drugs, non-preferred brand drugs, specialty drugs) do not say, so they are read as after the drug deductible.","Geisinger has not published its 2027 SBCs yet; this is the 2027 SBC it filed with the PA Insurance Department in SERFF form filing GSHP-134794460 (\"2027 - 22444PA0010045 - Geisinger Marketplace All-Access Extra HMO 10_50_500 (Gold).pdf\") for this plan.","The SBC equals the filing's benefit summary (sheet \"All-Access Extra HMO 10 50 500\") on the deductible, out-of-pocket limit, drug deductible, coverage examples and every cost used here, and the rate decision's rate pages on the deductible, coinsurance, primary care and specialist copays and out-of-pocket maximum."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794460/2027 - 22444PA0010045 - Geisinger Marketplace All-Access Extra HMO 10_50_500 (Gold).pdf","prev":{"planYear":2026,"rates":{"3":{"base21":540.92,"tobaccoFactor":1.099996},"6":{"base21":569.39,"tobaccoFactor":1.100002},"9":{"base21":683.27,"tobaccoFactor":1.09999}}}},{"market":"pennie","id":"22444PA0010053-01","standardId":"22444PA0010053","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 40/80/8400","metal":"Bronze","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bradford","Carbon","Centre","Clinton","Columbia","Juniata","Lackawanna","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northumberland","Pike","Schuylkill","Snyder","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming"],"rates":{"3":{"base21":441.1,"tobaccoFactor":1.1},"6":{"base21":464.31,"tobaccoFactor":1.099998},"9":{"base21":557.17,"tobaccoFactor":1.100005}},"ded":{"ind":8400,"fam":16800,"embedded":true},"drugDed":null,"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Access HMO 40 80 8400\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010106, 22444PA0010054, 22444PA0010055 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill. Tier 1 generics are $0 and Tier 3 non-preferred generics are no charge after the deductible.","Prescription drugs share the medical deductible (the filed summary says the drug deductible is combined with medical)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"3":{"base21":397.89,"tobaccoFactor":1.100003},"6":{"base21":418.84,"tobaccoFactor":1.09999},"9":{"base21":502.6,"tobaccoFactor":1.1}}}},{"market":"pennie","id":"22444PA0010054-01","standardId":"22444PA0010054","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 40/80/8400","metal":"Bronze","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Adams","Berks","Cumberland","Dauphin","Franklin","Fulton","Lancaster","Lebanon","Perry","York"],"rates":{"7":{"base21":580.39,"tobaccoFactor":1.100002},"9":{"base21":557.17,"tobaccoFactor":1.100005}},"ded":{"ind":8400,"fam":16800,"embedded":true},"drugDed":null,"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Access HMO 40 80 8400\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010106, 22444PA0010053, 22444PA0010055 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill. Tier 1 generics are $0 and Tier 3 non-preferred generics are no charge after the deductible.","Prescription drugs share the medical deductible (the filed summary says the drug deductible is combined with medical)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"7":{"base21":523.54,"tobaccoFactor":1.100011},"9":{"base21":502.6,"tobaccoFactor":1.1}}}},{"market":"pennie","id":"22444PA0010055-01","standardId":"22444PA0010055","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 40/80/8400","metal":"Bronze","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Lehigh","Northampton"],"rates":{"6":{"base21":464.31,"tobaccoFactor":1.099998}},"ded":{"ind":8400,"fam":16800,"embedded":true},"drugDed":null,"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Access HMO 40 80 8400\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010106, 22444PA0010053, 22444PA0010054 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill. Tier 1 generics are $0 and Tier 3 non-preferred generics are no charge after the deductible.","Prescription drugs share the medical deductible (the filed summary says the drug deductible is combined with medical)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"6":{"base21":418.84,"tobaccoFactor":1.09999}}}},{"market":"pennie","id":"22444PA0010082-01","standardId":"22444PA0010082","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 20/50/3250","metal":"Gold","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bedford","Blair","Cambria","Cameron","Clearfield","Elk","Huntingdon","Jefferson","Potter","Somerset"],"rates":{"2":{"base21":619.91,"tobaccoFactor":1.099998},"5":{"base21":588.91,"tobaccoFactor":1.100015}},"ded":{"ind":3250,"fam":6500,"embedded":true},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Access HMO 20 50 3250\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010035, 22444PA0010042, 22444PA0010036 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $15 copay.","Specialty drugs: 40% coinsurance up to $150 per fill (the cap is modelled here)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"2":{"base21":569.39,"tobaccoFactor":1.100002},"5":{"base21":540.92,"tobaccoFactor":1.099996}}}},{"market":"pennie","id":"22444PA0010098-01","standardId":"22444PA0010098","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 30/60/4900","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bedford","Blair","Cambria","Cameron","Clearfield","Elk","Huntingdon","Jefferson","Potter","Somerset"],"rates":{"2":{"base21":689.47,"tobaccoFactor":1.09999},"5":{"base21":654.99,"tobaccoFactor":1.100002}},"ded":{"ind":4900,"fam":9800,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family. Drug rows that say \"Deductible does not apply\" (generic drugs) are charged from the first fill; the others (preferred brand drugs, non-preferred brand drugs, specialty drugs) do not say, so they are read as after the drug deductible.","Geisinger has not published its 2027 SBCs yet; this is the 2027 SBC it filed with the PA Insurance Department in SERFF form filing GSHP-134794457 (\"2027 - 22444PA0010098 -  All-Access HMO (Silver) 30_60_4900.pdf\") for this plan.","The SBC equals the filing's benefit summary (sheet \"All-Access HMO 30 60 4900\") on the deductible, out-of-pocket limit, drug deductible, coverage examples and every cost used here, and the rate decision's rate pages on the deductible, coinsurance, primary care and specialist copays and out-of-pocket maximum."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/2027 - 22444PA0010098 -  All-Access HMO (Silver) 30_60_4900.pdf","prev":{"planYear":2026,"rates":{"2":{"base21":649.61,"tobaccoFactor":1.099998},"5":{"base21":617.13,"tobaccoFactor":1.099995}}}},{"market":"pennie","id":"22444PA0010098-04","standardId":"22444PA0010098","variant":"csr73","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 30/60/4900","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bedford","Blair","Cambria","Cameron","Clearfield","Elk","Huntingdon","Jefferson","Potter","Somerset"],"rates":{"2":{"base21":689.47,"tobaccoFactor":1.09999},"5":{"base21":654.99,"tobaccoFactor":1.100002}},"ded":{"ind":4000,"fam":8000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":9000,"fam":18000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"HMO 30 60 4900 (.73)\", in-network column; each rule's page is the sheet row); the rate decision prints no cost-sharing reduction amounts.","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with the same cost-sharing version of 22444PA0010038, 22444PA0010039, 22444PA0010040 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family; it applies to preferred brand drugs, non-preferred brand drugs, specialty drugs (the filed summary says \"after deductible\" there)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"2":{"base21":649.61,"tobaccoFactor":1.099998},"5":{"base21":617.13,"tobaccoFactor":1.099995}}}},{"market":"pennie","id":"22444PA0010098-05","standardId":"22444PA0010098","variant":"csr87","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 30/60/4900","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bedford","Blair","Cambria","Cameron","Clearfield","Elk","Huntingdon","Jefferson","Potter","Somerset"],"rates":{"2":{"base21":689.47,"tobaccoFactor":1.09999},"5":{"base21":654.99,"tobaccoFactor":1.100002}},"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":null,"oop":{"ind":4000,"fam":8000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"HMO 30 60 4900 (.87)\", in-network column; each rule's page is the sheet row); the rate decision prints no cost-sharing reduction amounts.","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with the same cost-sharing version of 22444PA0010038, 22444PA0010039, 22444PA0010040 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $15 copay.","Specialty drugs: 40% coinsurance up to $150 per fill (the cap is modelled here)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"2":{"base21":649.61,"tobaccoFactor":1.099998},"5":{"base21":617.13,"tobaccoFactor":1.099995}}}},{"market":"pennie","id":"22444PA0010098-06","standardId":"22444PA0010098","variant":"csr94","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 30/60/4900","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bedford","Blair","Cambria","Cameron","Clearfield","Elk","Huntingdon","Jefferson","Potter","Somerset"],"rates":{"2":{"base21":689.47,"tobaccoFactor":1.09999},"5":{"base21":654.99,"tobaccoFactor":1.100002}},"ded":{"ind":800,"fam":1600,"embedded":true},"drugDed":null,"oop":{"ind":3000,"fam":6000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":7,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":75}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"HMO 30 60 4900 (.94)\", in-network column; each rule's page is the sheet row); the rate decision prints no cost-sharing reduction amounts.","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with the same cost-sharing version of 22444PA0010038, 22444PA0010039, 22444PA0010040 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $1 copay.","Specialty drugs: 20% coinsurance up to $75 per fill (the cap is modelled here)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"2":{"base21":649.61,"tobaccoFactor":1.099998},"5":{"base21":617.13,"tobaccoFactor":1.099995}}}},{"market":"pennie","id":"22444PA0010106-01","standardId":"22444PA0010106","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 40/80/8400","metal":"Bronze","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bedford","Blair","Cambria","Cameron","Clearfield","Elk","Huntingdon","Jefferson","Potter","Somerset"],"rates":{"2":{"base21":464.31,"tobaccoFactor":1.099998},"5":{"base21":441.1,"tobaccoFactor":1.1}},"ded":{"ind":8400,"fam":16800,"embedded":true},"drugDed":null,"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Access HMO 40 80 8400\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010053, 22444PA0010054, 22444PA0010055 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill. Tier 1 generics are $0 and Tier 3 non-preferred generics are no charge after the deductible.","Prescription drugs share the medical deductible (the filed summary says the drug deductible is combined with medical)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"2":{"base21":418.84,"tobaccoFactor":1.09999},"5":{"base21":397.89,"tobaccoFactor":1.100003}}}},{"market":"pennie","id":"22444PA0010135-01","standardId":"22444PA0010135","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace Premier HMO 20/50/3250","metal":"Gold","network":"HMO","hsaEligible":false,"networkId":"PAN002","referral":false,"tiers":false,"counties":["Centre","Columbia","Mifflin","Montour","Northumberland","Snyder","Union"],"rates":{"6":{"base21":582.71,"tobaccoFactor":1.100015}},"ded":{"ind":3250,"fam":6500,"embedded":true},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794601, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"Premier HMO 20 50 3250\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010138, 22444PA0010141 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $15 copay.","Specialty drugs: 40% coinsurance up to $150 per fill (the cap is modelled here)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794601/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"6":{"base21":535.23,"tobaccoFactor":1.099994}}}},{"market":"pennie","id":"22444PA0010136-01","standardId":"22444PA0010136","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace Premier HMO 30/60/4900","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN002","referral":false,"tiers":false,"counties":["Centre","Columbia","Mifflin","Montour","Northumberland","Snyder","Union"],"rates":{"6":{"base21":648.1,"tobaccoFactor":1.1}},"ded":{"ind":4900,"fam":9800,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family. Drug rows that say \"Deductible does not apply\" (generic drugs) are charged from the first fill; the others (preferred brand drugs, non-preferred brand drugs, specialty drugs) do not say, so they are read as after the drug deductible.","Geisinger has not published its 2027 SBCs yet; this is the 2027 SBC it filed with the PA Insurance Department in SERFF form filing GSHP-134794601 (\"2027 - 22444PA0010136 - Premier HMO (Silver) 30_60_4900 v2.pdf\") for this plan.","The SBC equals the filing's benefit summary (sheet \"Premier HMO 30 60 4900\") on the deductible, out-of-pocket limit, drug deductible, coverage examples and every cost used here, and the rate decision's rate pages on the deductible, coinsurance, primary care and specialist copays and out-of-pocket maximum."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794601/2027 - 22444PA0010136 - Premier HMO (Silver) 30_60_4900 v2.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":610.63,"tobaccoFactor":1.099995}}}},{"market":"pennie","id":"22444PA0010136-04","standardId":"22444PA0010136","variant":"csr73","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace Premier HMO 30/60/4900","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN002","referral":false,"tiers":false,"counties":["Centre","Columbia","Mifflin","Montour","Northumberland","Snyder","Union"],"rates":{"6":{"base21":648.1,"tobaccoFactor":1.1}},"ded":{"ind":4000,"fam":8000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":9000,"fam":18000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794601, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"Premier HMO 30 60 4900 (.73)\", in-network column; each rule's page is the sheet row); the rate decision prints no cost-sharing reduction amounts.","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with the same cost-sharing version of 22444PA0010139, 22444PA0010142 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family; it applies to preferred brand drugs, non-preferred brand drugs, specialty drugs (the filed summary says \"after deductible\" there)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794601/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"6":{"base21":610.63,"tobaccoFactor":1.099995}}}},{"market":"pennie","id":"22444PA0010136-05","standardId":"22444PA0010136","variant":"csr87","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace Premier HMO 30/60/4900","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN002","referral":false,"tiers":false,"counties":["Centre","Columbia","Mifflin","Montour","Northumberland","Snyder","Union"],"rates":{"6":{"base21":648.1,"tobaccoFactor":1.1}},"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":null,"oop":{"ind":4000,"fam":8000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794601, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"Premier HMO 30 60 4900 (.87)\", in-network column; each rule's page is the sheet row); the rate decision prints no cost-sharing reduction amounts.","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with the same cost-sharing version of 22444PA0010139, 22444PA0010142 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $15 copay.","Specialty drugs: 40% coinsurance up to $150 per fill (the cap is modelled here)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794601/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"6":{"base21":610.63,"tobaccoFactor":1.099995}}}},{"market":"pennie","id":"22444PA0010136-06","standardId":"22444PA0010136","variant":"csr94","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace Premier HMO 30/60/4900","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN002","referral":false,"tiers":false,"counties":["Centre","Columbia","Mifflin","Montour","Northumberland","Snyder","Union"],"rates":{"6":{"base21":648.1,"tobaccoFactor":1.1}},"ded":{"ind":800,"fam":1600,"embedded":true},"drugDed":null,"oop":{"ind":3000,"fam":6000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":7,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":75}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794601, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"Premier HMO 30 60 4900 (.94)\", in-network column; each rule's page is the sheet row); the rate decision prints no cost-sharing reduction amounts.","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with the same cost-sharing version of 22444PA0010139, 22444PA0010142 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $1 copay.","Specialty drugs: 20% coinsurance up to $75 per fill (the cap is modelled here)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794601/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"6":{"base21":610.63,"tobaccoFactor":1.099995}}}},{"market":"pennie","id":"22444PA0010137-01","standardId":"22444PA0010137","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace Premier HMO 40/80/8400","metal":"Bronze","network":"HMO","hsaEligible":false,"networkId":"PAN002","referral":false,"tiers":false,"counties":["Centre","Columbia","Mifflin","Montour","Northumberland","Snyder","Union"],"rates":{"6":{"base21":436.45,"tobaccoFactor":1.100011}},"ded":{"ind":8400,"fam":16800,"embedded":true},"drugDed":null,"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794601, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"Premier HMO 40 80 8400\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010140, 22444PA0010143 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill. Tier 1 generics are $0 and Tier 3 non-preferred generics are no charge after the deductible.","Prescription drugs share the medical deductible (the filed summary says the drug deductible is combined with medical)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794601/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"6":{"base21":393.71,"tobaccoFactor":1.099997}}}},{"market":"pennie","id":"22444PA0010138-01","standardId":"22444PA0010138","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace Premier HMO 20/50/3250","metal":"Gold","network":"HMO","hsaEligible":false,"networkId":"PAN002","referral":false,"tiers":false,"counties":["Carbon","Monroe","Schuylkill"],"rates":{"3":{"base21":553.58,"tobaccoFactor":1.100004},"6":{"base21":582.71,"tobaccoFactor":1.100015}},"ded":{"ind":3250,"fam":6500,"embedded":true},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794601, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"Premier HMO 20 50 3250\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010135, 22444PA0010141 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $15 copay.","Specialty drugs: 40% coinsurance up to $150 per fill (the cap is modelled here)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794601/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"3":{"base21":508.47,"tobaccoFactor":1.099986},"6":{"base21":535.23,"tobaccoFactor":1.099994}}}},{"market":"pennie","id":"22444PA0010139-01","standardId":"22444PA0010139","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace Premier HMO 30/60/4900","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN002","referral":false,"tiers":false,"counties":["Carbon","Monroe","Schuylkill"],"rates":{"3":{"base21":615.7,"tobaccoFactor":1.099984},"6":{"base21":648.1,"tobaccoFactor":1.1}},"ded":{"ind":4900,"fam":9800,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family. Drug rows that say \"Deductible does not apply\" (generic drugs) are charged from the first fill; the others (preferred brand drugs, non-preferred brand drugs, specialty drugs) do not say, so they are read as after the drug deductible.","Geisinger has not published its 2027 SBCs yet; this is the 2027 SBC it filed with the PA Insurance Department in SERFF form filing GSHP-134794601 (\"2027 - 22444PA0010136 - Premier HMO (Silver) 30_60_4900 v2.pdf\") for 22444PA0010136-01. The filing's benefit summary (PY2027_Individual_6.3.2026.xlsx, sheet \"Premier HMO 30 60 4900\") lists this plan in one design with 22444PA0010136, 22444PA0010142; they differ only in service area, and Geisinger's SBCs print no plan ID.","The SBC equals the filing's benefit summary (sheet \"Premier HMO 30 60 4900\") on the deductible, out-of-pocket limit, drug deductible, coverage examples and every cost used here, and the rate decision's rate pages on the deductible, coinsurance, primary care and specialist copays and out-of-pocket maximum."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794601/2027 - 22444PA0010136 - Premier HMO (Silver) 30_60_4900 v2.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":580.1,"tobaccoFactor":1.1},"6":{"base21":610.63,"tobaccoFactor":1.099995}}}},{"market":"pennie","id":"22444PA0010139-04","standardId":"22444PA0010139","variant":"csr73","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace Premier HMO 30/60/4900","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN002","referral":false,"tiers":false,"counties":["Carbon","Monroe","Schuylkill"],"rates":{"3":{"base21":615.7,"tobaccoFactor":1.099984},"6":{"base21":648.1,"tobaccoFactor":1.1}},"ded":{"ind":4000,"fam":8000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":9000,"fam":18000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794601, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"Premier HMO 30 60 4900 (.73)\", in-network column; each rule's page is the sheet row); the rate decision prints no cost-sharing reduction amounts.","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with the same cost-sharing version of 22444PA0010136, 22444PA0010142 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family; it applies to preferred brand drugs, non-preferred brand drugs, specialty drugs (the filed summary says \"after deductible\" there)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794601/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"3":{"base21":580.1,"tobaccoFactor":1.1},"6":{"base21":610.63,"tobaccoFactor":1.099995}}}},{"market":"pennie","id":"22444PA0010139-05","standardId":"22444PA0010139","variant":"csr87","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace Premier HMO 30/60/4900","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN002","referral":false,"tiers":false,"counties":["Carbon","Monroe","Schuylkill"],"rates":{"3":{"base21":615.7,"tobaccoFactor":1.099984},"6":{"base21":648.1,"tobaccoFactor":1.1}},"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":null,"oop":{"ind":4000,"fam":8000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794601, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"Premier HMO 30 60 4900 (.87)\", in-network column; each rule's page is the sheet row); the rate decision prints no cost-sharing reduction amounts.","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with the same cost-sharing version of 22444PA0010136, 22444PA0010142 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $15 copay.","Specialty drugs: 40% coinsurance up to $150 per fill (the cap is modelled here)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794601/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"3":{"base21":580.1,"tobaccoFactor":1.1},"6":{"base21":610.63,"tobaccoFactor":1.099995}}}},{"market":"pennie","id":"22444PA0010139-06","standardId":"22444PA0010139","variant":"csr94","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace Premier HMO 30/60/4900","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN002","referral":false,"tiers":false,"counties":["Carbon","Monroe","Schuylkill"],"rates":{"3":{"base21":615.7,"tobaccoFactor":1.099984},"6":{"base21":648.1,"tobaccoFactor":1.1}},"ded":{"ind":800,"fam":1600,"embedded":true},"drugDed":null,"oop":{"ind":3000,"fam":6000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":7,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":75}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794601, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"Premier HMO 30 60 4900 (.94)\", in-network column; each rule's page is the sheet row); the rate decision prints no cost-sharing reduction amounts.","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with the same cost-sharing version of 22444PA0010136, 22444PA0010142 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $1 copay.","Specialty drugs: 20% coinsurance up to $75 per fill (the cap is modelled here)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794601/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"3":{"base21":580.1,"tobaccoFactor":1.1},"6":{"base21":610.63,"tobaccoFactor":1.099995}}}},{"market":"pennie","id":"22444PA0010140-01","standardId":"22444PA0010140","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace Premier HMO 40/80/8400","metal":"Bronze","network":"HMO","hsaEligible":false,"networkId":"PAN002","referral":false,"tiers":false,"counties":["Carbon","Monroe","Schuylkill"],"rates":{"3":{"base21":414.63,"tobaccoFactor":1.099993},"6":{"base21":436.45,"tobaccoFactor":1.100011}},"ded":{"ind":8400,"fam":16800,"embedded":true},"drugDed":null,"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794601, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"Premier HMO 40 80 8400\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010137, 22444PA0010143 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill. Tier 1 generics are $0 and Tier 3 non-preferred generics are no charge after the deductible.","Prescription drugs share the medical deductible (the filed summary says the drug deductible is combined with medical)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794601/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"3":{"base21":374.02,"tobaccoFactor":1.099995},"6":{"base21":393.71,"tobaccoFactor":1.099997}}}},{"market":"pennie","id":"22444PA0010141-01","standardId":"22444PA0010141","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace Premier HMO 20/50/3250","metal":"Gold","network":"HMO","hsaEligible":false,"networkId":"PAN002","referral":false,"tiers":false,"counties":["Lackawanna","Luzerne","Wayne"],"rates":{"3":{"base21":553.58,"tobaccoFactor":1.100004}},"ded":{"ind":3250,"fam":6500,"embedded":true},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794601, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"Premier HMO 20 50 3250\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010135, 22444PA0010138 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $15 copay.","Specialty drugs: 40% coinsurance up to $150 per fill (the cap is modelled here)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794601/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"3":{"base21":508.47,"tobaccoFactor":1.099986}}}},{"market":"pennie","id":"22444PA0010142-01","standardId":"22444PA0010142","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace Premier HMO 30/60/4900","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN002","referral":false,"tiers":false,"counties":["Lackawanna","Luzerne","Wayne"],"rates":{"3":{"base21":615.7,"tobaccoFactor":1.099984}},"ded":{"ind":4900,"fam":9800,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family. Drug rows that say \"Deductible does not apply\" (generic drugs) are charged from the first fill; the others (preferred brand drugs, non-preferred brand drugs, specialty drugs) do not say, so they are read as after the drug deductible.","Geisinger has not published its 2027 SBCs yet; this is the 2027 SBC it filed with the PA Insurance Department in SERFF form filing GSHP-134794601 (\"2027 - 22444PA0010136 - Premier HMO (Silver) 30_60_4900 v2.pdf\") for 22444PA0010136-01. The filing's benefit summary (PY2027_Individual_6.3.2026.xlsx, sheet \"Premier HMO 30 60 4900\") lists this plan in one design with 22444PA0010136, 22444PA0010139; they differ only in service area, and Geisinger's SBCs print no plan ID.","The SBC equals the filing's benefit summary (sheet \"Premier HMO 30 60 4900\") on the deductible, out-of-pocket limit, drug deductible, coverage examples and every cost used here, and the rate decision's rate pages on the deductible, coinsurance, primary care and specialist copays and out-of-pocket maximum."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794601/2027 - 22444PA0010136 - Premier HMO (Silver) 30_60_4900 v2.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":580.1,"tobaccoFactor":1.1}}}},{"market":"pennie","id":"22444PA0010142-04","standardId":"22444PA0010142","variant":"csr73","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace Premier HMO 30/60/4900","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN002","referral":false,"tiers":false,"counties":["Lackawanna","Luzerne","Wayne"],"rates":{"3":{"base21":615.7,"tobaccoFactor":1.099984}},"ded":{"ind":4000,"fam":8000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":9000,"fam":18000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794601, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"Premier HMO 30 60 4900 (.73)\", in-network column; each rule's page is the sheet row); the rate decision prints no cost-sharing reduction amounts.","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with the same cost-sharing version of 22444PA0010136, 22444PA0010139 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family; it applies to preferred brand drugs, non-preferred brand drugs, specialty drugs (the filed summary says \"after deductible\" there)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794601/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"3":{"base21":580.1,"tobaccoFactor":1.1}}}},{"market":"pennie","id":"22444PA0010142-05","standardId":"22444PA0010142","variant":"csr87","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace Premier HMO 30/60/4900","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN002","referral":false,"tiers":false,"counties":["Lackawanna","Luzerne","Wayne"],"rates":{"3":{"base21":615.7,"tobaccoFactor":1.099984}},"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":null,"oop":{"ind":4000,"fam":8000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794601, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"Premier HMO 30 60 4900 (.87)\", in-network column; each rule's page is the sheet row); the rate decision prints no cost-sharing reduction amounts.","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with the same cost-sharing version of 22444PA0010136, 22444PA0010139 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $15 copay.","Specialty drugs: 40% coinsurance up to $150 per fill (the cap is modelled here)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794601/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"3":{"base21":580.1,"tobaccoFactor":1.1}}}},{"market":"pennie","id":"22444PA0010142-06","standardId":"22444PA0010142","variant":"csr94","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace Premier HMO 30/60/4900","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN002","referral":false,"tiers":false,"counties":["Lackawanna","Luzerne","Wayne"],"rates":{"3":{"base21":615.7,"tobaccoFactor":1.099984}},"ded":{"ind":800,"fam":1600,"embedded":true},"drugDed":null,"oop":{"ind":3000,"fam":6000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":7,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":75}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794601, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"Premier HMO 30 60 4900 (.94)\", in-network column; each rule's page is the sheet row); the rate decision prints no cost-sharing reduction amounts.","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with the same cost-sharing version of 22444PA0010136, 22444PA0010139 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $1 copay.","Specialty drugs: 20% coinsurance up to $75 per fill (the cap is modelled here)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794601/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"3":{"base21":580.1,"tobaccoFactor":1.1}}}},{"market":"pennie","id":"22444PA0010143-01","standardId":"22444PA0010143","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace Premier HMO 40/80/8400","metal":"Bronze","network":"HMO","hsaEligible":false,"networkId":"PAN002","referral":false,"tiers":false,"counties":["Lackawanna","Luzerne","Wayne"],"rates":{"3":{"base21":414.63,"tobaccoFactor":1.099993}},"ded":{"ind":8400,"fam":16800,"embedded":true},"drugDed":null,"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794601, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"Premier HMO 40 80 8400\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010137, 22444PA0010140 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill. Tier 1 generics are $0 and Tier 3 non-preferred generics are no charge after the deductible.","Prescription drugs share the medical deductible (the filed summary says the drug deductible is combined with medical)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794601/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"3":{"base21":374.02,"tobaccoFactor":1.099995}}}},{"market":"pennie","id":"22444PA0010144-01","standardId":"22444PA0010144","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 25/50/250","metal":"Gold","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bedford","Blair","Cambria","Cameron","Clearfield","Elk","Huntingdon","Jefferson","Potter","Somerset"],"rates":{"2":{"base21":595.76,"tobaccoFactor":1.09999},"5":{"base21":565.97,"tobaccoFactor":1.100005}},"ded":{"ind":250,"fam":500,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":11500,"fam":23000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"lab":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Access HMO 25 50 250\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010146, 22444PA0010153, 22444PA0010152 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family; it applies to preferred brand drugs, non-preferred brand drugs, specialty drugs (the filed summary says \"after deductible\" there)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"2":{"base21":569.39,"tobaccoFactor":1.100002},"5":{"base21":540.92,"tobaccoFactor":1.099996}}}},{"market":"pennie","id":"22444PA0010146-01","standardId":"22444PA0010146","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 25/50/250","metal":"Gold","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bradford","Carbon","Centre","Clinton","Columbia","Juniata","Lackawanna","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northumberland","Pike","Schuylkill","Snyder","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming"],"rates":{"3":{"base21":565.97,"tobaccoFactor":1.100005},"6":{"base21":595.76,"tobaccoFactor":1.09999},"9":{"base21":714.91,"tobaccoFactor":1.099999}},"ded":{"ind":250,"fam":500,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":11500,"fam":23000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"lab":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Access HMO 25 50 250\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010144, 22444PA0010153, 22444PA0010152 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family; it applies to preferred brand drugs, non-preferred brand drugs, specialty drugs (the filed summary says \"after deductible\" there)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"3":{"base21":540.92,"tobaccoFactor":1.099996},"6":{"base21":569.39,"tobaccoFactor":1.100002},"9":{"base21":683.27,"tobaccoFactor":1.09999}}}},{"market":"pennie","id":"22444PA0010152-01","standardId":"22444PA0010152","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 25/50/250","metal":"Gold","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Lehigh","Northampton"],"rates":{"6":{"base21":595.76,"tobaccoFactor":1.09999}},"ded":{"ind":250,"fam":500,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":11500,"fam":23000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"lab":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Access HMO 25 50 250\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010144, 22444PA0010146, 22444PA0010153 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family; it applies to preferred brand drugs, non-preferred brand drugs, specialty drugs (the filed summary says \"after deductible\" there)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"6":{"base21":569.39,"tobaccoFactor":1.100002}}}},{"market":"pennie","id":"22444PA0010153-01","standardId":"22444PA0010153","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 25/50/250","metal":"Gold","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Adams","Berks","Cumberland","Dauphin","Franklin","Fulton","Lancaster","Lebanon","Perry","York"],"rates":{"7":{"base21":744.69,"tobaccoFactor":1.100001},"9":{"base21":714.91,"tobaccoFactor":1.099999}},"ded":{"ind":250,"fam":500,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":11500,"fam":23000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"lab":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Access HMO 25 50 250\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010144, 22444PA0010146, 22444PA0010152 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family; it applies to preferred brand drugs, non-preferred brand drugs, specialty drugs (the filed summary says \"after deductible\" there)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"7":{"base21":711.74,"tobaccoFactor":1.099994},"9":{"base21":683.27,"tobaccoFactor":1.09999}}}},{"market":"pennie","id":"22444PA0010157-01","standardId":"22444PA0010157","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 25/50/2500","metal":"Gold","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bedford","Blair","Cambria","Cameron","Clearfield","Elk","Huntingdon","Jefferson","Potter","Somerset"],"rates":{"2":{"base21":585.09,"tobaccoFactor":1.100002},"5":{"base21":555.84,"tobaccoFactor":1.099993}},"ded":{"ind":2500,"fam":5000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":6500,"fam":13000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Access HMO 25 50 2500\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010159, 22444PA0010167, 22444PA0010166 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family; it applies to preferred brand drugs, non-preferred brand drugs, specialty drugs (the filed summary says \"after deductible\" there)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"2":{"base21":534.5,"tobaccoFactor":1.1},"5":{"base21":507.78,"tobaccoFactor":1.100004}}}},{"market":"pennie","id":"22444PA0010159-01","standardId":"22444PA0010159","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 25/50/2500","metal":"Gold","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bradford","Carbon","Centre","Clinton","Columbia","Juniata","Lackawanna","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northumberland","Pike","Schuylkill","Snyder","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming"],"rates":{"3":{"base21":555.84,"tobaccoFactor":1.099993},"6":{"base21":585.09,"tobaccoFactor":1.100002},"9":{"base21":702.11,"tobaccoFactor":1.099999}},"ded":{"ind":2500,"fam":5000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":6500,"fam":13000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Access HMO 25 50 2500\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010157, 22444PA0010167, 22444PA0010166 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family; it applies to preferred brand drugs, non-preferred brand drugs, specialty drugs (the filed summary says \"after deductible\" there)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"3":{"base21":507.78,"tobaccoFactor":1.100004},"6":{"base21":534.5,"tobaccoFactor":1.1},"9":{"base21":641.4,"tobaccoFactor":1.1}}}},{"market":"pennie","id":"22444PA0010166-01","standardId":"22444PA0010166","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 25/50/2500","metal":"Gold","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Lehigh","Northampton"],"rates":{"6":{"base21":585.09,"tobaccoFactor":1.100002}},"ded":{"ind":2500,"fam":5000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":6500,"fam":13000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Access HMO 25 50 2500\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010157, 22444PA0010159, 22444PA0010167 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family; it applies to preferred brand drugs, non-preferred brand drugs, specialty drugs (the filed summary says \"after deductible\" there)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"6":{"base21":534.5,"tobaccoFactor":1.1}}}},{"market":"pennie","id":"22444PA0010167-01","standardId":"22444PA0010167","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 25/50/2500","metal":"Gold","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Adams","Berks","Cumberland","Dauphin","Franklin","Fulton","Lancaster","Lebanon","Perry","York"],"rates":{"7":{"base21":731.37,"tobaccoFactor":1.09999},"9":{"base21":702.11,"tobaccoFactor":1.099999}},"ded":{"ind":2500,"fam":5000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":6500,"fam":13000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Access HMO 25 50 2500\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010157, 22444PA0010159, 22444PA0010166 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family; it applies to preferred brand drugs, non-preferred brand drugs, specialty drugs (the filed summary says \"after deductible\" there)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"7":{"base21":668.13,"tobaccoFactor":1.099996},"9":{"base21":641.4,"tobaccoFactor":1.1}}}},{"market":"pennie","id":"22444PA0010171-01","standardId":"22444PA0010171","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 25/50/4000","metal":"Gold","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bedford","Blair","Cambria","Cameron","Clearfield","Elk","Huntingdon","Jefferson","Potter","Somerset"],"rates":{"2":{"base21":575.66,"tobaccoFactor":1.100007},"5":{"base21":546.88,"tobaccoFactor":1.100004}},"ded":{"ind":4000,"fam":8000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":7450,"fam":14900},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Access HMO 25 50 4000\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010173, 22444PA0010180, 22444PA0010179 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family; it applies to preferred brand drugs, non-preferred brand drugs, specialty drugs (the filed summary says \"after deductible\" there)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"2":{"base21":516.48,"tobaccoFactor":1.099985},"5":{"base21":490.65,"tobaccoFactor":1.10001}}}},{"market":"pennie","id":"22444PA0010173-01","standardId":"22444PA0010173","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 25/50/4000","metal":"Gold","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bradford","Carbon","Centre","Clinton","Columbia","Juniata","Lackawanna","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northumberland","Pike","Schuylkill","Snyder","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming"],"rates":{"3":{"base21":546.88,"tobaccoFactor":1.100004},"6":{"base21":575.66,"tobaccoFactor":1.100007},"9":{"base21":690.79,"tobaccoFactor":1.100001}},"ded":{"ind":4000,"fam":8000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":7450,"fam":14900},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Access HMO 25 50 4000\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010171, 22444PA0010180, 22444PA0010179 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family; it applies to preferred brand drugs, non-preferred brand drugs, specialty drugs (the filed summary says \"after deductible\" there)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"3":{"base21":490.65,"tobaccoFactor":1.10001},"6":{"base21":516.48,"tobaccoFactor":1.099985},"9":{"base21":619.77,"tobaccoFactor":1.100005}}}},{"market":"pennie","id":"22444PA0010179-01","standardId":"22444PA0010179","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 25/50/4000","metal":"Gold","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Lehigh","Northampton"],"rates":{"6":{"base21":575.66,"tobaccoFactor":1.100007}},"ded":{"ind":4000,"fam":8000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":7450,"fam":14900},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Access HMO 25 50 4000\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010171, 22444PA0010173, 22444PA0010180 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family; it applies to preferred brand drugs, non-preferred brand drugs, specialty drugs (the filed summary says \"after deductible\" there)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"6":{"base21":516.48,"tobaccoFactor":1.099985}}}},{"market":"pennie","id":"22444PA0010180-01","standardId":"22444PA0010180","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 25/50/4000","metal":"Gold","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Adams","Berks","Cumberland","Dauphin","Franklin","Fulton","Lancaster","Lebanon","Perry","York"],"rates":{"7":{"base21":719.58,"tobaccoFactor":1.099989},"9":{"base21":690.79,"tobaccoFactor":1.100001}},"ded":{"ind":4000,"fam":8000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":7450,"fam":14900},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Access HMO 25 50 4000\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010171, 22444PA0010173, 22444PA0010179 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family; it applies to preferred brand drugs, non-preferred brand drugs, specialty drugs (the filed summary says \"after deductible\" there)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"7":{"base21":645.59,"tobaccoFactor":1.100002},"9":{"base21":619.77,"tobaccoFactor":1.100005}}}},{"market":"pennie","id":"22444PA0010197-01","standardId":"22444PA0010197","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO Pharmacy First 8500","metal":"Bronze","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bedford","Blair","Cambria","Cameron","Clearfield","Elk","Huntingdon","Jefferson","Potter","Somerset"],"rates":{"2":{"base21":445.36,"tobaccoFactor":1.099987},"5":{"base21":423.09,"tobaccoFactor":1.100002}},"ded":{"ind":8500,"fam":17000,"embedded":true},"drugDed":null,"oop":{"ind":9000,"fam":18000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"}},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Access HMO Pharm First 8500\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010200, 22444PA0010201, 22444PA0010208 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $25 copay.","Prescription drugs share the medical deductible (the filed summary says the drug deductible is combined with medical)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"2":{"base21":401.74,"tobaccoFactor":1.09999},"5":{"base21":381.65,"tobaccoFactor":1.099987}}}},{"market":"pennie","id":"22444PA0010200-01","standardId":"22444PA0010200","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO Pharmacy First 8500","metal":"Bronze","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bradford","Carbon","Centre","Clinton","Columbia","Juniata","Lackawanna","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northumberland","Pike","Schuylkill","Snyder","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming"],"rates":{"3":{"base21":423.09,"tobaccoFactor":1.100002},"6":{"base21":445.36,"tobaccoFactor":1.099987},"9":{"base21":534.43,"tobaccoFactor":1.099994}},"ded":{"ind":8500,"fam":17000,"embedded":true},"drugDed":null,"oop":{"ind":9000,"fam":18000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"}},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Access HMO Pharm First 8500\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010197, 22444PA0010201, 22444PA0010208 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $25 copay.","Prescription drugs share the medical deductible (the filed summary says the drug deductible is combined with medical)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"3":{"base21":381.65,"tobaccoFactor":1.099987},"6":{"base21":401.74,"tobaccoFactor":1.09999},"9":{"base21":482.08,"tobaccoFactor":1.100004}}}},{"market":"pennie","id":"22444PA0010201-01","standardId":"22444PA0010201","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO Pharmacy First 8500","metal":"Bronze","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Adams","Berks","Cumberland","Dauphin","Franklin","Fulton","Lancaster","Lebanon","Perry","York"],"rates":{"7":{"base21":556.7,"tobaccoFactor":1.1},"9":{"base21":534.43,"tobaccoFactor":1.099994}},"ded":{"ind":8500,"fam":17000,"embedded":true},"drugDed":null,"oop":{"ind":9000,"fam":18000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"}},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Access HMO Pharm First 8500\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010197, 22444PA0010200, 22444PA0010208 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $25 copay.","Prescription drugs share the medical deductible (the filed summary says the drug deductible is combined with medical)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"7":{"base21":502.17,"tobaccoFactor":1.100006},"9":{"base21":482.08,"tobaccoFactor":1.100004}}}},{"market":"pennie","id":"22444PA0010208-01","standardId":"22444PA0010208","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO Pharmacy First 8500","metal":"Bronze","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Lehigh","Northampton"],"rates":{"6":{"base21":445.36,"tobaccoFactor":1.099987}},"ded":{"ind":8500,"fam":17000,"embedded":true},"drugDed":null,"oop":{"ind":9000,"fam":18000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"}},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Access HMO Pharm First 8500\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010197, 22444PA0010200, 22444PA0010201 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $25 copay.","Prescription drugs share the medical deductible (the filed summary says the drug deductible is combined with medical)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"6":{"base21":401.74,"tobaccoFactor":1.09999}}}},{"market":"pennie","id":"22444PA0010212-01","standardId":"22444PA0010212","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 25/50/0 Copay Based","metal":"Gold","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bedford","Blair","Cambria","Cameron","Clearfield","Elk","Huntingdon","Jefferson","Potter","Somerset"],"rates":{"2":{"base21":601.16,"tobaccoFactor":1.100007},"5":{"base21":571.1,"tobaccoFactor":1.1}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"copay","amount":1600,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":1600,"ded":"no_ded"},"perDay":{"maxDays":1}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":1600,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Access HMO 25 50 0 Copay\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010213, 22444PA0010214, 22444PA0010215 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Specialty drugs: 50% coinsurance up to $150 per fill (the cap is modelled here).","Hospital stay: $1,600 copay per admission (the first inpatient day of each admission is charged, later days are not); delivery facility fees take the same copay.","Delivery: the filed summary has one maternity row (\"$0\", used for delivery professional fees); delivery facility fees are the hospital stay's (\"$1,600 per stay\"), as the plan's having-a-baby example charges them."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"2":{"base21":567.34,"tobaccoFactor":1.099993},"5":{"base21":538.97,"tobaccoFactor":1.100006}}}},{"market":"pennie","id":"22444PA0010213-01","standardId":"22444PA0010213","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 25/50/0 Copay Based","metal":"Gold","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bradford","Carbon","Centre","Clinton","Columbia","Juniata","Lackawanna","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northumberland","Pike","Schuylkill","Snyder","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming"],"rates":{"3":{"base21":571.1,"tobaccoFactor":1.1},"6":{"base21":601.16,"tobaccoFactor":1.100007},"9":{"base21":721.39,"tobaccoFactor":1.100001}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"copay","amount":1600,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":1600,"ded":"no_ded"},"perDay":{"maxDays":1}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":1600,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Access HMO 25 50 0 Copay\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010212, 22444PA0010214, 22444PA0010215 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Specialty drugs: 50% coinsurance up to $150 per fill (the cap is modelled here).","Hospital stay: $1,600 copay per admission (the first inpatient day of each admission is charged, later days are not); delivery facility fees take the same copay.","Delivery: the filed summary has one maternity row (\"$0\", used for delivery professional fees); delivery facility fees are the hospital stay's (\"$1,600 per stay\"), as the plan's having-a-baby example charges them."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"3":{"base21":538.97,"tobaccoFactor":1.100006},"6":{"base21":567.34,"tobaccoFactor":1.099993},"9":{"base21":680.8,"tobaccoFactor":1.1}}}},{"market":"pennie","id":"22444PA0010214-01","standardId":"22444PA0010214","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 25/50/0 Copay Based","metal":"Gold","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Adams","Berks","Cumberland","Dauphin","Franklin","Fulton","Lancaster","Lebanon","Perry","York"],"rates":{"7":{"base21":751.45,"tobaccoFactor":1.100007},"9":{"base21":721.39,"tobaccoFactor":1.100001}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"copay","amount":1600,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":1600,"ded":"no_ded"},"perDay":{"maxDays":1}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":1600,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Access HMO 25 50 0 Copay\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010212, 22444PA0010213, 22444PA0010215 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Specialty drugs: 50% coinsurance up to $150 per fill (the cap is modelled here).","Hospital stay: $1,600 copay per admission (the first inpatient day of each admission is charged, later days are not); delivery facility fees take the same copay.","Delivery: the filed summary has one maternity row (\"$0\", used for delivery professional fees); delivery facility fees are the hospital stay's (\"$1,600 per stay\"), as the plan's having-a-baby example charges them."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"7":{"base21":709.17,"tobaccoFactor":1.100004},"9":{"base21":680.8,"tobaccoFactor":1.1}}}},{"market":"pennie","id":"22444PA0010215-01","standardId":"22444PA0010215","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 25/50/0 Copay Based","metal":"Gold","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Lehigh","Northampton"],"rates":{"6":{"base21":601.16,"tobaccoFactor":1.100007}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"copay","amount":1600,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":1600,"ded":"no_ded"},"perDay":{"maxDays":1}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":1600,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Access HMO 25 50 0 Copay\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010212, 22444PA0010213, 22444PA0010214 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Specialty drugs: 50% coinsurance up to $150 per fill (the cap is modelled here).","Hospital stay: $1,600 copay per admission (the first inpatient day of each admission is charged, later days are not); delivery facility fees take the same copay.","Delivery: the filed summary has one maternity row (\"$0\", used for delivery professional fees); delivery facility fees are the hospital stay's (\"$1,600 per stay\"), as the plan's having-a-baby example charges them."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"6":{"base21":567.34,"tobaccoFactor":1.099993}}}},{"market":"pennie","id":"22444PA0010216-01","standardId":"22444PA0010216","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 25/80/10500 Essential","metal":"Bronze","network":"HMO","hsaEligible":false,"counties":["Bedford","Blair","Cambria","Cameron","Clearfield","Elk","Huntingdon","Jefferson","Potter","Somerset"],"rates":{"2":{"base21":451.05,"tobaccoFactor":1.099989},"5":{"base21":428.5,"tobaccoFactor":1.099977}},"ded":{"ind":10500,"fam":21000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Acc HMO 25 80 10500 Essen\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010217, 22444PA0010218, 22444PA0010219 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill. Tier 1 generics are $0 and Tier 3 non-preferred generics are no charge after the deductible.","Prescription drugs share the medical deductible (the filed summary says the drug deductible is combined with medical)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx"},{"market":"pennie","id":"22444PA0010217-01","standardId":"22444PA0010217","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 25/80/10500 Essential","metal":"Bronze","network":"HMO","hsaEligible":false,"counties":["Bradford","Carbon","Centre","Clinton","Columbia","Juniata","Lackawanna","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northumberland","Pike","Schuylkill","Snyder","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming"],"rates":{"3":{"base21":428.5,"tobaccoFactor":1.099977},"6":{"base21":451.05,"tobaccoFactor":1.099989},"9":{"base21":541.26,"tobaccoFactor":1.099989}},"ded":{"ind":10500,"fam":21000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Acc HMO 25 80 10500 Essen\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010216, 22444PA0010218, 22444PA0010219 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill. Tier 1 generics are $0 and Tier 3 non-preferred generics are no charge after the deductible.","Prescription drugs share the medical deductible (the filed summary says the drug deductible is combined with medical)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx"},{"market":"pennie","id":"22444PA0010218-01","standardId":"22444PA0010218","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 25/80/10500 Essential","metal":"Bronze","network":"HMO","hsaEligible":false,"counties":["Adams","Berks","Cumberland","Dauphin","Franklin","Fulton","Lancaster","Lebanon","Perry","York"],"rates":{"7":{"base21":563.81,"tobaccoFactor":1.099998},"9":{"base21":541.26,"tobaccoFactor":1.099989}},"ded":{"ind":10500,"fam":21000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Acc HMO 25 80 10500 Essen\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010216, 22444PA0010217, 22444PA0010219 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill. Tier 1 generics are $0 and Tier 3 non-preferred generics are no charge after the deductible.","Prescription drugs share the medical deductible (the filed summary says the drug deductible is combined with medical)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx"},{"market":"pennie","id":"22444PA0010219-01","standardId":"22444PA0010219","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 25/80/10500 Essential","metal":"Bronze","network":"HMO","hsaEligible":false,"counties":["Lehigh","Northampton"],"rates":{"6":{"base21":451.05,"tobaccoFactor":1.099989}},"ded":{"ind":10500,"fam":21000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Acc HMO 25 80 10500 Essen\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010216, 22444PA0010217, 22444PA0010218 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill. Tier 1 generics are $0 and Tier 3 non-preferred generics are no charge after the deductible.","Prescription drugs share the medical deductible (the filed summary says the drug deductible is combined with medical)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx"},{"market":"pennie","id":"22444PA0040080-01","standardId":"22444PA0040080","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access Value","metal":"Catastrophic","network":"POS","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bradford","Carbon","Centre","Clinton","Columbia","Juniata","Lackawanna","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northumberland","Pike","Schuylkill","Snyder","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming"],"rates":{"3":{"base21":368.29,"tobaccoFactor":1.100003},"6":{"base21":387.67,"tobaccoFactor":1.100008},"9":{"base21":465.21,"tobaccoFactor":1.099998}},"ded":{"ind":12000,"fam":24000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":3,"rule":{"kind":"free","ded":"no_ded"}}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"}},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are no charge after the deductible.","Primary care visits: the first three visits are covered with no charge and the deductible does not apply; later visits are no charge after the deductible.","Prescription drugs share the medical deductible (the SBC says the drug deductible is combined with medical).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (specialist visits, urgent care, emergency room care, lab tests, x-rays, imaging, rehabilitation therapy, outpatient mental health visits, generic drugs, preferred brand drugs, non-preferred brand drugs, specialty drugs, outpatient surgery facility fees, outpatient surgeon fees, hospital stay facility fees, hospital stay physician fees, delivery facility fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","Geisinger has not published its 2027 SBCs yet; this is the 2027 SBC it filed with the PA Insurance Department in SERFF form filing GSHP-134794454 (\"2027 - 22444PA0040085 -  All-Access Value (Catastrophic) v4.pdf\") for 22444PA0040085-01. The filing's benefit summary (PY2027_Individual_6.3.2026.xlsx, sheet \"All-Access Value\") lists this plan in one design with 22444PA0040085, 22444PA0040081, 22444PA0040082; they differ only in service area, and Geisinger's SBCs print no plan ID.","The SBC equals the filing's benefit summary (sheet \"All-Access Value\") on the deductible, out-of-pocket limit, drug deductible, coverage examples and every cost used here, which also writes the \"No charge\" rows \"0% after deductible\", and the rate decision's rate pages on the deductible, coinsurance, primary care and specialist copays and out-of-pocket maximum (except primary care visits, below).","Primary care visits: the SBC is used (the SBC's limitations column: the deductible does not apply to the first three primary care visits (the catastrophic-plan rule); the workbook prints only \"0% after deductible\")."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794454/2027 - 22444PA0040085 -  All-Access Value (Catastrophic) v4.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":333.42,"tobaccoFactor":1.100024},"6":{"base21":350.97,"tobaccoFactor":1.100009},"9":{"base21":421.17,"tobaccoFactor":1.099983}}}},{"market":"pennie","id":"22444PA0040081-01","standardId":"22444PA0040081","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access Value","metal":"Catastrophic","network":"POS","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Adams","Berks","Cumberland","Dauphin","Franklin","Fulton","Lancaster","Lebanon","Perry","York"],"rates":{"7":{"base21":484.59,"tobaccoFactor":1.100002},"9":{"base21":465.21,"tobaccoFactor":1.099998}},"ded":{"ind":12000,"fam":24000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":3,"rule":{"kind":"free","ded":"no_ded"}}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"}},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are no charge after the deductible.","Primary care visits: the first three visits are covered with no charge and the deductible does not apply; later visits are no charge after the deductible.","Prescription drugs share the medical deductible (the SBC says the drug deductible is combined with medical).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (specialist visits, urgent care, emergency room care, lab tests, x-rays, imaging, rehabilitation therapy, outpatient mental health visits, generic drugs, preferred brand drugs, non-preferred brand drugs, specialty drugs, outpatient surgery facility fees, outpatient surgeon fees, hospital stay facility fees, hospital stay physician fees, delivery facility fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","Geisinger has not published its 2027 SBCs yet; this is the 2027 SBC it filed with the PA Insurance Department in SERFF form filing GSHP-134794454 (\"2027 - 22444PA0040085 -  All-Access Value (Catastrophic) v4.pdf\") for 22444PA0040085-01. The filing's benefit summary (PY2027_Individual_6.3.2026.xlsx, sheet \"All-Access Value\") lists this plan in one design with 22444PA0040085, 22444PA0040080, 22444PA0040082; they differ only in service area, and Geisinger's SBCs print no plan ID.","The SBC equals the filing's benefit summary (sheet \"All-Access Value\") on the deductible, out-of-pocket limit, drug deductible, coverage examples and every cost used here, which also writes the \"No charge\" rows \"0% after deductible\", and the rate decision's rate pages on the deductible, coinsurance, primary care and specialist copays and out-of-pocket maximum (except primary care visits, below).","Primary care visits: the SBC is used (the SBC's limitations column: the deductible does not apply to the first three primary care visits (the catastrophic-plan rule); the workbook prints only \"0% after deductible\")."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794454/2027 - 22444PA0040085 -  All-Access Value (Catastrophic) v4.pdf","prev":{"planYear":2026,"rates":{"7":{"base21":438.71,"tobaccoFactor":1.099998},"9":{"base21":421.17,"tobaccoFactor":1.099983}}}},{"market":"pennie","id":"22444PA0040082-01","standardId":"22444PA0040082","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access Value","metal":"Catastrophic","network":"POS","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Lehigh","Northampton"],"rates":{"6":{"base21":387.67,"tobaccoFactor":1.100008}},"ded":{"ind":12000,"fam":24000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":3,"rule":{"kind":"free","ded":"no_ded"}}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"}},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are no charge after the deductible.","Primary care visits: the first three visits are covered with no charge and the deductible does not apply; later visits are no charge after the deductible.","Prescription drugs share the medical deductible (the SBC says the drug deductible is combined with medical).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (specialist visits, urgent care, emergency room care, lab tests, x-rays, imaging, rehabilitation therapy, outpatient mental health visits, generic drugs, preferred brand drugs, non-preferred brand drugs, specialty drugs, outpatient surgery facility fees, outpatient surgeon fees, hospital stay facility fees, hospital stay physician fees, delivery facility fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","Geisinger has not published its 2027 SBCs yet; this is the 2027 SBC it filed with the PA Insurance Department in SERFF form filing GSHP-134794454 (\"2027 - 22444PA0040085 -  All-Access Value (Catastrophic) v4.pdf\") for 22444PA0040085-01. The filing's benefit summary (PY2027_Individual_6.3.2026.xlsx, sheet \"All-Access Value\") lists this plan in one design with 22444PA0040085, 22444PA0040080, 22444PA0040081; they differ only in service area, and Geisinger's SBCs print no plan ID.","The SBC equals the filing's benefit summary (sheet \"All-Access Value\") on the deductible, out-of-pocket limit, drug deductible, coverage examples and every cost used here, which also writes the \"No charge\" rows \"0% after deductible\", and the rate decision's rate pages on the deductible, coinsurance, primary care and specialist copays and out-of-pocket maximum (except primary care visits, below).","Primary care visits: the SBC is used (the SBC's limitations column: the deductible does not apply to the first three primary care visits (the catastrophic-plan rule); the workbook prints only \"0% after deductible\")."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794454/2027 - 22444PA0040085 -  All-Access Value (Catastrophic) v4.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":350.97,"tobaccoFactor":1.100009}}}},{"market":"pennie","id":"22444PA0040085-01","standardId":"22444PA0040085","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access Value","metal":"Catastrophic","network":"POS","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bedford","Blair","Cambria","Cameron","Clearfield","Elk","Huntingdon","Jefferson","Potter","Somerset"],"rates":{"2":{"base21":387.67,"tobaccoFactor":1.100008},"5":{"base21":368.29,"tobaccoFactor":1.100003}},"ded":{"ind":12000,"fam":24000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":3,"rule":{"kind":"free","ded":"no_ded"}}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"}},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are no charge after the deductible.","Primary care visits: the first three visits are covered with no charge and the deductible does not apply; later visits are no charge after the deductible.","Prescription drugs share the medical deductible (the SBC says the drug deductible is combined with medical).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (specialist visits, urgent care, emergency room care, lab tests, x-rays, imaging, rehabilitation therapy, outpatient mental health visits, generic drugs, preferred brand drugs, non-preferred brand drugs, specialty drugs, outpatient surgery facility fees, outpatient surgeon fees, hospital stay facility fees, hospital stay physician fees, delivery facility fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","Geisinger has not published its 2027 SBCs yet; this is the 2027 SBC it filed with the PA Insurance Department in SERFF form filing GSHP-134794454 (\"2027 - 22444PA0040085 -  All-Access Value (Catastrophic) v4.pdf\") for this plan.","The SBC equals the filing's benefit summary (sheet \"All-Access Value\") on the deductible, out-of-pocket limit, drug deductible, coverage examples and every cost used here, which also writes the \"No charge\" rows \"0% after deductible\", and the rate decision's rate pages on the deductible, coinsurance, primary care and specialist copays and out-of-pocket maximum (except primary care visits, below).","Primary care visits: the SBC is used (the SBC's limitations column: the deductible does not apply to the first three primary care visits (the catastrophic-plan rule); the workbook prints only \"0% after deductible\")."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794454/2027 - 22444PA0040085 -  All-Access Value (Catastrophic) v4.pdf","prev":{"planYear":2026,"rates":{"2":{"base21":350.97,"tobaccoFactor":1.100009},"5":{"base21":333.42,"tobaccoFactor":1.100024}}}},{"market":"pennie","id":"31609PA0070002-01","standardId":"31609PA0070002","variant":"standard","issuer":"QCC Insurance Company (Independence Blue Cross)","name":"Personal Choice PPO Gold","metal":"Gold","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":814.32,"tobaccoFactor":1.125,"tobaccoFactorByAge":{"21":1.125,"22":1.125,"23":1.125,"24":1.125,"25":1.124991,"26":1.125009,"27":1.124993,"28":1.124993,"29":1.125008,"30":1.175007,"31":1.174995,"32":1.175006,"33":1.174997,"34":1.175009,"35":1.174997,"36":1.175008,"37":1.174997,"38":1.175008,"39":1.174998,"40":1.225002,"41":1.225006,"42":1.225002,"43":1.224998,"44":1.224998,"45":1.224997,"46":1.224998,"47":1.225004,"48":1.225002,"49":1.225002,"50":1.374998,"51":1.374996,"52":1.374999,"53":1.375004,"54":1.375004,"55":1.375003,"56":1.375001,"57":1.374996,"58":1.374998,"59":1.375002,"60":1.375003,"61":1.375,"62":1.375001,"63":1.374999,"64+":1.375}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":8750,"fam":17500},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":200}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":750,"ded":"no_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":65,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"copay","amount":750,"ded":"no_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}}},"notes":["Prenatal care: the SBC says the office-visit cost share applies to the first OB visit only, so it is charged once here and later prenatal visits are no charge (they are part of the delivery fee); other copays or coinsurance may apply to other services such as ultrasounds.","Imaging (CT, PET, MRI): $120 copay per scan at freestanding facilities (used here); $160 copay per scan at hospital-based facilities.","Outpatient surgery facility fee: $300 copay per visit at freestanding facilities (used here); $700 copay per visit at hospital-based facilities.","X-rays: $60 copay per visit at freestanding facilities (used here); $90 copay per visit at hospital-based facilities.","Blood work: $10 copay per visit at freestanding labs (used here); $85 copay per visit at hospital-based facilities.","Non-preferred brand drugs: 50% coinsurance is capped at $200 per 30-day retail fill (the cap is modelled here).","Specialty drugs: 50% coinsurance is capped at $1,000 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill; 31-90 day mail-order fills cost more per fill.","Mental health: office visits $65 copay per visit (used here); other outpatient services $65 copay per visit.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); visits above the limit are not covered. The limit does not apply to therapy prescribed for mental health or substance use treatment.","Physical and occupational therapy: $65 copay per visit at freestanding facilities (used here); $95 copay per visit at hospital-based facilities.","Telemedicine visits with the designated telemedicine provider are free."],"sbcUrl":"https://www.ibx.com/pdfs/custom/ffm/2027/ppogold2027.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":659.43,"tobaccoFactor":1.125002,"tobaccoFactorByAge":{"21":1.125002,"22":1.125002,"23":1.125002,"24":1.125002,"25":1.125002,"26":1.124989,"27":1.125007,"28":1.125,"29":1.125003,"30":1.175002,"31":1.175001,"32":1.174988,"33":1.175,"34":1.174992,"35":1.175002,"36":1.174997,"37":1.175006,"38":1.175002,"39":1.175006,"40":1.225001,"41":1.224999,"42":1.22501,"43":1.224999,"44":1.225006,"45":1.225001,"46":1.224991,"47":1.224995,"48":1.225002,"49":1.224998,"50":1.375006,"51":1.375,"52":1.374997,"53":1.374996,"54":1.375004,"55":1.375001,"56":1.375001,"57":1.375002,"58":1.374996,"59":1.374996,"60":1.375003,"61":1.374997,"62":1.375004,"63":1.375,"64+":1.375001}}}}},{"market":"pennie","id":"31609PA0070003-01","standardId":"31609PA0070003","variant":"standard","issuer":"QCC Insurance Company (Independence Blue Cross)","name":"Personal Choice PPO Silver Classic","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN002","referral":false,"tiers":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":694.7,"tobaccoFactor":1.125004,"tobaccoFactorByAge":{"21":1.125004,"22":1.125004,"23":1.125004,"24":1.125004,"25":1.124993,"26":1.124998,"27":1.124991,"28":1.124997,"29":1.124998,"30":1.175008,"31":1.174996,"32":1.175,"33":1.174995,"34":1.174988,"35":1.174999,"36":1.175007,"37":1.175003,"38":1.175,"39":1.175007,"40":1.224998,"41":1.224997,"42":1.224991,"43":1.225,"44":1.224997,"45":1.224991,"46":1.224999,"47":1.224991,"48":1.225007,"49":1.224999,"50":1.375005,"51":1.374994,"52":1.375001,"53":1.374996,"54":1.375005,"55":1.374998,"56":1.374995,"57":1.375001,"58":1.374996,"59":1.375004,"60":1.374999,"61":1.374999,"62":1.375004,"63":1.375004,"64+":1.375001}}},"ded":{"ind":3500,"fam":7000,"embedded":true},"drugDed":null,"oop":{"ind":8250,"fam":16500},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":75,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":300}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":400}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":1000}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.25,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":75,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.25,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Prenatal care: the SBC says the office-visit cost share applies to the first OB visit only, so it is charged once here and later prenatal visits are no charge (they are part of the delivery fee); other copays or coinsurance may apply to other services such as ultrasounds.","Imaging (CT, PET, MRI): 30% coinsurance after the deductible at freestanding facilities (used here); 50% coinsurance after the deductible at hospital-based facilities.","Outpatient surgery facility fee: 30% coinsurance after the deductible at freestanding facilities (used here); 50% coinsurance after the deductible at hospital-based facilities.","X-rays: 30% coinsurance after the deductible at freestanding facilities (used here); 50% coinsurance after the deductible at hospital-based facilities.","Blood work: 20% coinsurance at freestanding labs (used here); 50% coinsurance at hospital-based facilities.","Preferred brand drugs: 50% coinsurance is capped at $300 per 30-day retail fill (the cap is modelled here).","Non-preferred brand drugs: 50% coinsurance is capped at $400 per 30-day retail fill (the cap is modelled here).","Specialty drugs: 50% coinsurance is capped at $1,000 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill; 31-90 day mail-order fills cost more per fill.","Mental health: office visits $75 copay per visit (used here); other outpatient services 30% coinsurance after the deductible.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); visits above the limit are not covered. The limit does not apply to therapy prescribed for mental health or substance use treatment.","Physical and occupational therapy: $75 copay per visit at freestanding facilities (used here); $105 copay per visit at hospital-based facilities.","Telemedicine visits with the designated telemedicine provider are free."],"sbcUrl":"https://www.ibx.com/pdfs/custom/ffm/2027/pposilverclassic2027.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":562.18,"tobaccoFactor":1.124996,"tobaccoFactorByAge":{"21":1.124996,"22":1.124996,"23":1.124996,"24":1.124996,"25":1.124993,"26":1.125002,"27":1.125008,"28":1.125006,"29":1.124992,"30":1.175012,"31":1.174993,"32":1.174992,"33":1.174999,"34":1.174992,"35":1.175012,"36":1.175001,"37":1.175005,"38":1.174994,"39":1.175004,"40":1.224992,"41":1.224999,"42":1.225,"43":1.225003,"44":1.224989,"45":1.224997,"46":1.225005,"47":1.224994,"48":1.22501,"49":1.224997,"50":1.375001,"51":1.374994,"52":1.374993,"53":1.374992,"54":1.375005,"55":1.374998,"56":1.374993,"57":1.374999,"58":1.375006,"59":1.375003,"60":1.375,"61":1.374994,"62":1.375002,"63":1.374997,"64+":1.374999}}}}},{"market":"pennie","id":"31609PA0070003-04","standardId":"31609PA0070003","variant":"csr73","issuer":"QCC Insurance Company (Independence Blue Cross)","name":"Personal Choice PPO Silver Classic","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN002","referral":false,"tiers":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":694.7,"tobaccoFactor":1.125004,"tobaccoFactorByAge":{"21":1.125004,"22":1.125004,"23":1.125004,"24":1.125004,"25":1.124993,"26":1.124998,"27":1.124991,"28":1.124997,"29":1.124998,"30":1.175008,"31":1.174996,"32":1.175,"33":1.174995,"34":1.174988,"35":1.174999,"36":1.175007,"37":1.175003,"38":1.175,"39":1.175007,"40":1.224998,"41":1.224997,"42":1.224991,"43":1.225,"44":1.224997,"45":1.224991,"46":1.224999,"47":1.224991,"48":1.225007,"49":1.224999,"50":1.375005,"51":1.374994,"52":1.375001,"53":1.374996,"54":1.375005,"55":1.374998,"56":1.374995,"57":1.375001,"58":1.374996,"59":1.375004,"60":1.374999,"61":1.374999,"62":1.375004,"63":1.375004,"64+":1.375001}}},"ded":{"ind":3250,"fam":6500,"embedded":true},"drugDed":null,"oop":{"ind":6900,"fam":13800},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"xray":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":75,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded","max":200}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":200}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":1000}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":75,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Independence publishes no SBC for this reduced cost-sharing version; its cost sharing comes from Independence's 2027 plan overview brochure, page 51, checked against the PA Insurance Department filing (pages 72, 73, 76, 80, 81).","Outpatient lab and pathology: 20% coinsurance at freestanding facilities (used here); 50% coinsurance at hospital-based facilities.","Mental health: office visits $75 copay (used here); all other outpatient services 20% coinsurance after the deductible.","Low-cost generic drugs: $3, no ded per 30-day retail fill; other generics as shown (retail generic, used here).","Preferred brand drugs: the coinsurance is capped at $200 per 30-day retail fill (the cap is modelled here).","Non-preferred brand drugs: the coinsurance is capped at $200 per 30-day retail fill (the cap is modelled here).","Specialty drugs: the coinsurance is capped at $1,000 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill.","Physical and occupational therapy: limited to 30 visits a year; visits above the limit are not covered.","Virtual care from the designated virtual provider (Teladoc Health) is free.","Independence's brochure gives no outpatient surgeon fee for this version; the standard version's SBC figure (coins 30% after_ded) is used, an upper bound — this version may cost less. Its text and page are those of the standard version's SBC (https://www.ibx.com/pdfs/custom/ffm/2027/pposilverclassic2027.pdf, page 3).","Prenatal care: the brochure has no prenatal row. The first OB visit is charged at this version's specialist cost share and later prenatal visits are no charge (part of the delivery fee): every Independence standard SBC prices prenatal care this way.","The deductible and out-of-pocket limit are the brochure's; no CMS plan file for 2027 exists yet to compare them with (the out-of-pocket limit is within the federal limit for this version)."],"sbcUrl":"https://www.ibx.com/pdfs/find-a-plan/individuals/2027-plan-overview-brochure.pdf#page=51","prev":{"planYear":2026,"rates":{"8":{"base21":562.18,"tobaccoFactor":1.124996,"tobaccoFactorByAge":{"21":1.124996,"22":1.124996,"23":1.124996,"24":1.124996,"25":1.124993,"26":1.125002,"27":1.125008,"28":1.125006,"29":1.124992,"30":1.175012,"31":1.174993,"32":1.174992,"33":1.174999,"34":1.174992,"35":1.175012,"36":1.175001,"37":1.175005,"38":1.174994,"39":1.175004,"40":1.224992,"41":1.224999,"42":1.225,"43":1.225003,"44":1.224989,"45":1.224997,"46":1.225005,"47":1.224994,"48":1.22501,"49":1.224997,"50":1.375001,"51":1.374994,"52":1.374993,"53":1.374992,"54":1.375005,"55":1.374998,"56":1.374993,"57":1.374999,"58":1.375006,"59":1.375003,"60":1.375,"61":1.374994,"62":1.375002,"63":1.374997,"64+":1.374999}}}}},{"market":"pennie","id":"31609PA0070003-05","standardId":"31609PA0070003","variant":"csr87","issuer":"QCC Insurance Company (Independence Blue Cross)","name":"Personal Choice PPO Silver Classic","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN002","referral":false,"tiers":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":694.7,"tobaccoFactor":1.125004,"tobaccoFactorByAge":{"21":1.125004,"22":1.125004,"23":1.125004,"24":1.125004,"25":1.124993,"26":1.124998,"27":1.124991,"28":1.124997,"29":1.124998,"30":1.175008,"31":1.174996,"32":1.175,"33":1.174995,"34":1.174988,"35":1.174999,"36":1.175007,"37":1.175003,"38":1.175,"39":1.175007,"40":1.224998,"41":1.224997,"42":1.224991,"43":1.225,"44":1.224997,"45":1.224991,"46":1.224999,"47":1.224991,"48":1.225007,"49":1.224999,"50":1.375005,"51":1.374994,"52":1.375001,"53":1.374996,"54":1.375005,"55":1.374998,"56":1.374995,"57":1.375001,"58":1.374996,"59":1.375004,"60":1.374999,"61":1.374999,"62":1.375004,"63":1.375004,"64+":1.375001}}},"ded":{"ind":2250,"fam":4500,"embedded":true},"drugDed":null,"oop":{"ind":3250,"fam":6500},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded","max":200}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":200}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":50,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}}},"notes":["Independence publishes no SBC for this reduced cost-sharing version; its cost sharing comes from Independence's 2027 plan overview brochure, page 58, checked against the PA Insurance Department filing (pages 72, 73, 76, 80, 81).","Outpatient lab and pathology: no charge at freestanding facilities (used here); 50% coinsurance at hospital-based facilities.","Mental health: office visits $50 copay (used here); all other outpatient services 10% coinsurance.","Low-cost generic drugs: $3, no ded per 30-day retail fill; other generics as shown (retail generic, used here).","Preferred brand drugs: the coinsurance is capped at $200 per 30-day retail fill (the cap is modelled here).","Non-preferred brand drugs: the coinsurance is capped at $200 per 30-day retail fill (the cap is modelled here).","Specialty drugs: the coinsurance is capped at $500 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill.","Physical and occupational therapy: limited to 30 visits a year; visits above the limit are not covered.","Virtual care from the designated virtual provider (Teladoc Health) is free.","Independence's brochure gives no outpatient surgeon fee for this version; the standard version's SBC figure (coins 30% after_ded) is used, an upper bound — this version may cost less. Its text and page are those of the standard version's SBC (https://www.ibx.com/pdfs/custom/ffm/2027/pposilverclassic2027.pdf, page 3).","Prenatal care: the brochure has no prenatal row. The first OB visit is charged at this version's specialist cost share and later prenatal visits are no charge (part of the delivery fee): every Independence standard SBC prices prenatal care this way.","The deductible and out-of-pocket limit are the brochure's; no CMS plan file for 2027 exists yet to compare them with (the out-of-pocket limit is within the federal limit for this version)."],"sbcUrl":"https://www.ibx.com/pdfs/find-a-plan/individuals/2027-plan-overview-brochure.pdf#page=58","prev":{"planYear":2026,"rates":{"8":{"base21":562.18,"tobaccoFactor":1.124996,"tobaccoFactorByAge":{"21":1.124996,"22":1.124996,"23":1.124996,"24":1.124996,"25":1.124993,"26":1.125002,"27":1.125008,"28":1.125006,"29":1.124992,"30":1.175012,"31":1.174993,"32":1.174992,"33":1.174999,"34":1.174992,"35":1.175012,"36":1.175001,"37":1.175005,"38":1.174994,"39":1.175004,"40":1.224992,"41":1.224999,"42":1.225,"43":1.225003,"44":1.224989,"45":1.224997,"46":1.225005,"47":1.224994,"48":1.22501,"49":1.224997,"50":1.375001,"51":1.374994,"52":1.374993,"53":1.374992,"54":1.375005,"55":1.374998,"56":1.374993,"57":1.374999,"58":1.375006,"59":1.375003,"60":1.375,"61":1.374994,"62":1.375002,"63":1.374997,"64+":1.374999}}}}},{"market":"pennie","id":"31609PA0070003-06","standardId":"31609PA0070003","variant":"csr94","issuer":"QCC Insurance Company (Independence Blue Cross)","name":"Personal Choice PPO Silver Classic","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN002","referral":false,"tiers":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":694.7,"tobaccoFactor":1.125004,"tobaccoFactorByAge":{"21":1.125004,"22":1.125004,"23":1.125004,"24":1.125004,"25":1.124993,"26":1.124998,"27":1.124991,"28":1.124997,"29":1.124998,"30":1.175008,"31":1.174996,"32":1.175,"33":1.174995,"34":1.174988,"35":1.174999,"36":1.175007,"37":1.175003,"38":1.175,"39":1.175007,"40":1.224998,"41":1.224997,"42":1.224991,"43":1.225,"44":1.224997,"45":1.224991,"46":1.224999,"47":1.224991,"48":1.225007,"49":1.224999,"50":1.375005,"51":1.374994,"52":1.375001,"53":1.374996,"54":1.375005,"55":1.374998,"56":1.374995,"57":1.375001,"58":1.374996,"59":1.375004,"60":1.374999,"61":1.374999,"62":1.375004,"63":1.375004,"64+":1.375001}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":3000,"fam":6000},"rules":{"pcp":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":10,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":4,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.15,"ded":"no_ded","max":200}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.15,"ded":"no_ded","max":200}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":10,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}}},"notes":["Independence publishes no SBC for this reduced cost-sharing version; its cost sharing comes from Independence's 2027 plan overview brochure, page 65, checked against the PA Insurance Department filing (pages 72, 73, 80, 81).","Outpatient lab and pathology: no charge at freestanding facilities (used here); 50% coinsurance at hospital-based facilities.","Mental health: office visits $10 copay (used here); all other outpatient services 10% coinsurance.","Low-cost generic drugs: $3 per 30-day retail fill; other generics as shown (retail generic, used here).","Preferred brand drugs: the coinsurance is capped at $200 per 30-day retail fill (the cap is modelled here).","Non-preferred brand drugs: the coinsurance is capped at $200 per 30-day retail fill (the cap is modelled here).","Specialty drugs: the coinsurance is capped at $500 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill.","Physical and occupational therapy: limited to 30 visits a year; visits above the limit are not covered.","Virtual care from the designated virtual provider (Teladoc Health) is free.","Independence's brochure gives no outpatient surgeon fee for this version; the standard version's SBC figure (coins 30% after_ded) is used, an upper bound — this version may cost less. Its text and page are those of the standard version's SBC (https://www.ibx.com/pdfs/custom/ffm/2027/pposilverclassic2027.pdf, page 3).","Prenatal care: the brochure has no prenatal row. The first OB visit is charged at this version's specialist cost share and later prenatal visits are no charge (part of the delivery fee): every Independence standard SBC prices prenatal care this way.","The deductible and out-of-pocket limit are the brochure's; no CMS plan file for 2027 exists yet to compare them with (the out-of-pocket limit is within the federal limit for this version)."],"sbcUrl":"https://www.ibx.com/pdfs/find-a-plan/individuals/2027-plan-overview-brochure.pdf#page=65","prev":{"planYear":2026,"rates":{"8":{"base21":562.18,"tobaccoFactor":1.124996,"tobaccoFactorByAge":{"21":1.124996,"22":1.124996,"23":1.124996,"24":1.124996,"25":1.124993,"26":1.125002,"27":1.125008,"28":1.125006,"29":1.124992,"30":1.175012,"31":1.174993,"32":1.174992,"33":1.174999,"34":1.174992,"35":1.175012,"36":1.175001,"37":1.175005,"38":1.174994,"39":1.175004,"40":1.224992,"41":1.224999,"42":1.225,"43":1.225003,"44":1.224989,"45":1.224997,"46":1.225005,"47":1.224994,"48":1.22501,"49":1.224997,"50":1.375001,"51":1.374994,"52":1.374993,"53":1.374992,"54":1.375005,"55":1.374998,"56":1.374993,"57":1.374999,"58":1.375006,"59":1.375003,"60":1.375,"61":1.374994,"62":1.375002,"63":1.374997,"64+":1.374999}}}}},{"market":"pennie","id":"31609PA0070004-01","standardId":"31609PA0070004","variant":"standard","issuer":"QCC Insurance Company (Independence Blue Cross)","name":"Personal Choice PPO Bronze","metal":"Bronze","network":"PPO","hsaEligible":false,"networkId":"PAN002","referral":false,"tiers":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":476.73,"tobaccoFactor":1.124997,"tobaccoFactorByAge":{"21":1.124997,"22":1.124997,"23":1.124997,"24":1.124997,"25":1.125,"26":1.124997,"27":1.124997,"28":1.124988,"29":1.124995,"30":1.174999,"31":1.174995,"32":1.175009,"33":1.175007,"34":1.174998,"35":1.175003,"36":1.174989,"37":1.175011,"38":1.174997,"39":1.175008,"40":1.224994,"41":1.225004,"42":1.224991,"43":1.225005,"44":1.225003,"45":1.225,"46":1.22499,"47":1.224994,"48":1.225005,"49":1.224997,"50":1.375,"51":1.374997,"52":1.374992,"53":1.375001,"54":1.374998,"55":1.374994,"56":1.375001,"57":1.374999,"58":1.374995,"59":1.375001,"60":1.374997,"61":1.375005,"62":1.374994,"63":1.374999,"64+":1.374999}}},"ded":{"ind":6000,"fam":12000,"embedded":true},"drugDed":null,"oop":{"ind":9200,"fam":18400},"rules":{"pcp":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"specialist":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.25,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"coins","rate":0.5,"ded":"after_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.25,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}}},"notes":["Prenatal care: the SBC says the office-visit cost share applies to the first OB visit only, so it is charged once here and later prenatal visits are no charge (they are part of the delivery fee); other copays or coinsurance may apply to other services such as ultrasounds.","Blood work: 20% coinsurance after the deductible at freestanding labs (used here); 50% coinsurance after the deductible at hospital-based facilities.","Prescription drug costs shown are for a 30-day retail fill; 31-90 day mail-order fills cost more per fill.","Mental health: office visits 50% coinsurance after the deductible (used here); other outpatient services 50% coinsurance after the deductible.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); visits above the limit are not covered. The limit does not apply to therapy prescribed for mental health or substance use treatment.","Telemedicine visits with the designated telemedicine provider are free."],"sbcUrl":"https://www.ibx.com/pdfs/custom/ffm/2027/ppobronze2027.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":385.68,"tobaccoFactor":1.125,"tobaccoFactorByAge":{"21":1.125,"22":1.125,"23":1.125,"24":1.125,"25":1.125019,"26":1.124981,"27":1.125015,"28":1.125015,"29":1.124983,"30":1.174986,"31":1.175011,"32":1.174988,"33":1.175006,"34":1.174982,"35":1.175005,"36":1.174983,"37":1.175006,"38":1.174983,"39":1.175005,"40":1.224995,"41":1.224988,"42":1.224997,"43":1.225003,"44":1.225004,"45":1.225005,"46":1.225005,"47":1.224993,"48":1.224996,"49":1.224995,"50":1.375004,"51":1.375009,"52":1.375002,"53":1.374992,"54":1.374992,"55":1.374993,"56":1.374999,"57":1.375008,"58":1.375004,"59":1.374996,"60":1.374993,"61":1.375,"62":1.374998,"63":1.375001,"64+":1.375}}}}},{"market":"pennie","id":"31609PA0070011-01","standardId":"31609PA0070011","variant":"standard","issuer":"QCC Insurance Company (Independence Blue Cross)","name":"Personal Choice PPO Gold Classic","metal":"Gold","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":679.9,"tobaccoFactor":1.125004,"tobaccoFactorByAge":{"21":1.125004,"22":1.125004,"23":1.125004,"24":1.125004,"25":1.125004,"26":1.124989,"27":1.124989,"28":1.124998,"29":1.124998,"30":1.174993,"31":1.175,"32":1.175005,"33":1.174999,"34":1.174994,"35":1.174992,"36":1.175001,"37":1.174999,"38":1.174996,"39":1.175006,"40":1.225006,"41":1.225004,"42":1.224994,"43":1.225001,"44":1.225001,"45":1.224999,"46":1.225004,"47":1.225007,"48":1.224992,"49":1.225,"50":1.374998,"51":1.375005,"52":1.375004,"53":1.374996,"54":1.374996,"55":1.374995,"56":1.374994,"57":1.374997,"58":1.374996,"59":1.375001,"60":1.375001,"61":1.374997,"62":1.375002,"63":1.375001,"64+":1.375001}}},"ded":{"ind":1250,"fam":2500,"embedded":true},"drugDed":null,"oop":{"ind":9200,"fam":18400},"rules":{"pcp":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"specialist":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":200}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":1000}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Prenatal care: the SBC says the office-visit cost share applies to the first OB visit only, so it is charged once here and later prenatal visits are no charge (they are part of the delivery fee); other copays or coinsurance may apply to other services such as ultrasounds.","Outpatient surgery facility fee: 20% coinsurance after the deductible at freestanding facilities (used here); 40% coinsurance after the deductible at hospital-based facilities.","Blood work: 20% coinsurance after the deductible at freestanding labs (used here); 50% coinsurance after the deductible at hospital-based facilities.","Non-preferred brand drugs: 50% coinsurance is capped at $200 per 30-day retail fill (the cap is modelled here).","Specialty drugs: 50% coinsurance is capped at $1,000 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill; 31-90 day mail-order fills cost more per fill.","Mental health: office visits 20% coinsurance after the deductible (used here); other outpatient services 20% coinsurance after the deductible.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); visits above the limit are not covered. The limit does not apply to therapy prescribed for mental health or substance use treatment.","Telemedicine visits with the designated telemedicine provider are free."],"sbcUrl":"https://www.ibx.com/pdfs/custom/ffm/2027/ppogoldclassic2027.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":550.52,"tobaccoFactor":1.125009,"tobaccoFactorByAge":{"21":1.125009,"22":1.125009,"23":1.125009,"24":1.125009,"25":1.125,"26":1.125007,"27":1.125004,"28":1.124996,"29":1.12501,"30":1.175005,"31":1.175002,"32":1.174997,"33":1.175006,"34":1.175003,"35":1.174986,"36":1.175001,"37":1.175001,"38":1.174998,"39":1.174996,"40":1.225013,"41":1.224992,"42":1.224995,"43":1.224989,"44":1.224996,"45":1.224995,"46":1.224999,"47":1.225008,"48":1.224997,"49":1.224992,"50":1.374999,"51":1.375,"52":1.374998,"53":1.375002,"54":1.375,"55":1.374998,"56":1.375004,"57":1.374994,"58":1.375007,"59":1.375003,"60":1.374999,"61":1.375,"62":1.375003,"63":1.374995,"64+":1.375003}}}}},{"market":"pennie","id":"31609PA0070012-01","standardId":"31609PA0070012","variant":"standard","issuer":"QCC Insurance Company (Independence Blue Cross)","name":"Personal Choice PPO Gold Preferred","metal":"Gold","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":877.55,"tobaccoFactor":1.124996,"tobaccoFactorByAge":{"21":1.124996,"22":1.124996,"23":1.124996,"24":1.124996,"25":1.124997,"26":1.125004,"27":1.125001,"28":1.124992,"29":1.125003,"30":1.174996,"31":1.175001,"32":1.175005,"33":1.175002,"34":1.174994,"35":1.174996,"36":1.174997,"37":1.174998,"38":1.175,"39":1.175002,"40":1.225,"41":1.225002,"42":1.225001,"43":1.224992,"44":1.224995,"45":1.225004,"46":1.224997,"47":1.224998,"48":1.225002,"49":1.225002,"50":1.375002,"51":1.375002,"52":1.374996,"53":1.375003,"54":1.375001,"55":1.374999,"56":1.375002,"57":1.374999,"58":1.375,"59":1.375001,"60":1.375002,"61":1.374996,"62":1.375,"63":1.375,"64+":1.374999}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":9750,"fam":19500},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":325,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":105,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":45,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":200}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"no_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":15,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"copay","amount":500,"ded":"no_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}}},"notes":["Prenatal care: the SBC says the office-visit cost share applies to the first OB visit only, so it is charged once here and later prenatal visits are no charge (they are part of the delivery fee); other copays or coinsurance may apply to other services such as ultrasounds.","Outpatient surgery facility fee: $300 copay per visit at freestanding facilities (used here); $700 copay per visit at hospital-based facilities.","Blood work: $10 copay per visit at freestanding labs (used here); $85 copay per visit at hospital-based facilities.","Non-preferred brand drugs: 50% coinsurance is capped at $200 per 30-day retail fill (the cap is modelled here).","Specialty drugs: 50% coinsurance is capped at $1,000 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill; 31-90 day mail-order fills cost more per fill.","Mental health: office visits $15 copay per visit (used here); other outpatient services $45 copay per visit.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); visits above the limit are not covered. The limit does not apply to therapy prescribed for mental health or substance use treatment.","Telemedicine visits with the designated telemedicine provider are free."],"sbcUrl":"https://www.ibx.com/pdfs/custom/ffm/2027/ppogoldpreferred2027.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":710.13,"tobaccoFactor":1.125005,"tobaccoFactorByAge":{"21":1.125005,"22":1.125005,"23":1.125005,"24":1.125005,"25":1.124998,"26":1.125005,"27":1.12499,"28":1.125002,"29":1.124987,"30":1.175,"31":1.174998,"32":1.175007,"33":1.174989,"34":1.174991,"35":1.174998,"36":1.175005,"37":1.175001,"38":1.175007,"39":1.175009,"40":1.22499,"41":1.224997,"42":1.225003,"43":1.224999,"44":1.224999,"45":1.224998,"46":1.224991,"47":1.225005,"48":1.225001,"49":1.225006,"50":1.375001,"51":1.375003,"52":1.375005,"53":1.374992,"54":1.375001,"55":1.375002,"56":1.375004,"57":1.374999,"58":1.375001,"59":1.374997,"60":1.375003,"61":1.374994,"62":1.375002,"63":1.375004,"64+":1.375002}}}}},{"market":"pennie","id":"31609PA0160001-01","standardId":"31609PA0160001","variant":"standard","issuer":"QCC Insurance Company (Independence Blue Cross)","name":"Personal Choice EPO Catastrophic","metal":"Catastrophic","network":"EPO","hsaEligible":false,"networkId":"PAN002","referral":false,"tiers":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":361.5,"tobaccoFactor":1.125007,"tobaccoFactorByAge":{"21":1.125007,"22":1.125007,"23":1.125007,"24":1.125007,"25":1.124976,"26":1.124993,"27":1.12501,"28":1.125003,"29":1.124988,"30":1.175018,"31":1.174996,"32":1.175003,"33":1.175002,"34":1.174999,"35":1.175008,"36":1.174992,"37":1.175001,"38":1.174988,"39":1.175007,"40":1.225,"41":1.224998,"42":1.224994,"43":1.224988,"44":1.224981,"45":1.224996,"46":1.225007,"47":1.225019,"48":1.225006,"49":1.224997,"50":1.374992,"51":1.374993,"52":1.375002,"53":1.375003,"54":1.375006,"55":1.374992,"56":1.375003,"57":1.374991,"58":1.375008,"59":1.375003,"60":1.375004,"61":1.374998,"62":1.374999,"63":1.374999,"64+":1.375002}}},"ded":{"ind":12000,"fam":24000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":3,"rule":{"kind":"copay","amount":50,"ded":"no_ded"}}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":3,"rule":{"kind":"free","ded":"no_ded"}}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"after_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Primary care visits: the first 3 visits are $50 copay per visit with no deductible; after visit 3 the SBC says \"No charge\", which is read as no charge after the deductible (this plan's deductible equals its out-of-pocket limit).","Prenatal care: the SBC says the office-visit cost share applies to the first OB visit only, so it is charged once here and later prenatal visits are no charge (they are part of the delivery fee); other copays or coinsurance may apply to other services such as ultrasounds.","Prescription drug costs shown are for a 30-day retail fill; 31-90 day mail-order fills cost more per fill.","Mental health office visits: the first 3 visits are no charge with no deductible; after visit 3 the SBC says \"No charge\", read as no charge after the deductible.","Mental health: office visits no charge (used here); other outpatient services no charge after the deductible.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); visits above the limit are not covered. The limit does not apply to therapy prescribed for mental health or substance use treatment.","Telemedicine visits with the designated telemedicine provider are free.","The SBC lists \"No charge\" for some services without saying whether the deductible applies. It is read as no charge after the deductible: the grid's banner says costs shown are after the deductible, and this plan's benefit chart in IBX's 2027 plan overview brochure lists these services as \"0% after ded\". This plan's deductible equals its out-of-pocket limit and the SBC coverage examples (Peg, Joe, Mia) show the deductible being paid in full."],"sbcUrl":"https://www.ibx.com/pdfs/custom/ffm/2027/epocatastrophic2027.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":307.28,"tobaccoFactor":1.125,"tobaccoFactorByAge":{"21":1.125,"22":1.125,"23":1.125,"24":1.125,"25":1.124988,"26":1.125028,"27":1.124988,"28":1.125026,"29":1.124996,"30":1.17502,"31":1.174987,"32":1.175016,"33":1.174997,"34":1.174995,"35":1.174993,"36":1.175023,"37":1.174995,"38":1.174994,"39":1.174992,"40":1.225006,"41":1.225005,"42":1.224979,"43":1.224999,"44":1.22501,"45":1.225012,"46":1.225007,"47":1.224994,"48":1.225,"49":1.225001,"50":1.375,"51":1.374991,"52":1.375002,"53":1.375002,"54":1.375008,"55":1.375013,"56":1.375014,"57":1.375007,"58":1.375005,"59":1.374995,"60":1.374994,"61":1.374991,"62":1.374992,"63":1.375001,"64+":1.375}}}}},{"market":"pennie","id":"31609PA0160005-01","standardId":"31609PA0160005","variant":"standard","issuer":"QCC Insurance Company (Independence Blue Cross)","name":"Personal Choice EPO Bronze Reserve","metal":"Bronze","network":"EPO","hsaEligible":false,"networkId":"PAN002","referral":false,"tiers":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":415.28,"tobaccoFactor":1.125,"tobaccoFactorByAge":{"21":1.125,"22":1.125,"23":1.125,"24":1.125,"25":1.125006,"26":1.124985,"27":1.12502,"28":1.125008,"29":1.125005,"30":1.175012,"31":1.175002,"32":1.174992,"33":1.174991,"34":1.175007,"35":1.175005,"36":1.175003,"37":1.174998,"38":1.174996,"39":1.175011,"40":1.224992,"41":1.225009,"42":1.224989,"43":1.22501,"44":1.224994,"45":1.225011,"46":1.225005,"47":1.225011,"48":1.224999,"49":1.224992,"50":1.374995,"51":1.37499,"52":1.374992,"53":1.375001,"54":1.375008,"55":1.375004,"56":1.375001,"57":1.374995,"58":1.375001,"59":1.375006,"60":1.374999,"61":1.374998,"62":1.374998,"63":1.374995,"64+":1.375}}},"ded":{"ind":7800,"fam":15600,"embedded":true},"drugDed":null,"oop":{"ind":7800,"fam":15600},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"after_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prenatal care: the SBC says the office-visit cost share applies to the first OB visit only, so it is charged once here and later prenatal visits are no charge (they are part of the delivery fee); other copays or coinsurance may apply to other services such as ultrasounds.","Prescription drug costs shown are for a 30-day retail fill; 31-90 day mail-order fills cost more per fill.","Mental health: office visits no charge after the deductible (used here); other outpatient services no charge after the deductible.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); visits above the limit are not covered. The limit does not apply to therapy prescribed for mental health or substance use treatment.","Telemedicine visits with the designated telemedicine provider are free.","The SBC lists \"No charge\" for some services without saying whether the deductible applies. It is read as no charge after the deductible: the grid's banner says costs shown are after the deductible, and this plan's benefit chart in IBX's 2027 plan overview brochure lists these services as \"0% after ded\". This plan's deductible equals its out-of-pocket limit and the SBC coverage examples (Peg, Joe, Mia) show the deductible being paid in full."],"sbcUrl":"https://www.ibx.com/pdfs/custom/ffm/2027/epobronzereserve2027.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":355.79,"tobaccoFactor":1.124989,"tobaccoFactorByAge":{"21":1.124989,"22":1.124989,"23":1.124989,"24":1.124989,"25":1.124997,"26":1.124997,"27":1.125003,"28":1.125019,"29":1.125009,"30":1.175004,"31":1.174993,"32":1.175006,"33":1.174995,"34":1.175005,"35":1.174985,"36":1.175015,"37":1.174995,"38":1.175002,"39":1.174985,"40":1.225005,"41":1.225002,"42":1.225001,"43":1.224995,"44":1.224992,"45":1.225008,"46":1.224981,"47":1.224996,"48":1.224988,"49":1.224999,"50":1.375,"51":1.374998,"52":1.375004,"53":1.375002,"54":1.375008,"55":1.375002,"56":1.374997,"57":1.375003,"58":1.375004,"59":1.375005,"60":1.375006,"61":1.374996,"62":1.375002,"63":1.375001,"64+":1.374996}}}}},{"market":"pennie","id":"31609PA0160006-01","standardId":"31609PA0160006","variant":"standard","issuer":"QCC Insurance Company (Independence Blue Cross)","name":"Personal Choice EPO Bronze Basic","metal":"Bronze","network":"EPO","hsaEligible":false,"networkId":"PAN002","referral":false,"tiers":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":372.11,"tobaccoFactor":1.12499,"tobaccoFactorByAge":{"21":1.12499,"22":1.12499,"23":1.12499,"24":1.12499,"25":1.125,"26":1.125,"27":1.12501,"28":1.125,"29":1.125003,"30":1.175025,"31":1.174991,"32":1.174985,"33":1.174993,"34":1.175012,"35":1.174987,"36":1.174984,"37":1.175006,"38":1.175003,"39":1.175,"40":1.224998,"41":1.224999,"42":1.224987,"43":1.225012,"44":1.224992,"45":1.225001,"46":1.224985,"47":1.224996,"48":1.225,"49":1.224993,"50":1.374998,"51":1.374991,"52":1.374993,"53":1.37501,"54":1.375014,"55":1.374989,"56":1.375001,"57":1.374999,"58":1.374997,"59":1.375005,"60":1.374994,"61":1.374999,"62":1.374999,"63":1.374994,"64+":1.374997}}},"ded":{"ind":9800,"fam":19600,"embedded":true},"drugDed":null,"oop":{"ind":9800,"fam":19600},"rules":{"pcp":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"after_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prenatal care: the SBC says the office-visit cost share applies to the first OB visit only, so it is charged once here and later prenatal visits are no charge (they are part of the delivery fee); other copays or coinsurance may apply to other services such as ultrasounds.","Prescription drug costs shown are for a 30-day retail fill; 31-90 day mail-order fills cost more per fill.","Mental health: office visits 40% coinsurance (used here); other outpatient services no charge after the deductible.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); visits above the limit are not covered. The limit does not apply to therapy prescribed for mental health or substance use treatment.","Telemedicine visits with the designated telemedicine provider are free.","The SBC lists \"No charge\" for some services without saying whether the deductible applies. It is read as no charge after the deductible: the grid's banner says costs shown are after the deductible, and this plan's benefit chart in IBX's 2027 plan overview brochure lists these services as \"0% after ded\". This plan's deductible equals its out-of-pocket limit and the SBC coverage examples (Peg, Joe, Mia) show the deductible being paid in full."],"sbcUrl":"https://www.ibx.com/pdfs/custom/ffm/2027/epobronzebasic2027.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":315.95,"tobaccoFactor":1.124988,"tobaccoFactorByAge":{"21":1.124988,"22":1.124988,"23":1.124988,"24":1.124988,"25":1.125028,"26":1.124996,"27":1.125,"28":1.125,"29":1.124989,"30":1.175014,"31":1.174991,"32":1.175001,"33":1.175002,"34":1.175018,"35":1.175011,"36":1.175004,"37":1.174997,"38":1.17502,"39":1.175006,"40":1.225024,"41":1.22498,"42":1.22502,"43":1.225008,"44":1.224999,"45":1.224996,"46":1.224991,"47":1.224996,"48":1.224999,"49":1.225005,"50":1.374984,"51":1.374985,"52":1.37501,"53":1.374996,"54":1.375006,"55":1.374995,"56":1.375005,"57":1.375002,"58":1.375,"59":1.374991,"60":1.375001,"61":1.374997,"62":1.375006,"63":1.375005,"64+":1.374996}}}}},{"market":"pennie","id":"31609PA0160009-01","standardId":"31609PA0160009","variant":"standard","issuer":"QCC Insurance Company (Independence Blue Cross)","name":"Personal Choice EPO Bronze Classic","metal":"Bronze","network":"EPO","hsaEligible":false,"networkId":"PAN002","referral":false,"tiers":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":401.99,"tobaccoFactor":1.125003,"tobaccoFactorByAge":{"21":1.125003,"22":1.125003,"23":1.125003,"24":1.125003,"25":1.125,"26":1.124988,"27":1.124997,"28":1.125,"29":1.125003,"30":1.174988,"31":1.174991,"32":1.175018,"33":1.175007,"34":1.174993,"35":1.17501,"36":1.175003,"37":1.174999,"38":1.174992,"39":1.175001,"40":1.225017,"41":1.224995,"42":1.224992,"43":1.225005,"44":1.225008,"45":1.225007,"46":1.224995,"47":1.225,"48":1.225013,"49":1.225011,"50":1.375012,"51":1.374998,"52":1.375006,"53":1.374997,"54":1.374996,"55":1.374994,"56":1.375,"57":1.375001,"58":1.374999,"59":1.374998,"60":1.375005,"61":1.375003,"62":1.374996,"63":1.375007,"64+":1.375001}}},"ded":{"ind":6200,"fam":12400,"embedded":true},"drugDed":null,"oop":{"ind":10850,"fam":21700},"rules":{"pcp":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":65,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}}},"notes":["Prenatal care: the SBC says the office-visit cost share applies to the first OB visit only, so it is charged once here and later prenatal visits are no charge (they are part of the delivery fee); other copays or coinsurance may apply to other services such as ultrasounds.","Prescription drug costs shown are for a 30-day retail fill; 31-90 day mail-order fills cost more per fill.","Mental health: office visits $65 copay per visit (used here); other outpatient services 50% coinsurance after the deductible.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); visits above the limit are not covered. The limit does not apply to therapy prescribed for mental health or substance use treatment.","Telemedicine visits with the designated telemedicine provider are free."],"sbcUrl":"https://www.ibx.com/pdfs/custom/ffm/2027/epobronzeclassic2027.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":350.98,"tobaccoFactor":1.124993,"tobaccoFactorByAge":{"21":1.124993,"22":1.124993,"23":1.124993,"24":1.124993,"25":1.125007,"26":1.125014,"27":1.125003,"28":1.124974,"29":1.12499,"30":1.175018,"31":1.17498,"32":1.174996,"33":1.175018,"34":1.17501,"35":1.174983,"36":1.174979,"37":1.175002,"38":1.174998,"39":1.17499,"40":1.225014,"41":1.224999,"42":1.224987,"43":1.224994,"44":1.224996,"45":1.224991,"46":1.225008,"47":1.224999,"48":1.225007,"49":1.225011,"50":1.375002,"51":1.374989,"52":1.375005,"53":1.375,"54":1.37501,"55":1.374989,"56":1.374994,"57":1.374997,"58":1.374997,"59":1.375,"60":1.375,"61":1.375006,"62":1.374991,"63":1.375006,"64+":1.374998}}}}},{"market":"pennie","id":"31609PA0160010-01","standardId":"31609PA0160010","variant":"standard","issuer":"QCC Insurance Company (Independence Blue Cross)","name":"Personal Choice EPO Gold Preferred Virtual Care","metal":"Gold","network":"EPO","hsaEligible":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":812.35,"tobaccoFactor":1.124995,"tobaccoFactorByAge":{"21":1.124995,"22":1.124995,"23":1.124995,"24":1.124995,"25":1.125,"26":1.124998,"27":1.125003,"28":1.125003,"29":1.125003,"30":1.174996,"31":1.175006,"32":1.175003,"33":1.17499,"34":1.175007,"35":1.174999,"36":1.175002,"37":1.174994,"38":1.174997,"39":1.174992,"40":1.225,"41":1.225002,"42":1.225008,"43":1.224999,"44":1.224999,"45":1.225007,"46":1.224992,"47":1.225006,"48":1.225005,"49":1.224999,"50":1.374998,"51":1.375002,"52":1.374999,"53":1.375002,"54":1.374995,"55":1.375001,"56":1.375003,"57":1.374996,"58":1.374999,"59":1.374997,"60":1.375,"61":1.375003,"62":1.375002,"63":1.374999,"64+":1.374998}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":9750,"fam":19500},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":325,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":105,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":45,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":200}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"no_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":15,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"copay","amount":500,"ded":"no_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}}},"notes":["IBX publishes no SBC for this plan. Its cost sharing comes from the plan grid IBX filed with the PA Insurance Department (SERFF filing INLG-134934709, approved 2026-09-18, \"PA Consumer_ 2027 Plan Grids_(EPO VPCP) (5-13-26).xlsx\", sheet \"EPO On-Exchange\", form 196 column; each rule's page is the spreadsheet row), checked against IBX's 2027 plan overview brochure (page 24) and the Department's 2027 rate decision (qcc pp. 72, 73, 74, 76, 77, 79, 81): every value they print agrees. The same grid's Silver Classic Virtual Care column gives exactly the rules of that plan's filed SBC.","Primary care visits: $15 copay for office visits (used here) and $5 copay for virtual visits; visits with the plan's virtual primary care provider are no charge.","Specialist visits: $15 copay in the office (used here); $5 copay for virtual visits.","Outpatient lab and pathology: $10 copay at freestanding facilities (used here); $85 copay at hospital-based facilities.","Outpatient surgery facility fee: $300 copay at freestanding facilities (used here); $700 copay at hospital-based facilities.","Mental health: office visits $15 copay (used here); other outpatient services $45 copay.","Low-cost generic drugs: $3 copay per 30-day retail fill; other generics as shown (retail generic, used here).","Non-preferred brand drugs: the coinsurance is capped at $200 per 30-day retail fill (the cap is modelled here).","Specialty drugs: the coinsurance is capped at $1,000 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill; 31-90 day mail-order fills cost more per fill.","Physical and occupational therapy: limited to 30 visits a year; visits above the limit are not covered.","Hospital stay: the copay is charged per day, up to five copays per admission.","Prenatal care: the grid prices the first OB visit; later prenatal visits are no charge (part of the delivery fee), as every IBX SBC says (\"Office visit cost share applies to the first OB visit only\").","Delivery professional fees: the grid has no separate row; its inpatient physician/surgeon fee row is used, as IBX's brochure prices inpatient professional services \"includes maternity\".","Virtual care from the designated virtual provider is free."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#INLG-134934709/PA Consumer_ 2027 Plan Grids_(EPO VPCP) (5-13-26).xlsx"},{"market":"pennie","id":"31609PA0160011-01","standardId":"31609PA0160011","variant":"standard","issuer":"QCC Insurance Company (Independence Blue Cross)","name":"Personal Choice EPO Silver Classic Virtual Care","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":645.95,"tobaccoFactor":1.124994,"tobaccoFactorByAge":{"21":1.124994,"22":1.124994,"23":1.124994,"24":1.124994,"25":1.125006,"26":1.124998,"27":1.125,"28":1.125002,"29":1.124997,"30":1.175012,"31":1.174993,"32":1.175003,"33":1.174995,"34":1.175011,"35":1.175005,"36":1.174999,"37":1.174993,"38":1.175002,"39":1.175002,"40":1.22501,"41":1.224998,"42":1.225008,"43":1.225007,"44":1.225002,"45":1.225001,"46":1.22499,"47":1.224996,"48":1.225001,"49":1.225002,"50":1.374995,"51":1.374998,"52":1.375005,"53":1.374998,"54":1.375005,"55":1.374996,"56":1.375003,"57":1.375002,"58":1.375003,"59":1.375001,"60":1.374996,"61":1.375,"62":1.375001,"63":1.375003,"64+":1.374998}}},"ded":{"ind":3500,"fam":7000,"embedded":true},"drugDed":null,"oop":{"ind":8250,"fam":16500},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":75,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":300}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":400}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":1000}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.25,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":75,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.25,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Primary care visits: $30 copay per visit (used here, the office visit; IBX's 2027 plan overview brochure and the PA Insurance Department filing give it as the office-visit copay). Visits with the plan's virtual primary care provider are free (\"Virtual Primary/In-Office: No charge\").","Prenatal care: the SBC says the office-visit cost share applies to the first OB visit only, so it is charged once here and later prenatal visits are no charge (they are part of the delivery fee); other copays or coinsurance may apply to other services such as ultrasounds.","Imaging (CT, PET, MRI): 30% coinsurance after the deductible at freestanding facilities (used here); 50% coinsurance after the deductible at hospital-based facilities.","Outpatient surgery facility fee: 30% coinsurance after the deductible at freestanding facilities (used here); 50% coinsurance after the deductible at hospital-based facilities.","X-rays: 30% coinsurance after the deductible at freestanding facilities (used here); 50% coinsurance after the deductible at hospital-based facilities.","Blood work: 20% coinsurance at freestanding labs (used here); 50% coinsurance at hospital-based facilities.","Preferred brand drugs: 50% coinsurance is capped at $300 per 30-day retail fill (the cap is modelled here).","Non-preferred brand drugs: 50% coinsurance is capped at $400 per 30-day retail fill (the cap is modelled here).","Specialty drugs: 50% coinsurance is capped at $1,000 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill; 31-90 day mail-order fills cost more per fill.","Mental health: office visits $75 copay per visit (used here); other outpatient services 30% coinsurance after the deductible.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); visits above the limit are not covered. The limit does not apply to therapy prescribed for mental health or substance use treatment.","Physical and occupational therapy: $75 copay per visit at freestanding facilities (used here); $105 copay per visit at hospital-based facilities.","Telemedicine visits with the designated telemedicine provider are free.","IBX has not published this plan's 2027 SBC on ibx.com. This is the SBC IBX filed with the PA Insurance Department (SERFF filing INLG-134934709, approved 2026-09-18)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#INLG-134934709/31609PA0160011-01eposilverclassicVPCP2027.pdf"},{"market":"pennie","id":"31609PA0160011-04","standardId":"31609PA0160011","variant":"csr73","issuer":"QCC Insurance Company (Independence Blue Cross)","name":"Personal Choice EPO Silver Classic Virtual Care","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":645.95,"tobaccoFactor":1.124994,"tobaccoFactorByAge":{"21":1.124994,"22":1.124994,"23":1.124994,"24":1.124994,"25":1.125006,"26":1.124998,"27":1.125,"28":1.125002,"29":1.124997,"30":1.175012,"31":1.174993,"32":1.175003,"33":1.174995,"34":1.175011,"35":1.175005,"36":1.174999,"37":1.174993,"38":1.175002,"39":1.175002,"40":1.22501,"41":1.224998,"42":1.225008,"43":1.225007,"44":1.225002,"45":1.225001,"46":1.22499,"47":1.224996,"48":1.225001,"49":1.225002,"50":1.374995,"51":1.374998,"52":1.375005,"53":1.374998,"54":1.375005,"55":1.374996,"56":1.375003,"57":1.375002,"58":1.375003,"59":1.375001,"60":1.374996,"61":1.375,"62":1.375001,"63":1.375003,"64+":1.374998}}},"ded":{"ind":3250,"fam":6500,"embedded":true},"drugDed":null,"oop":{"ind":6900,"fam":13800},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"xray":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":75,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded","max":200}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":200}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":1000}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":75,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Independence publishes no SBC for this reduced cost-sharing version; its cost sharing comes from Independence's 2027 plan overview brochure, page 57, checked against the PA Insurance Department filing (pages 72, 73, 76, 80, 81).","Outpatient lab and pathology: 20% coinsurance at freestanding facilities (used here); 50% coinsurance at hospital-based facilities.","Mental health: office visits $75 copay (used here); all other outpatient services 20% coinsurance after the deductible.","Low-cost generic drugs: $3, no ded per 30-day retail fill; other generics as shown (retail generic, used here).","Preferred brand drugs: the coinsurance is capped at $200 per 30-day retail fill (the cap is modelled here).","Non-preferred brand drugs: the coinsurance is capped at $200 per 30-day retail fill (the cap is modelled here).","Specialty drugs: the coinsurance is capped at $1,000 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill.","Physical and occupational therapy: limited to 30 visits a year; visits above the limit are not covered.","Virtual care from the designated virtual provider (Teladoc Health) is free.","Independence's brochure gives no outpatient surgeon fee for this version; the standard version's SBC figure (coins 30% after_ded) is used, an upper bound — this version may cost less. Its text and page are those of the standard version's SBC (https://serff-sfa.naic.org/serff/sfa/home/PA#INLG-134934709/31609PA0160011-01eposilverclassicVPCP2027.pdf, page 3).","Prenatal care: the brochure has no prenatal row. The first OB visit is charged at this version's specialist cost share and later prenatal visits are no charge (part of the delivery fee): every Independence standard SBC prices prenatal care this way.","The deductible and out-of-pocket limit are the brochure's; no CMS plan file for 2027 exists yet to compare them with (the out-of-pocket limit is within the federal limit for this version)."],"sbcUrl":"https://www.ibx.com/pdfs/find-a-plan/individuals/2027-plan-overview-brochure.pdf#page=57"},{"market":"pennie","id":"31609PA0160011-05","standardId":"31609PA0160011","variant":"csr87","issuer":"QCC Insurance Company (Independence Blue Cross)","name":"Personal Choice EPO Silver Classic Virtual Care","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":645.95,"tobaccoFactor":1.124994,"tobaccoFactorByAge":{"21":1.124994,"22":1.124994,"23":1.124994,"24":1.124994,"25":1.125006,"26":1.124998,"27":1.125,"28":1.125002,"29":1.124997,"30":1.175012,"31":1.174993,"32":1.175003,"33":1.174995,"34":1.175011,"35":1.175005,"36":1.174999,"37":1.174993,"38":1.175002,"39":1.175002,"40":1.22501,"41":1.224998,"42":1.225008,"43":1.225007,"44":1.225002,"45":1.225001,"46":1.22499,"47":1.224996,"48":1.225001,"49":1.225002,"50":1.374995,"51":1.374998,"52":1.375005,"53":1.374998,"54":1.375005,"55":1.374996,"56":1.375003,"57":1.375002,"58":1.375003,"59":1.375001,"60":1.374996,"61":1.375,"62":1.375001,"63":1.375003,"64+":1.374998}}},"ded":{"ind":2250,"fam":4500,"embedded":true},"drugDed":null,"oop":{"ind":3250,"fam":6500},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded","max":200}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":200}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":50,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}}},"notes":["Independence publishes no SBC for this reduced cost-sharing version; its cost sharing comes from Independence's 2027 plan overview brochure, page 64, checked against the PA Insurance Department filing (pages 72, 73, 76, 80, 81).","Outpatient lab and pathology: no charge at freestanding facilities (used here); 50% coinsurance at hospital-based facilities.","Mental health: office visits $50 copay (used here); all other outpatient services 10% coinsurance.","Low-cost generic drugs: $3, no ded per 30-day retail fill; other generics as shown (retail generic, used here).","Preferred brand drugs: the coinsurance is capped at $200 per 30-day retail fill (the cap is modelled here).","Non-preferred brand drugs: the coinsurance is capped at $200 per 30-day retail fill (the cap is modelled here).","Specialty drugs: the coinsurance is capped at $500 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill.","Physical and occupational therapy: limited to 30 visits a year; visits above the limit are not covered.","Virtual care from the designated virtual provider (Teladoc Health) is free.","Independence's brochure gives no outpatient surgeon fee for this version; the standard version's SBC figure (coins 30% after_ded) is used, an upper bound — this version may cost less. Its text and page are those of the standard version's SBC (https://serff-sfa.naic.org/serff/sfa/home/PA#INLG-134934709/31609PA0160011-01eposilverclassicVPCP2027.pdf, page 3).","Prenatal care: the brochure has no prenatal row. The first OB visit is charged at this version's specialist cost share and later prenatal visits are no charge (part of the delivery fee): every Independence standard SBC prices prenatal care this way.","The deductible and out-of-pocket limit are the brochure's; no CMS plan file for 2027 exists yet to compare them with (the out-of-pocket limit is within the federal limit for this version)."],"sbcUrl":"https://www.ibx.com/pdfs/find-a-plan/individuals/2027-plan-overview-brochure.pdf#page=64"},{"market":"pennie","id":"31609PA0160011-06","standardId":"31609PA0160011","variant":"csr94","issuer":"QCC Insurance Company (Independence Blue Cross)","name":"Personal Choice EPO Silver Classic Virtual Care","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":645.95,"tobaccoFactor":1.124994,"tobaccoFactorByAge":{"21":1.124994,"22":1.124994,"23":1.124994,"24":1.124994,"25":1.125006,"26":1.124998,"27":1.125,"28":1.125002,"29":1.124997,"30":1.175012,"31":1.174993,"32":1.175003,"33":1.174995,"34":1.175011,"35":1.175005,"36":1.174999,"37":1.174993,"38":1.175002,"39":1.175002,"40":1.22501,"41":1.224998,"42":1.225008,"43":1.225007,"44":1.225002,"45":1.225001,"46":1.22499,"47":1.224996,"48":1.225001,"49":1.225002,"50":1.374995,"51":1.374998,"52":1.375005,"53":1.374998,"54":1.375005,"55":1.374996,"56":1.375003,"57":1.375002,"58":1.375003,"59":1.375001,"60":1.374996,"61":1.375,"62":1.375001,"63":1.375003,"64+":1.374998}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":3000,"fam":6000},"rules":{"pcp":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":10,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":4,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.15,"ded":"no_ded","max":200}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.15,"ded":"no_ded","max":200}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":10,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}}},"notes":["Independence publishes no SBC for this reduced cost-sharing version; its cost sharing comes from Independence's 2027 plan overview brochure, page 71, checked against the PA Insurance Department filing (pages 72, 73, 80, 81).","Outpatient lab and pathology: no charge at freestanding facilities (used here); 50% coinsurance at hospital-based facilities.","Mental health: office visits $10 copay (used here); all other outpatient services 10% coinsurance.","Low-cost generic drugs: $3 per 30-day retail fill; other generics as shown (retail generic, used here).","Preferred brand drugs: the coinsurance is capped at $200 per 30-day retail fill (the cap is modelled here).","Non-preferred brand drugs: the coinsurance is capped at $200 per 30-day retail fill (the cap is modelled here).","Specialty drugs: the coinsurance is capped at $500 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill.","Separate prescription drug deductible ($0 individual / $0 family): drug cells marked \"after ded\" are after this deductible.","Physical and occupational therapy: limited to 30 visits a year; visits above the limit are not covered.","Virtual care from the designated virtual provider (Teladoc Health) is free.","Independence's brochure gives no outpatient surgeon fee for this version; the standard version's SBC figure (coins 30% after_ded) is used, an upper bound — this version may cost less. Its text and page are those of the standard version's SBC (https://serff-sfa.naic.org/serff/sfa/home/PA#INLG-134934709/31609PA0160011-01eposilverclassicVPCP2027.pdf, page 3).","Prenatal care: the brochure has no prenatal row. The first OB visit is charged at this version's specialist cost share and later prenatal visits are no charge (part of the delivery fee): every Independence standard SBC prices prenatal care this way.","The deductible and out-of-pocket limit are the brochure's; no CMS plan file for 2027 exists yet to compare them with (the out-of-pocket limit is within the federal limit for this version)."],"sbcUrl":"https://www.ibx.com/pdfs/find-a-plan/individuals/2027-plan-overview-brochure.pdf#page=71"},{"market":"pennie","id":"31609PA0160012-01","standardId":"31609PA0160012","variant":"standard","issuer":"QCC Insurance Company (Independence Blue Cross)","name":"Personal Choice EPO Bronze Virtual Care","metal":"Bronze","network":"EPO","hsaEligible":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":441.99,"tobaccoFactor":1.125003,"tobaccoFactorByAge":{"21":1.125003,"22":1.125003,"23":1.125003,"24":1.125003,"25":1.125,"26":1.124989,"27":1.124997,"28":1.12501,"29":1.124992,"30":1.174999,"31":1.174986,"32":1.175015,"33":1.175014,"34":1.174997,"35":1.175001,"36":1.175002,"37":1.175006,"38":1.175007,"39":1.174994,"40":1.225012,"41":1.224999,"42":1.225002,"43":1.224999,"44":1.225002,"45":1.225013,"46":1.224996,"47":1.225005,"48":1.225005,"49":1.225004,"50":1.375011,"51":1.375005,"52":1.375006,"53":1.374997,"54":1.375001,"55":1.374995,"56":1.375005,"57":1.374997,"58":1.374999,"59":1.375002,"60":1.375004,"61":1.375003,"62":1.375,"63":1.375007,"64+":1.375001}}},"ded":{"ind":6000,"fam":12000,"embedded":true},"drugDed":null,"oop":{"ind":9200,"fam":18400},"rules":{"pcp":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"specialist":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.25,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"coins","rate":0.5,"ded":"after_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.25,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}}},"notes":["IBX publishes no SBC for this plan. Its cost sharing comes from the plan grid IBX filed with the PA Insurance Department (SERFF filing INLG-134934709, approved 2026-09-18, \"PA Consumer_ 2027 Plan Grids_(EPO VPCP) (5-13-26).xlsx\", sheet \"EPO On-Exchange\", form 208 column; each rule's page is the spreadsheet row), checked against IBX's 2027 plan overview brochure (page 47) and the Department's 2027 rate decision (qcc pp. 72, 75, 79, 81): every value they print agrees. The same grid's Silver Classic Virtual Care column gives exactly the rules of that plan's filed SBC.","Primary care visits: 50% coinsurance for office visits (used here) and 50% coinsurance for virtual visits; visits with the plan's virtual primary care provider are no charge.","Specialist visits: 50% coinsurance after the deductible in the office (used here); 50% coinsurance after the deductible for virtual visits.","Outpatient lab and pathology: 20% coinsurance after the deductible at freestanding facilities (used here); 50% coinsurance after the deductible at hospital-based facilities.","Mental health: office visits 50% coinsurance after the deductible (used here); other outpatient services 50% coinsurance after the deductible.","Low-cost generic drugs: $5 copay per 30-day retail fill; other generics as shown (retail generic, used here).","Prescription drug costs shown are for a 30-day retail fill; 31-90 day mail-order fills cost more per fill.","Physical and occupational therapy: limited to 30 visits a year; visits above the limit are not covered.","Prenatal care: the grid prices the first OB visit; later prenatal visits are no charge (part of the delivery fee), as every IBX SBC says (\"Office visit cost share applies to the first OB visit only\").","Delivery professional fees: the grid has no separate row; its inpatient physician/surgeon fee row is used, as IBX's brochure prices inpatient professional services \"includes maternity\".","Virtual care from the designated virtual provider is free."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#INLG-134934709/PA Consumer_ 2027 Plan Grids_(EPO VPCP) (5-13-26).xlsx"},{"market":"pennie","id":"33709PA0870007-01","standardId":"33709PA0870007","variant":"standard","issuer":"Highmark Inc.","name":"my Direct Blue EPO Bronze 3800 HSA","metal":"Bronze","network":"EPO","hsaEligible":true,"networkId":"PAN002","referral":false,"tiers":false,"counties":["Allegheny","Armstrong","Beaver","Blair","Butler","Cambria","Clarion","Crawford","Erie","Fayette","Forest","Greene","Somerset","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":356.22,"tobaccoFactor":1.025013,"tobaccoFactorByAge":{"21":1.025013,"22":1.025013,"23":1.025013,"24":1.025013,"25":1.024997,"26":1.025002,"27":1.024992,"28":1.024999,"29":1.025012,"30":1.025006,"31":1.024996,"32":1.025011,"33":1.025003,"34":1.024997,"35":1.024994,"36":1.024991,"37":1.025011,"38":1.025008,"39":1.025003,"40":1.100011,"41":1.105002,"42":1.111994,"43":1.121,"44":1.132003,"45":1.14501,"46":1.159995,"47":1.177003,"48":1.195993,"49":1.216995,"50":1.225004,"51":1.225002,"52":1.224998,"53":1.225007,"54":1.225001,"55":1.224996,"56":1.225002,"57":1.224995,"58":1.224999,"59":1.225001,"60":1.225005,"61":1.225,"62":1.225,"63":1.224999,"64+":1.225001}},"4":{"base21":356.22,"tobaccoFactor":1.025013,"tobaccoFactorByAge":{"21":1.025013,"22":1.025013,"23":1.025013,"24":1.025013,"25":1.024997,"26":1.025002,"27":1.024992,"28":1.024999,"29":1.025012,"30":1.025006,"31":1.024996,"32":1.025011,"33":1.025003,"34":1.024997,"35":1.024994,"36":1.024991,"37":1.025011,"38":1.025008,"39":1.025003,"40":1.100011,"41":1.105002,"42":1.111994,"43":1.121,"44":1.132003,"45":1.14501,"46":1.159995,"47":1.177003,"48":1.195993,"49":1.216995,"50":1.225004,"51":1.225002,"52":1.224998,"53":1.225007,"54":1.225001,"55":1.224996,"56":1.225002,"57":1.224995,"58":1.224999,"59":1.225001,"60":1.225005,"61":1.225,"62":1.225,"63":1.224999,"64+":1.225001}},"5":{"base21":371.38,"tobaccoFactor":1.024988,"tobaccoFactorByAge":{"21":1.024988,"22":1.024988,"23":1.024988,"24":1.024988,"25":1.024995,"26":1.025007,"27":1.024999,"28":1.024994,"29":1.025002,"30":1.025005,"31":1.024998,"32":1.024992,"33":1.024994,"34":1.024997,"35":1.025009,"36":1.025,"37":1.024991,"38":1.025003,"39":1.025006,"40":1.099996,"41":1.104996,"42":1.111994,"43":1.121002,"44":1.131992,"45":1.145002,"46":1.159998,"47":1.176995,"48":1.195995,"49":1.216993,"50":1.225003,"51":1.225001,"52":1.225001,"53":1.224994,"54":1.224997,"55":1.224999,"56":1.225004,"57":1.225004,"58":1.224997,"59":1.225003,"60":1.224996,"61":1.225004,"62":1.225002,"63":1.225,"64+":1.224999}}},"ded":{"ind":3800,"fam":7600,"embedded":true},"drugDed":null,"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":180,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":550,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":550,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}}},"notes":["Diagnostic tests: $65 copay for blood work / lab and $180 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $30 copay for a 90-day mail-order supply.","Tier 2 drugs (preferred brand): 50% coinsurance (retail and mail order).","Tier 3 drugs (non-preferred brand): 50% coinsurance (retail and mail order).","Tier 4 drugs (specialty): 50% coinsurance (retail and mail order).","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","Deductible ($3,800): not charged for primary care and specialist visits, lab and x-ray, urgent care, outpatient mental health, rehabilitation therapy, Tier 1 drugs; every other service below is charged after the deductible."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/WPA/Individual/I_33709PA0870007-01_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":325.44,"tobaccoFactor":1.025012,"tobaccoFactorByAge":{"21":1.025012,"22":1.025012,"23":1.025012,"24":1.025012,"25":1.025005,"26":1.024996,"27":1.02501,"28":1.024989,"29":1.024988,"30":1.024988,"31":1.025001,"32":1.025013,"33":1.025008,"34":1.025008,"35":1.024994,"36":1.025007,"37":1.024994,"38":1.025006,"39":1.025005,"40":1.099998,"41":1.104999,"42":1.11201,"43":1.121009,"44":1.131995,"45":1.144997,"46":1.160009,"47":1.176994,"48":1.196001,"49":1.217003,"50":1.225002,"51":1.224994,"52":1.224994,"53":1.225004,"54":1.224997,"55":1.225001,"56":1.224998,"57":1.225003,"58":1.224995,"59":1.224998,"60":1.225001,"61":1.225,"62":1.224997,"63":1.225003,"64+":1.224998}},"4":{"base21":325.44,"tobaccoFactor":1.025012,"tobaccoFactorByAge":{"21":1.025012,"22":1.025012,"23":1.025012,"24":1.025012,"25":1.025005,"26":1.024996,"27":1.02501,"28":1.024989,"29":1.024988,"30":1.024988,"31":1.025001,"32":1.025013,"33":1.025008,"34":1.025008,"35":1.024994,"36":1.025007,"37":1.024994,"38":1.025006,"39":1.025005,"40":1.099998,"41":1.104999,"42":1.11201,"43":1.121009,"44":1.131995,"45":1.144997,"46":1.160009,"47":1.176994,"48":1.196001,"49":1.217003,"50":1.225002,"51":1.224994,"52":1.224994,"53":1.225004,"54":1.224997,"55":1.225001,"56":1.224998,"57":1.225003,"58":1.224995,"59":1.224998,"60":1.225001,"61":1.225,"62":1.224997,"63":1.225003,"64+":1.224998}},"5":{"base21":325.44,"tobaccoFactor":1.025012,"tobaccoFactorByAge":{"21":1.025012,"22":1.025012,"23":1.025012,"24":1.025012,"25":1.025005,"26":1.024996,"27":1.02501,"28":1.024989,"29":1.024988,"30":1.024988,"31":1.025001,"32":1.025013,"33":1.025008,"34":1.025008,"35":1.024994,"36":1.025007,"37":1.024994,"38":1.025006,"39":1.025005,"40":1.099998,"41":1.104999,"42":1.11201,"43":1.121009,"44":1.131995,"45":1.144997,"46":1.160009,"47":1.176994,"48":1.196001,"49":1.217003,"50":1.225002,"51":1.224994,"52":1.224994,"53":1.225004,"54":1.224997,"55":1.225001,"56":1.224998,"57":1.225003,"58":1.224995,"59":1.224998,"60":1.225001,"61":1.225,"62":1.224997,"63":1.225003,"64+":1.224998}}}}},{"market":"pennie","id":"33709PA0870012-01","standardId":"33709PA0870012","variant":"standard","issuer":"Highmark 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0","metal":"Gold","network":"EPO","hsaEligible":false,"networkId":"PAN002","referral":false,"tiers":false,"counties":["Allegheny","Armstrong","Beaver","Blair","Butler","Cambria","Clarion","Crawford","Erie","Fayette","Forest","Greene","Somerset","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":502.63,"tobaccoFactor":1.025008,"tobaccoFactorByAge":{"21":1.025008,"22":1.025008,"23":1.025008,"24":1.025008,"25":1.025008,"26":1.025005,"27":1.025002,"28":1.025002,"29":1.024998,"30":1.024996,"31":1.024994,"32":1.025008,"33":1.024994,"34":1.024992,"35":1.025008,"36":1.025007,"37":1.025006,"38":1.025005,"39":1.025003,"40":1.100006,"41":1.104994,"42":1.112,"43":1.120999,"44":1.132005,"45":1.144999,"46":1.159997,"47":1.176996,"48":1.195997,"49":1.217005,"50":1.224997,"51":1.225005,"52":1.224996,"53":1.225002,"54":1.224998,"55":1.224997,"56":1.224997,"57":1.224996,"58":1.225002,"59":1.225001,"60":1.224999,"61":1.225002,"62":1.224998,"63":1.225003,"64+":1.225003}},"4":{"base21":502.63,"tobaccoFactor":1.025008,"tobaccoFactorByAge":{"21":1.025008,"22":1.025008,"23":1.025008,"24":1.025008,"25":1.025008,"26":1.025005,"27":1.025002,"28":1.025002,"29":1.024998,"30":1.024996,"31":1.024994,"32":1.025008,"33":1.024994,"34":1.024992,"35":1.025008,"36":1.025007,"37":1.025006,"38":1.025005,"39":1.025003,"40":1.100006,"41":1.104994,"42":1.112,"43":1.120999,"44":1.132005,"45":1.144999,"46":1.159997,"47":1.176996,"48":1.195997,"49":1.217005,"50":1.224997,"51":1.225005,"52":1.224996,"53":1.225002,"54":1.224998,"55":1.224997,"56":1.224997,"57":1.224996,"58":1.225002,"59":1.225001,"60":1.224999,"61":1.225002,"62":1.224998,"63":1.225003,"64+":1.225003}},"5":{"base21":524.02,"tobaccoFactor":1.024999,"tobaccoFactorByAge":{"21":1.024999,"22":1.024999,"23":1.024999,"24":1.024999,"25":1.024994,"26":1.025009,"27":1.025001,"28":1.025,"29":1.025001,"30":1.025002,"31":1.024994,"32":1.025003,"33":1.024993,"34":1.024994,"35":1.025002,"36":1.024995,"37":1.025002,"38":1.024995,"39":1.024996,"40":1.1,"41":1.105002,"42":1.111993,"43":1.120996,"44":1.131997,"45":1.145002,"46":1.159994,"47":1.177,"48":1.196004,"49":1.216996,"50":1.225003,"51":1.224997,"52":1.225,"53":1.225005,"54":1.225004,"55":1.225003,"56":1.224999,"57":1.224997,"58":1.225,"59":1.224997,"60":1.224998,"61":1.224998,"62":1.225,"63":1.224997,"64+":1.224998}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":725,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":725,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Diagnostic tests: $45 copay for blood work / lab and $75 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): no charge (retail and mail order).","Tier 2 drugs (preferred brand): $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $60 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $100 copay for a 31-day retail supply ($200 for 60 days, $300 for 90 days); $200 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $725 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","No medical deductible: copays and coinsurance apply from the first 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Page 1 of the SBC lists only preventive care as covered before the deductible and its coverage examples charge the whole cost to the deductible, so \"No charge\" is read as free only after the deductible is 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The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","Deductible ($6,000): not charged for primary care and specialist visits, lab and x-ray, urgent care, outpatient mental health, rehabilitation therapy, Tier 1 drugs, Tier 2 drugs; every other service below is charged after the deductible.","Hospital physician fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC 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The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","Deductible ($3,000): not charged for primary care and specialist visits, lab and x-ray, urgent care, outpatient mental health, rehabilitation therapy, Tier 1 drugs, Tier 2 drugs; every other service below is charged after the deductible.","Hospital physician fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $450 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,500 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","No medical deductible: copays and coinsurance apply from the first visit."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/WPA/Individual/I_33709PA0870018-04_20270101_SBC.pdf"},{"market":"pennie","id":"33709PA0870018-05","standardId":"33709PA0870018","variant":"csr87","issuer":"Highmark Inc.","name":"my Direct Blue EPO Choice Silver 0","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Butler","Cambria","Clarion","Crawford","Erie","Forest","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":582.21,"tobaccoFactor":1.025008,"tobaccoFactorByAge":{"21":1.025008,"22":1.025008,"23":1.025008,"24":1.025008,"25":1.024994,"26":1.024992,"27":1.024993,"28":1.024998,"29":1.025004,"30":1.025,"31":1.025001,"32":1.025002,"33":1.025004,"34":1.025,"35":1.025005,"36":1.024996,"37":1.025001,"38":1.025006,"39":1.025002,"40":1.100005,"41":1.104994,"42":1.112,"43":1.121003,"44":1.131997,"45":1.144996,"46":1.159999,"47":1.177002,"48":1.195995,"49":1.217005,"50":1.224998,"51":1.225,"52":1.225004,"53":1.224996,"54":1.225,"55":1.224997,"56":1.225002,"57":1.224999,"58":1.224999,"59":1.225003,"60":1.225002,"61":1.224999,"62":1.225003,"63":1.224998,"64+":1.224999}},"4":{"base21":582.21,"tobaccoFactor":1.025008,"tobaccoFactorByAge":{"21":1.025008,"22":1.025008,"23":1.025008,"24":1.025008,"25":1.024994,"26":1.024992,"27":1.024993,"28":1.024998,"29":1.025004,"30":1.025,"31":1.025001,"32":1.025002,"33":1.025004,"34":1.025,"35":1.025005,"36":1.024996,"37":1.025001,"38":1.025006,"39":1.025002,"40":1.100005,"41":1.104994,"42":1.112,"43":1.121003,"44":1.131997,"45":1.144996,"46":1.159999,"47":1.177002,"48":1.195995,"49":1.217005,"50":1.224998,"51":1.225,"52":1.225004,"53":1.224996,"54":1.225,"55":1.224997,"56":1.225002,"57":1.224999,"58":1.224999,"59":1.225003,"60":1.225002,"61":1.224999,"62":1.225003,"63":1.224998,"64+":1.224999}},"5":{"base21":606.98,"tobaccoFactor":1.024993,"tobaccoFactorByAge":{"21":1.024993,"22":1.024993,"23":1.024993,"24":1.024993,"25":1.025008,"26":1.025002,"27":1.024995,"28":1.024993,"29":1.025,"30":1.024996,"31":1.025004,"32":1.024998,"33":1.025001,"34":1.024998,"35":1.024996,"36":1.024994,"37":1.025005,"38":1.025003,"39":1.025,"40":1.099997,"41":1.104999,"42":1.112005,"43":1.120995,"44":1.132001,"45":1.145,"46":1.160005,"47":1.176998,"48":1.195998,"49":1.217004,"50":1.225004,"51":1.224996,"52":1.224996,"53":1.224997,"54":1.225002,"55":1.224998,"56":1.225001,"57":1.224998,"58":1.224998,"59":1.224998,"60":1.224999,"61":1.224999,"62":1.225002,"63":1.225003,"64+":1.224999}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":3800,"fam":7600},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":550,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":550,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Diagnostic tests: $60 copay for blood work / lab and $90 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): no charge (retail and mail order).","Tier 2 drugs (preferred brand): $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $20 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $50 copay for a 31-day retail supply ($100 for 60 days, $150 for 90 days); $100 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $550 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","No medical deductible: copays and coinsurance apply from the first visit."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/WPA/Individual/I_33709PA0870018-05_20270101_SBC.pdf"},{"market":"pennie","id":"33709PA0870018-06","standardId":"33709PA0870018","variant":"csr94","issuer":"Highmark Inc.","name":"my Direct Blue EPO Choice Silver 0","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Butler","Cambria","Clarion","Crawford","Erie","Forest","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":582.21,"tobaccoFactor":1.025008,"tobaccoFactorByAge":{"21":1.025008,"22":1.025008,"23":1.025008,"24":1.025008,"25":1.024994,"26":1.024992,"27":1.024993,"28":1.024998,"29":1.025004,"30":1.025,"31":1.025001,"32":1.025002,"33":1.025004,"34":1.025,"35":1.025005,"36":1.024996,"37":1.025001,"38":1.025006,"39":1.025002,"40":1.100005,"41":1.104994,"42":1.112,"43":1.121003,"44":1.131997,"45":1.144996,"46":1.159999,"47":1.177002,"48":1.195995,"49":1.217005,"50":1.224998,"51":1.225,"52":1.225004,"53":1.224996,"54":1.225,"55":1.224997,"56":1.225002,"57":1.224999,"58":1.224999,"59":1.225003,"60":1.225002,"61":1.224999,"62":1.225003,"63":1.224998,"64+":1.224999}},"4":{"base21":582.21,"tobaccoFactor":1.025008,"tobaccoFactorByAge":{"21":1.025008,"22":1.025008,"23":1.025008,"24":1.025008,"25":1.024994,"26":1.024992,"27":1.024993,"28":1.024998,"29":1.025004,"30":1.025,"31":1.025001,"32":1.025002,"33":1.025004,"34":1.025,"35":1.025005,"36":1.024996,"37":1.025001,"38":1.025006,"39":1.025002,"40":1.100005,"41":1.104994,"42":1.112,"43":1.121003,"44":1.131997,"45":1.144996,"46":1.159999,"47":1.177002,"48":1.195995,"49":1.217005,"50":1.224998,"51":1.225,"52":1.225004,"53":1.224996,"54":1.225,"55":1.224997,"56":1.225002,"57":1.224999,"58":1.224999,"59":1.225003,"60":1.225002,"61":1.224999,"62":1.225003,"63":1.224998,"64+":1.224999}},"5":{"base21":606.98,"tobaccoFactor":1.024993,"tobaccoFactorByAge":{"21":1.024993,"22":1.024993,"23":1.024993,"24":1.024993,"25":1.025008,"26":1.025002,"27":1.024995,"28":1.024993,"29":1.025,"30":1.024996,"31":1.025004,"32":1.024998,"33":1.025001,"34":1.024998,"35":1.024996,"36":1.024994,"37":1.025005,"38":1.025003,"39":1.025,"40":1.099997,"41":1.104999,"42":1.112005,"43":1.120995,"44":1.132001,"45":1.145,"46":1.160005,"47":1.176998,"48":1.195998,"49":1.217004,"50":1.225004,"51":1.224996,"52":1.224996,"53":1.224997,"54":1.225002,"55":1.224998,"56":1.225001,"57":1.224998,"58":1.224998,"59":1.224998,"60":1.224999,"61":1.224999,"62":1.225002,"63":1.225003,"64+":1.224999}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":2500,"fam":5000},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":1,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":750}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":175,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Diagnostic tests: $5 copay for blood work / lab and $5 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): no charge (retail and mail order).","Tier 2 drugs (preferred brand): $1 copay for a 31-day retail supply ($2 for 60 days, $3 for 90 days); $2 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $5 copay for a 31-day retail supply ($10 for 60 days, $15 for 90 days); $10 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $750 for a 31-day retail supply ($500 / $1,500 for 60 days, $750 / $2,250 for 90 days) and a minimum of $500 and a maximum of $1,500 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $175 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","No medical deductible: copays and coinsurance apply from the first visit."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/WPA/Individual/I_33709PA0870018-06_20270101_SBC.pdf"},{"market":"pennie","id":"33709PA0870019-01","standardId":"33709PA0870019","variant":"standard","issuer":"Highmark Inc.","name":"my Direct Blue EPO Platinum 0","metal":"Platinum","network":"EPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Butler","Cambria","Clarion","Crawford","Erie","Forest","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":556.51,"tobaccoFactor":1.024995,"tobaccoFactorByAge":{"21":1.024995,"22":1.024995,"23":1.024995,"24":1.024995,"25":1.025003,"26":1.025006,"27":1.024999,"28":1.024995,"29":1.025003,"30":1.024998,"31":1.025008,"32":1.025002,"33":1.025004,"34":1.025,"35":1.024998,"36":1.024996,"37":1.024994,"38":1.025007,"39":1.025003,"40":1.099997,"41":1.104999,"42":1.112005,"43":1.121004,"44":1.131997,"45":1.144998,"46":1.159996,"47":1.177,"48":1.196002,"49":1.216998,"50":1.224996,"51":1.225005,"52":1.225,"53":1.225002,"54":1.224997,"55":1.225,"56":1.225003,"57":1.225002,"58":1.225002,"59":1.225003,"60":1.224998,"61":1.224998,"62":1.224999,"63":1.224997,"64+":1.224997}},"4":{"base21":556.51,"tobaccoFactor":1.024995,"tobaccoFactorByAge":{"21":1.024995,"22":1.024995,"23":1.024995,"24":1.024995,"25":1.025003,"26":1.025006,"27":1.024999,"28":1.024995,"29":1.025003,"30":1.024998,"31":1.025008,"32":1.025002,"33":1.025004,"34":1.025,"35":1.024998,"36":1.024996,"37":1.024994,"38":1.025007,"39":1.025003,"40":1.099997,"41":1.104999,"42":1.112005,"43":1.121004,"44":1.131997,"45":1.144998,"46":1.159996,"47":1.177,"48":1.196002,"49":1.216998,"50":1.224996,"51":1.225005,"52":1.225,"53":1.225002,"54":1.224997,"55":1.225,"56":1.225003,"57":1.225002,"58":1.225002,"59":1.225003,"60":1.224998,"61":1.224998,"62":1.224999,"63":1.224997,"64+":1.224997}},"5":{"base21":580.19,"tobaccoFactor":1.024992,"tobaccoFactorByAge":{"21":1.024992,"22":1.024992,"23":1.024992,"24":1.024992,"25":1.024995,"26":1.024995,"27":1.024998,"28":1.025005,"29":1.024999,"30":1.024995,"31":1.024999,"32":1.025001,"33":1.025005,"34":1.025002,"35":1.024993,"36":1.024999,"37":1.025004,"38":1.024996,"39":1.025007,"40":1.100003,"41":1.105003,"42":1.112,"43":1.121005,"44":1.132,"45":1.145001,"46":1.160004,"47":1.176999,"48":1.196003,"49":1.217003,"50":1.225,"51":1.224999,"52":1.225001,"53":1.225002,"54":1.225,"55":1.225,"56":1.225003,"57":1.224999,"58":1.224999,"59":1.224999,"60":1.224997,"61":1.224997,"62":1.225,"63":1.224999,"64+":1.225001}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":5400,"fam":10800},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":325,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":325,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): no charge (retail and mail order).","Tier 2 drugs (preferred brand): $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $20 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $50 copay for a 31-day retail supply ($100 for 60 days, $150 for 90 days); $100 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $325 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","No medical deductible: copays and coinsurance apply from the first visit."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/WPA/Individual/I_33709PA0870019-01_20270101_SBC.pdf"},{"market":"pennie","id":"33709PA0890004-01","standardId":"33709PA0890004","variant":"standard","issuer":"Highmark Inc.","name":"my Direct Blue EPO Gold 1800 HSA","metal":"Gold","network":"EPO","hsaEligible":true,"networkId":"PAN002","referral":false,"tiers":false,"counties":["Allegheny","Armstrong","Beaver","Blair","Butler","Cambria","Clarion","Crawford","Erie","Fayette","Forest","Greene","Somerset","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":461.52,"tobaccoFactor":1.025004,"tobaccoFactorByAge":{"21":1.025004,"22":1.025004,"23":1.025004,"24":1.025004,"25":1.024991,"26":1.025011,"27":1.024996,"28":1.024997,"29":1.024998,"30":1.025008,"31":1.024995,"32":1.025001,"33":1.024995,"34":1.025005,"35":1.025001,"36":1.024997,"37":1.024993,"38":1.025007,"39":1.024998,"40":1.099997,"41":1.104993,"42":1.112001,"43":1.121,"44":1.132007,"45":1.144996,"46":1.159993,"47":1.176999,"48":1.196,"49":1.216994,"50":1.224999,"51":1.224995,"52":1.225,"53":1.225003,"54":1.224996,"55":1.225002,"56":1.224996,"57":1.224998,"58":1.225001,"59":1.224999,"60":1.225001,"61":1.225003,"62":1.225001,"63":1.224998,"64+":1.225003}},"4":{"base21":461.52,"tobaccoFactor":1.025004,"tobaccoFactorByAge":{"21":1.025004,"22":1.025004,"23":1.025004,"24":1.025004,"25":1.024991,"26":1.025011,"27":1.024996,"28":1.024997,"29":1.024998,"30":1.025008,"31":1.024995,"32":1.025001,"33":1.024995,"34":1.025005,"35":1.025001,"36":1.024997,"37":1.024993,"38":1.025007,"39":1.024998,"40":1.099997,"41":1.104993,"42":1.112001,"43":1.121,"44":1.132007,"45":1.144996,"46":1.159993,"47":1.176999,"48":1.196,"49":1.216994,"50":1.224999,"51":1.224995,"52":1.225,"53":1.225003,"54":1.224996,"55":1.225002,"56":1.224996,"57":1.224998,"58":1.225001,"59":1.224999,"60":1.225001,"61":1.225003,"62":1.225001,"63":1.224998,"64+":1.225003}},"5":{"base21":481.16,"tobaccoFactor":1.025002,"tobaccoFactorByAge":{"21":1.025002,"22":1.025002,"23":1.025002,"24":1.025002,"25":1.025006,"26":1.025005,"27":1.025007,"28":1.025009,"29":1.024999,"30":1.024995,"31":1.024997,"32":1.025,"33":1.024999,"34":1.024994,"35":1.025001,"36":1.025007,"37":1.024997,"38":1.025003,"39":1.024999,"40":1.099997,"41":1.105001,"42":1.111993,"43":1.120993,"44":1.132003,"45":1.145006,"46":1.160002,"47":1.176996,"48":1.195996,"49":1.217004,"50":1.224996,"51":1.225004,"52":1.224995,"53":1.224997,"54":1.225002,"55":1.224997,"56":1.224997,"57":1.224998,"58":1.225,"59":1.224997,"60":1.224999,"61":1.224997,"62":1.224998,"63":1.225003,"64+":1.224998}}},"ded":{"ind":1800,"fam":3600,"embedded":false},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":175,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":15,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":130,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":130,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":450,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":450,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Diagnostic tests: $15 copay for blood work / lab and $15 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): no charge (retail and mail order).","Tier 2 drugs (preferred brand): $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $60 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $150 copay for a 31-day retail supply ($300 for 60 days, $450 for 90 days); $300 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $450 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility. The other days of the stay count toward the deductible until it is met, then cost nothing more.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","Deductible ($1,800): applies to everything except preventive care and children's vision and dental exams, even where the SBC shows a copay or \"No charge\".","Tier 1 drugs, hospital physician fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","Family deductible: the SBC says the overall family deductible must be met before the plan begins to pay (no individual deductible within a family), and the estimate uses the aggregate family 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $1,125 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility. The other days of the stay count toward the deductible until it is met, then cost nothing more.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","Deductible ($6,000): not charged for primary care and specialist visits, lab and x-ray, urgent care, outpatient mental health, rehabilitation therapy, Tier 1 drugs, Tier 2 drugs; every other service below is charged after the deductible.","Hospital physician fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $1,125 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility. The other days of the stay count toward the deductible until it is met, then cost nothing more.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","Deductible ($3,000): not charged for primary care and specialist visits, lab and x-ray, urgent care, outpatient mental health, rehabilitation therapy, Tier 1 drugs, Tier 2 drugs; every other service below is charged after the deductible.","Hospital physician fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC 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tests: $30 copay for blood work / lab and $50 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): no charge (retail and mail order).","Tier 2 drugs (preferred brand): $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $20 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $50 copay for a 31-day retail supply ($100 for 60 days, $150 for 90 days); $100 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $450 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","No medical deductible: copays and coinsurance apply from the first 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tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): no charge (retail and mail order).","Tier 2 drugs (preferred brand): $1 copay for a 31-day retail supply ($2 for 60 days, $3 for 90 days); $2 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $5 copay for a 31-day retail supply ($10 for 60 days, $15 for 90 days); $10 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $750 for a 31-day retail supply ($500 / $1,500 for 60 days, $750 / $2,250 for 90 days) and a minimum of $500 and a maximum of $1,500 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $175 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Mental health office visits: this SBC prints \"$1 copay/visit5\"; the stray \"5\" is read as a typo and the copay as $1, the amount this SBC prints for primary care and specialist visits and every other SBC of this plan design (CSR 94) prints for outpatient mental health.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","No medical deductible: copays and coinsurance apply from the first 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tests: $50 copay for blood work / lab and $100 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): no charge (retail and mail order).","Tier 2 drugs (preferred brand): $35 copay for a 31-day retail supply ($70 for 60 days, $105 for 90 days); $70 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $200 copay for a 31-day retail supply ($400 for 60 days, $600 for 90 days); $400 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $725 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility. The other days of the stay count toward the deductible until it is met, then cost nothing more.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","Deductible ($1,000): not charged for primary care and specialist visits, lab and x-ray, urgent care, outpatient mental health, rehabilitation therapy, emergency room, outpatient surgery, all prescription drugs; every other service below is charged after the deductible.","Hospital physician fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,500 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","No medical deductible: copays and coinsurance apply from the first visit."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/CPA/Individual/I_33709PA0940012-04_20270101_SBC.pdf"},{"market":"pennie","id":"33709PA0940012-05","standardId":"33709PA0940012","variant":"csr87","issuer":"Highmark Inc.","name":"my Direct Blue EPO Choice Silver 0","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Adams","Berks","Cumberland","Dauphin","Franklin","Lancaster","Lebanon","Lehigh","Northampton","Perry","Schuylkill","York"],"rates":{"6":{"base21":803.27,"tobaccoFactor":1.024998,"tobaccoFactorByAge":{"21":1.024998,"22":1.024998,"23":1.024998,"24":1.024998,"25":1.024998,"26":1.024995,"27":1.025005,"28":1.025001,"29":1.024998,"30":1.024997,"31":1.024995,"32":1.025003,"33":1.025002,"34":1.025001,"35":1.025,"36":1.024999,"37":1.024999,"38":1.024998,"39":1.024997,"40":1.100002,"41":1.105004,"42":1.111995,"43":1.120996,"44":1.132003,"45":1.145001,"46":1.160004,"47":1.177004,"48":1.196003,"49":1.216998,"50":1.224997,"51":1.224998,"52":1.225003,"53":1.225,"54":1.225,"55":1.225,"56":1.225002,"57":1.224998,"58":1.224998,"59":1.224998,"60":1.225002,"61":1.225001,"62":1.224999,"63":1.224999,"64+":1.225001}},"7":{"base21":843.84,"tobaccoFactor":1.025005,"tobaccoFactorByAge":{"21":1.025005,"22":1.025005,"23":1.025005,"24":1.025005,"25":1.024999,"26":1.024997,"27":1.025002,"28":1.024999,"29":1.025004,"30":1.024996,"31":1.025,"32":1.025004,"33":1.024997,"34":1.025,"35":1.025001,"36":1.025002,"37":1.025003,"38":1.025004,"39":1.024997,"40":1.099997,"41":1.104999,"42":1.112004,"43":1.121004,"44":1.132003,"45":1.144998,"46":1.159999,"47":1.177001,"48":1.196002,"49":1.216999,"50":1.225002,"51":1.225003,"52":1.225003,"53":1.224999,"54":1.225,"55":1.225002,"56":1.224998,"57":1.225,"58":1.224999,"59":1.225001,"60":1.225,"61":1.225001,"62":1.225001,"63":1.225,"64+":1.224999}},"9":{"base21":843.84,"tobaccoFactor":1.025005,"tobaccoFactorByAge":{"21":1.025005,"22":1.025005,"23":1.025005,"24":1.025005,"25":1.024999,"26":1.024997,"27":1.025002,"28":1.024999,"29":1.025004,"30":1.024996,"31":1.025,"32":1.025004,"33":1.024997,"34":1.025,"35":1.025001,"36":1.025002,"37":1.025003,"38":1.025004,"39":1.024997,"40":1.099997,"41":1.104999,"42":1.112004,"43":1.121004,"44":1.132003,"45":1.144998,"46":1.159999,"47":1.177001,"48":1.196002,"49":1.216999,"50":1.225002,"51":1.225003,"52":1.225003,"53":1.224999,"54":1.225,"55":1.225002,"56":1.224998,"57":1.225,"58":1.224999,"59":1.225001,"60":1.225,"61":1.225001,"62":1.225001,"63":1.225,"64+":1.224999}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":3800,"fam":7600},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":550,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":550,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Diagnostic tests: $60 copay for blood work / lab and $90 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): no charge (retail and mail order).","Tier 2 drugs (preferred brand): $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $20 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $50 copay for a 31-day retail supply ($100 for 60 days, $150 for 90 days); $100 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $550 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","No medical deductible: copays and coinsurance apply from the first visit."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/CPA/Individual/I_33709PA0940012-05_20270101_SBC.pdf"},{"market":"pennie","id":"33709PA0940012-06","standardId":"33709PA0940012","variant":"csr94","issuer":"Highmark Inc.","name":"my Direct Blue EPO Choice Silver 0","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Adams","Berks","Cumberland","Dauphin","Franklin","Lancaster","Lebanon","Lehigh","Northampton","Perry","Schuylkill","York"],"rates":{"6":{"base21":803.27,"tobaccoFactor":1.024998,"tobaccoFactorByAge":{"21":1.024998,"22":1.024998,"23":1.024998,"24":1.024998,"25":1.024998,"26":1.024995,"27":1.025005,"28":1.025001,"29":1.024998,"30":1.024997,"31":1.024995,"32":1.025003,"33":1.025002,"34":1.025001,"35":1.025,"36":1.024999,"37":1.024999,"38":1.024998,"39":1.024997,"40":1.100002,"41":1.105004,"42":1.111995,"43":1.120996,"44":1.132003,"45":1.145001,"46":1.160004,"47":1.177004,"48":1.196003,"49":1.216998,"50":1.224997,"51":1.224998,"52":1.225003,"53":1.225,"54":1.225,"55":1.225,"56":1.225002,"57":1.224998,"58":1.224998,"59":1.224998,"60":1.225002,"61":1.225001,"62":1.224999,"63":1.224999,"64+":1.225001}},"7":{"base21":843.84,"tobaccoFactor":1.025005,"tobaccoFactorByAge":{"21":1.025005,"22":1.025005,"23":1.025005,"24":1.025005,"25":1.024999,"26":1.024997,"27":1.025002,"28":1.024999,"29":1.025004,"30":1.024996,"31":1.025,"32":1.025004,"33":1.024997,"34":1.025,"35":1.025001,"36":1.025002,"37":1.025003,"38":1.025004,"39":1.024997,"40":1.099997,"41":1.104999,"42":1.112004,"43":1.121004,"44":1.132003,"45":1.144998,"46":1.159999,"47":1.177001,"48":1.196002,"49":1.216999,"50":1.225002,"51":1.225003,"52":1.225003,"53":1.224999,"54":1.225,"55":1.225002,"56":1.224998,"57":1.225,"58":1.224999,"59":1.225001,"60":1.225,"61":1.225001,"62":1.225001,"63":1.225,"64+":1.224999}},"9":{"base21":843.84,"tobaccoFactor":1.025005,"tobaccoFactorByAge":{"21":1.025005,"22":1.025005,"23":1.025005,"24":1.025005,"25":1.024999,"26":1.024997,"27":1.025002,"28":1.024999,"29":1.025004,"30":1.024996,"31":1.025,"32":1.025004,"33":1.024997,"34":1.025,"35":1.025001,"36":1.025002,"37":1.025003,"38":1.025004,"39":1.024997,"40":1.099997,"41":1.104999,"42":1.112004,"43":1.121004,"44":1.132003,"45":1.144998,"46":1.159999,"47":1.177001,"48":1.196002,"49":1.216999,"50":1.225002,"51":1.225003,"52":1.225003,"53":1.224999,"54":1.225,"55":1.225002,"56":1.224998,"57":1.225,"58":1.224999,"59":1.225001,"60":1.225,"61":1.225001,"62":1.225001,"63":1.225,"64+":1.224999}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":2500,"fam":5000},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":1,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":750}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":175,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): no charge (retail and mail order).","Tier 2 drugs (preferred brand): $1 copay for a 31-day retail supply ($2 for 60 days, $3 for 90 days); $2 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $5 copay for a 31-day retail supply ($10 for 60 days, $15 for 90 days); $10 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $750 for a 31-day retail supply ($500 / $1,500 for 60 days, $750 / $2,250 for 90 days) and a minimum of $500 and a maximum of $1,500 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $175 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","No medical deductible: copays and coinsurance apply from the first visit."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/CPA/Individual/I_33709PA0940012-06_20270101_SBC.pdf"},{"market":"pennie","id":"33709PA0940013-01","standardId":"33709PA0940013","variant":"standard","issuer":"Highmark Inc.","name":"my Direct Blue EPO Platinum 0","metal":"Platinum","network":"EPO","hsaEligible":false,"counties":["Adams","Berks","Cumberland","Dauphin","Franklin","Lancaster","Lebanon","Lehigh","Northampton","Perry","Schuylkill","York"],"rates":{"6":{"base21":704.82,"tobaccoFactor":1.024999,"tobaccoFactorByAge":{"21":1.024999,"22":1.024999,"23":1.024999,"24":1.024999,"25":1.024999,"26":1.024995,"27":1.025005,"28":1.024995,"29":1.025003,"30":1.025001,"31":1.024997,"32":1.025006,"33":1.025001,"34":1.024999,"35":1.024997,"36":1.024996,"37":1.024995,"38":1.025005,"39":1.025003,"40":1.100004,"41":1.105004,"42":1.112005,"43":1.121001,"44":1.131999,"45":1.145005,"46":1.160003,"47":1.177001,"48":1.196003,"49":1.217004,"50":1.224998,"51":1.225,"52":1.225002,"53":1.224999,"54":1.225001,"55":1.224998,"56":1.225001,"57":1.224999,"58":1.224998,"59":1.225002,"60":1.225001,"61":1.224999,"62":1.224998,"63":1.224999,"64+":1.224998}},"7":{"base21":740.42,"tobaccoFactor":1.024999,"tobaccoFactorByAge":{"21":1.024999,"22":1.024999,"23":1.024999,"24":1.024999,"25":1.024994,"26":1.024994,"27":1.025001,"28":1.024999,"29":1.024996,"30":1.025001,"31":1.024996,"32":1.025002,"33":1.025005,"34":1.024998,"35":1.025,"36":1.025002,"37":1.025004,"38":1.024996,"39":1.025,"40":1.100004,"41":1.104997,"42":1.112001,"43":1.120995,"44":1.132003,"45":1.145,"46":1.159999,"47":1.177001,"48":1.196004,"49":1.217003,"50":1.225002,"51":1.225001,"52":1.224998,"53":1.224998,"54":1.225,"55":1.225002,"56":1.225003,"57":1.225,"58":1.224999,"59":1.224998,"60":1.225001,"61":1.225,"62":1.225002,"63":1.225001,"64+":1.224998}},"9":{"base21":740.42,"tobaccoFactor":1.024999,"tobaccoFactorByAge":{"21":1.024999,"22":1.024999,"23":1.024999,"24":1.024999,"25":1.024994,"26":1.024994,"27":1.025001,"28":1.024999,"29":1.024996,"30":1.025001,"31":1.024996,"32":1.025002,"33":1.025005,"34":1.024998,"35":1.025,"36":1.025002,"37":1.025004,"38":1.024996,"39":1.025,"40":1.100004,"41":1.104997,"42":1.112001,"43":1.120995,"44":1.132003,"45":1.145,"46":1.159999,"47":1.177001,"48":1.196004,"49":1.217003,"50":1.225002,"51":1.225001,"52":1.224998,"53":1.224998,"54":1.225,"55":1.225002,"56":1.225003,"57":1.225,"58":1.224999,"59":1.224998,"60":1.225001,"61":1.225,"62":1.225002,"63":1.225001,"64+":1.224998}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":5400,"fam":10800},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":325,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":325,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): no charge (retail and mail order).","Tier 2 drugs (preferred brand): $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $20 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $50 copay for a 31-day retail supply ($100 for 60 days, $150 for 90 days); $100 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $325 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","No medical deductible: copays and coinsurance apply from the first visit."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/CPA/Individual/I_33709PA0940013-01_20270101_SBC.pdf"},{"market":"pennie","id":"33709PA0950004-01","standardId":"33709PA0950004","variant":"standard","issuer":"Highmark Inc.","name":"my Direct Blue EPO Gold 1800 HSA","metal":"Gold","network":"EPO","hsaEligible":true,"networkId":"PAN005","referral":false,"tiers":false,"counties":["Adams","Berks","Cumberland","Dauphin","Franklin","Lancaster","Lebanon","Lehigh","Northampton","Perry","Schuylkill","York"],"rates":{"6":{"base21":599.58,"tobaccoFactor":1.025001,"tobaccoFactorByAge":{"21":1.025001,"22":1.025001,"23":1.025001,"24":1.025001,"25":1.025001,"26":1.025001,"27":1.025002,"28":1.024995,"29":1.024995,"30":1.024996,"31":1.024996,"32":1.024996,"33":1.025003,"34":1.025004,"35":1.025004,"36":1.025004,"37":1.025004,"38":1.025004,"39":1.025004,"40":1.100005,"41":1.105002,"42":1.112003,"43":1.121001,"44":1.131995,"45":1.145001,"46":1.160001,"47":1.176996,"48":1.195999,"49":1.216995,"50":1.224999,"51":1.225,"52":1.225004,"53":1.225003,"54":1.224998,"55":1.225001,"56":1.224997,"57":1.225003,"58":1.225,"59":1.225,"60":1.224998,"61":1.224997,"62":1.224998,"63":1.224999,"64+":1.225002}},"7":{"base21":629.86,"tobaccoFactor":1.025006,"tobaccoFactorByAge":{"21":1.025006,"22":1.025006,"23":1.025006,"24":1.025006,"25":1.025001,"26":1.024993,"27":1.024997,"28":1.025005,"29":1.025,"30":1.024997,"31":1.025,"32":1.025003,"33":1.024994,"34":1.025005,"35":1.024997,"36":1.025002,"37":1.024995,"38":1.025,"39":1.024997,"40":1.100005,"41":1.105002,"42":1.111999,"43":1.120999,"44":1.132002,"45":1.145,"46":1.160004,"47":1.176999,"48":1.195995,"49":1.217004,"50":1.225001,"51":1.225004,"52":1.225004,"53":1.224996,"54":1.225001,"55":1.224998,"56":1.225001,"57":1.225001,"58":1.225001,"59":1.224997,"60":1.224998,"61":1.225,"62":1.225001,"63":1.224998,"64+":1.225002}},"9":{"base21":629.86,"tobaccoFactor":1.025006,"tobaccoFactorByAge":{"21":1.025006,"22":1.025006,"23":1.025006,"24":1.025006,"25":1.025001,"26":1.024993,"27":1.024997,"28":1.025005,"29":1.025,"30":1.024997,"31":1.025,"32":1.025003,"33":1.024994,"34":1.025005,"35":1.024997,"36":1.025002,"37":1.024995,"38":1.025,"39":1.024997,"40":1.100005,"41":1.105002,"42":1.111999,"43":1.120999,"44":1.132002,"45":1.145,"46":1.160004,"47":1.176999,"48":1.195995,"49":1.217004,"50":1.225001,"51":1.225004,"52":1.225004,"53":1.224996,"54":1.225001,"55":1.224998,"56":1.225001,"57":1.225001,"58":1.225001,"59":1.224997,"60":1.224998,"61":1.225,"62":1.225001,"63":1.224998,"64+":1.225002}}},"ded":{"ind":1800,"fam":3600,"embedded":false},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":175,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":15,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":130,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":130,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":450,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":450,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): no charge (retail and mail order).","Tier 2 drugs (preferred brand): $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $60 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $150 copay for a 31-day retail supply ($300 for 60 days, $450 for 90 days); $300 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $450 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility. The other days of the stay count toward the deductible until it is met, then cost nothing more.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","Deductible ($1,800): applies to everything except preventive care and children's vision and dental exams, even where the SBC shows a copay or \"No charge\".","Tier 1 drugs, hospital physician fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","Family deductible: the SBC says the overall family deductible must be met before the plan begins to pay (no individual deductible within a family), and the estimate uses the aggregate family deductible."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/CPA/Individual/I_33709PA0950004-01_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"7":{"base21":533.29,"tobaccoFactor":1.024996,"tobaccoFactorByAge":{"21":1.024996,"22":1.024996,"23":1.024996,"24":1.024996,"25":1.025008,"26":1.024996,"27":1.024996,"28":1.024996,"29":1.025002,"30":1.024997,"31":1.024997,"32":1.024997,"33":1.024997,"34":1.025007,"35":1.024997,"36":1.025002,"37":1.025007,"38":1.024997,"39":1.025007,"40":1.099994,"41":1.105006,"42":1.112,"43":1.120994,"44":1.131998,"45":1.145,"46":1.159999,"47":1.176994,"48":1.196002,"49":1.216995,"50":1.224996,"51":1.224997,"52":1.225,"53":1.225,"54":1.225002,"55":1.225001,"56":1.225001,"57":1.225003,"58":1.224997,"59":1.224997,"60":1.224997,"61":1.224999,"62":1.224999,"63":1.225,"64+":1.225}},"9":{"base21":533.29,"tobaccoFactor":1.024996,"tobaccoFactorByAge":{"21":1.024996,"22":1.024996,"23":1.024996,"24":1.024996,"25":1.025008,"26":1.024996,"27":1.024996,"28":1.024996,"29":1.025002,"30":1.024997,"31":1.024997,"32":1.024997,"33":1.024997,"34":1.025007,"35":1.024997,"36":1.025002,"37":1.025007,"38":1.024997,"39":1.025007,"40":1.099994,"41":1.105006,"42":1.112,"43":1.120994,"44":1.131998,"45":1.145,"46":1.159999,"47":1.176994,"48":1.196002,"49":1.216995,"50":1.224996,"51":1.224997,"52":1.225,"53":1.225,"54":1.225002,"55":1.225001,"56":1.225001,"57":1.225003,"58":1.224997,"59":1.224997,"60":1.224997,"61":1.224999,"62":1.224999,"63":1.225,"64+":1.225}}}}},{"market":"pennie","id":"33709PA0960001-01","standardId":"33709PA0960001","variant":"standard","issuer":"Highmark Inc.","name":"my Direct Blue Major Events EPO Catastrophic 12000 HSA - 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The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","Deductible ($12,000): applies to everything except preventive care and children's vision and dental exams, even where the SBC shows a copay or \"No charge\".","Several services show \"No charge\" with no deductible waiver. Page 1 of the SBC lists only preventive care as covered before the deductible and its coverage examples charge the whole cost to the deductible, so \"No charge\" is read as free only after the deductible is met."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/CPA/Individual/I_33709PA0960001-01_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"7":{"base21":314.71,"tobaccoFactor":1.025007,"tobaccoFactorByAge":{"21":1.025007,"22":1.025007,"23":1.025007,"24":1.025007,"25":1.025002,"26":1.025011,"27":1.025014,"28":1.024993,"29":1.024989,"30":1.025,"31":1.025003,"32":1.025007,"33":1.025012,"34":1.024996,"35":1.024988,"36":1.025007,"37":1.024999,"38":1.024992,"39":1.025003,"40":1.1,"41":1.104991,"42":1.111993,"43":1.12099,"44":1.131991,"45":1.144992,"46":1.159997,"47":1.176991,"48":1.195997,"49":1.217005,"50":1.225008,"51":1.225001,"52":1.225,"53":1.224996,"54":1.225,"55":1.225007,"56":1.225001,"57":1.224995,"58":1.224996,"59":1.225003,"60":1.225004,"61":1.225004,"62":1.225004,"63":1.225001,"64+":1.225001}},"9":{"base21":314.71,"tobaccoFactor":1.025007,"tobaccoFactorByAge":{"21":1.025007,"22":1.025007,"23":1.025007,"24":1.025007,"25":1.025002,"26":1.025011,"27":1.025014,"28":1.024993,"29":1.024989,"30":1.025,"31":1.025003,"32":1.025007,"33":1.025012,"34":1.024996,"35":1.024988,"36":1.025007,"37":1.024999,"38":1.024992,"39":1.025003,"40":1.1,"41":1.104991,"42":1.111993,"43":1.12099,"44":1.131991,"45":1.144992,"46":1.159997,"47":1.176991,"48":1.195997,"49":1.217005,"50":1.225008,"51":1.225001,"52":1.225,"53":1.224996,"54":1.225,"55":1.225007,"56":1.225001,"57":1.224995,"58":1.224996,"59":1.225003,"60":1.225004,"61":1.225004,"62":1.225004,"63":1.225001,"64+":1.225001}}}}},{"market":"pennie","id":"33709PA1040001-01","standardId":"33709PA1040001","variant":"standard","issuer":"Highmark Inc.","name":"my Direct Blue Major Events EPO Catastrophic 12000 HSA - 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The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","Deductible ($12,000): applies to everything except preventive care and children's vision and dental exams, even where the SBC shows a copay or \"No charge\".","Several services show \"No charge\" with no deductible waiver. Page 1 of the SBC lists only preventive care as covered before the deductible and its coverage examples charge the whole cost to the deductible, so \"No charge\" is read as free only after the deductible is met."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/WPA/Individual/I_33709PA1040001-01_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":236.35,"tobaccoFactor":1.025005,"tobaccoFactorByAge":{"21":1.025005,"22":1.025005,"23":1.025005,"24":1.025005,"25":1.024989,"26":1.024998,"27":1.024991,"28":1.024989,"29":1.024992,"30":1.025013,"31":1.025006,"32":1.025,"33":1.025004,"34":1.024989,"35":1.024998,"36":1.025008,"37":1.025017,"38":1.024992,"39":1.025011,"40":1.100013,"41":1.104995,"42":1.111987,"43":1.121005,"44":1.131989,"45":1.145009,"46":1.159986,"47":1.177007,"48":1.195999,"49":1.217009,"50":1.225007,"51":1.225005,"52":1.225009,"53":1.224992,"54":1.225005,"55":1.225003,"56":1.225009,"57":1.225008,"58":1.225001,"59":1.224993,"60":1.225006,"61":1.224998,"62":1.224997,"63":1.224993,"64+":1.225005}},"4":{"base21":236.35,"tobaccoFactor":1.025005,"tobaccoFactorByAge":{"21":1.025005,"22":1.025005,"23":1.025005,"24":1.025005,"25":1.024989,"26":1.024998,"27":1.024991,"28":1.024989,"29":1.024992,"30":1.025013,"31":1.025006,"32":1.025,"33":1.025004,"34":1.024989,"35":1.024998,"36":1.025008,"37":1.025017,"38":1.024992,"39":1.025011,"40":1.100013,"41":1.104995,"42":1.111987,"43":1.121005,"44":1.131989,"45":1.145009,"46":1.159986,"47":1.177007,"48":1.195999,"49":1.217009,"50":1.225007,"51":1.225005,"52":1.225009,"53":1.224992,"54":1.225005,"55":1.225003,"56":1.225009,"57":1.225008,"58":1.225001,"59":1.224993,"60":1.225006,"61":1.224998,"62":1.224997,"63":1.224993,"64+":1.225005}},"5":{"base21":236.35,"tobaccoFactor":1.025005,"tobaccoFactorByAge":{"21":1.025005,"22":1.025005,"23":1.025005,"24":1.025005,"25":1.024989,"26":1.024998,"27":1.024991,"28":1.024989,"29":1.024992,"30":1.025013,"31":1.025006,"32":1.025,"33":1.025004,"34":1.024989,"35":1.024998,"36":1.025008,"37":1.025017,"38":1.024992,"39":1.025011,"40":1.100013,"41":1.104995,"42":1.111987,"43":1.121005,"44":1.131989,"45":1.145009,"46":1.159986,"47":1.177007,"48":1.195999,"49":1.217009,"50":1.225007,"51":1.225005,"52":1.225009,"53":1.224992,"54":1.225005,"55":1.225003,"56":1.225009,"57":1.225008,"58":1.225001,"59":1.224993,"60":1.225006,"61":1.224998,"62":1.224997,"63":1.224993,"64+":1.225005}}}}},{"market":"pennie","id":"33709PA1120001-01","standardId":"33709PA1120001","variant":"standard","issuer":"Highmark 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tests: $65 copay for blood work / lab and $180 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $30 copay for a 90-day mail-order supply.","Tier 2 drugs (preferred brand): 50% coinsurance (retail and mail order).","Tier 3 drugs (non-preferred brand): 50% coinsurance (retail and mail order).","Tier 4 drugs (specialty): 50% coinsurance (retail and mail order).","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","Deductible ($3,800): not charged for primary care and specialist visits, lab and x-ray, urgent care, outpatient mental health, rehabilitation therapy, Tier 1 drugs; every other service below is charged after the deductible.","Highmark's on-exchange SBC address for this plan (33709PA1120001-01) still served the 2026 SBC on 2026-10-31. This record uses the 2027 SBC of the same plan sold off Pennie (33709PA1120001-00): the plan's filed statement of variability (SERFF HGHM-134915570, EPO ADV CDP_6 SOV.xlsx) gives the on- and off-exchange plans one set of benefits, and its deductible, out-of-pocket limit, coinsurance and primary care copay match the rate 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The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","Deductible ($1,000): not charged for primary care and specialist visits, lab and x-ray, urgent care, outpatient mental health, rehabilitation therapy, emergency room, outpatient surgery, all prescription drugs; every other service below is charged after the deductible.","Hospital physician fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC 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The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. 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Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): $5 copay for a 31-day retail supply ($10 for 60 days, $15 for 90 days); $10 copay for a 90-day mail-order supply.","Tier 2 drugs (preferred brand): $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $60 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $250 copay for a 31-day retail supply ($500 for 60 days, $750 for 90 days); $500 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,500 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","No medical deductible: copays and coinsurance apply from the first visit."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/CPA/Individual/I_33709PA1120007-01_20270101_SBC.pdf"},{"market":"pennie","id":"33709PA1120007-04","standardId":"33709PA1120007","variant":"csr73","issuer":"Highmark Inc.","name":"my Direct Blue EPO Choice Silver 0 + Adult Dental and Vision","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Adams","Berks","Cumberland","Dauphin","Franklin","Lancaster","Lebanon","Lehigh","Northampton","Perry","Schuylkill","York"],"rates":{"6":{"base21":817.16,"tobaccoFactor":1.025001,"tobaccoFactorByAge":{"21":1.025001,"22":1.025001,"23":1.025001,"24":1.025001,"25":1.024999,"26":1.025001,"27":1.025001,"28":1.025004,"29":1.025,"30":1.025003,"31":1.025003,"32":1.025003,"33":1.024996,"34":1.024999,"35":1.024996,"36":1.025002,"37":1.024999,"38":1.024996,"39":1.024999,"40":1.099997,"41":1.104997,"42":1.112003,"43":1.121004,"44":1.132002,"45":1.145002,"46":1.160001,"47":1.177002,"48":1.196002,"49":1.216998,"50":1.225003,"51":1.225,"52":1.225002,"53":1.225002,"54":1.224998,"55":1.225,"56":1.225002,"57":1.225,"58":1.225001,"59":1.225,"60":1.225001,"61":1.225,"62":1.224999,"63":1.225001,"64+":1.224999}},"7":{"base21":858.43,"tobaccoFactor":1.024999,"tobaccoFactorByAge":{"21":1.024999,"22":1.024999,"23":1.024999,"24":1.024999,"25":1.025004,"26":1.025005,"27":1.024999,"28":1.025002,"29":1.024995,"30":1.025002,"31":1.024997,"32":1.025002,"33":1.025,"34":1.024997,"35":1.025005,"36":1.025003,"37":1.025001,"38":1.025,"39":1.024997,"40":1.100003,"41":1.105003,"42":1.111999,"43":1.120999,"44":1.132001,"45":1.145002,"46":1.159997,"47":1.177003,"48":1.195999,"49":1.216999,"50":1.224999,"51":1.225001,"52":1.224998,"53":1.225,"54":1.225001,"55":1.225001,"56":1.224999,"57":1.225001,"58":1.225001,"59":1.225,"60":1.225,"61":1.224999,"62":1.225,"63":1.225,"64+":1.225}},"9":{"base21":858.43,"tobaccoFactor":1.024999,"tobaccoFactorByAge":{"21":1.024999,"22":1.024999,"23":1.024999,"24":1.024999,"25":1.025004,"26":1.025005,"27":1.024999,"28":1.025002,"29":1.024995,"30":1.025002,"31":1.024997,"32":1.025002,"33":1.025,"34":1.024997,"35":1.025005,"36":1.025003,"37":1.025001,"38":1.025,"39":1.024997,"40":1.100003,"41":1.105003,"42":1.111999,"43":1.120999,"44":1.132001,"45":1.145002,"46":1.159997,"47":1.177003,"48":1.195999,"49":1.216999,"50":1.224999,"51":1.225001,"52":1.224998,"53":1.225,"54":1.225001,"55":1.225001,"56":1.224999,"57":1.225001,"58":1.225001,"59":1.225,"60":1.225,"61":1.224999,"62":1.225,"63":1.225,"64+":1.225}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":8775,"fam":17550},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":1250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":800,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":2500,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":2500,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Diagnostic tests: $65 copay for blood work / lab and $175 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): $5 copay for a 31-day retail supply ($10 for 60 days, $15 for 90 days); $10 copay for a 90-day mail-order supply.","Tier 2 drugs (preferred brand): $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $60 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $250 copay for a 31-day retail supply ($500 for 60 days, $750 for 90 days); $500 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,500 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","No medical deductible: copays and coinsurance apply from the first visit."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/CPA/Individual/I_33709PA1120007-04_20270101_SBC.pdf"},{"market":"pennie","id":"33709PA1120007-05","standardId":"33709PA1120007","variant":"csr87","issuer":"Highmark Inc.","name":"my Direct Blue EPO Choice Silver 0 + Adult Dental and Vision","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Adams","Berks","Cumberland","Dauphin","Franklin","Lancaster","Lebanon","Lehigh","Northampton","Perry","Schuylkill","York"],"rates":{"6":{"base21":817.16,"tobaccoFactor":1.025001,"tobaccoFactorByAge":{"21":1.025001,"22":1.025001,"23":1.025001,"24":1.025001,"25":1.024999,"26":1.025001,"27":1.025001,"28":1.025004,"29":1.025,"30":1.025003,"31":1.025003,"32":1.025003,"33":1.024996,"34":1.024999,"35":1.024996,"36":1.025002,"37":1.024999,"38":1.024996,"39":1.024999,"40":1.099997,"41":1.104997,"42":1.112003,"43":1.121004,"44":1.132002,"45":1.145002,"46":1.160001,"47":1.177002,"48":1.196002,"49":1.216998,"50":1.225003,"51":1.225,"52":1.225002,"53":1.225002,"54":1.224998,"55":1.225,"56":1.225002,"57":1.225,"58":1.225001,"59":1.225,"60":1.225001,"61":1.225,"62":1.224999,"63":1.225001,"64+":1.224999}},"7":{"base21":858.43,"tobaccoFactor":1.024999,"tobaccoFactorByAge":{"21":1.024999,"22":1.024999,"23":1.024999,"24":1.024999,"25":1.025004,"26":1.025005,"27":1.024999,"28":1.025002,"29":1.024995,"30":1.025002,"31":1.024997,"32":1.025002,"33":1.025,"34":1.024997,"35":1.025005,"36":1.025003,"37":1.025001,"38":1.025,"39":1.024997,"40":1.100003,"41":1.105003,"42":1.111999,"43":1.120999,"44":1.132001,"45":1.145002,"46":1.159997,"47":1.177003,"48":1.195999,"49":1.216999,"50":1.224999,"51":1.225001,"52":1.224998,"53":1.225,"54":1.225001,"55":1.225001,"56":1.224999,"57":1.225001,"58":1.225001,"59":1.225,"60":1.225,"61":1.224999,"62":1.225,"63":1.225,"64+":1.225}},"9":{"base21":858.43,"tobaccoFactor":1.024999,"tobaccoFactorByAge":{"21":1.024999,"22":1.024999,"23":1.024999,"24":1.024999,"25":1.025004,"26":1.025005,"27":1.024999,"28":1.025002,"29":1.024995,"30":1.025002,"31":1.024997,"32":1.025002,"33":1.025,"34":1.024997,"35":1.025005,"36":1.025003,"37":1.025001,"38":1.025,"39":1.024997,"40":1.100003,"41":1.105003,"42":1.111999,"43":1.120999,"44":1.132001,"45":1.145002,"46":1.159997,"47":1.177003,"48":1.195999,"49":1.216999,"50":1.224999,"51":1.225001,"52":1.224998,"53":1.225,"54":1.225001,"55":1.225001,"56":1.224999,"57":1.225001,"58":1.225001,"59":1.225,"60":1.225,"61":1.224999,"62":1.225,"63":1.225,"64+":1.225}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":3800,"fam":7600},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":550,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":550,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Diagnostic tests: $60 copay for blood work / lab and $90 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): no charge (retail and mail order).","Tier 2 drugs (preferred brand): $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $20 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $50 copay for a 31-day retail supply ($100 for 60 days, $150 for 90 days); $100 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $550 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $175 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. 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The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","Deductible ($3,800): not charged for primary care and specialist visits, lab and x-ray, urgent care, outpatient mental health, rehabilitation therapy, Tier 1 drugs; every other service below is charged after the 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,500 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","No medical deductible: copays and coinsurance apply from the first visit."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/WPA/Individual/I_33709PA1150008-04_20270101_SBC.pdf"},{"market":"pennie","id":"33709PA1150008-05","standardId":"33709PA1150008","variant":"csr87","issuer":"Highmark Inc.","name":"my Direct Blue EPO Choice Silver 0 + Adult Dental and Vision","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Butler","Cambria","Clarion","Crawford","Erie","Forest","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":598.01,"tobaccoFactor":1.025,"tobaccoFactorByAge":{"21":1.025,"22":1.025,"23":1.025,"24":1.025,"25":1.025,"26":1.025002,"27":1.025004,"28":1.024998,"29":1.025001,"30":1.025002,"31":1.025004,"32":1.025005,"33":1.024999,"34":1.025001,"35":1.025001,"36":1.025002,"37":1.025002,"38":1.025003,"39":1.025004,"40":1.100005,"41":1.104995,"42":1.111995,"43":1.120998,"44":1.132005,"45":1.144998,"46":1.159996,"47":1.177,"48":1.196001,"49":1.217004,"50":1.224999,"51":1.225,"52":1.225003,"53":1.225003,"54":1.225001,"55":1.224999,"56":1.224999,"57":1.224997,"58":1.225,"59":1.225,"60":1.225003,"61":1.224999,"62":1.225001,"63":1.225,"64+":1.225002}},"4":{"base21":598.01,"tobaccoFactor":1.025,"tobaccoFactorByAge":{"21":1.025,"22":1.025,"23":1.025,"24":1.025,"25":1.025,"26":1.025002,"27":1.025004,"28":1.024998,"29":1.025001,"30":1.025002,"31":1.025004,"32":1.025005,"33":1.024999,"34":1.025001,"35":1.025001,"36":1.025002,"37":1.025002,"38":1.025003,"39":1.025004,"40":1.100005,"41":1.104995,"42":1.111995,"43":1.120998,"44":1.132005,"45":1.144998,"46":1.159996,"47":1.177,"48":1.196001,"49":1.217004,"50":1.224999,"51":1.225,"52":1.225003,"53":1.225003,"54":1.225001,"55":1.224999,"56":1.224999,"57":1.224997,"58":1.225,"59":1.225,"60":1.225003,"61":1.224999,"62":1.225001,"63":1.225,"64+":1.225002}},"5":{"base21":623.46,"tobaccoFactor":1.025006,"tobaccoFactorByAge":{"21":1.025006,"22":1.025006,"23":1.025006,"24":1.025006,"25":1.025002,"26":1.024999,"27":1.024993,"28":1.024996,"29":1.024998,"30":1.024999,"31":1.024993,"32":1.025002,"33":1.024996,"34":1.024997,"35":1.025004,"36":1.024998,"37":1.025005,"38":1.024999,"39":1.025,"40":1.100003,"41":1.104997,"42":1.111999,"43":1.120999,"44":1.132002,"45":1.144999,"46":1.16,"47":1.176999,"48":1.195996,"49":1.217004,"50":1.225002,"51":1.225001,"52":1.224998,"53":1.225001,"54":1.225004,"55":1.224999,"56":1.225001,"57":1.225001,"58":1.225,"59":1.225003,"60":1.225003,"61":1.224999,"62":1.225,"63":1.224999,"64+":1.225002}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":3800,"fam":7600},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":550,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":550,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Diagnostic tests: $60 copay for blood work / lab and $90 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): no charge (retail and mail order).","Tier 2 drugs (preferred brand): $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $20 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $50 copay for a 31-day retail supply ($100 for 60 days, $150 for 90 days); $100 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $550 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","No medical deductible: copays and coinsurance apply from the first visit."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/WPA/Individual/I_33709PA1150008-05_20270101_SBC.pdf"},{"market":"pennie","id":"33709PA1150008-06","standardId":"33709PA1150008","variant":"csr94","issuer":"Highmark Inc.","name":"my Direct Blue EPO Choice Silver 0 + Adult Dental and Vision","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Butler","Cambria","Clarion","Crawford","Erie","Forest","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":598.01,"tobaccoFactor":1.025,"tobaccoFactorByAge":{"21":1.025,"22":1.025,"23":1.025,"24":1.025,"25":1.025,"26":1.025002,"27":1.025004,"28":1.024998,"29":1.025001,"30":1.025002,"31":1.025004,"32":1.025005,"33":1.024999,"34":1.025001,"35":1.025001,"36":1.025002,"37":1.025002,"38":1.025003,"39":1.025004,"40":1.100005,"41":1.104995,"42":1.111995,"43":1.120998,"44":1.132005,"45":1.144998,"46":1.159996,"47":1.177,"48":1.196001,"49":1.217004,"50":1.224999,"51":1.225,"52":1.225003,"53":1.225003,"54":1.225001,"55":1.224999,"56":1.224999,"57":1.224997,"58":1.225,"59":1.225,"60":1.225003,"61":1.224999,"62":1.225001,"63":1.225,"64+":1.225002}},"4":{"base21":598.01,"tobaccoFactor":1.025,"tobaccoFactorByAge":{"21":1.025,"22":1.025,"23":1.025,"24":1.025,"25":1.025,"26":1.025002,"27":1.025004,"28":1.024998,"29":1.025001,"30":1.025002,"31":1.025004,"32":1.025005,"33":1.024999,"34":1.025001,"35":1.025001,"36":1.025002,"37":1.025002,"38":1.025003,"39":1.025004,"40":1.100005,"41":1.104995,"42":1.111995,"43":1.120998,"44":1.132005,"45":1.144998,"46":1.159996,"47":1.177,"48":1.196001,"49":1.217004,"50":1.224999,"51":1.225,"52":1.225003,"53":1.225003,"54":1.225001,"55":1.224999,"56":1.224999,"57":1.224997,"58":1.225,"59":1.225,"60":1.225003,"61":1.224999,"62":1.225001,"63":1.225,"64+":1.225002}},"5":{"base21":623.46,"tobaccoFactor":1.025006,"tobaccoFactorByAge":{"21":1.025006,"22":1.025006,"23":1.025006,"24":1.025006,"25":1.025002,"26":1.024999,"27":1.024993,"28":1.024996,"29":1.024998,"30":1.024999,"31":1.024993,"32":1.025002,"33":1.024996,"34":1.024997,"35":1.025004,"36":1.024998,"37":1.025005,"38":1.024999,"39":1.025,"40":1.100003,"41":1.104997,"42":1.111999,"43":1.120999,"44":1.132002,"45":1.144999,"46":1.16,"47":1.176999,"48":1.195996,"49":1.217004,"50":1.225002,"51":1.225001,"52":1.224998,"53":1.225001,"54":1.225004,"55":1.224999,"56":1.225001,"57":1.225001,"58":1.225,"59":1.225003,"60":1.225003,"61":1.224999,"62":1.225,"63":1.224999,"64+":1.225002}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":2500,"fam":5000},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":1,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":750}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":175,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Diagnostic tests: $5 copay for blood work / lab and $5 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): no charge (retail and mail order).","Tier 2 drugs (preferred brand): $1 copay for a 31-day retail supply ($2 for 60 days, $3 for 90 days); $2 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $5 copay for a 31-day retail supply ($10 for 60 days, $15 for 90 days); $10 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $750 for a 31-day retail supply ($500 / $1,500 for 60 days, $750 / $2,250 for 90 days) and a minimum of $500 and a maximum of $1,500 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $175 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. 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Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): no charge (retail and mail order).","Tier 2 drugs (preferred brand): no charge (retail and mail order).","Tier 3 drugs (non-preferred brand): no charge (retail and mail order).","Tier 4 drugs (specialty): no charge (retail and mail order).","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","Deductible ($9,500): applies to everything except preventive care and children's vision and dental exams, even where the SBC shows a copay or \"No charge\".","Several services show \"No charge\" with no deductible waiver. Page 1 of the SBC lists only preventive care as covered before the deductible and its coverage examples charge the whole cost to the deductible, so \"No charge\" is read as free only after the deductible is met."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/WPA/Individual/I_33709PA1160006-01_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":351.76,"tobaccoFactor":1.024989,"tobaccoFactorByAge":{"21":1.024989,"22":1.024989,"23":1.024989,"24":1.024989,"25":1.025002,"26":1.025014,"27":1.025011,"28":1.025003,"29":1.024999,"30":1.024997,"31":1.024994,"32":1.024992,"33":1.025011,"34":1.025009,"35":1.025009,"36":1.025008,"37":1.025007,"38":1.025006,"39":1.025005,"40":1.100011,"41":1.105002,"42":1.111998,"43":1.121004,"44":1.132008,"45":1.144997,"46":1.159995,"47":1.176992,"48":1.196008,"49":1.216997,"50":1.224994,"51":1.225005,"52":1.224994,"53":1.225003,"54":1.225004,"55":1.224994,"56":1.225002,"57":1.225001,"58":1.224997,"59":1.225004,"60":1.224997,"61":1.224999,"62":1.225003,"63":1.225,"64+":1.225002}},"4":{"base21":351.76,"tobaccoFactor":1.024989,"tobaccoFactorByAge":{"21":1.024989,"22":1.024989,"23":1.024989,"24":1.024989,"25":1.025002,"26":1.025014,"27":1.025011,"28":1.025003,"29":1.024999,"30":1.024997,"31":1.024994,"32":1.024992,"33":1.025011,"34":1.025009,"35":1.025009,"36":1.025008,"37":1.025007,"38":1.025006,"39":1.025005,"40":1.100011,"41":1.105002,"42":1.111998,"43":1.121004,"44":1.132008,"45":1.144997,"46":1.159995,"47":1.176992,"48":1.196008,"49":1.216997,"50":1.224994,"51":1.225005,"52":1.224994,"53":1.225003,"54":1.225004,"55":1.224994,"56":1.225002,"57":1.225001,"58":1.224997,"59":1.225004,"60":1.224997,"61":1.224999,"62":1.225003,"63":1.225,"64+":1.225002}}}}},{"market":"pennie","id":"33709PA1160007-01","standardId":"33709PA1160007","variant":"standard","issuer":"Highmark 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tests: $55 copay for blood work / lab and $125 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $20 copay for a 90-day mail-order supply.","Tier 2 drugs (preferred brand): $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $60 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $250 copay for a 31-day retail supply ($500 for 60 days, $750 for 90 days); $500 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $1,125 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility. The other days of the stay count toward the deductible until it is met, then cost nothing more.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","Deductible ($6,000): not charged for primary care and specialist visits, lab and x-ray, urgent care, outpatient mental health, rehabilitation therapy, Tier 1 drugs, Tier 2 drugs; every other service below is charged after the deductible.","Hospital physician fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC 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tests: $55 copay for blood work / lab and $125 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $20 copay for a 90-day mail-order supply.","Tier 2 drugs (preferred brand): $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $60 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $250 copay for a 31-day retail supply ($500 for 60 days, $750 for 90 days); $500 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $1,125 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility. The other days of the stay count toward the deductible until it is met, then cost nothing more.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","Deductible ($3,000): not charged for primary care and specialist visits, lab and x-ray, urgent care, outpatient mental health, rehabilitation therapy, Tier 1 drugs, Tier 2 drugs; every other service below is charged after the deductible.","Hospital physician fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $450 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $175 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","No medical deductible: copays and coinsurance apply from the first 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $725 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility. The other days of the stay count toward the deductible until it is met, then cost nothing more.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","Deductible ($1,000): not charged for primary care and specialist visits, lab and x-ray, urgent care, outpatient mental health, rehabilitation therapy, outpatient surgery, all prescription drugs; every other service below is charged after the deductible.","Hospital physician fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/WPA/Individual/I_33709PA1160008-01_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":467.23,"tobaccoFactor":1.024998,"tobaccoFactorByAge":{"21":1.024998,"22":1.024998,"23":1.024998,"24":1.024998,"25":1.025005,"26":1.024998,"27":1.024997,"28":1.025006,"29":1.024999,"30":1.025004,"31":1.025004,"32":1.025003,"33":1.024994,"34":1.024999,"35":1.024993,"36":1.025005,"37":1.024999,"38":1.024993,"39":1.024998,"40":1.099997,"41":1.104992,"42":1.112005,"43":1.121004,"44":1.132001,"45":1.145002,"46":1.160006,"47":1.177001,"48":1.196002,"49":1.217002,"50":1.225005,"51":1.224999,"52":1.225004,"53":1.225001,"54":1.225004,"55":1.224998,"56":1.224999,"57":1.224996,"58":1.224998,"59":1.225004,"60":1.224997,"61":1.225002,"62":1.225001,"63":1.224997,"64+":1.225}},"4":{"base21":467.23,"tobaccoFactor":1.024998,"tobaccoFactorByAge":{"21":1.024998,"22":1.024998,"23":1.024998,"24":1.024998,"25":1.025005,"26":1.024998,"27":1.024997,"28":1.025006,"29":1.024999,"30":1.025004,"31":1.025004,"32":1.025003,"33":1.024994,"34":1.024999,"35":1.024993,"36":1.025005,"37":1.024999,"38":1.024993,"39":1.024998,"40":1.099997,"41":1.104992,"42":1.112005,"43":1.121004,"44":1.132001,"45":1.145002,"46":1.160006,"47":1.177001,"48":1.196002,"49":1.217002,"50":1.225005,"51":1.224999,"52":1.225004,"53":1.225001,"54":1.225004,"55":1.224998,"56":1.224999,"57":1.224996,"58":1.224998,"59":1.225004,"60":1.224997,"61":1.225002,"62":1.225001,"63":1.224997,"64+":1.225}}}}},{"market":"pennie","id":"33709PA1160009-01","standardId":"33709PA1160009","variant":"standard","issuer":"Highmark Inc.","name":"my Blue Access PPO Bronze 0 HSA","metal":"Bronze","network":"PPO","hsaEligible":true,"counties":["Allegheny","Armstrong","Beaver","Butler","Erie","Mercer","Washington","Westmoreland"],"rates":{"1":{"base21":462.9,"tobaccoFactor":1.024995,"tobaccoFactorByAge":{"21":1.024995,"22":1.024995,"23":1.024995,"24":1.024995,"25":1.025003,"26":1.024999,"27":1.025004,"28":1.025001,"29":1.025,"30":1.024991,"31":1.024995,"32":1.025,"33":1.024993,"34":1.025002,"35":1.024997,"36":1.024993,"37":1.025006,"38":1.025001,"39":1.024992,"40":1.100002,"41":1.104994,"42":1.111993,"43":1.121004,"44":1.131999,"45":1.144996,"46":1.160006,"47":1.176998,"48":1.195999,"49":1.217004,"50":1.225004,"51":1.224994,"52":1.225005,"53":1.224998,"54":1.225005,"55":1.224999,"56":1.225001,"57":1.225,"58":1.224999,"59":1.225001,"60":1.225,"61":1.225001,"62":1.225,"63":1.225001,"64+":1.225002}},"4":{"base21":462.9,"tobaccoFactor":1.024995,"tobaccoFactorByAge":{"21":1.024995,"22":1.024995,"23":1.024995,"24":1.024995,"25":1.025003,"26":1.024999,"27":1.025004,"28":1.025001,"29":1.025,"30":1.024991,"31":1.024995,"32":1.025,"33":1.024993,"34":1.025002,"35":1.024997,"36":1.024993,"37":1.025006,"38":1.025001,"39":1.024992,"40":1.100002,"41":1.104994,"42":1.111993,"43":1.121004,"44":1.131999,"45":1.144996,"46":1.160006,"47":1.176998,"48":1.195999,"49":1.217004,"50":1.225004,"51":1.224994,"52":1.225005,"53":1.224998,"54":1.225005,"55":1.224999,"56":1.225001,"57":1.225,"58":1.224999,"59":1.225001,"60":1.225,"61":1.225001,"62":1.225,"63":1.225001,"64+":1.225002}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":11600,"fam":23200},"rules":{"pcp":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":2750,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":75,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":600,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":600,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":2750,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":2750,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Diagnostic tests: $75 copay for blood work / lab and $175 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $30 copay for a 90-day mail-order supply.","Tier 2 drugs (preferred brand): $50 copay for a 31-day retail supply ($100 for 60 days, $150 for 90 days); $100 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $250 copay for a 31-day retail supply ($500 for 60 days, $750 for 90 days); $500 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance (retail and mail order).","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,750 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,500 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","No medical deductible: copays and coinsurance apply from the first visit."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/WPA/Individual/I_33709PA1160010-01_20270101_SBC.pdf"},{"market":"pennie","id":"33709PA1160010-04","standardId":"33709PA1160010","variant":"csr73","issuer":"Highmark Inc.","name":"my Blue Access PPO Choice Silver 0","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Butler","Erie","Mercer","Washington","Westmoreland"],"rates":{"1":{"base21":694.55,"tobaccoFactor":1.024995,"tobaccoFactorByAge":{"21":1.024995,"22":1.024995,"23":1.024995,"24":1.024995,"25":1.024995,"26":1.024999,"27":1.025004,"28":1.024994,"29":1.025,"30":1.025003,"31":1.024994,"32":1.024998,"33":1.024998,"34":1.025001,"35":1.025002,"36":1.025003,"37":1.025004,"38":1.025005,"39":1.024997,"40":1.099997,"41":1.104998,"42":1.111999,"43":1.120997,"44":1.132002,"45":1.144995,"46":1.159997,"47":1.177002,"48":1.196004,"49":1.216997,"50":1.225003,"51":1.224999,"52":1.225003,"53":1.225001,"54":1.224998,"55":1.224999,"56":1.225001,"57":1.225,"58":1.224997,"59":1.225,"60":1.225001,"61":1.225,"62":1.224998,"63":1.225,"64+":1.224999}},"4":{"base21":694.55,"tobaccoFactor":1.024995,"tobaccoFactorByAge":{"21":1.024995,"22":1.024995,"23":1.024995,"24":1.024995,"25":1.024995,"26":1.024999,"27":1.025004,"28":1.024994,"29":1.025,"30":1.025003,"31":1.024994,"32":1.024998,"33":1.024998,"34":1.025001,"35":1.025002,"36":1.025003,"37":1.025004,"38":1.025005,"39":1.024997,"40":1.099997,"41":1.104998,"42":1.111999,"43":1.120997,"44":1.132002,"45":1.144995,"46":1.159997,"47":1.177002,"48":1.196004,"49":1.216997,"50":1.225003,"51":1.224999,"52":1.225003,"53":1.225001,"54":1.224998,"55":1.224999,"56":1.225001,"57":1.225,"58":1.224997,"59":1.225,"60":1.225001,"61":1.225,"62":1.224998,"63":1.225,"64+":1.224999}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":8775,"fam":17550},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":1250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":800,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":2500,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":2500,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Diagnostic tests: $65 copay for blood work / lab and $175 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): $5 copay for a 31-day retail supply ($10 for 60 days, $15 for 90 days); $10 copay for a 90-day mail-order supply.","Tier 2 drugs (preferred brand): $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $60 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $250 copay for a 31-day retail supply ($500 for 60 days, $750 for 90 days); $500 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,500 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $725 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $725 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility. The other days of the stay count toward the deductible until it is met, then cost nothing more.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","Deductible ($1,000): not charged for primary care and specialist visits, lab and x-ray, urgent care, outpatient mental health, rehabilitation therapy, outpatient surgery, all prescription drugs; every other service below is charged after the deductible.","Hospital physician fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/WPA/Individual/I_33709PA1170006-01_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":481.09,"tobaccoFactor":1.025006,"tobaccoFactorByAge":{"21":1.025006,"22":1.025006,"23":1.025006,"24":1.025006,"25":1.02501,"26":1.025008,"27":1.024991,"28":1.024993,"29":1.025003,"30":1.024998,"31":1.025001,"32":1.025003,"33":1.025002,"34":1.024998,"35":1.025005,"36":1.024994,"37":1.025,"38":1.025007,"39":1.025002,"40":1.099995,"41":1.105,"42":1.111995,"43":1.120994,"44":1.131993,"45":1.145,"46":1.159997,"47":1.176996,"48":1.196,"49":1.216999,"50":1.225004,"51":1.225004,"52":1.225005,"53":1.225001,"54":1.224996,"55":1.225003,"56":1.225004,"57":1.224996,"58":1.225,"59":1.224998,"60":1.225002,"61":1.225001,"62":1.225001,"63":1.225,"64+":1.225003}},"4":{"base21":481.09,"tobaccoFactor":1.025006,"tobaccoFactorByAge":{"21":1.025006,"22":1.025006,"23":1.025006,"24":1.025006,"25":1.02501,"26":1.025008,"27":1.024991,"28":1.024993,"29":1.025003,"30":1.024998,"31":1.025001,"32":1.025003,"33":1.025002,"34":1.024998,"35":1.025005,"36":1.024994,"37":1.025,"38":1.025007,"39":1.025002,"40":1.099995,"41":1.105,"42":1.111995,"43":1.120994,"44":1.131993,"45":1.145,"46":1.159997,"47":1.176996,"48":1.196,"49":1.216999,"50":1.225004,"51":1.225004,"52":1.225005,"53":1.225001,"54":1.224996,"55":1.225003,"56":1.225004,"57":1.224996,"58":1.225,"59":1.224998,"60":1.225002,"61":1.225001,"62":1.225001,"63":1.225,"64+":1.225003}}}}},{"market":"pennie","id":"33709PA1170007-01","standardId":"33709PA1170007","variant":"standard","issuer":"Highmark Inc.","name":"my Blue Access PPO Bronze 0 HSA + Adult Dental and Vision","metal":"Bronze","network":"PPO","hsaEligible":true,"counties":["Allegheny","Armstrong","Beaver","Butler","Erie","Mercer","Washington","Westmoreland"],"rates":{"1":{"base21":478.71,"tobaccoFactor":1.025005,"tobaccoFactorByAge":{"21":1.025005,"22":1.025005,"23":1.025005,"24":1.025005,"25":1.025009,"26":1.02501,"27":1.024996,"28":1.025002,"29":1.024996,"30":1.024994,"31":1.024999,"32":1.025004,"33":1.025005,"34":1.025002,"35":1.024992,"36":1.025,"37":1.025007,"38":1.024997,"39":1.024995,"40":1.100002,"41":1.104993,"42":1.111999,"43":1.120996,"44":1.132006,"45":1.144996,"46":1.159998,"47":1.176993,"48":1.196004,"49":1.217001,"50":1.224999,"51":1.225003,"52":1.225001,"53":1.225002,"54":1.224999,"55":1.224998,"56":1.225003,"57":1.225,"58":1.224997,"59":1.225002,"60":1.224997,"61":1.225003,"62":1.225001,"63":1.225001,"64+":1.225001}},"4":{"base21":478.71,"tobaccoFactor":1.025005,"tobaccoFactorByAge":{"21":1.025005,"22":1.025005,"23":1.025005,"24":1.025005,"25":1.025009,"26":1.02501,"27":1.024996,"28":1.025002,"29":1.024996,"30":1.024994,"31":1.024999,"32":1.025004,"33":1.025005,"34":1.025002,"35":1.024992,"36":1.025,"37":1.025007,"38":1.024997,"39":1.024995,"40":1.100002,"41":1.104993,"42":1.111999,"43":1.120996,"44":1.132006,"45":1.144996,"46":1.159998,"47":1.176993,"48":1.196004,"49":1.217001,"50":1.224999,"51":1.225003,"52":1.225001,"53":1.225002,"54":1.224999,"55":1.224998,"56":1.225003,"57":1.225,"58":1.224997,"59":1.225002,"60":1.224997,"61":1.225003,"62":1.225001,"63":1.225001,"64+":1.225001}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":11600,"fam":23200},"rules":{"pcp":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":2750,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":75,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":600,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":600,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":2750,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":2750,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Diagnostic tests: $75 copay for blood work / lab and $175 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $30 copay for a 90-day mail-order supply.","Tier 2 drugs (preferred brand): $50 copay for a 31-day retail supply ($100 for 60 days, $150 for 90 days); $100 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $250 copay for a 31-day retail supply ($500 for 60 days, $750 for 90 days); $500 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance (retail and mail order).","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,750 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,500 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,500 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $550 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $175 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $450 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility. The other days of the stay count toward the deductible until it is met, then cost nothing more.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","Deductible ($1,800): applies to everything except preventive care and children's vision and dental exams, even where the SBC shows a copay or \"No charge\".","Tier 1 drugs, hospital physician fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","Family deductible: the SBC says the overall family deductible must be met before the plan begins to pay (no individual deductible within a family), and the estimate uses the aggregate family 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $450 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility. The other days of the stay count toward the deductible until it is met, then cost nothing more.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","Deductible ($1,800): applies to everything except preventive care and children's vision and dental exams, even where the SBC shows a copay or \"No charge\".","Tier 1 drugs, hospital physician fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","Family deductible: the SBC says the overall family deductible must be met before the plan begins to pay (no individual deductible within a family), and the estimate uses the aggregate family 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The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","Deductible ($3,800): not charged for primary care and specialist visits, lab and x-ray, urgent care, outpatient mental health, rehabilitation therapy, Tier 1 drugs; every other service below is charged after the 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $1,125 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility. The other days of the stay count toward the deductible until it is met, then cost nothing more.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","Deductible ($6,000): not charged for primary care and specialist visits, lab and x-ray, urgent care, outpatient mental health, rehabilitation therapy, Tier 1 drugs, Tier 2 drugs; every other service below is charged after the deductible.","Hospital physician fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $1,125 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility. The other days of the stay count toward the deductible until it is met, then cost nothing more.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","Deductible ($3,000): not charged for primary care and specialist visits, lab and x-ray, urgent care, outpatient mental health, rehabilitation therapy, Tier 1 drugs, Tier 2 drugs; every other service below is charged after the deductible.","Hospital physician fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC 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This is a reading, not something the SBC 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This is a reading, not something the SBC 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Page 1 of the SBC lists only preventive care as covered before the deductible and its coverage examples charge the whole cost to the deductible, so \"No charge\" is read as free only after the deductible is 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tests: $55 copay for blood work / lab and $125 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $20 copay for a 90-day mail-order supply.","Tier 2 drugs (preferred brand): $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $60 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $250 copay for a 31-day retail supply ($500 for 60 days, $750 for 90 days); $500 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $1,125 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility. The other days of the stay count toward the deductible until it is met, then cost nothing more.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","Deductible ($6,000): not charged for primary care and specialist visits, lab and x-ray, urgent care, outpatient mental health, rehabilitation therapy, Tier 1 drugs, Tier 2 drugs; every other service below is charged after the deductible.","Hospital physician fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/CPA/Individual/I_33709PA1480006-01_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":792.92,"tobaccoFactor":1.024996,"tobaccoFactorByAge":{"21":1.024996,"22":1.024996,"23":1.024996,"24":1.024996,"25":1.024997,"26":1.025002,"27":1.024995,"28":1.025003,"29":1.024998,"30":1.025001,"31":1.024995,"32":1.024999,"33":1.025002,"34":1.025005,"35":1.024996,"36":1.024998,"37":1.024999,"38":1.025001,"39":1.025003,"40":1.100005,"41":1.105,"42":1.112001,"43":1.120996,"44":1.132002,"45":1.144998,"46":1.159999,"47":1.176999,"48":1.196001,"49":1.217,"50":1.225003,"51":1.225,"52":1.225,"53":1.224999,"54":1.225001,"55":1.225002,"56":1.224998,"57":1.225001,"58":1.225,"59":1.224998,"60":1.225002,"61":1.224998,"62":1.224998,"63":1.225001,"64+":1.225}},"7":{"base21":792.92,"tobaccoFactor":1.024996,"tobaccoFactorByAge":{"21":1.024996,"22":1.024996,"23":1.024996,"24":1.024996,"25":1.024997,"26":1.025002,"27":1.024995,"28":1.025003,"29":1.024998,"30":1.025001,"31":1.024995,"32":1.024999,"33":1.025002,"34":1.025005,"35":1.024996,"36":1.024998,"37":1.024999,"38":1.025001,"39":1.025003,"40":1.100005,"41":1.105,"42":1.112001,"43":1.120996,"44":1.132002,"45":1.144998,"46":1.159999,"47":1.176999,"48":1.196001,"49":1.217,"50":1.225003,"51":1.225,"52":1.225,"53":1.224999,"54":1.225001,"55":1.225002,"56":1.224998,"57":1.225001,"58":1.225,"59":1.224998,"60":1.225002,"61":1.224998,"62":1.224998,"63":1.225001,"64+":1.225}},"9":{"base21":792.92,"tobaccoFactor":1.024996,"tobaccoFactorByAge":{"21":1.024996,"22":1.024996,"23":1.024996,"24":1.024996,"25":1.024997,"26":1.025002,"27":1.024995,"28":1.025003,"29":1.024998,"30":1.025001,"31":1.024995,"32":1.024999,"33":1.025002,"34":1.025005,"35":1.024996,"36":1.024998,"37":1.024999,"38":1.025001,"39":1.025003,"40":1.100005,"41":1.105,"42":1.112001,"43":1.120996,"44":1.132002,"45":1.144998,"46":1.159999,"47":1.176999,"48":1.196001,"49":1.217,"50":1.225003,"51":1.225,"52":1.225,"53":1.224999,"54":1.225001,"55":1.225002,"56":1.224998,"57":1.225001,"58":1.225,"59":1.224998,"60":1.225002,"61":1.224998,"62":1.224998,"63":1.225001,"64+":1.225}}}}},{"market":"pennie","id":"33709PA1480006-04","standardId":"33709PA1480006","variant":"csr73","issuer":"Highmark 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has not published a 2027 SBC for this plan (its SBC address still served the 2026 SBC on 2026-10-31). This record is built from the statement of variability filed with the Pennsylvania Insurance Department, SERFF HGHM-134915275 (\"BA PPO CDP_5 SOV.xlsx\", column \"my Blue Access PPO Extra Savings Silver 3000\", \"Silver, Enhanced CSR Level 1\").","The statement of variability prints the same cost sharing for this plan as for its standard version (33709PA1480006-01) on every row except the deductible ($3,000 / $6,000 family) and the out-of-pocket limit ($7,800 / $15,600 family); the rules here are the standard version's, read from its 2027 SBC (which the statement of variability matches, as it matches the 2027 SBCs of the plan's other cost-sharing versions). The visit limit, the specialty drug minimum and maximum and the per-stay hospital copay come from that SBC; the statement of variability does not print them.","Diagnostic tests: $55 copay for blood work / lab and $125 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the standard version's SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $20 copay for a 90-day mail-order supply.","Tier 2 drugs (preferred brand): $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $60 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $250 copay for a 31-day retail supply ($500 for 60 days, $750 for 90 days); $500 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the standard version's SBC lists a $1,125 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility. The other days of the stay count toward the deductible until it is met, then cost nothing more.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","Deductible ($3,000): not charged for primary care and specialist visits, lab and x-ray, urgent care, outpatient mental health, rehabilitation therapy, Tier 1 drugs, Tier 2 drugs; every other service below is charged after the deductible.","Hospital physician fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the standard version's SBC states."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#HGHM-134915275/BA PPO CDP_5 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tests: $50 copay for blood work / lab and $100 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): no charge (retail and mail order).","Tier 2 drugs (preferred brand): $35 copay for a 31-day retail supply ($70 for 60 days, $105 for 90 days); $70 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $200 copay for a 31-day retail supply ($400 for 60 days, $600 for 90 days); $400 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $725 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility. The other days of the stay count toward the deductible until it is met, then cost nothing more.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","Emergency room care: the SBC cell says \"Deductible does not apply.\", but page 1 does not name it among the services covered before the deductible. The cell is followed (page 1 lists examples); other SBCs of this plan design name it on page 1 as well.","Deductible ($1,000): not charged for primary care and specialist visits, lab and x-ray, urgent care, outpatient mental health, rehabilitation therapy, emergency room, outpatient surgery, all prescription drugs; every other service below is charged after the deductible.","Hospital physician fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC 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tests: $75 copay for blood work / lab and $175 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $30 copay for a 90-day mail-order supply.","Tier 2 drugs (preferred brand): $50 copay for a 31-day retail supply ($100 for 60 days, $150 for 90 days); $100 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $250 copay for a 31-day retail supply ($500 for 60 days, $750 for 90 days); $500 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance (retail and mail order).","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,750 copay per visit, treated here as one copay per admission (charged on the first hospital day of 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The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,500 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","No medical deductible: copays and coinsurance apply from the first visit."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/CPA/Individual/I_33709PA1480009-01_20270101_SBC.pdf"},{"market":"pennie","id":"33709PA1480009-04","standardId":"33709PA1480009","variant":"csr73","issuer":"Highmark Inc.","name":"my Blue Access PPO Choice Silver 0","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Lehigh","Mifflin","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Union","York"],"rates":{"6":{"base21":913.22,"tobaccoFactor":1.024999,"tobaccoFactorByAge":{"21":1.024999,"22":1.024999,"23":1.024999,"24":1.024999,"25":1.024998,"26":1.025002,"27":1.025004,"28":1.025003,"29":1.025003,"30":1.024998,"31":1.025,"32":1.025001,"33":1.024999,"34":1.025003,"35":1.025001,"36":1.024999,"37":1.024996,"38":1.025003,"39":1.024998,"40":1.1,"41":1.105003,"42":1.111998,"43":1.121002,"44":1.131999,"45":1.145,"46":1.159998,"47":1.176998,"48":1.196,"49":1.217003,"50":1.225002,"51":1.224999,"52":1.225002,"53":1.225001,"54":1.225002,"55":1.225001,"56":1.224999,"57":1.224999,"58":1.225001,"59":1.225,"60":1.225001,"61":1.224999,"62":1.225001,"63":1.224999,"64+":1.224999}},"7":{"base21":959.34,"tobaccoFactor":1.024996,"tobaccoFactorByAge":{"21":1.024996,"22":1.024996,"23":1.024996,"24":1.024996,"25":1.025001,"26":1.025001,"27":1.024995,"28":1.025,"29":1.025002,"30":1.024999,"31":1.025003,"32":1.024998,"33":1.024998,"34":1.025003,"35":1.025002,"36":1.025,"37":1.024999,"38":1.024997,"39":1.025002,"40":1.099997,"41":1.104999,"42":1.112003,"43":1.121,"44":1.132003,"45":1.145002,"46":1.159999,"47":1.176998,"48":1.196,"49":1.217001,"50":1.225,"51":1.224998,"52":1.224999,"53":1.225002,"54":1.224999,"55":1.225,"56":1.224999,"57":1.225,"58":1.225,"59":1.225,"60":1.225,"61":1.224999,"62":1.225,"63":1.224999,"64+":1.224998}},"9":{"base21":959.34,"tobaccoFactor":1.024996,"tobaccoFactorByAge":{"21":1.024996,"22":1.024996,"23":1.024996,"24":1.024996,"25":1.025001,"26":1.025001,"27":1.024995,"28":1.025,"29":1.025002,"30":1.024999,"31":1.025003,"32":1.024998,"33":1.024998,"34":1.025003,"35":1.025002,"36":1.025,"37":1.024999,"38":1.024997,"39":1.025002,"40":1.099997,"41":1.104999,"42":1.112003,"43":1.121,"44":1.132003,"45":1.145002,"46":1.159999,"47":1.176998,"48":1.196,"49":1.217001,"50":1.225,"51":1.224998,"52":1.224999,"53":1.225002,"54":1.224999,"55":1.225,"56":1.224999,"57":1.225,"58":1.225,"59":1.225,"60":1.225,"61":1.224999,"62":1.225,"63":1.224999,"64+":1.224998}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":8775,"fam":17550},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":1250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":800,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":2500,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":2500,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Diagnostic tests: $65 copay for blood work / lab and $175 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,500 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","No medical deductible: copays and coinsurance apply from the first visit."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/CPA/Individual/I_33709PA1480009-04_20270101_SBC.pdf"},{"market":"pennie","id":"33709PA1480009-05","standardId":"33709PA1480009","variant":"csr87","issuer":"Highmark Inc.","name":"my Blue Access PPO Choice Silver 0","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Lehigh","Mifflin","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Union","York"],"rates":{"6":{"base21":913.22,"tobaccoFactor":1.024999,"tobaccoFactorByAge":{"21":1.024999,"22":1.024999,"23":1.024999,"24":1.024999,"25":1.024998,"26":1.025002,"27":1.025004,"28":1.025003,"29":1.025003,"30":1.024998,"31":1.025,"32":1.025001,"33":1.024999,"34":1.025003,"35":1.025001,"36":1.024999,"37":1.024996,"38":1.025003,"39":1.024998,"40":1.1,"41":1.105003,"42":1.111998,"43":1.121002,"44":1.131999,"45":1.145,"46":1.159998,"47":1.176998,"48":1.196,"49":1.217003,"50":1.225002,"51":1.224999,"52":1.225002,"53":1.225001,"54":1.225002,"55":1.225001,"56":1.224999,"57":1.224999,"58":1.225001,"59":1.225,"60":1.225001,"61":1.224999,"62":1.225001,"63":1.224999,"64+":1.224999}},"7":{"base21":959.34,"tobaccoFactor":1.024996,"tobaccoFactorByAge":{"21":1.024996,"22":1.024996,"23":1.024996,"24":1.024996,"25":1.025001,"26":1.025001,"27":1.024995,"28":1.025,"29":1.025002,"30":1.024999,"31":1.025003,"32":1.024998,"33":1.024998,"34":1.025003,"35":1.025002,"36":1.025,"37":1.024999,"38":1.024997,"39":1.025002,"40":1.099997,"41":1.104999,"42":1.112003,"43":1.121,"44":1.132003,"45":1.145002,"46":1.159999,"47":1.176998,"48":1.196,"49":1.217001,"50":1.225,"51":1.224998,"52":1.224999,"53":1.225002,"54":1.224999,"55":1.225,"56":1.224999,"57":1.225,"58":1.225,"59":1.225,"60":1.225,"61":1.224999,"62":1.225,"63":1.224999,"64+":1.224998}},"9":{"base21":959.34,"tobaccoFactor":1.024996,"tobaccoFactorByAge":{"21":1.024996,"22":1.024996,"23":1.024996,"24":1.024996,"25":1.025001,"26":1.025001,"27":1.024995,"28":1.025,"29":1.025002,"30":1.024999,"31":1.025003,"32":1.024998,"33":1.024998,"34":1.025003,"35":1.025002,"36":1.025,"37":1.024999,"38":1.024997,"39":1.025002,"40":1.099997,"41":1.104999,"42":1.112003,"43":1.121,"44":1.132003,"45":1.145002,"46":1.159999,"47":1.176998,"48":1.196,"49":1.217001,"50":1.225,"51":1.224998,"52":1.224999,"53":1.225002,"54":1.224999,"55":1.225,"56":1.224999,"57":1.225,"58":1.225,"59":1.225,"60":1.225,"61":1.224999,"62":1.225,"63":1.224999,"64+":1.224998}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":3800,"fam":7600},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":550,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":550,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Diagnostic tests: $60 copay for blood work / lab and $90 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): no charge (retail and mail order).","Tier 2 drugs (preferred brand): $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $20 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $50 copay for a 31-day retail supply ($100 for 60 days, $150 for 90 days); $100 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $550 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $175 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","No medical deductible: copays and coinsurance apply from the first visit."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/CPA/Individual/I_33709PA1480009-06_20270101_SBC.pdf"},{"market":"pennie","id":"33709PA1490001-01","standardId":"33709PA1490001","variant":"standard","issuer":"Highmark Inc.","name":"my Blue Access PPO Bronze 3800 HSA + Adult Dental and Vision","metal":"Bronze","network":"PPO","hsaEligible":true,"networkId":"PAN003","referral":false,"tiers":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Lehigh","Mifflin","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Union","York"],"rates":{"6":{"base21":548.53,"tobaccoFactor":1.024994,"tobaccoFactorByAge":{"21":1.024994,"22":1.024994,"23":1.024994,"24":1.024994,"25":1.025004,"26":1.024996,"27":1.024997,"28":1.025006,"29":1.025008,"30":1.024993,"31":1.024994,"32":1.024996,"33":1.025002,"34":1.025003,"35":1.025004,"36":1.025004,"37":1.025004,"38":1.025005,"39":1.025006,"40":1.099997,"41":1.105,"42":1.111998,"43":1.121003,"44":1.131998,"45":1.144998,"46":1.160002,"47":1.176999,"48":1.195997,"49":1.217004,"50":1.225004,"51":1.225003,"52":1.224996,"53":1.225004,"54":1.225,"55":1.224996,"56":1.225002,"57":1.224998,"58":1.224999,"59":1.225,"60":1.225,"61":1.225001,"62":1.224997,"63":1.224998,"64+":1.225001}},"7":{"base21":576.24,"tobaccoFactor":1.025007,"tobaccoFactorByAge":{"21":1.025007,"22":1.025007,"23":1.025007,"24":1.025007,"25":1.024994,"26":1.024997,"27":1.025004,"28":1.025001,"29":1.025,"30":1.024999,"31":1.025005,"32":1.024997,"33":1.025002,"34":1.025001,"35":1.024994,"36":1.025001,"37":1.024993,"38":1.025,"39":1.025,"40":1.099996,"41":1.105004,"42":1.111994,"43":1.121004,"44":1.131998,"45":1.144996,"46":1.160003,"47":1.177004,"48":1.195999,"49":1.217004,"50":1.224999,"51":1.225004,"52":1.224996,"53":1.224996,"54":1.224999,"55":1.225,"56":1.224998,"57":1.225002,"58":1.225001,"59":1.225001,"60":1.224999,"61":1.225002,"62":1.225002,"63":1.225001,"64+":1.224999}},"9":{"base21":576.24,"tobaccoFactor":1.025007,"tobaccoFactorByAge":{"21":1.025007,"22":1.025007,"23":1.025007,"24":1.025007,"25":1.024994,"26":1.024997,"27":1.025004,"28":1.025001,"29":1.025,"30":1.024999,"31":1.025005,"32":1.024997,"33":1.025002,"34":1.025001,"35":1.024994,"36":1.025001,"37":1.024993,"38":1.025,"39":1.025,"40":1.099996,"41":1.105004,"42":1.111994,"43":1.121004,"44":1.131998,"45":1.144996,"46":1.160003,"47":1.177004,"48":1.195999,"49":1.217004,"50":1.224999,"51":1.225004,"52":1.224996,"53":1.224996,"54":1.224999,"55":1.225,"56":1.224998,"57":1.225002,"58":1.225001,"59":1.225001,"60":1.224999,"61":1.225002,"62":1.225002,"63":1.225001,"64+":1.224999}}},"ded":{"ind":3800,"fam":7600,"embedded":true},"drugDed":null,"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":180,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":550,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":550,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}}},"notes":["Diagnostic tests: $65 copay for blood work / lab and $180 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $30 copay for a 90-day mail-order supply.","Tier 2 drugs (preferred brand): 50% coinsurance (retail and mail order).","Tier 3 drugs (non-preferred brand): 50% coinsurance (retail and mail order).","Tier 4 drugs (specialty): 50% coinsurance (retail and mail order).","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","Deductible ($3,800): not charged for primary care and specialist visits, lab and x-ray, urgent care, outpatient mental health, rehabilitation therapy, Tier 1 drugs; every other service below is charged after the 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $725 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","No medical deductible: copays and coinsurance apply from the first 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tests: $50 copay for blood work / lab and $100 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): no charge (retail and mail order).","Tier 2 drugs (preferred brand): $35 copay for a 31-day retail supply ($70 for 60 days, $105 for 90 days); $70 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $200 copay for a 31-day retail supply ($400 for 60 days, $600 for 90 days); $400 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $725 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility. The other days of the stay count toward the deductible until it is met, then cost nothing more.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","Emergency room care: the SBC cell says \"Deductible does not apply.\", but page 1 does not name it among the services covered before the deductible. The cell is followed (page 1 lists examples); other SBCs of this plan design name it on page 1 as well.","Deductible ($1,000): not charged for primary care and specialist visits, lab and x-ray, urgent care, outpatient mental health, rehabilitation therapy, emergency room, outpatient surgery, all prescription drugs; every other service below is charged after the deductible.","Hospital physician fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/CPA/Individual/I_33709PA1490005-01_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":660.81,"tobaccoFactor":1.025,"tobaccoFactorByAge":{"21":1.025,"22":1.025,"23":1.025,"24":1.025,"25":1.025006,"26":1.025005,"27":1.024995,"28":1.025003,"29":1.025005,"30":1.024999,"31":1.025004,"32":1.024996,"33":1.024998,"34":1.025006,"35":1.025003,"36":1.025,"37":1.024998,"38":1.024995,"39":1.025002,"40":1.099998,"41":1.105001,"42":1.111996,"43":1.120997,"44":1.132005,"45":1.145,"46":1.160005,"47":1.176996,"48":1.195998,"49":1.216998,"50":1.225002,"51":1.224998,"52":1.225002,"53":1.224999,"54":1.225002,"55":1.224998,"56":1.225003,"57":1.225001,"58":1.224999,"59":1.225,"60":1.224998,"61":1.225001,"62":1.224997,"63":1.225,"64+":1.225002}},"7":{"base21":660.81,"tobaccoFactor":1.025,"tobaccoFactorByAge":{"21":1.025,"22":1.025,"23":1.025,"24":1.025,"25":1.025006,"26":1.025005,"27":1.024995,"28":1.025003,"29":1.025005,"30":1.024999,"31":1.025004,"32":1.024996,"33":1.024998,"34":1.025006,"35":1.025003,"36":1.025,"37":1.024998,"38":1.024995,"39":1.025002,"40":1.099998,"41":1.105001,"42":1.111996,"43":1.120997,"44":1.132005,"45":1.145,"46":1.160005,"47":1.176996,"48":1.195998,"49":1.216998,"50":1.225002,"51":1.224998,"52":1.225002,"53":1.224999,"54":1.225002,"55":1.224998,"56":1.225003,"57":1.225001,"58":1.224999,"59":1.225,"60":1.224998,"61":1.225001,"62":1.224997,"63":1.225,"64+":1.225002}},"9":{"base21":660.81,"tobaccoFactor":1.025,"tobaccoFactorByAge":{"21":1.025,"22":1.025,"23":1.025,"24":1.025,"25":1.025006,"26":1.025005,"27":1.024995,"28":1.025003,"29":1.025005,"30":1.024999,"31":1.025004,"32":1.024996,"33":1.024998,"34":1.025006,"35":1.025003,"36":1.025,"37":1.024998,"38":1.024995,"39":1.025002,"40":1.099998,"41":1.105001,"42":1.111996,"43":1.120997,"44":1.132005,"45":1.145,"46":1.160005,"47":1.176996,"48":1.195998,"49":1.216998,"50":1.225002,"51":1.224998,"52":1.225002,"53":1.224999,"54":1.225002,"55":1.224998,"56":1.225003,"57":1.225001,"58":1.224999,"59":1.225,"60":1.224998,"61":1.225001,"62":1.224997,"63":1.225,"64+":1.225002}}}}},{"market":"pennie","id":"33709PA1490006-01","standardId":"33709PA1490006","variant":"standard","issuer":"Highmark 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tests: $75 copay for blood work / lab and $175 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $30 copay for a 90-day mail-order supply.","Tier 2 drugs (preferred brand): $50 copay for a 31-day retail supply ($100 for 60 days, $150 for 90 days); $100 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $250 copay for a 31-day retail supply ($500 for 60 days, $750 for 90 days); $500 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance (retail and mail order).","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,750 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,500 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,500 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","No medical deductible: copays and coinsurance apply from the first visit."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/CPA/Individual/I_33709PA1490007-04_20270101_SBC.pdf"},{"market":"pennie","id":"33709PA1490007-05","standardId":"33709PA1490007","variant":"csr87","issuer":"Highmark Inc.","name":"my Blue Access PPO Choice Silver 0 + Adult Dental and Vision","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Lehigh","Mifflin","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Union","York"],"rates":{"6":{"base21":927.1,"tobaccoFactor":1.025003,"tobaccoFactorByAge":{"21":1.025003,"22":1.025003,"23":1.025003,"24":1.025003,"25":1.025,"26":1.024996,"27":1.025,"28":1.024996,"29":1.025004,"30":1.025003,"31":1.024997,"32":1.025001,"33":1.025003,"34":1.025002,"35":1.024997,"36":1.025002,"37":1.024997,"38":1.025001,"39":1.025,"40":1.099997,"41":1.104997,"42":1.111998,"43":1.121003,"44":1.131999,"45":1.145003,"46":1.159997,"47":1.176998,"48":1.196001,"49":1.216998,"50":1.225003,"51":1.224998,"52":1.224999,"53":1.225001,"54":1.225002,"55":1.224999,"56":1.225001,"57":1.224999,"58":1.225002,"59":1.225,"60":1.224999,"61":1.225,"62":1.225,"63":1.225,"64+":1.224999}},"7":{"base21":973.93,"tobaccoFactor":1.025002,"tobaccoFactorByAge":{"21":1.025002,"22":1.025002,"23":1.025002,"24":1.025002,"25":1.025004,"26":1.024997,"27":1.025003,"28":1.025003,"29":1.025004,"30":1.025004,"31":1.025,"32":1.024997,"33":1.025001,"34":1.025001,"35":1.024997,"36":1.025001,"37":1.024997,"38":1.025002,"39":1.025002,"40":1.100002,"41":1.105003,"42":1.111999,"43":1.121003,"44":1.132003,"45":1.144999,"46":1.159997,"47":1.177001,"48":1.196002,"49":1.217,"50":1.224998,"51":1.225002,"52":1.225,"53":1.224998,"54":1.224999,"55":1.225001,"56":1.225,"57":1.225,"58":1.224999,"59":1.225001,"60":1.225,"61":1.225001,"62":1.224999,"63":1.224999,"64+":1.224999}},"9":{"base21":973.93,"tobaccoFactor":1.025002,"tobaccoFactorByAge":{"21":1.025002,"22":1.025002,"23":1.025002,"24":1.025002,"25":1.025004,"26":1.024997,"27":1.025003,"28":1.025003,"29":1.025004,"30":1.025004,"31":1.025,"32":1.024997,"33":1.025001,"34":1.025001,"35":1.024997,"36":1.025001,"37":1.024997,"38":1.025002,"39":1.025002,"40":1.100002,"41":1.105003,"42":1.111999,"43":1.121003,"44":1.132003,"45":1.144999,"46":1.159997,"47":1.177001,"48":1.196002,"49":1.217,"50":1.224998,"51":1.225002,"52":1.225,"53":1.224998,"54":1.224999,"55":1.225001,"56":1.225,"57":1.225,"58":1.224999,"59":1.225001,"60":1.225,"61":1.225001,"62":1.224999,"63":1.224999,"64+":1.224999}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":3800,"fam":7600},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":550,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":550,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Diagnostic tests: $60 copay for blood work / lab and $90 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): no charge (retail and mail order).","Tier 2 drugs (preferred brand): $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $20 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $50 copay for a 31-day retail supply ($100 for 60 days, $150 for 90 days); $100 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $550 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","No medical deductible: copays and coinsurance apply from the first visit."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/CPA/Individual/I_33709PA1490007-05_20270101_SBC.pdf"},{"market":"pennie","id":"33709PA1490007-06","standardId":"33709PA1490007","variant":"csr94","issuer":"Highmark Inc.","name":"my Blue Access PPO Choice Silver 0 + Adult Dental and Vision","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Lehigh","Mifflin","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Union","York"],"rates":{"6":{"base21":927.1,"tobaccoFactor":1.025003,"tobaccoFactorByAge":{"21":1.025003,"22":1.025003,"23":1.025003,"24":1.025003,"25":1.025,"26":1.024996,"27":1.025,"28":1.024996,"29":1.025004,"30":1.025003,"31":1.024997,"32":1.025001,"33":1.025003,"34":1.025002,"35":1.024997,"36":1.025002,"37":1.024997,"38":1.025001,"39":1.025,"40":1.099997,"41":1.104997,"42":1.111998,"43":1.121003,"44":1.131999,"45":1.145003,"46":1.159997,"47":1.176998,"48":1.196001,"49":1.216998,"50":1.225003,"51":1.224998,"52":1.224999,"53":1.225001,"54":1.225002,"55":1.224999,"56":1.225001,"57":1.224999,"58":1.225002,"59":1.225,"60":1.224999,"61":1.225,"62":1.225,"63":1.225,"64+":1.224999}},"7":{"base21":973.93,"tobaccoFactor":1.025002,"tobaccoFactorByAge":{"21":1.025002,"22":1.025002,"23":1.025002,"24":1.025002,"25":1.025004,"26":1.024997,"27":1.025003,"28":1.025003,"29":1.025004,"30":1.025004,"31":1.025,"32":1.024997,"33":1.025001,"34":1.025001,"35":1.024997,"36":1.025001,"37":1.024997,"38":1.025002,"39":1.025002,"40":1.100002,"41":1.105003,"42":1.111999,"43":1.121003,"44":1.132003,"45":1.144999,"46":1.159997,"47":1.177001,"48":1.196002,"49":1.217,"50":1.224998,"51":1.225002,"52":1.225,"53":1.224998,"54":1.224999,"55":1.225001,"56":1.225,"57":1.225,"58":1.224999,"59":1.225001,"60":1.225,"61":1.225001,"62":1.224999,"63":1.224999,"64+":1.224999}},"9":{"base21":973.93,"tobaccoFactor":1.025002,"tobaccoFactorByAge":{"21":1.025002,"22":1.025002,"23":1.025002,"24":1.025002,"25":1.025004,"26":1.024997,"27":1.025003,"28":1.025003,"29":1.025004,"30":1.025004,"31":1.025,"32":1.024997,"33":1.025001,"34":1.025001,"35":1.024997,"36":1.025001,"37":1.024997,"38":1.025002,"39":1.025002,"40":1.100002,"41":1.105003,"42":1.111999,"43":1.121003,"44":1.132003,"45":1.144999,"46":1.159997,"47":1.177001,"48":1.196002,"49":1.217,"50":1.224998,"51":1.225002,"52":1.225,"53":1.224998,"54":1.224999,"55":1.225001,"56":1.225,"57":1.225,"58":1.224999,"59":1.225001,"60":1.225,"61":1.225001,"62":1.224999,"63":1.224999,"64+":1.224999}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":2500,"fam":5000},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":1,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":750}},"outpatientFacility":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":175,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): no charge (retail and mail order).","Tier 2 drugs (preferred brand): $1 copay for a 31-day retail supply ($2 for 60 days, $3 for 90 days); $2 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $5 copay for a 31-day retail supply ($10 for 60 days, $15 for 90 days); $10 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $750 for a 31-day retail supply ($500 / $1,500 for 60 days, $750 / $2,250 for 90 days) and a minimum of $500 and a maximum of $1,500 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $175 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","No medical deductible: copays and coinsurance apply from the first visit."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/CPA/Individual/I_33709PA1490007-06_20270101_SBC.pdf"},{"market":"pennie","id":"33709PA1500003-01","standardId":"33709PA1500003","variant":"standard","issuer":"Highmark Inc.","name":"my Blue Access PPO Gold 1800 HSA","metal":"Gold","network":"PPO","hsaEligible":true,"networkId":"PAN003","referral":false,"tiers":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Lehigh","Mifflin","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Union","York"],"rates":{"6":{"base21":681.53,"tobaccoFactor":1.025003,"tobaccoFactorByAge":{"21":1.025003,"22":1.025003,"23":1.025003,"24":1.025003,"25":1.025005,"26":1.025004,"27":1.025006,"28":1.024999,"29":1.025006,"30":1.025002,"31":1.025003,"32":1.025005,"33":1.024998,"34":1.024995,"35":1.024999,"36":1.025004,"37":1.024996,"38":1.025,"39":1.024997,"40":1.1,"41":1.104998,"42":1.112001,"43":1.121005,"44":1.132003,"45":1.145001,"46":1.160002,"47":1.177004,"48":1.195997,"49":1.216997,"50":1.224998,"51":1.225003,"52":1.225001,"53":1.224999,"54":1.224999,"55":1.225002,"56":1.224999,"57":1.225,"58":1.224999,"59":1.224997,"60":1.225002,"61":1.225001,"62":1.225001,"63":1.224999,"64+":1.224999}},"7":{"base21":715.95,"tobaccoFactor":1.025002,"tobaccoFactorByAge":{"21":1.025002,"22":1.025002,"23":1.025002,"24":1.025002,"25":1.025,"26":1.025002,"27":1.025003,"28":1.025005,"29":1.025002,"30":1.025006,"31":1.024994,"32":1.024995,"33":1.024997,"34":1.025001,"35":1.024997,"36":1.025005,"37":1.025001,"38":1.024998,"39":1.025002,"40":1.100002,"41":1.105002,"42":1.112004,"43":1.121004,"44":1.131996,"45":1.145004,"46":1.160001,"47":1.177002,"48":1.195997,"49":1.217003,"50":1.225004,"51":1.224999,"52":1.224997,"53":1.224999,"54":1.224998,"55":1.225001,"56":1.225,"57":1.224998,"58":1.224998,"59":1.224998,"60":1.225002,"61":1.225,"62":1.225001,"63":1.224999,"64+":1.225002}},"9":{"base21":715.95,"tobaccoFactor":1.025002,"tobaccoFactorByAge":{"21":1.025002,"22":1.025002,"23":1.025002,"24":1.025002,"25":1.025,"26":1.025002,"27":1.025003,"28":1.025005,"29":1.025002,"30":1.025006,"31":1.024994,"32":1.024995,"33":1.024997,"34":1.025001,"35":1.024997,"36":1.025005,"37":1.025001,"38":1.024998,"39":1.025002,"40":1.100002,"41":1.105002,"42":1.112004,"43":1.121004,"44":1.131996,"45":1.145004,"46":1.160001,"47":1.177002,"48":1.195997,"49":1.217003,"50":1.225004,"51":1.224999,"52":1.224997,"53":1.224999,"54":1.224998,"55":1.225001,"56":1.225,"57":1.224998,"58":1.224998,"59":1.224998,"60":1.225002,"61":1.225,"62":1.225001,"63":1.224999,"64+":1.225002}}},"ded":{"ind":1800,"fam":3600,"embedded":false},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":175,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":15,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":130,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":130,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":450,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":450,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): no charge (retail and mail order).","Tier 2 drugs (preferred brand): $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $60 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $150 copay for a 31-day retail supply ($300 for 60 days, $450 for 90 days); $300 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $450 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility. The other days of the stay count toward the deductible until it is met, then cost nothing more.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","Deductible ($1,800): applies to everything except preventive care and children's vision and dental exams, even where the SBC shows a copay or \"No charge\".","Tier 1 drugs, hospital physician fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","Family deductible: the SBC says the overall family deductible must be met before the plan begins to pay (no individual deductible within a family), and the estimate uses the aggregate family deductible."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/CPA/Individual/I_33709PA1500003-01_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":641.64,"tobaccoFactor":1.024998,"tobaccoFactorByAge":{"21":1.024998,"22":1.024998,"23":1.024998,"24":1.024998,"25":1.025007,"26":1.025006,"27":1.024999,"28":1.025005,"29":1.025,"30":1.025005,"31":1.024998,"32":1.025005,"33":1.025004,"34":1.024995,"35":1.024997,"36":1.024999,"37":1.025002,"38":1.025004,"39":1.024995,"40":1.099998,"41":1.105001,"42":1.112001,"43":1.121005,"44":1.131999,"45":1.145003,"46":1.159996,"47":1.177,"48":1.196,"49":1.217003,"50":1.224997,"51":1.225001,"52":1.225002,"53":1.224997,"54":1.225002,"55":1.224998,"56":1.224997,"57":1.225001,"58":1.224998,"59":1.224998,"60":1.225002,"61":1.225002,"62":1.224999,"63":1.225002,"64+":1.225002}},"7":{"base21":641.64,"tobaccoFactor":1.024998,"tobaccoFactorByAge":{"21":1.024998,"22":1.024998,"23":1.024998,"24":1.024998,"25":1.025007,"26":1.025006,"27":1.024999,"28":1.025005,"29":1.025,"30":1.025005,"31":1.024998,"32":1.025005,"33":1.025004,"34":1.024995,"35":1.024997,"36":1.024999,"37":1.025002,"38":1.025004,"39":1.024995,"40":1.099998,"41":1.105001,"42":1.112001,"43":1.121005,"44":1.131999,"45":1.145003,"46":1.159996,"47":1.177,"48":1.196,"49":1.217003,"50":1.224997,"51":1.225001,"52":1.225002,"53":1.224997,"54":1.225002,"55":1.224998,"56":1.224997,"57":1.225001,"58":1.224998,"59":1.224998,"60":1.225002,"61":1.225002,"62":1.224999,"63":1.225002,"64+":1.225002}},"9":{"base21":641.64,"tobaccoFactor":1.024998,"tobaccoFactorByAge":{"21":1.024998,"22":1.024998,"23":1.024998,"24":1.024998,"25":1.025007,"26":1.025006,"27":1.024999,"28":1.025005,"29":1.025,"30":1.025005,"31":1.024998,"32":1.025005,"33":1.025004,"34":1.024995,"35":1.024997,"36":1.024999,"37":1.025002,"38":1.025004,"39":1.024995,"40":1.099998,"41":1.105001,"42":1.112001,"43":1.121005,"44":1.131999,"45":1.145003,"46":1.159996,"47":1.177,"48":1.196,"49":1.217003,"50":1.224997,"51":1.225001,"52":1.225002,"53":1.224997,"54":1.225002,"55":1.224998,"56":1.224997,"57":1.225001,"58":1.224998,"59":1.224998,"60":1.225002,"61":1.225002,"62":1.224999,"63":1.225002,"64+":1.225002}}}}},{"market":"pennie","id":"33709PA1510001-01","standardId":"33709PA1510001","variant":"standard","issuer":"Highmark Inc.","name":"my Blue Access Major Events PPO Catastrophic 12000 HSA - 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The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,500 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,500 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","No medical deductible: copays and coinsurance apply from the first visit."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/WPA/Individual/I_33709PA1630004-04_20270101_SBC.pdf"},{"market":"pennie","id":"33709PA1630004-05","standardId":"33709PA1630004","variant":"csr87","issuer":"Highmark Inc.","name":"Together Blue with AHN EPO Choice Silver 0","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Erie","Washington","Westmoreland"],"rates":{"1":{"base21":473.99,"tobaccoFactor":1.025001,"tobaccoFactorByAge":{"21":1.025001,"22":1.025001,"23":1.025001,"24":1.025001,"25":1.025006,"26":1.024991,"27":1.025003,"28":1.024999,"29":1.025,"30":1.025001,"31":1.024993,"32":1.025003,"33":1.025007,"34":1.025008,"35":1.024999,"36":1.025008,"37":1.025,"38":1.024992,"39":1.024992,"40":1.100007,"41":1.105002,"42":1.111999,"43":1.121004,"44":1.132007,"45":1.144994,"46":1.160002,"47":1.176999,"48":1.195995,"49":1.216997,"50":1.224996,"51":1.225003,"52":1.225004,"53":1.224998,"54":1.224997,"55":1.225005,"56":1.225,"57":1.225,"58":1.225001,"59":1.225004,"60":1.224998,"61":1.225,"62":1.225001,"63":1.224997,"64+":1.224998}},"4":{"base21":473.99,"tobaccoFactor":1.025001,"tobaccoFactorByAge":{"21":1.025001,"22":1.025001,"23":1.025001,"24":1.025001,"25":1.025006,"26":1.024991,"27":1.025003,"28":1.024999,"29":1.025,"30":1.025001,"31":1.024993,"32":1.025003,"33":1.025007,"34":1.025008,"35":1.024999,"36":1.025008,"37":1.025,"38":1.024992,"39":1.024992,"40":1.100007,"41":1.105002,"42":1.111999,"43":1.121004,"44":1.132007,"45":1.144994,"46":1.160002,"47":1.176999,"48":1.195995,"49":1.216997,"50":1.224996,"51":1.225003,"52":1.225004,"53":1.224998,"54":1.224997,"55":1.225005,"56":1.225,"57":1.225,"58":1.225001,"59":1.225004,"60":1.224998,"61":1.225,"62":1.225001,"63":1.224997,"64+":1.224998}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":3800,"fam":7600},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":550,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":550,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Diagnostic tests: $60 copay for blood work / lab and $90 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): no charge (retail and mail order).","Tier 2 drugs (preferred brand): $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $20 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $50 copay for a 31-day retail supply ($100 for 60 days, $150 for 90 days); $100 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $550 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","No medical deductible: copays and coinsurance apply from the first visit."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/WPA/Individual/I_33709PA1630004-05_20270101_SBC.pdf"},{"market":"pennie","id":"33709PA1630004-06","standardId":"33709PA1630004","variant":"csr94","issuer":"Highmark Inc.","name":"Together Blue with AHN EPO Choice Silver 0","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Erie","Washington","Westmoreland"],"rates":{"1":{"base21":473.99,"tobaccoFactor":1.025001,"tobaccoFactorByAge":{"21":1.025001,"22":1.025001,"23":1.025001,"24":1.025001,"25":1.025006,"26":1.024991,"27":1.025003,"28":1.024999,"29":1.025,"30":1.025001,"31":1.024993,"32":1.025003,"33":1.025007,"34":1.025008,"35":1.024999,"36":1.025008,"37":1.025,"38":1.024992,"39":1.024992,"40":1.100007,"41":1.105002,"42":1.111999,"43":1.121004,"44":1.132007,"45":1.144994,"46":1.160002,"47":1.176999,"48":1.195995,"49":1.216997,"50":1.224996,"51":1.225003,"52":1.225004,"53":1.224998,"54":1.224997,"55":1.225005,"56":1.225,"57":1.225,"58":1.225001,"59":1.225004,"60":1.224998,"61":1.225,"62":1.225001,"63":1.224997,"64+":1.224998}},"4":{"base21":473.99,"tobaccoFactor":1.025001,"tobaccoFactorByAge":{"21":1.025001,"22":1.025001,"23":1.025001,"24":1.025001,"25":1.025006,"26":1.024991,"27":1.025003,"28":1.024999,"29":1.025,"30":1.025001,"31":1.024993,"32":1.025003,"33":1.025007,"34":1.025008,"35":1.024999,"36":1.025008,"37":1.025,"38":1.024992,"39":1.024992,"40":1.100007,"41":1.105002,"42":1.111999,"43":1.121004,"44":1.132007,"45":1.144994,"46":1.160002,"47":1.176999,"48":1.195995,"49":1.216997,"50":1.224996,"51":1.225003,"52":1.225004,"53":1.224998,"54":1.224997,"55":1.225005,"56":1.225,"57":1.225,"58":1.225001,"59":1.225004,"60":1.224998,"61":1.225,"62":1.225001,"63":1.224997,"64+":1.224998}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":2500,"fam":5000},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":1,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":750}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":175,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Diagnostic tests: $5 copay for blood work / lab and $5 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): no charge (retail and mail order).","Tier 2 drugs (preferred brand): $1 copay for a 31-day retail supply ($2 for 60 days, $3 for 90 days); $2 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $5 copay for a 31-day retail supply ($10 for 60 days, $15 for 90 days); $10 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $750 for a 31-day retail supply ($500 / $1,500 for 60 days, $750 / $2,250 for 90 days) and a minimum of $500 and a maximum of $1,500 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $175 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","No medical deductible: copays and coinsurance apply from the first visit."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/WPA/Individual/I_33709PA1630004-06_20270101_SBC.pdf"},{"market":"pennie","id":"33709PA1630005-01","standardId":"33709PA1630005","variant":"standard","issuer":"Highmark Inc.","name":"Together Blue with AHN EPO Silver 6000","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Erie","Washington","Westmoreland"],"rates":{"1":{"base21":403.38,"tobaccoFactor":1.024989,"tobaccoFactorByAge":{"21":1.024989,"22":1.024989,"23":1.024989,"24":1.024989,"25":1.024988,"26":1.025008,"27":1.025004,"28":1.024996,"29":1.02499,"30":1.025009,"31":1.025004,"32":1.025,"33":1.024997,"34":1.024995,"35":1.024993,"36":1.024992,"37":1.024991,"38":1.025009,"39":1.025006,"40":1.099996,"41":1.105008,"42":1.111997,"43":1.120992,"44":1.131992,"45":1.145001,"46":1.159998,"47":1.176992,"48":1.196003,"49":1.216996,"50":1.225001,"51":1.225003,"52":1.225006,"53":1.224997,"54":1.224995,"55":1.225004,"56":1.225005,"57":1.224996,"58":1.225003,"59":1.225,"60":1.224997,"61":1.225002,"62":1.224996,"63":1.225004,"64+":1.224999}},"4":{"base21":403.38,"tobaccoFactor":1.024989,"tobaccoFactorByAge":{"21":1.024989,"22":1.024989,"23":1.024989,"24":1.024989,"25":1.024988,"26":1.025008,"27":1.025004,"28":1.024996,"29":1.02499,"30":1.025009,"31":1.025004,"32":1.025,"33":1.024997,"34":1.024995,"35":1.024993,"36":1.024992,"37":1.024991,"38":1.025009,"39":1.025006,"40":1.099996,"41":1.105008,"42":1.111997,"43":1.120992,"44":1.131992,"45":1.145001,"46":1.159998,"47":1.176992,"48":1.196003,"49":1.216996,"50":1.225001,"51":1.225003,"52":1.225006,"53":1.224997,"54":1.224995,"55":1.225004,"56":1.225005,"57":1.224996,"58":1.225003,"59":1.225,"60":1.224997,"61":1.225002,"62":1.224996,"63":1.225004,"64+":1.224999}}},"ded":{"ind":6000,"fam":12000,"embedded":true},"drugDed":null,"oop":{"ind":9350,"fam":18700},"rules":{"pcp":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":750,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":600,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":55,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":1125,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":1125,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Diagnostic tests: $55 copay for blood work / lab and $125 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $20 copay for a 90-day mail-order supply.","Tier 2 drugs (preferred brand): $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $60 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $250 copay for a 31-day retail supply ($500 for 60 days, $750 for 90 days); $500 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $1,125 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility. The other days of the stay count toward the deductible until it is met, then cost nothing more.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","Deductible ($6,000): not charged for primary care and specialist visits, lab and x-ray, urgent care, outpatient mental health, rehabilitation therapy, Tier 1 drugs, Tier 2 drugs; every other service below is charged after the deductible.","Hospital physician fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/WPA/Individual/I_33709PA1630005-01_20270101_SBC.pdf"},{"market":"pennie","id":"33709PA1630005-04","standardId":"33709PA1630005","variant":"csr73","issuer":"Highmark Inc.","name":"Together Blue with AHN EPO Silver 6000","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Erie","Washington","Westmoreland"],"rates":{"1":{"base21":403.38,"tobaccoFactor":1.024989,"tobaccoFactorByAge":{"21":1.024989,"22":1.024989,"23":1.024989,"24":1.024989,"25":1.024988,"26":1.025008,"27":1.025004,"28":1.024996,"29":1.02499,"30":1.025009,"31":1.025004,"32":1.025,"33":1.024997,"34":1.024995,"35":1.024993,"36":1.024992,"37":1.024991,"38":1.025009,"39":1.025006,"40":1.099996,"41":1.105008,"42":1.111997,"43":1.120992,"44":1.131992,"45":1.145001,"46":1.159998,"47":1.176992,"48":1.196003,"49":1.216996,"50":1.225001,"51":1.225003,"52":1.225006,"53":1.224997,"54":1.224995,"55":1.225004,"56":1.225005,"57":1.224996,"58":1.225003,"59":1.225,"60":1.224997,"61":1.225002,"62":1.224996,"63":1.225004,"64+":1.224999}},"4":{"base21":403.38,"tobaccoFactor":1.024989,"tobaccoFactorByAge":{"21":1.024989,"22":1.024989,"23":1.024989,"24":1.024989,"25":1.024988,"26":1.025008,"27":1.025004,"28":1.024996,"29":1.02499,"30":1.025009,"31":1.025004,"32":1.025,"33":1.024997,"34":1.024995,"35":1.024993,"36":1.024992,"37":1.024991,"38":1.025009,"39":1.025006,"40":1.099996,"41":1.105008,"42":1.111997,"43":1.120992,"44":1.131992,"45":1.145001,"46":1.159998,"47":1.176992,"48":1.196003,"49":1.216996,"50":1.225001,"51":1.225003,"52":1.225006,"53":1.224997,"54":1.224995,"55":1.225004,"56":1.225005,"57":1.224996,"58":1.225003,"59":1.225,"60":1.224997,"61":1.225002,"62":1.224996,"63":1.225004,"64+":1.224999}}},"ded":{"ind":3000,"fam":6000,"embedded":true},"drugDed":null,"oop":{"ind":7800,"fam":15600},"rules":{"pcp":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":750,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":600,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":55,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":1125,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":1125,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Diagnostic tests: $55 copay for blood work / lab and $125 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $20 copay for a 90-day mail-order supply.","Tier 2 drugs (preferred brand): $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $60 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $250 copay for a 31-day retail supply ($500 for 60 days, $750 for 90 days); $500 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $1,125 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility. The other days of the stay count toward the deductible until it is met, then cost nothing more.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","Deductible ($3,000): not charged for primary care and specialist visits, lab and x-ray, urgent care, outpatient mental health, rehabilitation therapy, Tier 1 drugs, Tier 2 drugs; every other service below is charged after the deductible.","Hospital physician fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/WPA/Individual/I_33709PA1630005-04_20270101_SBC.pdf"},{"market":"pennie","id":"33709PA1630005-05","standardId":"33709PA1630005","variant":"csr87","issuer":"Highmark Inc.","name":"Together Blue with AHN EPO Silver 6000","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Erie","Washington","Westmoreland"],"rates":{"1":{"base21":403.38,"tobaccoFactor":1.024989,"tobaccoFactorByAge":{"21":1.024989,"22":1.024989,"23":1.024989,"24":1.024989,"25":1.024988,"26":1.025008,"27":1.025004,"28":1.024996,"29":1.02499,"30":1.025009,"31":1.025004,"32":1.025,"33":1.024997,"34":1.024995,"35":1.024993,"36":1.024992,"37":1.024991,"38":1.025009,"39":1.025006,"40":1.099996,"41":1.105008,"42":1.111997,"43":1.120992,"44":1.131992,"45":1.145001,"46":1.159998,"47":1.176992,"48":1.196003,"49":1.216996,"50":1.225001,"51":1.225003,"52":1.225006,"53":1.224997,"54":1.224995,"55":1.225004,"56":1.225005,"57":1.224996,"58":1.225003,"59":1.225,"60":1.224997,"61":1.225002,"62":1.224996,"63":1.225004,"64+":1.224999}},"4":{"base21":403.38,"tobaccoFactor":1.024989,"tobaccoFactorByAge":{"21":1.024989,"22":1.024989,"23":1.024989,"24":1.024989,"25":1.024988,"26":1.025008,"27":1.025004,"28":1.024996,"29":1.02499,"30":1.025009,"31":1.025004,"32":1.025,"33":1.024997,"34":1.024995,"35":1.024993,"36":1.024992,"37":1.024991,"38":1.025009,"39":1.025006,"40":1.099996,"41":1.105008,"42":1.111997,"43":1.120992,"44":1.131992,"45":1.145001,"46":1.159998,"47":1.176992,"48":1.196003,"49":1.216996,"50":1.225001,"51":1.225003,"52":1.225006,"53":1.224997,"54":1.224995,"55":1.225004,"56":1.225005,"57":1.224996,"58":1.225003,"59":1.225,"60":1.224997,"61":1.225002,"62":1.224996,"63":1.225004,"64+":1.224999}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":3800,"fam":7600},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":15,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":450,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Diagnostic tests: $30 copay for blood work / lab and $50 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): no charge (retail and mail order).","Tier 2 drugs (preferred brand): $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $20 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $50 copay for a 31-day retail supply ($100 for 60 days, $150 for 90 days); $100 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $450 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","No medical deductible: copays and coinsurance apply from the first visit."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/WPA/Individual/I_33709PA1630005-05_20270101_SBC.pdf"},{"market":"pennie","id":"33709PA1630005-06","standardId":"33709PA1630005","variant":"csr94","issuer":"Highmark Inc.","name":"Together Blue with AHN EPO Silver 6000","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Erie","Washington","Westmoreland"],"rates":{"1":{"base21":403.38,"tobaccoFactor":1.024989,"tobaccoFactorByAge":{"21":1.024989,"22":1.024989,"23":1.024989,"24":1.024989,"25":1.024988,"26":1.025008,"27":1.025004,"28":1.024996,"29":1.02499,"30":1.025009,"31":1.025004,"32":1.025,"33":1.024997,"34":1.024995,"35":1.024993,"36":1.024992,"37":1.024991,"38":1.025009,"39":1.025006,"40":1.099996,"41":1.105008,"42":1.111997,"43":1.120992,"44":1.131992,"45":1.145001,"46":1.159998,"47":1.176992,"48":1.196003,"49":1.216996,"50":1.225001,"51":1.225003,"52":1.225006,"53":1.224997,"54":1.224995,"55":1.225004,"56":1.225005,"57":1.224996,"58":1.225003,"59":1.225,"60":1.224997,"61":1.225002,"62":1.224996,"63":1.225004,"64+":1.224999}},"4":{"base21":403.38,"tobaccoFactor":1.024989,"tobaccoFactorByAge":{"21":1.024989,"22":1.024989,"23":1.024989,"24":1.024989,"25":1.024988,"26":1.025008,"27":1.025004,"28":1.024996,"29":1.02499,"30":1.025009,"31":1.025004,"32":1.025,"33":1.024997,"34":1.024995,"35":1.024993,"36":1.024992,"37":1.024991,"38":1.025009,"39":1.025006,"40":1.099996,"41":1.105008,"42":1.111997,"43":1.120992,"44":1.131992,"45":1.145001,"46":1.159998,"47":1.176992,"48":1.196003,"49":1.216996,"50":1.225001,"51":1.225003,"52":1.225006,"53":1.224997,"54":1.224995,"55":1.225004,"56":1.225005,"57":1.224996,"58":1.225003,"59":1.225,"60":1.224997,"61":1.225002,"62":1.224996,"63":1.225004,"64+":1.224999}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":2600,"fam":5200},"rules":{"pcp":{"base":{"kind":"copay","amount":1,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":1,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":1,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":1,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":1,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":1,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":1,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":750}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":175,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Diagnostic tests: $1 copay for blood work / lab and $1 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): no charge (retail and mail order).","Tier 2 drugs (preferred brand): $1 copay for a 31-day retail supply ($2 for 60 days, $3 for 90 days); $2 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $5 copay for a 31-day retail supply ($10 for 60 days, $15 for 90 days); $10 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $750 for a 31-day retail supply ($500 / $1,500 for 60 days, $750 / $2,250 for 90 days) and a minimum of $500 and a maximum of $1,500 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $175 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","No medical deductible: copays and coinsurance apply from the first visit."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/WPA/Individual/I_33709PA1630005-06_20270101_SBC.pdf"},{"market":"pennie","id":"33709PA1630007-01","standardId":"33709PA1630007","variant":"standard","issuer":"Highmark Inc.","name":"Together Blue with AHN EPO Gold 0","metal":"Gold","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Erie","Washington","Westmoreland"],"rates":{"1":{"base21":415.37,"tobaccoFactor":1.02499,"tobaccoFactorByAge":{"21":1.02499,"22":1.02499,"23":1.02499,"24":1.02499,"25":1.02501,"26":1.024992,"27":1.024994,"28":1.025005,"29":1.025,"30":1.025008,"31":1.02501,"32":1.024991,"33":1.024999,"34":1.025007,"35":1.025001,"36":1.024995,"37":1.025008,"38":1.025002,"39":1.02501,"40":1.099992,"41":1.105009,"42":1.111997,"43":1.120995,"44":1.132008,"45":1.145001,"46":1.160001,"47":1.176997,"48":1.196001,"49":1.216999,"50":1.225005,"51":1.224999,"52":1.225,"53":1.224996,"54":1.224997,"55":1.224997,"56":1.225002,"57":1.225001,"58":1.224999,"59":1.224998,"60":1.224996,"61":1.225002,"62":1.225003,"63":1.225001,"64+":1.224996}},"4":{"base21":415.37,"tobaccoFactor":1.02499,"tobaccoFactorByAge":{"21":1.02499,"22":1.02499,"23":1.02499,"24":1.02499,"25":1.02501,"26":1.024992,"27":1.024994,"28":1.025005,"29":1.025,"30":1.025008,"31":1.02501,"32":1.024991,"33":1.024999,"34":1.025007,"35":1.025001,"36":1.024995,"37":1.025008,"38":1.025002,"39":1.02501,"40":1.099992,"41":1.105009,"42":1.111997,"43":1.120995,"44":1.132008,"45":1.145001,"46":1.160001,"47":1.176997,"48":1.196001,"49":1.216999,"50":1.225005,"51":1.224999,"52":1.225,"53":1.224996,"54":1.224997,"55":1.224997,"56":1.225002,"57":1.225001,"58":1.224999,"59":1.224998,"60":1.224996,"61":1.225002,"62":1.225003,"63":1.225001,"64+":1.224996}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":725,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":725,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Diagnostic tests: $45 copay for blood work / lab and $75 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): no charge (retail and mail order).","Tier 2 drugs (preferred brand): $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $60 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $100 copay for a 31-day retail supply ($200 for 60 days, $300 for 90 days); $200 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $725 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","No medical deductible: copays and coinsurance apply from the first visit."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/WPA/Individual/I_33709PA1630007-01_20270101_SBC.pdf"},{"market":"pennie","id":"33709PA1630008-01","standardId":"33709PA1630008","variant":"standard","issuer":"Highmark Inc.","name":"Together Blue with AHN Virtual Choice EPO Gold 1000","metal":"Gold","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Erie","Washington","Westmoreland"],"rates":{"1":{"base21":369.33,"tobaccoFactor":1.024991,"tobaccoFactorByAge":{"21":1.024991,"22":1.024991,"23":1.024991,"24":1.024991,"25":1.024999,"26":1.024987,"27":1.025009,"28":1.025009,"29":1.024995,"30":1.025001,"31":1.024997,"32":1.024993,"33":1.024997,"34":1.025002,"35":1.024993,"36":1.025007,"37":1.024998,"38":1.02499,"39":1.024995,"40":1.1,"41":1.104997,"42":1.112003,"43":1.120994,"44":1.132009,"45":1.145,"46":1.16,"47":1.177009,"48":1.195992,"49":1.217004,"50":1.224993,"51":1.225,"52":1.225001,"53":1.224998,"54":1.225004,"55":1.224997,"56":1.224999,"57":1.224996,"58":1.225004,"59":1.225002,"60":1.224999,"61":1.225,"62":1.225004,"63":1.225001,"64+":1.225002}},"4":{"base21":369.33,"tobaccoFactor":1.024991,"tobaccoFactorByAge":{"21":1.024991,"22":1.024991,"23":1.024991,"24":1.024991,"25":1.024999,"26":1.024987,"27":1.025009,"28":1.025009,"29":1.024995,"30":1.025001,"31":1.024997,"32":1.024993,"33":1.024997,"34":1.025002,"35":1.024993,"36":1.025007,"37":1.024998,"38":1.02499,"39":1.024995,"40":1.1,"41":1.104997,"42":1.112003,"43":1.120994,"44":1.132009,"45":1.145,"46":1.16,"47":1.177009,"48":1.195992,"49":1.217004,"50":1.224993,"51":1.225,"52":1.225001,"53":1.224998,"54":1.225004,"55":1.224997,"56":1.224999,"57":1.224996,"58":1.225004,"59":1.225002,"60":1.224999,"61":1.225,"62":1.225004,"63":1.225001,"64+":1.225002}}},"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":8000,"fam":16000},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":35,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":625,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":625,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":725,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":725,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Diagnostic tests: $50 copay for blood work / lab and $100 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): no charge (retail and mail order).","Tier 2 drugs (preferred brand): $35 copay for a 31-day retail supply ($70 for 60 days, $105 for 90 days); $70 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $200 copay for a 31-day retail supply ($400 for 60 days, $600 for 90 days); $400 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $725 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility. The other days of the stay count toward the deductible until it is met, then cost nothing more.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","Deductible ($1,000): not charged for primary care and specialist visits, lab and x-ray, urgent care, outpatient mental health, rehabilitation therapy, outpatient surgery, all prescription drugs; every other service below is charged after the deductible.","Hospital physician fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/WPA/Individual/I_33709PA1630008-01_20270101_SBC.pdf"},{"market":"pennie","id":"33709PA1630009-01","standardId":"33709PA1630009","variant":"standard","issuer":"Highmark Inc.","name":"Together Blue with AHN EPO Platinum 0","metal":"Platinum","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Erie","Washington","Westmoreland"],"rates":{"1":{"base21":474.9,"tobaccoFactor":1.024995,"tobaccoFactorByAge":{"21":1.024995,"22":1.024995,"23":1.024995,"24":1.024995,"25":1.025,"26":1.025005,"27":1.024995,"28":1.025009,"29":1.025009,"30":1.025009,"31":1.025,"32":1.025008,"33":1.024994,"34":1.024994,"35":1.025003,"36":1.024994,"37":1.025003,"38":1.024995,"39":1.024995,"40":1.099997,"41":1.104994,"42":1.111992,"43":1.121004,"44":1.131994,"45":1.145007,"46":1.160006,"47":1.176998,"48":1.196005,"49":1.217001,"50":1.225002,"51":1.225,"52":1.225005,"53":1.225,"54":1.225,"55":1.224998,"56":1.225003,"57":1.225001,"58":1.224999,"59":1.225003,"60":1.225002,"61":1.225003,"62":1.225002,"63":1.225002,"64+":1.225002}},"4":{"base21":474.9,"tobaccoFactor":1.024995,"tobaccoFactorByAge":{"21":1.024995,"22":1.024995,"23":1.024995,"24":1.024995,"25":1.025,"26":1.025005,"27":1.024995,"28":1.025009,"29":1.025009,"30":1.025009,"31":1.025,"32":1.025008,"33":1.024994,"34":1.024994,"35":1.025003,"36":1.024994,"37":1.025003,"38":1.024995,"39":1.024995,"40":1.099997,"41":1.104994,"42":1.111992,"43":1.121004,"44":1.131994,"45":1.145007,"46":1.160006,"47":1.176998,"48":1.196005,"49":1.217001,"50":1.225002,"51":1.225,"52":1.225005,"53":1.225,"54":1.225,"55":1.224998,"56":1.225003,"57":1.225001,"58":1.224999,"59":1.225003,"60":1.225002,"61":1.225003,"62":1.225002,"63":1.225002,"64+":1.225002}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":5400,"fam":10800},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":325,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":325,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): no charge (retail and mail order).","Tier 2 drugs (preferred brand): $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $20 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $50 copay for a 31-day retail supply ($100 for 60 days, $150 for 90 days); $100 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $325 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","No medical deductible: copays and coinsurance apply from the first visit."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/WPA/Individual/I_33709PA1630009-01_20270101_SBC.pdf"},{"market":"pennie","id":"33709PA1630010-01","standardId":"33709PA1630010","variant":"standard","issuer":"Highmark Inc.","name":"Together Blue with AHN Major Events EPO Catastrophic 12000 HSA - 3 Free PCP Visits","metal":"Catastrophic","network":"EPO","hsaEligible":true,"counties":["Allegheny","Beaver","Butler","Erie","Washington","Westmoreland"],"rates":{"1":{"base21":230.21,"tobaccoFactor":1.025021,"tobaccoFactorByAge":{"21":1.025021,"22":1.025021,"23":1.025021,"24":1.025021,"25":1.025008,"26":1.024985,"27":1.024994,"28":1.025016,"29":1.025,"30":1.024991,"31":1.024999,"32":1.025006,"33":1.024983,"34":1.025012,"35":1.024989,"36":1.025004,"37":1.025018,"38":1.024997,"39":1.024989,"40":1.099997,"41":1.104994,"42":1.111989,"43":1.121003,"44":1.131996,"45":1.144997,"46":1.159997,"47":1.177005,"48":1.195994,"49":1.216988,"50":1.224998,"51":1.224997,"52":1.225004,"53":1.225007,"54":1.225005,"55":1.225003,"56":1.224994,"57":1.225001,"58":1.224999,"59":1.225002,"60":1.225004,"61":1.225,"62":1.224996,"63":1.225007,"64+":1.224997}},"4":{"base21":230.21,"tobaccoFactor":1.025021,"tobaccoFactorByAge":{"21":1.025021,"22":1.025021,"23":1.025021,"24":1.025021,"25":1.025008,"26":1.024985,"27":1.024994,"28":1.025016,"29":1.025,"30":1.024991,"31":1.024999,"32":1.025006,"33":1.024983,"34":1.025012,"35":1.024989,"36":1.025004,"37":1.025018,"38":1.024997,"39":1.024989,"40":1.099997,"41":1.104994,"42":1.111989,"43":1.121003,"44":1.131996,"45":1.144997,"46":1.159997,"47":1.177005,"48":1.195994,"49":1.216988,"50":1.224998,"51":1.224997,"52":1.225004,"53":1.225007,"54":1.225005,"55":1.225003,"56":1.224994,"57":1.225001,"58":1.224999,"59":1.225002,"60":1.225004,"61":1.225,"62":1.224996,"63":1.225007,"64+":1.224997}}},"ded":{"ind":12000,"fam":24000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":3,"rule":{"kind":"free","ded":"no_ded"}}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Primary care: the first 3 visits a year are free even before the deductible; after that you pay the full cost until the deductible is met, then nothing.","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): no charge (retail and mail order).","Tier 2 drugs (preferred brand): no charge (retail and mail order).","Tier 3 drugs (non-preferred brand): no charge (retail and mail order).","Tier 4 drugs (specialty): no charge (retail and mail order).","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","Deductible ($12,000): applies to everything except preventive care and children's vision and dental exams, even where the SBC shows a copay or \"No charge\".","Several services show \"No charge\" with no deductible waiver. Page 1 of the SBC lists only preventive care as covered before the deductible and its coverage examples charge the whole cost to the deductible, so \"No charge\" is read as free only after the deductible is met."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/WPA/Individual/I_33709PA1630010-01_20270101_SBC.pdf"},{"market":"pennie","id":"33709PA1640001-01","standardId":"33709PA1640001","variant":"standard","issuer":"Highmark Inc.","name":"Together Blue with AHN EPO Bronze 3800 HSA + Adult Dental and Vision","metal":"Bronze","network":"EPO","hsaEligible":true,"counties":["Allegheny","Beaver","Butler","Erie","Washington","Westmoreland"],"rates":{"1":{"base21":297.89,"tobaccoFactor":1.025009,"tobaccoFactorByAge":{"21":1.025009,"22":1.025009,"23":1.025009,"24":1.025009,"25":1.02501,"26":1.025013,"27":1.024985,"28":1.025015,"29":1.02499,"30":1.024992,"31":1.024996,"32":1.025,"33":1.024995,"34":1.024997,"35":1.024999,"36":1.025,"37":1.025001,"38":1.025002,"39":1.025004,"40":1.1,"41":1.104989,"42":1.112009,"43":1.120992,"44":1.131996,"45":1.144996,"46":1.15999,"47":1.176997,"48":1.195996,"49":1.217001,"50":1.225006,"51":1.224998,"52":1.224995,"53":1.224996,"54":1.225,"55":1.225007,"56":1.224999,"57":1.224999,"58":1.225001,"59":1.225004,"60":1.225005,"61":1.224999,"62":1.224995,"63":1.225002,"64+":1.225005}},"4":{"base21":297.89,"tobaccoFactor":1.025009,"tobaccoFactorByAge":{"21":1.025009,"22":1.025009,"23":1.025009,"24":1.025009,"25":1.02501,"26":1.025013,"27":1.024985,"28":1.025015,"29":1.02499,"30":1.024992,"31":1.024996,"32":1.025,"33":1.024995,"34":1.024997,"35":1.024999,"36":1.025,"37":1.025001,"38":1.025002,"39":1.025004,"40":1.1,"41":1.104989,"42":1.112009,"43":1.120992,"44":1.131996,"45":1.144996,"46":1.15999,"47":1.176997,"48":1.195996,"49":1.217001,"50":1.225006,"51":1.224998,"52":1.224995,"53":1.224996,"54":1.225,"55":1.225007,"56":1.224999,"57":1.224999,"58":1.225001,"59":1.225004,"60":1.225005,"61":1.224999,"62":1.224995,"63":1.225002,"64+":1.225005}}},"ded":{"ind":3800,"fam":7600,"embedded":true},"drugDed":null,"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":180,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":550,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":550,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}}},"notes":["Diagnostic tests: $65 copay for blood work / lab and $180 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $30 copay for a 90-day mail-order supply.","Tier 2 drugs (preferred brand): 50% coinsurance (retail and mail order).","Tier 3 drugs (non-preferred brand): 50% coinsurance (retail and mail order).","Tier 4 drugs (specialty): 50% coinsurance (retail and mail order).","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","Deductible ($3,800): not charged for primary care and specialist visits, lab and x-ray, urgent care, outpatient mental health, rehabilitation therapy, Tier 1 drugs; every other service below is charged after the deductible."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/WPA/Individual/I_33709PA1640001-01_20270101_SBC.pdf"},{"market":"pennie","id":"33709PA1640002-01","standardId":"33709PA1640002","variant":"standard","issuer":"Highmark Inc.","name":"Together Blue with AHN EPO Bronze 0 HSA + Adult Dental and Vision","metal":"Bronze","network":"EPO","hsaEligible":true,"counties":["Allegheny","Beaver","Butler","Erie","Washington","Westmoreland"],"rates":{"1":{"base21":328.35,"tobaccoFactor":1.025004,"tobaccoFactorByAge":{"21":1.025004,"22":1.025004,"23":1.025004,"24":1.025004,"25":1.024995,"26":1.025013,"27":1.024992,"28":1.024992,"29":1.025012,"30":1.025008,"31":1.024989,"32":1.024997,"33":1.02499,"34":1.025011,"35":1.024998,"36":1.025008,"37":1.024994,"38":1.025005,"39":1.025001,"40":1.099993,"41":1.105003,"42":1.112008,"43":1.120991,"44":1.132003,"45":1.144999,"46":1.15999,"47":1.177004,"48":1.195995,"49":1.217006,"50":1.225006,"51":1.224995,"52":1.224998,"53":1.224997,"54":1.224998,"55":1.225001,"56":1.225001,"57":1.224997,"58":1.224995,"59":1.225003,"60":1.225004,"61":1.225002,"62":1.224996,"63":1.225,"64+":1.225004}},"4":{"base21":328.35,"tobaccoFactor":1.025004,"tobaccoFactorByAge":{"21":1.025004,"22":1.025004,"23":1.025004,"24":1.025004,"25":1.024995,"26":1.025013,"27":1.024992,"28":1.024992,"29":1.025012,"30":1.025008,"31":1.024989,"32":1.024997,"33":1.02499,"34":1.025011,"35":1.024998,"36":1.025008,"37":1.024994,"38":1.025005,"39":1.025001,"40":1.099993,"41":1.105003,"42":1.112008,"43":1.120991,"44":1.132003,"45":1.144999,"46":1.15999,"47":1.177004,"48":1.195995,"49":1.217006,"50":1.225006,"51":1.224995,"52":1.224998,"53":1.224997,"54":1.224998,"55":1.225001,"56":1.225001,"57":1.224997,"58":1.224995,"59":1.225003,"60":1.225004,"61":1.225002,"62":1.224996,"63":1.225,"64+":1.225004}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":11600,"fam":23200},"rules":{"pcp":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":2750,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":75,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":600,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":600,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":2750,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":2750,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Diagnostic tests: $75 copay for blood work / lab and $175 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $30 copay for a 90-day mail-order supply.","Tier 2 drugs (preferred brand): $50 copay for a 31-day retail supply ($100 for 60 days, $150 for 90 days); $100 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $250 copay for a 31-day retail supply ($500 for 60 days, $750 for 90 days); $500 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance (retail and mail order).","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,750 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,500 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $550 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $175 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","No medical deductible: copays and coinsurance apply from the first visit."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/WPA/Individual/I_33709PA1640003-06_20270101_SBC.pdf"},{"market":"pennie","id":"33709PA1640005-01","standardId":"33709PA1640005","variant":"standard","issuer":"Highmark Inc.","name":"Together Blue with AHN EPO Gold 0 + Adult Dental and Vision","metal":"Gold","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Erie","Washington","Westmoreland"],"rates":{"1":{"base21":431.19,"tobaccoFactor":1.025001,"tobaccoFactorByAge":{"21":1.025001,"22":1.025001,"23":1.025001,"24":1.025001,"25":1.024994,"26":1.025003,"27":1.025006,"28":1.025005,"29":1.024995,"30":1.02501,"31":1.024992,"32":1.024995,"33":1.024992,"34":1.025007,"35":1.024995,"36":1.025002,"37":1.025009,"38":1.024997,"39":1.024993,"40":1.100007,"41":1.105003,"42":1.112002,"43":1.121001,"44":1.131995,"45":1.144996,"46":1.160006,"47":1.177001,"48":1.196,"49":1.217004,"50":1.224994,"51":1.225002,"52":1.225002,"53":1.225004,"54":1.224997,"55":1.225001,"56":1.224997,"57":1.224998,"58":1.224999,"59":1.225002,"60":1.225003,"61":1.225001,"62":1.224998,"63":1.225003,"64+":1.224997}},"4":{"base21":431.19,"tobaccoFactor":1.025001,"tobaccoFactorByAge":{"21":1.025001,"22":1.025001,"23":1.025001,"24":1.025001,"25":1.024994,"26":1.025003,"27":1.025006,"28":1.025005,"29":1.024995,"30":1.02501,"31":1.024992,"32":1.024995,"33":1.024992,"34":1.025007,"35":1.024995,"36":1.025002,"37":1.025009,"38":1.024997,"39":1.024993,"40":1.100007,"41":1.105003,"42":1.112002,"43":1.121001,"44":1.131995,"45":1.144996,"46":1.160006,"47":1.177001,"48":1.196,"49":1.217004,"50":1.224994,"51":1.225002,"52":1.225002,"53":1.225004,"54":1.224997,"55":1.225001,"56":1.224997,"57":1.224998,"58":1.224999,"59":1.225002,"60":1.225003,"61":1.225001,"62":1.224998,"63":1.225003,"64+":1.224997}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":725,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":725,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Diagnostic tests: $45 copay for blood work / lab and $75 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): no charge (retail and mail order).","Tier 2 drugs (preferred brand): $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $60 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $100 copay for a 31-day retail supply ($200 for 60 days, $300 for 90 days); $200 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $725 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $725 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility. The other days of the stay count toward the deductible until it is met, then cost nothing more.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","Deductible ($1,000): not charged for primary care and specialist visits, lab and x-ray, urgent care, outpatient mental health, rehabilitation therapy, outpatient surgery, all prescription drugs; every other service below is charged after the deductible.","Hospital physician fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/WPA/Individual/I_33709PA1640006-01_20270101_SBC.pdf"},{"market":"pennie","id":"33709PA1640007-01","standardId":"33709PA1640007","variant":"standard","issuer":"Highmark Inc.","name":"Together Blue with AHN EPO Platinum 0 + Adult Dental and Vision","metal":"Platinum","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Erie","Washington","Westmoreland"],"rates":{"1":{"base21":490.72,"tobaccoFactor":1.025004,"tobaccoFactorByAge":{"21":1.025004,"22":1.025004,"23":1.025004,"24":1.025004,"25":1.025006,"26":1.024995,"27":1.025006,"28":1.025009,"29":1.025004,"30":1.024992,"31":1.025003,"32":1.024995,"33":1.025005,"34":1.024995,"35":1.024997,"36":1.025,"37":1.025004,"38":1.025007,"39":1.024996,"40":1.099994,"41":1.105005,"42":1.111996,"43":1.121007,"44":1.131998,"45":1.145004,"46":1.159996,"47":1.177001,"48":1.196004,"49":1.217005,"50":1.225004,"51":1.225002,"52":1.225005,"53":1.224999,"54":1.225,"55":1.225,"56":1.224999,"57":1.224997,"58":1.225001,"59":1.224999,"60":1.225002,"61":1.225002,"62":1.224997,"63":1.225002,"64+":1.225003}},"4":{"base21":490.72,"tobaccoFactor":1.025004,"tobaccoFactorByAge":{"21":1.025004,"22":1.025004,"23":1.025004,"24":1.025004,"25":1.025006,"26":1.024995,"27":1.025006,"28":1.025009,"29":1.025004,"30":1.024992,"31":1.025003,"32":1.024995,"33":1.025005,"34":1.024995,"35":1.024997,"36":1.025,"37":1.025004,"38":1.025007,"39":1.024996,"40":1.099994,"41":1.105005,"42":1.111996,"43":1.121007,"44":1.131998,"45":1.145004,"46":1.159996,"47":1.177001,"48":1.196004,"49":1.217005,"50":1.225004,"51":1.225002,"52":1.225005,"53":1.224999,"54":1.225,"55":1.225,"56":1.224999,"57":1.224997,"58":1.225001,"59":1.224999,"60":1.225002,"61":1.225002,"62":1.224997,"63":1.225002,"64+":1.225003}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":5400,"fam":10800},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":325,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":325,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): no charge (retail and mail order).","Tier 2 drugs (preferred brand): $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $20 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $50 copay for a 31-day retail supply ($100 for 60 days, $150 for 90 days); $100 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $325 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","No medical deductible: copays and coinsurance apply from the first visit."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/WPA/Individual/I_33709PA1640007-01_20270101_SBC.pdf"},{"market":"pennie","id":"33709PA1650001-01","standardId":"33709PA1650001","variant":"standard","issuer":"Highmark Inc.","name":"Together Blue with AHN EPO Gold 1800 HSA","metal":"Gold","network":"EPO","hsaEligible":true,"counties":["Allegheny","Beaver","Butler","Erie","Washington","Westmoreland"],"rates":{"1":{"base21":377.11,"tobaccoFactor":1.025006,"tobaccoFactorByAge":{"21":1.025006,"22":1.025006,"23":1.025006,"24":1.025006,"25":1.025012,"26":1.02499,"27":1.024999,"28":1.025005,"29":1.025001,"30":1.024999,"31":1.025007,"32":1.024993,"33":1.02499,"34":1.02501,"35":1.024998,"36":1.025008,"37":1.024997,"38":1.025006,"39":1.025005,"40":1.10001,"41":1.10501,"42":1.111994,"43":1.120999,"44":1.132,"45":1.145,"46":1.160005,"47":1.177005,"48":1.196004,"49":1.217005,"50":1.224997,"51":1.224993,"52":1.225004,"53":1.224997,"54":1.224995,"55":1.225005,"56":1.225006,"57":1.225001,"58":1.225002,"59":1.224995,"60":1.224997,"61":1.225002,"62":1.224996,"63":1.225003,"64+":1.225001}},"4":{"base21":377.11,"tobaccoFactor":1.025006,"tobaccoFactorByAge":{"21":1.025006,"22":1.025006,"23":1.025006,"24":1.025006,"25":1.025012,"26":1.02499,"27":1.024999,"28":1.025005,"29":1.025001,"30":1.024999,"31":1.025007,"32":1.024993,"33":1.02499,"34":1.02501,"35":1.024998,"36":1.025008,"37":1.024997,"38":1.025006,"39":1.025005,"40":1.10001,"41":1.10501,"42":1.111994,"43":1.120999,"44":1.132,"45":1.145,"46":1.160005,"47":1.177005,"48":1.196004,"49":1.217005,"50":1.224997,"51":1.224993,"52":1.225004,"53":1.224997,"54":1.224995,"55":1.225005,"56":1.225006,"57":1.225001,"58":1.225002,"59":1.224995,"60":1.224997,"61":1.225002,"62":1.224996,"63":1.225003,"64+":1.225001}}},"ded":{"ind":1800,"fam":3600,"embedded":false},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":175,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":15,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":130,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":130,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":450,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":450,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Diagnostic tests: $15 copay for blood work / lab and $15 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): no charge (retail and mail order).","Tier 2 drugs (preferred brand): $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $60 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $150 copay for a 31-day retail supply ($300 for 60 days, $450 for 90 days); $300 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $450 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility. The other days of the stay count toward the deductible until it is met, then cost nothing more.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","Deductible ($1,800): applies to everything except preventive care and children's vision and dental exams, even where the SBC shows a copay or \"No charge\".","Tier 1 drugs, hospital physician fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","Family deductible: the SBC says the overall family deductible must be met before the plan begins to pay (no individual deductible within a family), and the estimate uses the aggregate family deductible."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/WPA/Individual/I_33709PA1650001-01_20270101_SBC.pdf"},{"market":"pennie","id":"33871PA0040002-01","standardId":"33871PA0040002","variant":"standard","issuer":"Keystone Health Plan East","name":"Keystone HMO Gold","metal":"Gold","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":true,"tiers":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":691.79,"tobaccoFactor":1.124995,"tobaccoFactorByAge":{"21":1.124995,"22":1.124995,"23":1.124995,"24":1.124995,"25":1.125,"26":1.125002,"27":1.124993,"28":1.12499,"29":1.125008,"30":1.175004,"31":1.175011,"32":1.175002,"33":1.175008,"34":1.175,"35":1.175,"36":1.175003,"37":1.174992,"38":1.175006,"39":1.174998,"40":1.224995,"41":1.225,"42":1.225001,"43":1.224999,"44":1.225003,"45":1.225009,"46":1.22499,"47":1.224995,"48":1.224997,"49":1.225006,"50":1.374994,"51":1.374999,"52":1.375001,"53":1.375001,"54":1.375004,"55":1.375001,"56":1.374999,"57":1.375001,"58":1.375003,"59":1.374998,"60":1.375,"61":1.374998,"62":1.375002,"63":1.375005,"64+":1.374998}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":8000,"fam":16000},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":200}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":750,"ded":"no_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":65,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"copay","amount":750,"ded":"no_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded"}}},"notes":["Prenatal care: the SBC says the office-visit cost share applies to the first OB visit only, so it is charged once here and later prenatal visits are no charge (they are part of the delivery fee); other copays or coinsurance may apply to other services such as ultrasounds.","Outpatient surgery facility fee: $300 copay per visit at freestanding facilities (used here); $700 copay per visit at hospital-based facilities.","Non-preferred brand drugs: 50% coinsurance is capped at $200 per 30-day retail fill (the cap is modelled here).","Specialty drugs: 50% coinsurance is capped at $1,000 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill; 31-90 day mail-order fills cost more per fill.","Mental health: office visits $65 copay per visit (used here); other outpatient services $65 copay per visit.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); visits above the limit are not covered. The limit does not apply to therapy prescribed for mental health or substance use treatment.","Telemedicine visits with the designated telemedicine provider are free."],"sbcUrl":"https://www.ibx.com/pdfs/custom/ffm/2027/hmogold2027.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":588.86,"tobaccoFactor":1.125004,"tobaccoFactorByAge":{"21":1.125004,"22":1.125004,"23":1.125004,"24":1.125004,"25":1.124996,"26":1.12501,"27":1.124998,"28":1.124998,"29":1.125006,"30":1.174996,"31":1.174992,"32":1.175002,"33":1.175009,"34":1.174994,"35":1.174989,"36":1.174997,"37":1.175004,"38":1.174999,"39":1.175001,"40":1.225005,"41":1.22499,"42":1.224995,"43":1.225009,"44":1.224995,"45":1.225,"46":1.225,"47":1.225002,"48":1.224992,"49":1.224995,"50":1.375002,"51":1.375007,"52":1.375005,"53":1.375003,"54":1.374994,"55":1.374996,"56":1.375001,"57":1.375004,"58":1.374995,"59":1.375,"60":1.374998,"61":1.374998,"62":1.375005,"63":1.375002,"64+":1.375001}}}}},{"market":"pennie","id":"33871PA0040005-01","standardId":"33871PA0040005","variant":"standard","issuer":"Keystone Health Plan East","name":"Keystone HMO Gold Proactive","metal":"Gold","network":"HMO","hsaEligible":false,"networkId":"PAN005","referral":true,"tiers":true,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":630.46,"tobaccoFactor":1.125004,"tobaccoFactorByAge":{"21":1.125004,"22":1.125004,"23":1.125004,"24":1.125004,"25":1.124996,"26":1.125002,"27":1.125,"28":1.124995,"29":1.125007,"30":1.175007,"31":1.17501,"32":1.175013,"33":1.175006,"34":1.174998,"35":1.175008,"36":1.174991,"37":1.175001,"38":1.174998,"39":1.175004,"40":1.225001,"41":1.224996,"42":1.225005,"43":1.225007,"44":1.225001,"45":1.225005,"46":1.225,"47":1.225003,"48":1.225,"49":1.225008,"50":1.375,"51":1.375001,"52":1.374994,"53":1.374998,"54":1.374999,"55":1.374997,"56":1.375005,"57":1.374999,"58":1.375004,"59":1.375001,"60":1.374999,"61":1.375002,"62":1.374999,"63":1.375,"64+":1.375001}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":10500,"fam":21000},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":300}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"no_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":40,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"copay","amount":350,"ded":"no_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Prenatal care: the SBC says the office-visit cost share applies to the first OB visit only, so it is charged once here and later prenatal visits are no charge (they are part of the delivery fee); other copays or coinsurance may apply to other services such as ultrasounds.","Non-preferred brand drugs: 50% coinsurance is capped at $300 per 30-day retail fill (the cap is modelled here).","Specialty drugs: 50% coinsurance is capped at $1,000 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill; 31-90 day mail-order fills cost more per fill.","Mental health: office visits $40 copay per visit (used here); other outpatient services $40 copay per visit.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); visits above the limit are not covered. The limit does not apply to therapy prescribed for mental health or substance use treatment.","Telemedicine visits with the designated telemedicine provider are free.","This plan has three provider tiers. The rules use Tier 1 (Preferred), the tier the deductible ($0 individual / $0 family) and out-of-pocket limit describe. Tier 2 (Enhanced) and Tier 3 (Standard) providers have higher cost sharing (no deductible in any tier).","Primary care: Tier 1 $15 copay per visit (used here); Tier 2 $30 copay per visit; Tier 3 $45 copay per visit.","Specialist: Tier 1 $40 copay per visit (used here); Tier 2 $60 copay per visit; Tier 3 $80 copay per visit.","Emergency room: Tier 1 $400 copay per visit (used here); Tier 2 $400 copay per visit; Tier 3 $400 copay per visit.","Hospital stay facility fee: Tier 1 $350 copay per day (up to 5 days per admission) (used here); Tier 2 $700 copay per day (up to 5 days per admission); Tier 3 $1,100 copay per day (up to 5 days per admission).","Outpatient surgery facility fee: Tier 1 $150 copay per visit (used here); Tier 2 $550 copay per visit; Tier 3 $1,000 copay per visit."],"sbcUrl":"https://www.ibx.com/pdfs/custom/ffm/2027/hmogoldproactive-indiv-2027.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":538.75,"tobaccoFactor":1.124993,"tobaccoFactorByAge":{"21":1.124993,"22":1.124993,"23":1.124993,"24":1.124993,"25":1.124993,"26":1.125,"27":1.125007,"28":1.124996,"29":1.125004,"30":1.175002,"31":1.174997,"32":1.175009,"33":1.175002,"34":1.175005,"35":1.174998,"36":1.175007,"37":1.175,"38":1.175009,"39":1.175011,"40":1.225004,"41":1.225005,"42":1.225008,"43":1.22501,"44":1.225011,"45":1.224986,"46":1.224989,"47":1.224993,"48":1.224996,"49":1.225,"50":1.375001,"51":1.375001,"52":1.375005,"53":1.374997,"54":1.375003,"55":1.375001,"56":1.375002,"57":1.375001,"58":1.374995,"59":1.374994,"60":1.374997,"61":1.375001,"62":1.374996,"63":1.375002,"64+":1.374998}}}}},{"market":"pennie","id":"33871PA0040006-01","standardId":"33871PA0040006","variant":"standard","issuer":"Keystone Health Plan East","name":"Keystone HMO Silver Proactive","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN005","referral":true,"tiers":true,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":534.9,"tobaccoFactor":1.124995,"tobaccoFactorByAge":{"21":1.124995,"22":1.124995,"23":1.124995,"24":1.124995,"25":1.125,"26":1.124986,"27":1.124996,"28":1.125,"29":1.125002,"30":1.175009,"31":1.174998,"32":1.174987,"33":1.174997,"34":1.175,"35":1.175002,"36":1.174988,"37":1.17499,"38":1.174991,"39":1.175012,"40":1.225,"41":1.225001,"42":1.225005,"43":1.225002,"44":1.224995,"45":1.224987,"46":1.225002,"47":1.224999,"48":1.225005,"49":1.224998,"50":1.375001,"51":1.374994,"52":1.375005,"53":1.374991,"54":1.375005,"55":1.374999,"56":1.375,"57":1.374999,"58":1.374994,"59":1.375002,"60":1.374997,"61":1.374999,"62":1.375001,"63":1.375005,"64+":1.374998}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":{"ind":225,"fam":450,"embedded":true},"oop":{"ind":10500,"fam":21000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":950,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":375,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":90,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":600,"ded":"no_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":90,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"copay","amount":600,"ded":"no_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Prenatal care: the SBC says the office-visit cost share applies to the first OB visit only, so it is charged once here and later prenatal visits are no charge (they are part of the delivery fee); other copays or coinsurance may apply to other services such as ultrasounds.","Non-preferred brand drugs: 50% coinsurance is capped at $500 per 30-day retail fill (the cap is modelled here).","Specialty drugs: 50% coinsurance is capped at $1,000 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill; 31-90 day mail-order fills cost more per fill.","Mental health: office visits $90 copay per visit (used here); other outpatient services $90 copay per visit.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); visits above the limit are not covered. The limit does not apply to therapy prescribed for mental health or substance use treatment.","Telemedicine visits with the designated telemedicine provider are free.","This plan has three provider tiers. The rules use Tier 1 (Preferred), the tier the deductible ($0 individual / $0 family) and out-of-pocket limit describe. Tier 2 (Enhanced) and Tier 3 (Standard) providers have a higher deductible ($6,000 individual / $12,000 family) and higher cost sharing.","Primary care: Tier 1 $40 copay per visit (used here); Tier 2 $70 copay per visit; Tier 3 $80 copay per visit.","Specialist: Tier 1 $90 copay per visit (used here); Tier 2 $140 copay per visit; Tier 3 $150 copay per visit.","Emergency room: Tier 1 $950 copay per visit (used here); Tier 2 $950 copay per visit; Tier 3 $950 copay per visit.","Hospital stay facility fee: Tier 1 $600 copay per day (up to 5 days per admission) (used here); Tier 2 $900 copay per day (up to 5 days per admission) after the deductible; Tier 3 $1,300 copay per day (up to 5 days per admission) after the deductible.","Outpatient surgery facility fee: Tier 1 $350 copay per visit (used here); Tier 2 $950 copay per visit after the deductible; Tier 3 $1,500 copay per visit after the deductible.","Separate prescription drug deductible ($225 individual / $450 family) applies to preferred brand, non-preferred brand, specialty drugs; the other drug tiers say the deductible does not apply. The SBC diabetes example shows a $200 deductible, which fits the drug deductible rather than the medical one."],"sbcUrl":"https://www.ibx.com/pdfs/custom/ffm/2027/hmosilverproactive-indiv-2027.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":460.13,"tobaccoFactor":1.125008,"tobaccoFactorByAge":{"21":1.125008,"22":1.125008,"23":1.125008,"24":1.125008,"25":1.125008,"26":1.125008,"27":1.124984,"28":1.125,"29":1.124998,"30":1.174993,"31":1.175008,"32":1.175004,"33":1.174987,"34":1.174991,"35":1.175002,"36":1.174995,"37":1.175005,"38":1.174998,"39":1.175002,"40":1.224998,"41":1.224991,"42":1.225007,"43":1.225,"44":1.225,"45":1.22499,"46":1.224993,"47":1.225006,"48":1.225,"49":1.224999,"50":1.374998,"51":1.375009,"52":1.375007,"53":1.374988,"54":1.374997,"55":1.374996,"56":1.375005,"57":1.374998,"58":1.375005,"59":1.374996,"60":1.375003,"61":1.374997,"62":1.375007,"63":1.375006,"64+":1.375003}}}}},{"market":"pennie","id":"33871PA0040006-04","standardId":"33871PA0040006","variant":"csr73","issuer":"Keystone Health Plan East","name":"Keystone HMO Silver Proactive","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN005","referral":true,"tiers":true,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":534.9,"tobaccoFactor":1.124995,"tobaccoFactorByAge":{"21":1.124995,"22":1.124995,"23":1.124995,"24":1.124995,"25":1.125,"26":1.124986,"27":1.124996,"28":1.125,"29":1.125002,"30":1.175009,"31":1.174998,"32":1.174987,"33":1.174997,"34":1.175,"35":1.175002,"36":1.174988,"37":1.17499,"38":1.174991,"39":1.175012,"40":1.225,"41":1.225001,"42":1.225005,"43":1.225002,"44":1.224995,"45":1.224987,"46":1.225002,"47":1.224999,"48":1.225005,"49":1.224998,"50":1.375001,"51":1.374994,"52":1.375005,"53":1.374991,"54":1.375005,"55":1.374999,"56":1.375,"57":1.374999,"58":1.374994,"59":1.375002,"60":1.374997,"61":1.374999,"62":1.375001,"63":1.375005,"64+":1.374998}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":{"ind":225,"fam":450,"embedded":true},"oop":{"ind":8400,"fam":16800},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":950,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":375,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":90,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":600,"ded":"no_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":90,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"copay","amount":600,"ded":"no_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Independence publishes no SBC for this reduced cost-sharing version; its cost sharing comes from Independence's 2027 plan overview brochure, page 52, checked against the PA Insurance Department filing (pages 85, 87, 90, 94, 96).","Mental health: office visits $90 copay (used here); all other outpatient services $90 copay.","Low-cost generic drugs: $7, no ded per 30-day retail fill; other generics as shown (retail generic, used here).","Non-preferred brand drugs: the coinsurance is capped at $500 per 30-day retail fill (the cap is modelled here).","Specialty drugs: the coinsurance is capped at $1,000 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill.","Separate prescription drug deductible ($225 individual / $450 family): drug cells marked \"after ded\" are after this deductible.","Physical and occupational therapy: limited to 30 visits a year; visits above the limit are not covered.","Hospital stay: the copay is charged per day, up to five copays per admission (brochure footnote 7).","Virtual care from the designated virtual provider (Teladoc Health) is free.","This plan has three provider tiers. The rules use Tier 1 (Preferred), the tier the deductible ($0 individual / $0 family) and out-of-pocket limit describe. Tier 2 (Enhanced) and Tier 3 (Standard) providers have a $3,500 individual / $7,000 family deductible and higher cost sharing (each rule's text gives all three tiers).","Independence's brochure gives no outpatient surgeon fee for this version; the standard version's SBC figure (copay 5 no_ded) is used, an upper bound — this version may cost less. Its text and page are those of the standard version's SBC (https://www.ibx.com/pdfs/custom/ffm/2027/hmosilverproactive-indiv-2027.pdf, page 3).","Prenatal care: the brochure has no prenatal row. The first OB visit is charged at this version's specialist cost share and later prenatal visits are no charge (part of the delivery fee): every Independence standard SBC prices prenatal care this way.","The deductible and out-of-pocket limit are the brochure's; no CMS plan file for 2027 exists yet to compare them with (the out-of-pocket limit is within the federal limit for this version)."],"sbcUrl":"https://www.ibx.com/pdfs/find-a-plan/individuals/2027-plan-overview-brochure.pdf#page=52","prev":{"planYear":2026,"rates":{"8":{"base21":460.13,"tobaccoFactor":1.125008,"tobaccoFactorByAge":{"21":1.125008,"22":1.125008,"23":1.125008,"24":1.125008,"25":1.125008,"26":1.125008,"27":1.124984,"28":1.125,"29":1.124998,"30":1.174993,"31":1.175008,"32":1.175004,"33":1.174987,"34":1.174991,"35":1.175002,"36":1.174995,"37":1.175005,"38":1.174998,"39":1.175002,"40":1.224998,"41":1.224991,"42":1.225007,"43":1.225,"44":1.225,"45":1.22499,"46":1.224993,"47":1.225006,"48":1.225,"49":1.224999,"50":1.374998,"51":1.375009,"52":1.375007,"53":1.374988,"54":1.374997,"55":1.374996,"56":1.375005,"57":1.374998,"58":1.375005,"59":1.374996,"60":1.375003,"61":1.374997,"62":1.375007,"63":1.375006,"64+":1.375003}}}}},{"market":"pennie","id":"33871PA0040006-05","standardId":"33871PA0040006","variant":"csr87","issuer":"Keystone Health Plan East","name":"Keystone HMO Silver Proactive","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN005","referral":true,"tiers":true,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":534.9,"tobaccoFactor":1.124995,"tobaccoFactorByAge":{"21":1.124995,"22":1.124995,"23":1.124995,"24":1.124995,"25":1.125,"26":1.124986,"27":1.124996,"28":1.125,"29":1.125002,"30":1.175009,"31":1.174998,"32":1.174987,"33":1.174997,"34":1.175,"35":1.175002,"36":1.174988,"37":1.17499,"38":1.174991,"39":1.175012,"40":1.225,"41":1.225001,"42":1.225005,"43":1.225002,"44":1.224995,"45":1.224987,"46":1.225002,"47":1.224999,"48":1.225005,"49":1.224998,"50":1.375001,"51":1.374994,"52":1.375005,"53":1.374991,"54":1.375005,"55":1.374999,"56":1.375,"57":1.374999,"58":1.374994,"59":1.375002,"60":1.374997,"61":1.374999,"62":1.375001,"63":1.375005,"64+":1.374998}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":4000,"fam":8000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":400}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"no_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":40,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"copay","amount":200,"ded":"no_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Independence publishes no SBC for this reduced cost-sharing version; its cost sharing comes from Independence's 2027 plan overview brochure, page 59, checked against the PA Insurance Department filing (pages 85, 87, 92, 94, 96).","Mental health: office visits $40 copay (used here); all other outpatient services $40 copay.","Low-cost generic drugs: $3 per 30-day retail fill; other generics as shown (retail generic, used here).","Non-preferred brand drugs: the coinsurance is capped at $400 per 30-day retail fill (the cap is modelled here).","Specialty drugs: the coinsurance is capped at $500 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill.","Physical and occupational therapy: limited to 30 visits a year; visits above the limit are not covered.","Hospital stay: the copay is charged per day, up to five copays per admission (brochure footnote 7).","Virtual care from the designated virtual provider (Teladoc Health) is free.","This plan has three provider tiers. The rules use Tier 1 (Preferred), the tier the deductible ($0 individual / $0 family) and out-of-pocket limit describe. Tier 2 (Enhanced) and Tier 3 (Standard) providers have a $1,750 individual / $3,500 family deductible and higher cost sharing (each rule's text gives all three tiers).","Independence's brochure gives no outpatient surgeon fee for this version; the standard version's SBC figure (copay 5 no_ded) is used, an upper bound — this version may cost less. Its text and page are those of the standard version's SBC (https://www.ibx.com/pdfs/custom/ffm/2027/hmosilverproactive-indiv-2027.pdf, page 3).","Prenatal care: the brochure has no prenatal row. The first OB visit is charged at this version's specialist cost share and later prenatal visits are no charge (part of the delivery fee): every Independence standard SBC prices prenatal care this way.","The deductible and out-of-pocket limit are the brochure's; no CMS plan file for 2027 exists yet to compare them with (the out-of-pocket limit is within the federal limit for this version)."],"sbcUrl":"https://www.ibx.com/pdfs/find-a-plan/individuals/2027-plan-overview-brochure.pdf#page=59","prev":{"planYear":2026,"rates":{"8":{"base21":460.13,"tobaccoFactor":1.125008,"tobaccoFactorByAge":{"21":1.125008,"22":1.125008,"23":1.125008,"24":1.125008,"25":1.125008,"26":1.125008,"27":1.124984,"28":1.125,"29":1.124998,"30":1.174993,"31":1.175008,"32":1.175004,"33":1.174987,"34":1.174991,"35":1.175002,"36":1.174995,"37":1.175005,"38":1.174998,"39":1.175002,"40":1.224998,"41":1.224991,"42":1.225007,"43":1.225,"44":1.225,"45":1.22499,"46":1.224993,"47":1.225006,"48":1.225,"49":1.224999,"50":1.374998,"51":1.375009,"52":1.375007,"53":1.374988,"54":1.374997,"55":1.374996,"56":1.375005,"57":1.374998,"58":1.375005,"59":1.374996,"60":1.375003,"61":1.374997,"62":1.375007,"63":1.375006,"64+":1.375003}}}}},{"market":"pennie","id":"33871PA0040006-06","standardId":"33871PA0040006","variant":"csr94","issuer":"Keystone Health Plan East","name":"Keystone HMO Silver Proactive","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN005","referral":true,"tiers":true,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":534.9,"tobaccoFactor":1.124995,"tobaccoFactorByAge":{"21":1.124995,"22":1.124995,"23":1.124995,"24":1.124995,"25":1.125,"26":1.124986,"27":1.124996,"28":1.125,"29":1.125002,"30":1.175009,"31":1.174998,"32":1.174987,"33":1.174997,"34":1.175,"35":1.175002,"36":1.174988,"37":1.17499,"38":1.174991,"39":1.175012,"40":1.225,"41":1.225001,"42":1.225005,"43":1.225002,"44":1.224995,"45":1.224987,"46":1.225002,"47":1.224999,"48":1.225005,"49":1.224998,"50":1.375001,"51":1.374994,"52":1.375005,"53":1.374991,"54":1.375005,"55":1.374999,"56":1.375,"57":1.374999,"58":1.374994,"59":1.375002,"60":1.374997,"61":1.374999,"62":1.375001,"63":1.375005,"64+":1.374998}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":3500,"fam":7000},"rules":{"pcp":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":15,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":4,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.05,"ded":"no_ded","max":400}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":15,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Independence publishes no SBC for this reduced cost-sharing version; its cost sharing comes from Independence's 2027 plan overview brochure, page 66, checked against the PA Insurance Department filing (pages 85, 87, 92, 94, 96).","Mental health: office visits $15 copay (used here); all other outpatient services $15 copay.","Low-cost generic drugs: $1 per 30-day retail fill; other generics as shown (retail generic, used here).","Non-preferred brand drugs: the coinsurance is capped at $400 per 30-day retail fill (the cap is modelled here).","Specialty drugs: the coinsurance is capped at $500 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill.","Physical and occupational therapy: limited to 30 visits a year; visits above the limit are not covered.","Hospital stay: the copay is charged per day, up to five copays per admission (brochure footnote 7).","Virtual care from the designated virtual provider (Teladoc Health) is free.","This plan has three provider tiers. The rules use Tier 1 (Preferred), the tier the deductible ($0 individual / $0 family) and out-of-pocket limit describe. Tier 2 (Enhanced) and Tier 3 (Standard) providers have a $200 individual / $400 family deductible and higher cost sharing (each rule's text gives all three tiers).","Independence's brochure gives no outpatient surgeon fee for this version; the standard version's SBC figure (copay 5 no_ded) is used, an upper bound — this version may cost less. Its text and page are those of the standard version's SBC (https://www.ibx.com/pdfs/custom/ffm/2027/hmosilverproactive-indiv-2027.pdf, page 3).","Prenatal care: the brochure has no prenatal row. The first OB visit is charged at this version's specialist cost share and later prenatal visits are no charge (part of the delivery fee): every Independence standard SBC prices prenatal care this way.","The deductible and out-of-pocket limit are the brochure's; no CMS plan file for 2027 exists yet to compare them with (the out-of-pocket limit is within the federal limit for this version)."],"sbcUrl":"https://www.ibx.com/pdfs/find-a-plan/individuals/2027-plan-overview-brochure.pdf#page=66","prev":{"planYear":2026,"rates":{"8":{"base21":460.13,"tobaccoFactor":1.125008,"tobaccoFactorByAge":{"21":1.125008,"22":1.125008,"23":1.125008,"24":1.125008,"25":1.125008,"26":1.125008,"27":1.124984,"28":1.125,"29":1.124998,"30":1.174993,"31":1.175008,"32":1.175004,"33":1.174987,"34":1.174991,"35":1.175002,"36":1.174995,"37":1.175005,"38":1.174998,"39":1.175002,"40":1.224998,"41":1.224991,"42":1.225007,"43":1.225,"44":1.225,"45":1.22499,"46":1.224993,"47":1.225006,"48":1.225,"49":1.224999,"50":1.374998,"51":1.375009,"52":1.375007,"53":1.374988,"54":1.374997,"55":1.374996,"56":1.375005,"57":1.374998,"58":1.375005,"59":1.374996,"60":1.375003,"61":1.374997,"62":1.375007,"63":1.375006,"64+":1.375003}}}}},{"market":"pennie","id":"33871PA0040010-01","standardId":"33871PA0040010","variant":"standard","issuer":"Keystone Health Plan East","name":"Keystone HMO Silver Proactive Lite","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN005","referral":true,"tiers":true,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":527.59,"tobaccoFactor":1.125002,"tobaccoFactorByAge":{"21":1.125002,"22":1.125002,"23":1.125002,"24":1.125002,"25":1.124995,"26":1.124998,"27":1.125011,"28":1.125007,"29":1.125006,"30":1.175014,"31":1.175002,"32":1.174993,"33":1.175002,"34":1.175007,"35":1.175009,"36":1.174993,"37":1.174995,"38":1.174998,"39":1.175002,"40":1.225002,"41":1.225004,"42":1.224988,"43":1.225005,"44":1.225008,"45":1.224995,"46":1.224997,"47":1.225001,"48":1.225003,"49":1.224994,"50":1.374995,"51":1.374995,"52":1.374993,"53":1.375005,"54":1.375009,"55":1.374993,"56":1.374995,"57":1.374998,"58":1.374998,"59":1.374996,"60":1.374997,"61":1.375001,"62":1.374998,"63":1.374998,"64+":1.375001}}},"ded":{"ind":2000,"fam":4000,"embedded":true},"drugDed":{"ind":225,"fam":450,"embedded":true},"oop":{"ind":10500,"fam":21000},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":950,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":90,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":90,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":5,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":600,"ded":"after_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":90,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"copay","amount":600,"ded":"after_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prenatal care: the SBC says the office-visit cost share applies to the first OB visit only, so it is charged once here and later prenatal visits are no charge (they are part of the delivery fee); other copays or coinsurance may apply to other services such as ultrasounds.","Non-preferred brand drugs: 50% coinsurance is capped at $500 per 30-day retail fill (the cap is modelled here).","Specialty drugs: 50% coinsurance is capped at $1,000 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill; 31-90 day mail-order fills cost more per fill.","Mental health: office visits $90 copay per visit (used here); other outpatient services $90 copay per visit.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); visits above the limit are not covered. The limit does not apply to therapy prescribed for mental health or substance use treatment.","Telemedicine visits with the designated telemedicine provider are free.","This plan has three provider tiers. The rules use Tier 1 (Preferred), the tier the deductible ($2,000 individual / $4,000 family) and out-of-pocket limit describe. Tier 2 (Enhanced) and Tier 3 (Standard) providers have a higher deductible ($6,500 individual / $13,000 family) and higher cost sharing.","Primary care: Tier 1 $50 copay per visit (used here); Tier 2 $60 copay per visit; Tier 3 $70 copay per visit.","Specialist: Tier 1 $90 copay per visit (used here); Tier 2 $120 copay per visit; Tier 3 $140 copay per visit.","Emergency room: Tier 1 $950 copay per visit (used here); Tier 2 $950 copay per visit; Tier 3 $950 copay per visit.","Hospital stay facility fee: Tier 1 $600 copay per day (up to 5 days per admission) after the deductible (used here); Tier 2 $900 copay per day (up to 5 days per admission) after the deductible; Tier 3 $1,300 copay per day (up to 5 days per admission) after the deductible.","Outpatient surgery facility fee: Tier 1 $350 copay per visit after the deductible (used here); Tier 2 $950 copay per visit after the deductible; Tier 3 $1,500 copay per visit after the deductible.","Separate prescription drug deductible ($225 individual / $450 family) applies to preferred brand, non-preferred brand, specialty drugs; the other drug tiers say the deductible does not apply. The SBC diabetes example shows a $200 deductible, which fits the drug deductible rather than the medical one.","The SBC lists \"No charge\" for some services without saying whether the deductible applies. It is read as no charge after the deductible: the grid's banner says costs shown are after the deductible, and this plan's benefit chart in IBX's 2027 plan overview brochure lists these services as \"0% after ded\"."],"sbcUrl":"https://www.ibx.com/pdfs/custom/ffm/2027/hmosilverproactivelite-2027.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":455.17,"tobaccoFactor":1.125008,"tobaccoFactorByAge":{"21":1.125008,"22":1.125008,"23":1.125008,"24":1.125008,"25":1.124992,"26":1.125019,"27":1.125005,"28":1.125008,"29":1.124985,"30":1.175003,"31":1.175001,"32":1.174996,"33":1.175008,"34":1.174997,"35":1.175003,"36":1.17499,"37":1.174996,"38":1.175001,"39":1.175011,"40":1.224992,"41":1.224997,"42":1.225004,"43":1.224991,"44":1.224999,"45":1.224991,"46":1.224984,"47":1.224998,"48":1.225007,"49":1.225004,"50":1.375002,"51":1.375007,"52":1.375007,"53":1.374993,"54":1.374999,"55":1.375004,"56":1.375004,"57":1.375001,"58":1.375005,"59":1.374997,"60":1.375001,"61":1.374995,"62":1.375002,"63":1.375006,"64+":1.375003}}}}},{"market":"pennie","id":"33871PA0040010-04","standardId":"33871PA0040010","variant":"csr73","issuer":"Keystone Health Plan East","name":"Keystone HMO Silver Proactive Lite","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN005","referral":true,"tiers":true,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":527.59,"tobaccoFactor":1.125002,"tobaccoFactorByAge":{"21":1.125002,"22":1.125002,"23":1.125002,"24":1.125002,"25":1.124995,"26":1.124998,"27":1.125011,"28":1.125007,"29":1.125006,"30":1.175014,"31":1.175002,"32":1.174993,"33":1.175002,"34":1.175007,"35":1.175009,"36":1.174993,"37":1.174995,"38":1.174998,"39":1.175002,"40":1.225002,"41":1.225004,"42":1.224988,"43":1.225005,"44":1.225008,"45":1.224995,"46":1.224997,"47":1.225001,"48":1.225003,"49":1.224994,"50":1.374995,"51":1.374995,"52":1.374993,"53":1.375005,"54":1.375009,"55":1.374993,"56":1.374995,"57":1.374998,"58":1.374998,"59":1.374996,"60":1.374997,"61":1.375001,"62":1.374998,"63":1.374998,"64+":1.375001}}},"ded":{"ind":2000,"fam":4000,"embedded":true},"drugDed":{"ind":225,"fam":450,"embedded":true},"oop":{"ind":8400,"fam":16800},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":950,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":90,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":90,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":5,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":600,"ded":"after_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":90,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"copay","amount":600,"ded":"after_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Independence publishes no SBC for this reduced cost-sharing version; its cost sharing comes from Independence's 2027 plan overview brochure, page 53, checked against the PA Insurance Department filing (pages 85, 87, 90, 94, 96).","Mental health: office visits $90 copay (used here); all other outpatient services $90 copay.","Low-cost generic drugs: $5, no ded per 30-day retail fill; other generics as shown (retail generic, used here).","Non-preferred brand drugs: the coinsurance is capped at $500 per 30-day retail fill (the cap is modelled here).","Specialty drugs: the coinsurance is capped at $1,000 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill.","Separate prescription drug deductible ($225 individual / $450 family): drug cells marked \"after ded\" are after this deductible.","Physical and occupational therapy: limited to 30 visits a year; visits above the limit are not covered.","Hospital stay: the copay is charged per day, up to five copays per admission (brochure footnote 7).","Virtual care from the designated virtual provider (Teladoc Health) is free.","This plan has three provider tiers. The rules use Tier 1 (Preferred), the tier the deductible ($2,000 individual / $4,000 family) and out-of-pocket limit describe. Tier 2 (Enhanced) and Tier 3 (Standard) providers have a $6,500 individual / $13,000 family deductible and higher cost sharing (each rule's text gives all three tiers).","Independence's brochure gives no outpatient surgeon fee for this version; the standard version's SBC figure (copay 5 after_ded) is used, an upper bound — this version may cost less. Its text and page are those of the standard version's SBC (https://www.ibx.com/pdfs/custom/ffm/2027/hmosilverproactivelite-2027.pdf, page 3).","Prenatal care: the brochure has no prenatal row. The first OB visit is charged at this version's specialist cost share and later prenatal visits are no charge (part of the delivery fee): every Independence standard SBC prices prenatal care this way.","The deductible and out-of-pocket limit are the brochure's; no CMS plan file for 2027 exists yet to compare them with (the out-of-pocket limit is within the federal limit for this version)."],"sbcUrl":"https://www.ibx.com/pdfs/find-a-plan/individuals/2027-plan-overview-brochure.pdf#page=53","prev":{"planYear":2026,"rates":{"8":{"base21":455.17,"tobaccoFactor":1.125008,"tobaccoFactorByAge":{"21":1.125008,"22":1.125008,"23":1.125008,"24":1.125008,"25":1.124992,"26":1.125019,"27":1.125005,"28":1.125008,"29":1.124985,"30":1.175003,"31":1.175001,"32":1.174996,"33":1.175008,"34":1.174997,"35":1.175003,"36":1.17499,"37":1.174996,"38":1.175001,"39":1.175011,"40":1.224992,"41":1.224997,"42":1.225004,"43":1.224991,"44":1.224999,"45":1.224991,"46":1.224984,"47":1.224998,"48":1.225007,"49":1.225004,"50":1.375002,"51":1.375007,"52":1.375007,"53":1.374993,"54":1.374999,"55":1.375004,"56":1.375004,"57":1.375001,"58":1.375005,"59":1.374997,"60":1.375001,"61":1.374995,"62":1.375002,"63":1.375006,"64+":1.375003}}}}},{"market":"pennie","id":"33871PA0040010-05","standardId":"33871PA0040010","variant":"csr87","issuer":"Keystone Health Plan East","name":"Keystone HMO Silver Proactive Lite","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN005","referral":true,"tiers":true,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":527.59,"tobaccoFactor":1.125002,"tobaccoFactorByAge":{"21":1.125002,"22":1.125002,"23":1.125002,"24":1.125002,"25":1.124995,"26":1.124998,"27":1.125011,"28":1.125007,"29":1.125006,"30":1.175014,"31":1.175002,"32":1.174993,"33":1.175002,"34":1.175007,"35":1.175009,"36":1.174993,"37":1.174995,"38":1.174998,"39":1.175002,"40":1.225002,"41":1.225004,"42":1.224988,"43":1.225005,"44":1.225008,"45":1.224995,"46":1.224997,"47":1.225001,"48":1.225003,"49":1.224994,"50":1.374995,"51":1.374995,"52":1.374993,"53":1.375005,"54":1.375009,"55":1.374993,"56":1.374995,"57":1.374998,"58":1.374998,"59":1.374996,"60":1.374997,"61":1.375001,"62":1.374998,"63":1.374998,"64+":1.375001}}},"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":4000,"fam":8000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":400}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":5,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":300,"ded":"after_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":40,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"copay","amount":300,"ded":"after_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Independence publishes no SBC for this reduced cost-sharing version; its cost sharing comes from Independence's 2027 plan overview brochure, page 60, checked against the PA Insurance Department filing (pages 86, 88, 92, 94, 96).","Mental health: office visits $40 copay (used here); all other outpatient services $40 copay.","Low-cost generic drugs: $3 per 30-day retail fill; other generics as shown (retail generic, used here).","Non-preferred brand drugs: the coinsurance is capped at $400 per 30-day retail fill (the cap is modelled here).","Specialty drugs: the coinsurance is capped at $500 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill.","Physical and occupational therapy: limited to 30 visits a year; visits above the limit are not covered.","Hospital stay: the copay is charged per day, up to five copays per admission (brochure footnote 7).","Virtual care from the designated virtual provider (Teladoc Health) is free.","This plan has three provider tiers. The rules use Tier 1 (Preferred), the tier the deductible ($1,000 individual / $2,000 family) and out-of-pocket limit describe. Tier 2 (Enhanced) and Tier 3 (Standard) providers have a $2,000 individual / $4,000 family deductible and higher cost sharing (each rule's text gives all three tiers).","Independence's brochure gives no outpatient surgeon fee for this version; the standard version's SBC figure (copay 5 after_ded) is used, an upper bound — this version may cost less. Its text and page are those of the standard version's SBC (https://www.ibx.com/pdfs/custom/ffm/2027/hmosilverproactivelite-2027.pdf, page 3).","Prenatal care: the brochure has no prenatal row. The first OB visit is charged at this version's specialist cost share and later prenatal visits are no charge (part of the delivery fee): every Independence standard SBC prices prenatal care this way.","The deductible and out-of-pocket limit are the brochure's; no CMS plan file for 2027 exists yet to compare them with (the out-of-pocket limit is within the federal limit for this version)."],"sbcUrl":"https://www.ibx.com/pdfs/find-a-plan/individuals/2027-plan-overview-brochure.pdf#page=60","prev":{"planYear":2026,"rates":{"8":{"base21":455.17,"tobaccoFactor":1.125008,"tobaccoFactorByAge":{"21":1.125008,"22":1.125008,"23":1.125008,"24":1.125008,"25":1.124992,"26":1.125019,"27":1.125005,"28":1.125008,"29":1.124985,"30":1.175003,"31":1.175001,"32":1.174996,"33":1.175008,"34":1.174997,"35":1.175003,"36":1.17499,"37":1.174996,"38":1.175001,"39":1.175011,"40":1.224992,"41":1.224997,"42":1.225004,"43":1.224991,"44":1.224999,"45":1.224991,"46":1.224984,"47":1.224998,"48":1.225007,"49":1.225004,"50":1.375002,"51":1.375007,"52":1.375007,"53":1.374993,"54":1.374999,"55":1.375004,"56":1.375004,"57":1.375001,"58":1.375005,"59":1.374997,"60":1.375001,"61":1.374995,"62":1.375002,"63":1.375006,"64+":1.375003}}}}},{"market":"pennie","id":"33871PA0040010-06","standardId":"33871PA0040010","variant":"csr94","issuer":"Keystone Health Plan East","name":"Keystone HMO Silver Proactive Lite","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN005","referral":true,"tiers":true,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":527.59,"tobaccoFactor":1.125002,"tobaccoFactorByAge":{"21":1.125002,"22":1.125002,"23":1.125002,"24":1.125002,"25":1.124995,"26":1.124998,"27":1.125011,"28":1.125007,"29":1.125006,"30":1.175014,"31":1.175002,"32":1.174993,"33":1.175002,"34":1.175007,"35":1.175009,"36":1.174993,"37":1.174995,"38":1.174998,"39":1.175002,"40":1.225002,"41":1.225004,"42":1.224988,"43":1.225005,"44":1.225008,"45":1.224995,"46":1.224997,"47":1.225001,"48":1.225003,"49":1.224994,"50":1.374995,"51":1.374995,"52":1.374993,"53":1.375005,"54":1.375009,"55":1.374993,"56":1.374995,"57":1.374998,"58":1.374998,"59":1.374996,"60":1.374997,"61":1.375001,"62":1.374998,"63":1.374998,"64+":1.375001}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":3500,"fam":7000},"rules":{"pcp":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":15,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":4,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.05,"ded":"no_ded","max":400}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":5,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":15,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Independence publishes no SBC for this reduced cost-sharing version; its cost sharing comes from Independence's 2027 plan overview brochure, page 67, checked against the PA Insurance Department filing (pages 86, 88, 92, 94, 96).","Mental health: office visits $15 copay (used here); all other outpatient services $15 copay.","Low-cost generic drugs: $1 per 30-day retail fill; other generics as shown (retail generic, used here).","Non-preferred brand drugs: the coinsurance is capped at $400 per 30-day retail fill (the cap is modelled here).","Specialty drugs: the coinsurance is capped at $500 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill.","Physical and occupational therapy: limited to 30 visits a year; visits above the limit are not covered.","Hospital stay: the copay is charged per day, up to five copays per admission (brochure footnote 7).","Virtual care from the designated virtual provider (Teladoc Health) is free.","This plan has three provider tiers. The rules use Tier 1 (Preferred), the tier the deductible ($0 individual / $0 family) and out-of-pocket limit describe. Tier 2 (Enhanced) and Tier 3 (Standard) providers have a $200 individual / $400 family deductible and higher cost sharing (each rule's text gives all three tiers).","Independence's brochure gives no outpatient surgeon fee for this version; the standard version's SBC figure (copay 5 after_ded) is used, an upper bound — this version may cost less. Its text and page are those of the standard version's SBC (https://www.ibx.com/pdfs/custom/ffm/2027/hmosilverproactivelite-2027.pdf, page 3).","Prenatal care: the brochure has no prenatal row. The first OB visit is charged at this version's specialist cost share and later prenatal visits are no charge (part of the delivery fee): every Independence standard SBC prices prenatal care this way.","The deductible and out-of-pocket limit are the brochure's; no CMS plan file for 2027 exists yet to compare them with (the out-of-pocket limit is within the federal limit for this version)."],"sbcUrl":"https://www.ibx.com/pdfs/find-a-plan/individuals/2027-plan-overview-brochure.pdf#page=67","prev":{"planYear":2026,"rates":{"8":{"base21":455.17,"tobaccoFactor":1.125008,"tobaccoFactorByAge":{"21":1.125008,"22":1.125008,"23":1.125008,"24":1.125008,"25":1.124992,"26":1.125019,"27":1.125005,"28":1.125008,"29":1.124985,"30":1.175003,"31":1.175001,"32":1.174996,"33":1.175008,"34":1.174997,"35":1.175003,"36":1.17499,"37":1.174996,"38":1.175001,"39":1.175011,"40":1.224992,"41":1.224997,"42":1.225004,"43":1.224991,"44":1.224999,"45":1.224991,"46":1.224984,"47":1.224998,"48":1.225007,"49":1.225004,"50":1.375002,"51":1.375007,"52":1.375007,"53":1.374993,"54":1.374999,"55":1.375004,"56":1.375004,"57":1.375001,"58":1.375005,"59":1.374997,"60":1.375001,"61":1.374995,"62":1.375002,"63":1.375006,"64+":1.375003}}}}},{"market":"pennie","id":"33871PA0040014-01","standardId":"33871PA0040014","variant":"standard","issuer":"Keystone Health Plan East","name":"Keystone HMO Bronze","metal":"Bronze","network":"HMO","hsaEligible":false,"networkId":"PAN002","referral":true,"tiers":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":325.24,"tobaccoFactor":1.125015,"tobaccoFactorByAge":{"21":1.125015,"22":1.125015,"23":1.125015,"24":1.125015,"25":1.125008,"26":1.124996,"27":1.125011,"28":1.124993,"29":1.125021,"30":1.174997,"31":1.17501,"32":1.174992,"33":1.174982,"34":1.175008,"35":1.17502,"36":1.174978,"37":1.174991,"38":1.175003,"39":1.175003,"40":1.224992,"41":1.225004,"42":1.22502,"43":1.224992,"44":1.224998,"45":1.224997,"46":1.225003,"47":1.225002,"48":1.225003,"49":1.224994,"50":1.375,"51":1.37501,"52":1.37499,"53":1.375002,"54":1.374991,"55":1.374995,"56":1.37501,"57":1.375002,"58":1.375005,"59":1.374994,"60":1.374997,"61":1.375011,"62":1.375007,"63":1.374999,"64+":1.375005}}},"ded":{"ind":8500,"fam":17000,"embedded":true},"drugDed":null,"oop":{"ind":10500,"fam":21000},"rules":{"pcp":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":150,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":300}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":400}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":750,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":120,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":700,"ded":"after_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":150,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"copay","amount":700,"ded":"after_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}}},"notes":["Prenatal care: the SBC says the office-visit cost share applies to the first OB visit only, so it is charged once here and later prenatal visits are no charge (they are part of the delivery fee); other copays or coinsurance may apply to other services such as ultrasounds.","Outpatient surgery facility fee: $750 copay per visit after the deductible at freestanding facilities (used here); $1,000 copay per visit after the deductible at hospital-based facilities.","Preferred brand drugs: 50% coinsurance is capped at $300 per 30-day retail fill (the cap is modelled here).","Non-preferred brand drugs: 50% coinsurance is capped at $400 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill; 31-90 day mail-order fills cost more per fill.","Mental health: office visits $150 copay per visit (used here); other outpatient services $150 copay per visit.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); visits above the limit are not covered. The limit does not apply to therapy prescribed for mental health or substance use treatment.","Telemedicine visits with the designated telemedicine provider are free."],"sbcUrl":"https://www.ibx.com/pdfs/custom/ffm/2027/hmobronze2027.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":279.92,"tobaccoFactor":1.125,"tobaccoFactorByAge":{"21":1.125,"22":1.125,"23":1.125,"24":1.125,"25":1.125,"26":1.125,"27":1.125,"28":1.125021,"29":1.124988,"30":1.175002,"31":1.174984,"32":1.174996,"33":1.175016,"34":1.175004,"35":1.174999,"36":1.174993,"37":1.175016,"38":1.17501,"39":1.174999,"40":1.224996,"41":1.22499,"42":1.225026,"43":1.22501,"44":1.224984,"45":1.225012,"46":1.224993,"47":1.225023,"48":1.224987,"49":1.225007,"50":1.374985,"51":1.375002,"52":1.375018,"53":1.375,"54":1.374998,"55":1.374996,"56":1.37501,"57":1.374995,"58":1.374993,"59":1.375005,"60":1.375003,"61":1.37499,"62":1.375002,"63":1.375012,"64+":1.375}}}}},{"market":"pennie","id":"33871PA0040015-01","standardId":"33871PA0040015","variant":"standard","issuer":"Keystone Health Plan East","name":"Keystone HMO Silver Basic","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN002","referral":true,"tiers":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":493.85,"tobaccoFactor":1.124997,"tobaccoFactorByAge":{"21":1.124997,"22":1.124997,"23":1.124997,"24":1.124997,"25":1.124982,"26":1.125015,"27":1.125012,"28":1.125016,"29":1.125005,"30":1.174998,"31":1.175009,"32":1.175003,"33":1.175008,"34":1.175004,"35":1.175002,"36":1.174997,"37":1.174995,"38":1.174993,"39":1.175005,"40":1.225006,"41":1.225011,"42":1.225002,"43":1.225009,"44":1.225,"45":1.224997,"46":1.224993,"47":1.224993,"48":1.225007,"49":1.224994,"50":1.374991,"51":1.375004,"52":1.37499,"53":1.375006,"54":1.375001,"55":1.374997,"56":1.375003,"57":1.375003,"58":1.374997,"59":1.375001,"60":1.374995,"61":1.374996,"62":1.374999,"63":1.374997,"64+":1.374999}}},"ded":{"ind":5500,"fam":11000,"embedded":true},"drugDed":null,"oop":{"ind":9600,"fam":19200},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":600,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":300}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":400}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":1650,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":120,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":80,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}}},"notes":["Prenatal care: the SBC says the office-visit cost share applies to the first OB visit only, so it is charged once here and later prenatal visits are no charge (they are part of the delivery fee); other copays or coinsurance may apply to other services such as ultrasounds.","Preferred brand drugs: 50% coinsurance is capped at $300 per 30-day retail fill (the cap is modelled here).","Non-preferred brand drugs: 50% coinsurance is capped at $400 per 30-day retail fill (the cap is modelled here).","Specialty drugs: 50% coinsurance is capped at $1,000 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill; 31-90 day mail-order fills cost more per fill.","Mental health: office visits $80 copay per visit (used here); other outpatient services $120 copay per visit.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); visits above the limit are not covered. The limit does not apply to therapy prescribed for mental health or substance use treatment.","Telemedicine visits with the designated telemedicine provider are free."],"sbcUrl":"https://www.ibx.com/pdfs/custom/ffm/2027/hmosilverbasic2027.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":422.51,"tobaccoFactor":1.124991,"tobaccoFactorByAge":{"21":1.124991,"22":1.124991,"23":1.124991,"24":1.124991,"25":1.125012,"26":1.124997,"27":1.125003,"28":1.125003,"29":1.125003,"30":1.174997,"31":1.174988,"32":1.174999,"33":1.175,"34":1.174995,"35":1.174992,"36":1.174989,"37":1.174986,"38":1.175002,"39":1.174997,"40":1.224994,"41":1.224991,"42":1.224997,"43":1.224993,"44":1.224989,"45":1.225012,"46":1.224987,"47":1.225007,"48":1.225,"49":1.225,"50":1.375007,"51":1.374997,"52":1.375003,"53":1.375,"54":1.374997,"55":1.374995,"56":1.374995,"57":1.374998,"58":1.374991,"59":1.375008,"60":1.375001,"61":1.375001,"62":1.374999,"63":1.375001,"64+":1.374997}}}}},{"market":"pennie","id":"33871PA0040015-04","standardId":"33871PA0040015","variant":"csr73","issuer":"Keystone Health Plan East","name":"Keystone HMO Silver Basic","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN002","referral":true,"tiers":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":493.85,"tobaccoFactor":1.124997,"tobaccoFactorByAge":{"21":1.124997,"22":1.124997,"23":1.124997,"24":1.124997,"25":1.124982,"26":1.125015,"27":1.125012,"28":1.125016,"29":1.125005,"30":1.174998,"31":1.175009,"32":1.175003,"33":1.175008,"34":1.175004,"35":1.175002,"36":1.174997,"37":1.174995,"38":1.174993,"39":1.175005,"40":1.225006,"41":1.225011,"42":1.225002,"43":1.225009,"44":1.225,"45":1.224997,"46":1.224993,"47":1.224993,"48":1.225007,"49":1.224994,"50":1.374991,"51":1.375004,"52":1.37499,"53":1.375006,"54":1.375001,"55":1.374997,"56":1.375003,"57":1.375003,"58":1.374997,"59":1.375001,"60":1.374995,"61":1.374996,"62":1.374999,"63":1.374997,"64+":1.374999}}},"ded":{"ind":5000,"fam":10000,"embedded":true},"drugDed":null,"oop":{"ind":8400,"fam":16800},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":600,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":300}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":400}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":1650,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":120,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":80,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}}},"notes":["Independence publishes no SBC for this reduced cost-sharing version; its cost sharing comes from Independence's 2027 plan overview brochure, page 54, checked against the PA Insurance Department filing (pages 86, 88, 94, 96).","Mental health: office visits $80 copay (used here); all other outpatient services $120 copay.","Low-cost generic drugs: $3, no ded per 30-day retail fill; other generics as shown (retail generic, used here).","Preferred brand drugs: the coinsurance is capped at $300 per 30-day retail fill (the cap is modelled here).","Non-preferred brand drugs: the coinsurance is capped at $400 per 30-day retail fill (the cap is modelled here).","Specialty drugs: the coinsurance is capped at $1,000 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill.","Physical and occupational therapy: limited to 30 visits a year; visits above the limit are not covered.","Virtual care from the designated virtual provider (Teladoc Health) is free.","Independence's brochure gives no outpatient surgeon fee for this version; the standard version's SBC figure (copay 120 after_ded) is used, an upper bound — this version may cost less. Its text and page are those of the standard version's SBC (https://www.ibx.com/pdfs/custom/ffm/2027/hmosilverbasic2027.pdf, page 3).","Prenatal care: the brochure has no prenatal row. The first OB visit is charged at this version's specialist cost share and later prenatal visits are no charge (part of the delivery fee): every Independence standard SBC prices prenatal care this way.","The deductible and out-of-pocket limit are the brochure's; no CMS plan file for 2027 exists yet to compare them with (the out-of-pocket limit is within the federal limit for this version)."],"sbcUrl":"https://www.ibx.com/pdfs/find-a-plan/individuals/2027-plan-overview-brochure.pdf#page=54","prev":{"planYear":2026,"rates":{"8":{"base21":422.51,"tobaccoFactor":1.124991,"tobaccoFactorByAge":{"21":1.124991,"22":1.124991,"23":1.124991,"24":1.124991,"25":1.125012,"26":1.124997,"27":1.125003,"28":1.125003,"29":1.125003,"30":1.174997,"31":1.174988,"32":1.174999,"33":1.175,"34":1.174995,"35":1.174992,"36":1.174989,"37":1.174986,"38":1.175002,"39":1.174997,"40":1.224994,"41":1.224991,"42":1.224997,"43":1.224993,"44":1.224989,"45":1.225012,"46":1.224987,"47":1.225007,"48":1.225,"49":1.225,"50":1.375007,"51":1.374997,"52":1.375003,"53":1.375,"54":1.374997,"55":1.374995,"56":1.374995,"57":1.374998,"58":1.374991,"59":1.375008,"60":1.375001,"61":1.375001,"62":1.374999,"63":1.375001,"64+":1.374997}}}}},{"market":"pennie","id":"33871PA0040015-05","standardId":"33871PA0040015","variant":"csr87","issuer":"Keystone Health Plan East","name":"Keystone HMO Silver Basic","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN002","referral":true,"tiers":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":493.85,"tobaccoFactor":1.124997,"tobaccoFactorByAge":{"21":1.124997,"22":1.124997,"23":1.124997,"24":1.124997,"25":1.124982,"26":1.125015,"27":1.125012,"28":1.125016,"29":1.125005,"30":1.174998,"31":1.175009,"32":1.175003,"33":1.175008,"34":1.175004,"35":1.175002,"36":1.174997,"37":1.174995,"38":1.174993,"39":1.175005,"40":1.225006,"41":1.225011,"42":1.225002,"43":1.225009,"44":1.225,"45":1.224997,"46":1.224993,"47":1.224993,"48":1.225007,"49":1.224994,"50":1.374991,"51":1.375004,"52":1.37499,"53":1.375006,"54":1.375001,"55":1.374997,"56":1.375003,"57":1.375003,"58":1.374997,"59":1.375001,"60":1.374995,"61":1.374996,"62":1.374999,"63":1.374997,"64+":1.374999}}},"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":3500,"fam":7000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded","max":300}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":400}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":1000,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":120,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":40,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Independence publishes no SBC for this reduced cost-sharing version; its cost sharing comes from Independence's 2027 plan overview brochure, page 61, checked against the PA Insurance Department filing (pages 86, 88, 94, 96).","Mental health: office visits $40 copay (used here); all other outpatient services $70 copay.","Low-cost generic drugs: $3, no ded per 30-day retail fill; other generics as shown (retail generic, used here).","Preferred brand drugs: the coinsurance is capped at $300 per 30-day retail fill (the cap is modelled here).","Non-preferred brand drugs: the coinsurance is capped at $400 per 30-day retail fill (the cap is modelled here).","Specialty drugs: the coinsurance is capped at $1,000 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill.","Physical and occupational therapy: limited to 30 visits a year; visits above the limit are not covered.","Virtual care from the designated virtual provider (Teladoc Health) is free.","Independence's brochure gives no outpatient surgeon fee for this version; the standard version's SBC figure (copay 120 after_ded) is used, an upper bound — this version may cost less. Its text and page are those of the standard version's SBC (https://www.ibx.com/pdfs/custom/ffm/2027/hmosilverbasic2027.pdf, page 3).","Prenatal care: the brochure has no prenatal row. The first OB visit is charged at this version's specialist cost share and later prenatal visits are no charge (part of the delivery fee): every Independence standard SBC prices prenatal care this way.","The deductible and out-of-pocket limit are the brochure's; no CMS plan file for 2027 exists yet to compare them with (the out-of-pocket limit is within the federal limit for this version)."],"sbcUrl":"https://www.ibx.com/pdfs/find-a-plan/individuals/2027-plan-overview-brochure.pdf#page=61","prev":{"planYear":2026,"rates":{"8":{"base21":422.51,"tobaccoFactor":1.124991,"tobaccoFactorByAge":{"21":1.124991,"22":1.124991,"23":1.124991,"24":1.124991,"25":1.125012,"26":1.124997,"27":1.125003,"28":1.125003,"29":1.125003,"30":1.174997,"31":1.174988,"32":1.174999,"33":1.175,"34":1.174995,"35":1.174992,"36":1.174989,"37":1.174986,"38":1.175002,"39":1.174997,"40":1.224994,"41":1.224991,"42":1.224997,"43":1.224993,"44":1.224989,"45":1.225012,"46":1.224987,"47":1.225007,"48":1.225,"49":1.225,"50":1.375007,"51":1.374997,"52":1.375003,"53":1.375,"54":1.374997,"55":1.374995,"56":1.374995,"57":1.374998,"58":1.374991,"59":1.375008,"60":1.375001,"61":1.375001,"62":1.374999,"63":1.375001,"64+":1.374997}}}}},{"market":"pennie","id":"33871PA0040015-06","standardId":"33871PA0040015","variant":"csr94","issuer":"Keystone Health Plan East","name":"Keystone HMO Silver Basic","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN002","referral":true,"tiers":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":493.85,"tobaccoFactor":1.124997,"tobaccoFactorByAge":{"21":1.124997,"22":1.124997,"23":1.124997,"24":1.124997,"25":1.124982,"26":1.125015,"27":1.125012,"28":1.125016,"29":1.125005,"30":1.174998,"31":1.175009,"32":1.175003,"33":1.175008,"34":1.175004,"35":1.175002,"36":1.174997,"37":1.174995,"38":1.174993,"39":1.175005,"40":1.225006,"41":1.225011,"42":1.225002,"43":1.225009,"44":1.225,"45":1.224997,"46":1.224993,"47":1.224993,"48":1.225007,"49":1.224994,"50":1.374991,"51":1.375004,"52":1.37499,"53":1.375006,"54":1.375001,"55":1.374997,"56":1.375003,"57":1.375003,"58":1.374997,"59":1.375001,"60":1.374995,"61":1.374996,"62":1.374999,"63":1.374997,"64+":1.374999}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":2750,"fam":5500},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":30,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":4,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.05,"ded":"no_ded","max":300}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.15,"ded":"no_ded","max":400}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":120,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":30,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}}},"notes":["Independence publishes no SBC for this reduced cost-sharing version; its cost sharing comes from Independence's 2027 plan overview brochure, page 68, checked against the PA Insurance Department filing (pages 86, 88, 94, 96).","Mental health: office visits $30 copay (used here); all other outpatient services $30 copay.","Low-cost generic drugs: $3 per 30-day retail fill; other generics as shown (retail generic, used here).","Preferred brand drugs: the coinsurance is capped at $300 per 30-day retail fill (the cap is modelled here).","Non-preferred brand drugs: the coinsurance is capped at $400 per 30-day retail fill (the cap is modelled here).","Specialty drugs: the coinsurance is capped at $1,000 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill.","Physical and occupational therapy: limited to 30 visits a year; visits above the limit are not covered.","Virtual care from the designated virtual provider (Teladoc Health) is free.","Independence's brochure gives no outpatient surgeon fee for this version; the standard version's SBC figure (copay 120 after_ded) is used, an upper bound — this version may cost less. Its text and page are those of the standard version's SBC (https://www.ibx.com/pdfs/custom/ffm/2027/hmosilverbasic2027.pdf, page 3).","Prenatal care: the brochure has no prenatal row. The first OB visit is charged at this version's specialist cost share and later prenatal visits are no charge (part of the delivery fee): every Independence standard SBC prices prenatal care this way.","The deductible and out-of-pocket limit are the brochure's; no CMS plan file for 2027 exists yet to compare them with (the out-of-pocket limit is within the federal limit for this version)."],"sbcUrl":"https://www.ibx.com/pdfs/find-a-plan/individuals/2027-plan-overview-brochure.pdf#page=68","prev":{"planYear":2026,"rates":{"8":{"base21":422.51,"tobaccoFactor":1.124991,"tobaccoFactorByAge":{"21":1.124991,"22":1.124991,"23":1.124991,"24":1.124991,"25":1.125012,"26":1.124997,"27":1.125003,"28":1.125003,"29":1.125003,"30":1.174997,"31":1.174988,"32":1.174999,"33":1.175,"34":1.174995,"35":1.174992,"36":1.174989,"37":1.174986,"38":1.175002,"39":1.174997,"40":1.224994,"41":1.224991,"42":1.224997,"43":1.224993,"44":1.224989,"45":1.225012,"46":1.224987,"47":1.225007,"48":1.225,"49":1.225,"50":1.375007,"51":1.374997,"52":1.375003,"53":1.375,"54":1.374997,"55":1.374995,"56":1.374995,"57":1.374998,"58":1.374991,"59":1.375008,"60":1.375001,"61":1.375001,"62":1.374999,"63":1.375001,"64+":1.374997}}}}},{"market":"pennie","id":"33871PA0040016-01","standardId":"33871PA0040016","variant":"standard","issuer":"Keystone Health Plan East","name":"Keystone HMO Silver Proactive Basic","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN005","referral":true,"tiers":true,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":462.24,"tobaccoFactor":1.125,"tobaccoFactorByAge":{"21":1.125,"22":1.125,"23":1.125,"24":1.125,"25":1.124997,"26":1.125008,"27":1.124992,"28":1.125007,"29":1.124988,"30":1.174996,"31":1.174992,"32":1.175009,"33":1.175004,"34":1.174995,"35":1.174999,"36":1.174986,"37":1.175011,"38":1.174998,"39":1.174989,"40":1.225006,"41":1.224993,"42":1.224991,"43":1.224994,"44":1.224994,"45":1.225014,"46":1.225006,"47":1.225003,"48":1.225005,"49":1.224999,"50":1.375006,"51":1.375,"52":1.375001,"53":1.374996,"54":1.375,"55":1.37499,"56":1.374997,"57":1.375,"58":1.374999,"59":1.374997,"60":1.374996,"61":1.375005,"62":1.374994,"63":1.375001,"64+":1.375}}},"ded":{"ind":2500,"fam":5000,"embedded":true},"drugDed":{"ind":225,"fam":450,"embedded":true},"oop":{"ind":10500,"fam":21000},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":950,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":400}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":5,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":600,"ded":"after_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":100,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"copay","amount":600,"ded":"after_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prenatal care: the SBC says the office-visit cost share applies to the first OB visit only, so it is charged once here and later prenatal visits are no charge (they are part of the delivery fee); other copays or coinsurance may apply to other services such as ultrasounds.","Preferred brand drugs: 50% coinsurance is capped at $400 per 30-day retail fill (the cap is modelled here).","Non-preferred brand drugs: 50% coinsurance is capped at $500 per 30-day retail fill (the cap is modelled here).","Specialty drugs: 50% coinsurance is capped at $1,000 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill; 31-90 day mail-order fills cost more per fill.","Mental health: office visits $100 copay per visit (used here); other outpatient services $100 copay per visit.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); visits above the limit are not covered. The limit does not apply to therapy prescribed for mental health or substance use treatment.","Telemedicine visits with the designated telemedicine provider are free.","This plan has three provider tiers. The rules use Tier 1 (Preferred), the tier the deductible ($2,500 individual / $5,000 family) and out-of-pocket limit describe. Tier 2 (Enhanced) and Tier 3 (Standard) providers have a higher deductible ($7,000 individual / $14,000 family) and higher cost sharing.","Primary care: Tier 1 $50 copay per visit (used here); Tier 2 $60 copay per visit; Tier 3 $70 copay per visit.","Specialist: Tier 1 $100 copay per visit (used here); Tier 2 $120 copay per visit; Tier 3 $140 copay per visit.","Emergency room: Tier 1 $950 copay per visit (used here); Tier 2 $950 copay per visit; Tier 3 $950 copay per visit.","Hospital stay facility fee: Tier 1 $600 copay per day (up to 5 days per admission) after the deductible (used here); Tier 2 $900 copay per day (up to 5 days per admission) after the deductible; Tier 3 $1,300 copay per day (up to 5 days per admission) after the deductible.","Outpatient surgery facility fee: Tier 1 $350 copay per visit after the deductible (used here); Tier 2 $950 copay per visit after the deductible; Tier 3 $1,500 copay per visit after the deductible.","Separate prescription drug deductible ($225 individual / $450 family) applies to preferred brand, non-preferred brand, specialty drugs; the other drug tiers say the deductible does not apply. The SBC diabetes example shows a $200 deductible, which fits the drug deductible rather than the medical one.","The SBC lists \"No charge\" for some services without saying whether the deductible applies. It is read as no charge after the deductible: the grid's banner says costs shown are after the deductible, and this plan's benefit chart in IBX's 2027 plan overview brochure lists these services as \"0% after ded\"."],"sbcUrl":"https://www.ibx.com/pdfs/custom/ffm/2027/hmosilverproactivebasic2027.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":399.39,"tobaccoFactor":1.124991,"tobaccoFactorByAge":{"21":1.124991,"22":1.124991,"23":1.124991,"24":1.124991,"25":1.124991,"26":1.124994,"27":1.125,"28":1.124983,"29":1.124989,"30":1.175002,"31":1.175009,"32":1.174992,"33":1.174995,"34":1.174999,"35":1.175003,"36":1.175003,"37":1.175006,"38":1.175006,"39":1.175009,"40":1.225011,"41":1.224996,"42":1.225004,"43":1.225012,"44":1.225002,"45":1.224997,"46":1.224991,"47":1.22499,"48":1.225008,"49":1.225006,"50":1.374998,"51":1.37501,"52":1.374995,"53":1.374994,"54":1.374997,"55":1.375,"56":1.374992,"57":1.375009,"58":1.374991,"59":1.375006,"60":1.375002,"61":1.374992,"62":1.374997,"63":1.374996,"64+":1.374997}}}}},{"market":"pennie","id":"33871PA0040016-04","standardId":"33871PA0040016","variant":"csr73","issuer":"Keystone Health Plan East","name":"Keystone HMO Silver Proactive Basic","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN005","referral":true,"tiers":true,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":462.24,"tobaccoFactor":1.125,"tobaccoFactorByAge":{"21":1.125,"22":1.125,"23":1.125,"24":1.125,"25":1.124997,"26":1.125008,"27":1.124992,"28":1.125007,"29":1.124988,"30":1.174996,"31":1.174992,"32":1.175009,"33":1.175004,"34":1.174995,"35":1.174999,"36":1.174986,"37":1.175011,"38":1.174998,"39":1.174989,"40":1.225006,"41":1.224993,"42":1.224991,"43":1.224994,"44":1.224994,"45":1.225014,"46":1.225006,"47":1.225003,"48":1.225005,"49":1.224999,"50":1.375006,"51":1.375,"52":1.375001,"53":1.374996,"54":1.375,"55":1.37499,"56":1.374997,"57":1.375,"58":1.374999,"59":1.374997,"60":1.374996,"61":1.375005,"62":1.374994,"63":1.375001,"64+":1.375}}},"ded":{"ind":2500,"fam":5000,"embedded":true},"drugDed":{"ind":225,"fam":450,"embedded":true},"oop":{"ind":8750,"fam":17500},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":800,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded","max":400}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":5,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":600,"ded":"after_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":100,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"copay","amount":600,"ded":"after_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Independence publishes no SBC for this reduced cost-sharing version; its cost sharing comes from Independence's 2027 plan overview brochure, page 55, checked against the PA Insurance Department filing (pages 86, 88, 90, 94, 96).","Mental health: office visits $100 copay (used here); all other outpatient services $100 copay.","Low-cost generic drugs: $5, no ded per 30-day retail fill; other generics as shown (retail generic, used here).","Preferred brand drugs: the coinsurance is capped at $400 per 30-day retail fill (the cap is modelled here).","Non-preferred brand drugs: the coinsurance is capped at $500 per 30-day retail fill (the cap is modelled here).","Specialty drugs: the coinsurance is capped at $1,000 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill.","Separate prescription drug deductible ($225 individual / $450 family): drug cells marked \"after ded\" are after this deductible.","Physical and occupational therapy: limited to 30 visits a year; visits above the limit are not covered.","Hospital stay: the copay is charged per day, up to five copays per admission (brochure footnote 7).","Virtual care from the designated virtual provider (Teladoc Health) is free.","This plan has three provider tiers. The rules use Tier 1 (Preferred), the tier the deductible ($2,500 individual / $5,000 family) and out-of-pocket limit describe. Tier 2 (Enhanced) and Tier 3 (Standard) providers have a $6,500 individual / $13,000 family deductible and higher cost sharing (each rule's text gives all three tiers).","Independence's brochure gives no outpatient surgeon fee for this version; the standard version's SBC figure (copay 5 after_ded) is used, an upper bound — this version may cost less. Its text and page are those of the standard version's SBC (https://www.ibx.com/pdfs/custom/ffm/2027/hmosilverproactivebasic2027.pdf, page 4).","Prenatal care: the brochure has no prenatal row. The first OB visit is charged at this version's specialist cost share and later prenatal visits are no charge (part of the delivery fee): every Independence standard SBC prices prenatal care this way.","The deductible and out-of-pocket limit are the brochure's; no CMS plan file for 2027 exists yet to compare them with (the out-of-pocket limit is within the federal limit for this version)."],"sbcUrl":"https://www.ibx.com/pdfs/find-a-plan/individuals/2027-plan-overview-brochure.pdf#page=55","prev":{"planYear":2026,"rates":{"8":{"base21":399.39,"tobaccoFactor":1.124991,"tobaccoFactorByAge":{"21":1.124991,"22":1.124991,"23":1.124991,"24":1.124991,"25":1.124991,"26":1.124994,"27":1.125,"28":1.124983,"29":1.124989,"30":1.175002,"31":1.175009,"32":1.174992,"33":1.174995,"34":1.174999,"35":1.175003,"36":1.175003,"37":1.175006,"38":1.175006,"39":1.175009,"40":1.225011,"41":1.224996,"42":1.225004,"43":1.225012,"44":1.225002,"45":1.224997,"46":1.224991,"47":1.22499,"48":1.225008,"49":1.225006,"50":1.374998,"51":1.37501,"52":1.374995,"53":1.374994,"54":1.374997,"55":1.375,"56":1.374992,"57":1.375009,"58":1.374991,"59":1.375006,"60":1.375002,"61":1.374992,"62":1.374997,"63":1.374996,"64+":1.374997}}}}},{"market":"pennie","id":"33871PA0040016-05","standardId":"33871PA0040016","variant":"csr87","issuer":"Keystone Health Plan East","name":"Keystone HMO Silver Proactive Basic","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN005","referral":true,"tiers":true,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":462.24,"tobaccoFactor":1.125,"tobaccoFactorByAge":{"21":1.125,"22":1.125,"23":1.125,"24":1.125,"25":1.124997,"26":1.125008,"27":1.124992,"28":1.125007,"29":1.124988,"30":1.174996,"31":1.174992,"32":1.175009,"33":1.175004,"34":1.174995,"35":1.174999,"36":1.174986,"37":1.175011,"38":1.174998,"39":1.174989,"40":1.225006,"41":1.224993,"42":1.224991,"43":1.224994,"44":1.224994,"45":1.225014,"46":1.225006,"47":1.225003,"48":1.225005,"49":1.224999,"50":1.375006,"51":1.375,"52":1.375001,"53":1.374996,"54":1.375,"55":1.37499,"56":1.374997,"57":1.375,"58":1.374999,"59":1.374997,"60":1.374996,"61":1.375005,"62":1.374994,"63":1.375001,"64+":1.375}}},"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":4000,"fam":8000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":300}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":400}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":5,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":300,"ded":"after_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":40,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"copay","amount":300,"ded":"after_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Independence publishes no SBC for this reduced cost-sharing version; its cost sharing comes from Independence's 2027 plan overview brochure, page 62, checked against the PA Insurance Department filing (pages 86, 88, 92, 94, 96).","Mental health: office visits $40 copay (used here); all other outpatient services $40 copay.","Low-cost generic drugs: $3 per 30-day retail fill; other generics as shown (retail generic, used here).","Preferred brand drugs: the coinsurance is capped at $300 per 30-day retail fill (the cap is modelled here).","Non-preferred brand drugs: the coinsurance is capped at $400 per 30-day retail fill (the cap is modelled here).","Specialty drugs: the coinsurance is capped at $500 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill.","Physical and occupational therapy: limited to 30 visits a year; visits above the limit are not covered.","Hospital stay: the copay is charged per day, up to five copays per admission (brochure footnote 7).","Virtual care from the designated virtual provider (Teladoc Health) is free.","This plan has three provider tiers. The rules use Tier 1 (Preferred), the tier the deductible ($1,000 individual / $2,000 family) and out-of-pocket limit describe. Tier 2 (Enhanced) and Tier 3 (Standard) providers have a $2,000 individual / $4,000 family deductible and higher cost sharing (each rule's text gives all three tiers).","Independence's brochure gives no outpatient surgeon fee for this version; the standard version's SBC figure (copay 5 after_ded) is used, an upper bound — this version may cost less. Its text and page are those of the standard version's SBC (https://www.ibx.com/pdfs/custom/ffm/2027/hmosilverproactivebasic2027.pdf, page 4).","Prenatal care: the brochure has no prenatal row. The first OB visit is charged at this version's specialist cost share and later prenatal visits are no charge (part of the delivery fee): every Independence standard SBC prices prenatal care this way.","The deductible and out-of-pocket limit are the brochure's; no CMS plan file for 2027 exists yet to compare them with (the out-of-pocket limit is within the federal limit for this version)."],"sbcUrl":"https://www.ibx.com/pdfs/find-a-plan/individuals/2027-plan-overview-brochure.pdf#page=62","prev":{"planYear":2026,"rates":{"8":{"base21":399.39,"tobaccoFactor":1.124991,"tobaccoFactorByAge":{"21":1.124991,"22":1.124991,"23":1.124991,"24":1.124991,"25":1.124991,"26":1.124994,"27":1.125,"28":1.124983,"29":1.124989,"30":1.175002,"31":1.175009,"32":1.174992,"33":1.174995,"34":1.174999,"35":1.175003,"36":1.175003,"37":1.175006,"38":1.175006,"39":1.175009,"40":1.225011,"41":1.224996,"42":1.225004,"43":1.225012,"44":1.225002,"45":1.224997,"46":1.224991,"47":1.22499,"48":1.225008,"49":1.225006,"50":1.374998,"51":1.37501,"52":1.374995,"53":1.374994,"54":1.374997,"55":1.375,"56":1.374992,"57":1.375009,"58":1.374991,"59":1.375006,"60":1.375002,"61":1.374992,"62":1.374997,"63":1.374996,"64+":1.374997}}}}},{"market":"pennie","id":"33871PA0040016-06","standardId":"33871PA0040016","variant":"csr94","issuer":"Keystone Health Plan East","name":"Keystone HMO Silver Proactive Basic","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN005","referral":true,"tiers":true,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":462.24,"tobaccoFactor":1.125,"tobaccoFactorByAge":{"21":1.125,"22":1.125,"23":1.125,"24":1.125,"25":1.124997,"26":1.125008,"27":1.124992,"28":1.125007,"29":1.124988,"30":1.174996,"31":1.174992,"32":1.175009,"33":1.175004,"34":1.174995,"35":1.174999,"36":1.174986,"37":1.175011,"38":1.174998,"39":1.174989,"40":1.225006,"41":1.224993,"42":1.224991,"43":1.224994,"44":1.224994,"45":1.225014,"46":1.225006,"47":1.225003,"48":1.225005,"49":1.224999,"50":1.375006,"51":1.375,"52":1.375001,"53":1.374996,"54":1.375,"55":1.37499,"56":1.374997,"57":1.375,"58":1.374999,"59":1.374997,"60":1.374996,"61":1.375005,"62":1.374994,"63":1.375001,"64+":1.375}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":3500,"fam":7000},"rules":{"pcp":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":15,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":4,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.05,"ded":"no_ded","max":300}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.05,"ded":"no_ded","max":400}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":5,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":15,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Independence publishes no SBC for this reduced cost-sharing version; its cost sharing comes from Independence's 2027 plan overview brochure, page 69, checked against the PA Insurance Department filing (pages 86, 88, 92, 94, 96).","Mental health: office visits $15 copay (used here); all other outpatient services $15 copay.","Low-cost generic drugs: $1 per 30-day retail fill; other generics as shown (retail generic, used here).","Preferred brand drugs: the coinsurance is capped at $300 per 30-day retail fill (the cap is modelled here).","Non-preferred brand drugs: the coinsurance is capped at $400 per 30-day retail fill (the cap is modelled here).","Specialty drugs: the coinsurance is capped at $500 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill.","Physical and occupational therapy: limited to 30 visits a year; visits above the limit are not covered.","Hospital stay: the copay is charged per day, up to five copays per admission (brochure footnote 7).","Virtual care from the designated virtual provider (Teladoc Health) is free.","This plan has three provider tiers. The rules use Tier 1 (Preferred), the tier the deductible ($0 individual / $0 family) and out-of-pocket limit describe. Tier 2 (Enhanced) and Tier 3 (Standard) providers have a $200 individual / $400 family deductible and higher cost sharing (each rule's text gives all three tiers).","Independence's brochure gives no outpatient surgeon fee for this version; the standard version's SBC figure (copay 5 after_ded) is used, an upper bound — this version may cost less. Its text and page are those of the standard version's SBC (https://www.ibx.com/pdfs/custom/ffm/2027/hmosilverproactivebasic2027.pdf, page 4).","Prenatal care: the brochure has no prenatal row. The first OB visit is charged at this version's specialist cost share and later prenatal visits are no charge (part of the delivery fee): every Independence standard SBC prices prenatal care this way.","The deductible and out-of-pocket limit are the brochure's; no CMS plan file for 2027 exists yet to compare them with (the out-of-pocket limit is within the federal limit for this version)."],"sbcUrl":"https://www.ibx.com/pdfs/find-a-plan/individuals/2027-plan-overview-brochure.pdf#page=69","prev":{"planYear":2026,"rates":{"8":{"base21":399.39,"tobaccoFactor":1.124991,"tobaccoFactorByAge":{"21":1.124991,"22":1.124991,"23":1.124991,"24":1.124991,"25":1.124991,"26":1.124994,"27":1.125,"28":1.124983,"29":1.124989,"30":1.175002,"31":1.175009,"32":1.174992,"33":1.174995,"34":1.174999,"35":1.175003,"36":1.175003,"37":1.175006,"38":1.175006,"39":1.175009,"40":1.225011,"41":1.224996,"42":1.225004,"43":1.225012,"44":1.225002,"45":1.224997,"46":1.224991,"47":1.22499,"48":1.225008,"49":1.225006,"50":1.374998,"51":1.37501,"52":1.374995,"53":1.374994,"54":1.374997,"55":1.375,"56":1.374992,"57":1.375009,"58":1.374991,"59":1.375006,"60":1.375002,"61":1.374992,"62":1.374997,"63":1.374996,"64+":1.374997}}}}},{"market":"pennie","id":"33871PA0040017-01","standardId":"33871PA0040017","variant":"standard","issuer":"Keystone Health Plan East","name":"Keystone HMO Gold Classic","metal":"Gold","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":true,"tiers":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":567.9,"tobaccoFactor":1.125004,"tobaccoFactorByAge":{"21":1.125004,"22":1.125004,"23":1.125004,"24":1.125004,"25":1.124998,"26":1.124998,"27":1.124992,"28":1.124994,"29":1.125008,"30":1.175,"31":1.174992,"32":1.175,"33":1.175001,"34":1.175,"35":1.175008,"36":1.174999,"37":1.175006,"38":1.175,"39":1.174999,"40":1.224999,"41":1.22499,"42":1.224992,"43":1.224995,"44":1.224992,"45":1.224998,"46":1.225004,"47":1.224992,"48":1.224992,"49":1.225001,"50":1.374999,"51":1.375006,"52":1.374998,"53":1.374996,"54":1.374995,"55":1.374994,"56":1.374999,"57":1.375001,"58":1.375001,"59":1.375007,"60":1.375,"61":1.374997,"62":1.374998,"63":1.375003,"64+":1.375001}}},"ded":{"ind":500,"fam":1000,"embedded":true},"drugDed":null,"oop":{"ind":8000,"fam":16000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":200}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":80,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Prenatal care: the SBC says the office-visit cost share applies to the first OB visit only, so it is charged once here and later prenatal visits are no charge (they are part of the delivery fee); other copays or coinsurance may apply to other services such as ultrasounds.","Outpatient surgery facility fee: $300 copay per visit at freestanding facilities (used here); $700 copay per visit at hospital-based facilities.","Non-preferred brand drugs: 50% coinsurance is capped at $200 per 30-day retail fill (the cap is modelled here).","Specialty drugs: 50% coinsurance is capped at $1,000 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill; 31-90 day mail-order fills cost more per fill.","Mental health: office visits $80 copay per visit (used here); other outpatient services $80 copay per visit.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); visits above the limit are not covered. The limit does not apply to therapy prescribed for mental health or substance use treatment.","Telemedicine visits with the designated telemedicine provider are free."],"sbcUrl":"https://www.ibx.com/pdfs/custom/ffm/2027/hmogoldclassic2027.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":483.11,"tobaccoFactor":1.125003,"tobaccoFactorByAge":{"21":1.125003,"22":1.125003,"23":1.125003,"24":1.125003,"25":1.125,"26":1.125005,"27":1.125005,"28":1.124995,"29":1.125009,"30":1.175004,"31":1.175007,"32":1.17499,"33":1.174992,"34":1.174987,"35":1.174995,"36":1.174983,"37":1.175007,"38":1.174995,"39":1.17501,"40":1.225004,"41":1.225004,"42":1.225005,"43":1.225007,"44":1.225011,"45":1.224997,"46":1.224985,"47":1.225003,"48":1.225009,"49":1.224997,"50":1.37501,"51":1.375006,"52":1.375004,"53":1.375003,"54":1.375,"55":1.374998,"56":1.374998,"57":1.374998,"58":1.375008,"59":1.374994,"60":1.375004,"61":1.375002,"62":1.374998,"63":1.374998,"64+":1.375001}}}}},{"market":"pennie","id":"33871PA0040018-01","standardId":"33871PA0040018","variant":"standard","issuer":"Keystone Health Plan East","name":"Keystone HMO Silver Proactive Essential","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN005","referral":true,"tiers":true,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":442.64,"tobaccoFactor":1.125,"tobaccoFactorByAge":{"21":1.125,"22":1.125,"23":1.125,"24":1.125,"25":1.124997,"26":1.125006,"27":1.124987,"28":1.124992,"29":1.125013,"30":1.175,"31":1.175003,"32":1.175006,"33":1.175002,"34":1.175004,"35":1.174983,"36":1.175002,"37":1.175003,"38":1.175004,"39":1.175006,"40":1.225017,"41":1.224997,"42":1.224996,"43":1.225002,"44":1.224995,"45":1.225011,"46":1.224998,"47":1.224991,"48":1.22499,"49":1.225005,"50":1.374987,"51":1.375,"52":1.37501,"53":1.374999,"54":1.375,"55":1.374991,"56":1.374995,"57":1.375003,"58":1.374997,"59":1.374999,"60":1.375004,"61":1.374998,"62":1.375002,"63":1.375007,"64+":1.375}}},"ded":{"ind":5000,"fam":10000,"embedded":true},"drugDed":{"ind":225,"fam":450,"embedded":true},"oop":{"ind":10500,"fam":21000},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":975,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":400}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":5,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":600,"ded":"after_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":100,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"copay","amount":600,"ded":"after_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prenatal care: the SBC says the office-visit cost share applies to the first OB visit only, so it is charged once here and later prenatal visits are no charge (they are part of the delivery fee); other copays or coinsurance may apply to other services such as ultrasounds.","Preferred brand drugs: 50% coinsurance is capped at $400 per 30-day retail fill (the cap is modelled here).","Non-preferred brand drugs: 50% coinsurance is capped at $500 per 30-day retail fill (the cap is modelled here).","Specialty drugs: 50% coinsurance is capped at $1,000 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill; 31-90 day mail-order fills cost more per fill.","Mental health: office visits $100 copay per visit (used here); other outpatient services $100 copay per visit.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); visits above the limit are not covered. The limit does not apply to therapy prescribed for mental health or substance use treatment.","Telemedicine visits with the designated telemedicine provider are free.","This plan has three provider tiers. The rules use Tier 1 (Preferred), the tier the deductible ($5,000 individual / $10,000 family) and out-of-pocket limit describe. Tier 2 (Enhanced) and Tier 3 (Standard) providers have a higher deductible ($8,000 individual / $16,000 family) and higher cost sharing.","Primary care: Tier 1 $50 copay per visit (used here); Tier 2 $60 copay per visit; Tier 3 $70 copay per visit.","Specialist: Tier 1 $100 copay per visit (used here); Tier 2 $120 copay per visit; Tier 3 $140 copay per visit.","Emergency room: Tier 1 $975 copay per visit (used here); Tier 2 $975 copay per visit; Tier 3 $975 copay per visit.","Hospital stay facility fee: Tier 1 $600 copay per day (up to 5 days per admission) after the deductible (used here); Tier 2 $900 copay per day (up to 5 days per admission) after the deductible; Tier 3 $1,300 copay per day (up to 5 days per admission) after the deductible.","Outpatient surgery facility fee: Tier 1 $350 copay per visit after the deductible (used here); Tier 2 $950 copay per visit after the deductible; Tier 3 $1,500 copay per visit after the deductible.","Separate prescription drug deductible ($225 individual / $450 family) applies to preferred brand, non-preferred brand, specialty drugs; the other drug tiers say the deductible does not apply. The SBC diabetes example shows a $200 deductible, which fits the drug deductible rather than the medical one.","The SBC lists \"No charge\" for some services without saying whether the deductible applies. It is read as no charge after the deductible: the grid's banner says costs shown are after the deductible, and this plan's benefit chart in IBX's 2027 plan overview brochure lists these services as \"0% after ded\"."],"sbcUrl":"https://www.ibx.com/pdfs/custom/ffm/2027/hmosilverproactiveessential2027.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":383.14,"tobaccoFactor":1.124993,"tobaccoFactorByAge":{"21":1.124993,"22":1.124993,"23":1.124993,"24":1.124993,"25":1.125016,"26":1.124994,"27":1.124997,"28":1.125003,"29":1.12502,"30":1.175022,"31":1.174999,"32":1.175003,"33":1.175011,"34":1.175005,"35":1.174989,"36":1.174999,"37":1.174984,"38":1.175014,"39":1.175008,"40":1.224997,"41":1.224997,"42":1.224993,"43":1.224996,"44":1.224998,"45":1.225016,"46":1.225,"47":1.224998,"48":1.225005,"49":1.225002,"50":1.375002,"51":1.374986,"52":1.375002,"53":1.374995,"54":1.375012,"55":1.375,"56":1.374999,"57":1.374999,"58":1.375,"59":1.375009,"60":1.375,"61":1.375007,"62":1.375005,"63":1.375003,"64+":1.374998}}}}},{"market":"pennie","id":"33871PA0040018-04","standardId":"33871PA0040018","variant":"csr73","issuer":"Keystone Health Plan East","name":"Keystone HMO Silver Proactive Essential","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN005","referral":true,"tiers":true,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":442.64,"tobaccoFactor":1.125,"tobaccoFactorByAge":{"21":1.125,"22":1.125,"23":1.125,"24":1.125,"25":1.124997,"26":1.125006,"27":1.124987,"28":1.124992,"29":1.125013,"30":1.175,"31":1.175003,"32":1.175006,"33":1.175002,"34":1.175004,"35":1.174983,"36":1.175002,"37":1.175003,"38":1.175004,"39":1.175006,"40":1.225017,"41":1.224997,"42":1.224996,"43":1.225002,"44":1.224995,"45":1.225011,"46":1.224998,"47":1.224991,"48":1.22499,"49":1.225005,"50":1.374987,"51":1.375,"52":1.37501,"53":1.374999,"54":1.375,"55":1.374991,"56":1.374995,"57":1.375003,"58":1.374997,"59":1.374999,"60":1.375004,"61":1.374998,"62":1.375002,"63":1.375007,"64+":1.375}}},"ded":{"ind":4500,"fam":9000,"embedded":true},"drugDed":{"ind":225,"fam":450,"embedded":true},"oop":{"ind":8750,"fam":17500},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":750,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded","max":400}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":5,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":600,"ded":"after_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":100,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"copay","amount":600,"ded":"after_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Independence publishes no SBC for this reduced cost-sharing version; its cost sharing comes from Independence's 2027 plan overview brochure, page 56, checked against the PA Insurance Department filing (pages 86, 88, 90, 94, 96).","Mental health: office visits $100 copay (used here); all other outpatient services $100 copay.","Low-cost generic drugs: $5, no ded per 30-day retail fill; other generics as shown (retail generic, used here).","Preferred brand drugs: the coinsurance is capped at $400 per 30-day retail fill (the cap is modelled here).","Non-preferred brand drugs: the coinsurance is capped at $500 per 30-day retail fill (the cap is modelled here).","Specialty drugs: the coinsurance is capped at $1,000 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill.","Separate prescription drug deductible ($225 individual / $450 family): drug cells marked \"after ded\" are after this deductible.","Physical and occupational therapy: limited to 30 visits a year; visits above the limit are not covered.","Hospital stay: the copay is charged per day, up to five copays per admission (brochure footnote 7).","Virtual care from the designated virtual provider (Teladoc Health) is free.","This plan has three provider tiers. The rules use Tier 1 (Preferred), the tier the deductible ($4,500 individual / $9,000 family) and out-of-pocket limit describe. Tier 2 (Enhanced) and Tier 3 (Standard) providers have a $6,900 individual / $13,800 family deductible and higher cost sharing (each rule's text gives all three tiers).","Independence's brochure gives no outpatient surgeon fee for this version; the standard version's SBC figure (copay 5 after_ded) is used, an upper bound — this version may cost less. Its text and page are those of the standard version's SBC (https://www.ibx.com/pdfs/custom/ffm/2027/hmosilverproactiveessential2027.pdf, page 4).","Prenatal care: the brochure has no prenatal row. The first OB visit is charged at this version's specialist cost share and later prenatal visits are no charge (part of the delivery fee): every Independence standard SBC prices prenatal care this way.","The deductible and out-of-pocket limit are the brochure's; no CMS plan file for 2027 exists yet to compare them with (the out-of-pocket limit is within the federal limit for this version)."],"sbcUrl":"https://www.ibx.com/pdfs/find-a-plan/individuals/2027-plan-overview-brochure.pdf#page=56","prev":{"planYear":2026,"rates":{"8":{"base21":383.14,"tobaccoFactor":1.124993,"tobaccoFactorByAge":{"21":1.124993,"22":1.124993,"23":1.124993,"24":1.124993,"25":1.125016,"26":1.124994,"27":1.124997,"28":1.125003,"29":1.12502,"30":1.175022,"31":1.174999,"32":1.175003,"33":1.175011,"34":1.175005,"35":1.174989,"36":1.174999,"37":1.174984,"38":1.175014,"39":1.175008,"40":1.224997,"41":1.224997,"42":1.224993,"43":1.224996,"44":1.224998,"45":1.225016,"46":1.225,"47":1.224998,"48":1.225005,"49":1.225002,"50":1.375002,"51":1.374986,"52":1.375002,"53":1.374995,"54":1.375012,"55":1.375,"56":1.374999,"57":1.374999,"58":1.375,"59":1.375009,"60":1.375,"61":1.375007,"62":1.375005,"63":1.375003,"64+":1.374998}}}}},{"market":"pennie","id":"33871PA0040018-05","standardId":"33871PA0040018","variant":"csr87","issuer":"Keystone Health Plan East","name":"Keystone HMO Silver Proactive Essential","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN005","referral":true,"tiers":true,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":442.64,"tobaccoFactor":1.125,"tobaccoFactorByAge":{"21":1.125,"22":1.125,"23":1.125,"24":1.125,"25":1.124997,"26":1.125006,"27":1.124987,"28":1.124992,"29":1.125013,"30":1.175,"31":1.175003,"32":1.175006,"33":1.175002,"34":1.175004,"35":1.174983,"36":1.175002,"37":1.175003,"38":1.175004,"39":1.175006,"40":1.225017,"41":1.224997,"42":1.224996,"43":1.225002,"44":1.224995,"45":1.225011,"46":1.224998,"47":1.224991,"48":1.22499,"49":1.225005,"50":1.374987,"51":1.375,"52":1.37501,"53":1.374999,"54":1.375,"55":1.374991,"56":1.374995,"57":1.375003,"58":1.374997,"59":1.374999,"60":1.375004,"61":1.374998,"62":1.375002,"63":1.375007,"64+":1.375}}},"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":null,"oop":{"ind":4000,"fam":8000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":300}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":400}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":5,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":300,"ded":"after_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":40,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"copay","amount":300,"ded":"after_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Independence publishes no SBC for this reduced cost-sharing version; its cost sharing comes from Independence's 2027 plan overview brochure, page 63, checked against the PA Insurance Department filing (pages 86, 88, 92, 94, 96).","Mental health: office visits $40 copay (used here); all other outpatient services $40 copay.","Low-cost generic drugs: $3 per 30-day retail fill; other generics as shown (retail generic, used here).","Preferred brand drugs: the coinsurance is capped at $300 per 30-day retail fill (the cap is modelled here).","Non-preferred brand drugs: the coinsurance is capped at $400 per 30-day retail fill (the cap is modelled here).","Specialty drugs: the coinsurance is capped at $500 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill.","Physical and occupational therapy: limited to 30 visits a year; visits above the limit are not covered.","Hospital stay: the copay is charged per day, up to five copays per admission (brochure footnote 7).","Virtual care from the designated virtual provider (Teladoc Health) is free.","This plan has three provider tiers. The rules use Tier 1 (Preferred), the tier the deductible ($1,500 individual / $3,000 family) and out-of-pocket limit describe. Tier 2 (Enhanced) and Tier 3 (Standard) providers have a $2,000 individual / $4,000 family deductible and higher cost sharing (each rule's text gives all three tiers).","Independence's brochure gives no outpatient surgeon fee for this version; the standard version's SBC figure (copay 5 after_ded) is used, an upper bound — this version may cost less. Its text and page are those of the standard version's SBC (https://www.ibx.com/pdfs/custom/ffm/2027/hmosilverproactiveessential2027.pdf, page 4).","Prenatal care: the brochure has no prenatal row. The first OB visit is charged at this version's specialist cost share and later prenatal visits are no charge (part of the delivery fee): every Independence standard SBC prices prenatal care this way.","The deductible and out-of-pocket limit are the brochure's; no CMS plan file for 2027 exists yet to compare them with (the out-of-pocket limit is within the federal limit for this version)."],"sbcUrl":"https://www.ibx.com/pdfs/find-a-plan/individuals/2027-plan-overview-brochure.pdf#page=63","prev":{"planYear":2026,"rates":{"8":{"base21":383.14,"tobaccoFactor":1.124993,"tobaccoFactorByAge":{"21":1.124993,"22":1.124993,"23":1.124993,"24":1.124993,"25":1.125016,"26":1.124994,"27":1.124997,"28":1.125003,"29":1.12502,"30":1.175022,"31":1.174999,"32":1.175003,"33":1.175011,"34":1.175005,"35":1.174989,"36":1.174999,"37":1.174984,"38":1.175014,"39":1.175008,"40":1.224997,"41":1.224997,"42":1.224993,"43":1.224996,"44":1.224998,"45":1.225016,"46":1.225,"47":1.224998,"48":1.225005,"49":1.225002,"50":1.375002,"51":1.374986,"52":1.375002,"53":1.374995,"54":1.375012,"55":1.375,"56":1.374999,"57":1.374999,"58":1.375,"59":1.375009,"60":1.375,"61":1.375007,"62":1.375005,"63":1.375003,"64+":1.374998}}}}},{"market":"pennie","id":"33871PA0040018-06","standardId":"33871PA0040018","variant":"csr94","issuer":"Keystone Health Plan East","name":"Keystone HMO Silver Proactive Essential","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN005","referral":true,"tiers":true,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":442.64,"tobaccoFactor":1.125,"tobaccoFactorByAge":{"21":1.125,"22":1.125,"23":1.125,"24":1.125,"25":1.124997,"26":1.125006,"27":1.124987,"28":1.124992,"29":1.125013,"30":1.175,"31":1.175003,"32":1.175006,"33":1.175002,"34":1.175004,"35":1.174983,"36":1.175002,"37":1.175003,"38":1.175004,"39":1.175006,"40":1.225017,"41":1.224997,"42":1.224996,"43":1.225002,"44":1.224995,"45":1.225011,"46":1.224998,"47":1.224991,"48":1.22499,"49":1.225005,"50":1.374987,"51":1.375,"52":1.37501,"53":1.374999,"54":1.375,"55":1.374991,"56":1.374995,"57":1.375003,"58":1.374997,"59":1.374999,"60":1.375004,"61":1.374998,"62":1.375002,"63":1.375007,"64+":1.375}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":3500,"fam":7000},"rules":{"pcp":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":15,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.05,"ded":"no_ded","max":300}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.05,"ded":"no_ded","max":400}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":5,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":15,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Independence publishes no SBC for this reduced cost-sharing version; its cost sharing comes from Independence's 2027 plan overview brochure, page 70, checked against the PA Insurance Department filing (pages 86, 88, 92, 94, 96).","Mental health: office visits $15 copay (used here); all other outpatient services $15 copay.","Low-cost generic drugs: $1 per 30-day retail fill; other generics as shown (retail generic, used here).","Preferred brand drugs: the coinsurance is capped at $300 per 30-day retail fill (the cap is modelled here).","Non-preferred brand drugs: the coinsurance is capped at $400 per 30-day retail fill (the cap is modelled here).","Specialty drugs: the coinsurance is capped at $500 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill.","Physical and occupational therapy: limited to 30 visits a year; visits above the limit are not covered.","Hospital stay: the copay is charged per day, up to five copays per admission (brochure footnote 7).","Virtual care from the designated virtual provider (Teladoc Health) is free.","This plan has three provider tiers. The rules use Tier 1 (Preferred), the tier the deductible ($0 individual / $0 family) and out-of-pocket limit describe. Tier 2 (Enhanced) and Tier 3 (Standard) providers have a $0 individual / $0 family deductible and higher cost sharing (each rule's text gives all three tiers).","Independence's brochure gives no outpatient surgeon fee for this version; the standard version's SBC figure (copay 5 after_ded) is used, an upper bound — this version may cost less. Its text and page are those of the standard version's SBC (https://www.ibx.com/pdfs/custom/ffm/2027/hmosilverproactiveessential2027.pdf, page 4).","Prenatal care: the brochure has no prenatal row. The first OB visit is charged at this version's specialist cost share and later prenatal visits are no charge (part of the delivery fee): every Independence standard SBC prices prenatal care this way.","The deductible and out-of-pocket limit are the brochure's; no CMS plan file for 2027 exists yet to compare them with (the out-of-pocket limit is within the federal limit for this version)."],"sbcUrl":"https://www.ibx.com/pdfs/find-a-plan/individuals/2027-plan-overview-brochure.pdf#page=70","prev":{"planYear":2026,"rates":{"8":{"base21":383.14,"tobaccoFactor":1.124993,"tobaccoFactorByAge":{"21":1.124993,"22":1.124993,"23":1.124993,"24":1.124993,"25":1.125016,"26":1.124994,"27":1.124997,"28":1.125003,"29":1.12502,"30":1.175022,"31":1.174999,"32":1.175003,"33":1.175011,"34":1.175005,"35":1.174989,"36":1.174999,"37":1.174984,"38":1.175014,"39":1.175008,"40":1.224997,"41":1.224997,"42":1.224993,"43":1.224996,"44":1.224998,"45":1.225016,"46":1.225,"47":1.224998,"48":1.225005,"49":1.225002,"50":1.375002,"51":1.374986,"52":1.375002,"53":1.374995,"54":1.375012,"55":1.375,"56":1.374999,"57":1.374999,"58":1.375,"59":1.375009,"60":1.375,"61":1.375007,"62":1.375005,"63":1.375003,"64+":1.374998}}}}},{"market":"pennie","id":"33871PA0040019-01","standardId":"33871PA0040019","variant":"standard","issuer":"Keystone Health Plan East","name":"Keystone HMO Gold Proactive Value","metal":"Gold","network":"HMO","hsaEligible":false,"networkId":"PAN005","referral":true,"tiers":true,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":579.11,"tobaccoFactor":1.125002,"tobaccoFactorByAge":{"21":1.125002,"22":1.125002,"23":1.125002,"24":1.125002,"25":1.124985,"26":1.124989,"27":1.124994,"28":1.125006,"29":1.125012,"30":1.175006,"31":1.175003,"32":1.174999,"33":1.175,"34":1.174997,"35":1.175011,"36":1.174994,"37":1.174994,"38":1.175007,"39":1.17499,"40":1.22501,"41":1.225,"42":1.225004,"43":1.225005,"44":1.225001,"45":1.22501,"46":1.224988,"47":1.225001,"48":1.225001,"49":1.224999,"50":1.375001,"51":1.375005,"52":1.375002,"53":1.375002,"54":1.375,"55":1.374998,"56":1.375002,"57":1.375004,"58":1.375001,"59":1.375005,"60":1.375002,"61":1.375002,"62":1.375002,"63":1.375004,"64+":1.375001}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":10500,"fam":21000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"no_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":60,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"copay","amount":350,"ded":"no_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Prenatal care: the SBC says the office-visit cost share applies to the first OB visit only, so it is charged once here and later prenatal visits are no charge (they are part of the delivery fee); other copays or coinsurance may apply to other services such as ultrasounds.","Prescription drug costs shown are for a 30-day retail fill; 31-90 day mail-order fills cost more per fill.","Mental health: office visits $60 copay per visit (used here); other outpatient services $60 copay per visit.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); visits above the limit are not covered. The limit does not apply to therapy prescribed for mental health or substance use treatment.","Telemedicine visits with the designated telemedicine provider are free.","This plan has three provider tiers. The rules use Tier 1 (Preferred), the tier the deductible ($0 individual / $0 family) and out-of-pocket limit describe. Tier 2 (Enhanced) and Tier 3 (Standard) providers have a higher deductible ($4,000 individual / $8,000 family) and higher cost sharing.","Primary care: Tier 1 $25 copay per visit (used here); Tier 2 $40 copay per visit; Tier 3 $55 copay per visit.","Specialist: Tier 1 $60 copay per visit (used here); Tier 2 $80 copay per visit; Tier 3 $100 copay per visit.","Emergency room: Tier 1 $450 copay per visit (used here); Tier 2 $450 copay per visit; Tier 3 $450 copay per visit.","Hospital stay facility fee: Tier 1 $350 copay per day (up to 5 days per admission) (used here); Tier 2 $700 copay per day (up to 5 days per admission) after the deductible; Tier 3 $1,100 copay per day (up to 5 days per admission) after the deductible.","Outpatient surgery facility fee: Tier 1 $150 copay per visit (used here); Tier 2 $550 copay per visit after the deductible; Tier 3 $1,000 copay per visit after the deductible."],"sbcUrl":"https://www.ibx.com/pdfs/custom/ffm/2027/hmogoldproactivevalue2027.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":494.31,"tobaccoFactor":1.125003,"tobaccoFactorByAge":{"21":1.125003,"22":1.125003,"23":1.125003,"24":1.125003,"25":1.124987,"26":1.125017,"27":1.12499,"28":1.125012,"29":1.124998,"30":1.174996,"31":1.174984,"32":1.174992,"33":1.175014,"34":1.175007,"35":1.175002,"36":1.175,"37":1.174995,"38":1.174993,"39":1.175002,"40":1.225001,"41":1.225003,"42":1.225006,"43":1.224992,"44":1.225009,"45":1.224999,"46":1.224986,"47":1.224991,"48":1.224994,"49":1.225,"50":1.374994,"51":1.375001,"52":1.375006,"53":1.375004,"54":1.375004,"55":1.375003,"56":1.37499,"57":1.375003,"58":1.375006,"59":1.375001,"60":1.374996,"61":1.375001,"62":1.375003,"63":1.375,"64+":1.375001}}}}},{"market":"pennie","id":"33871PA0040027-01","standardId":"33871PA0040027","variant":"standard","issuer":"Keystone Health Plan East","name":"Keystone HMO Bronze Proactive","metal":"Bronze","network":"HMO","hsaEligible":false,"networkId":"PAN005","referral":true,"tiers":true,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":297.13,"tobaccoFactor":1.124996,"tobaccoFactorByAge":{"21":1.124996,"22":1.124996,"23":1.124996,"24":1.124996,"25":1.125,"26":1.124992,"27":1.12502,"28":1.124992,"29":1.124996,"30":1.175009,"31":1.175015,"32":1.175021,"33":1.17502,"34":1.174983,"35":1.174998,"36":1.175008,"37":1.17499,"38":1.175004,"39":1.174996,"40":1.225002,"41":1.225017,"42":1.224994,"43":1.224994,"44":1.225011,"45":1.22498,"46":1.224994,"47":1.225017,"48":1.224985,"49":1.225015,"50":1.375016,"51":1.374989,"52":1.375,"53":1.37499,"54":1.375002,"55":1.374992,"56":1.375014,"57":1.374998,"58":1.374988,"59":1.375005,"60":1.374995,"61":1.374997,"62":1.375001,"63":1.374996,"64+":1.374999}}},"ded":{"ind":8000,"fam":16000,"embedded":true},"drugDed":{"ind":225,"fam":450,"embedded":true},"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":170,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":170,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":975,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":150,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":750,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":140,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":700,"ded":"after_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":170,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"copay","amount":700,"ded":"after_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Prenatal care: the SBC says the office-visit cost share applies to the first OB visit only, so it is charged once here and later prenatal visits are no charge (they are part of the delivery fee); other copays or coinsurance may apply to other services such as ultrasounds.","Prescription drug costs shown are for a 30-day retail fill; 31-90 day mail-order fills cost more per fill.","Mental health: office visits $150 copay per visit (used here); other outpatient services $150 copay per visit.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); visits above the limit are not covered. The limit does not apply to therapy prescribed for mental health or substance use treatment.","Telemedicine visits with the designated telemedicine provider are free.","This plan has three provider tiers. The rules use Tier 1 (Preferred), the tier the deductible ($8,000 individual / $16,000 family) and out-of-pocket limit describe. Tier 2 (Enhanced) and Tier 3 (Standard) providers have a higher deductible ($9,800 individual / $19,600 family) and higher cost sharing.","Primary care: Tier 1 $85 copay per visit (used here); Tier 2 $95 copay per visit; Tier 3 $105 copay per visit.","Specialist: Tier 1 $170 copay per visit (used here); Tier 2 $180 copay per visit; Tier 3 $190 copay per visit.","Emergency room: Tier 1 $975 copay per visit (used here); Tier 2 $975 copay per visit; Tier 3 $975 copay per visit.","Hospital stay facility fee: Tier 1 $700 copay per day (up to 5 days per admission) after the deductible (used here); Tier 2 $900 copay per day (up to 5 days per admission) after the deductible; Tier 3 $1,300 copay per day (up to 5 days per admission) after the deductible.","Outpatient surgery facility fee: Tier 1 $750 copay per visit after the deductible (used here); Tier 2 $1,000 copay per visit after the deductible; Tier 3 $1,250 copay per visit after the deductible.","Separate prescription drug deductible ($225 individual / $450 family) applies to preferred brand, non-preferred brand, specialty drugs; the other drug tiers say the deductible does not apply. The SBC diabetes example shows a $200 deductible, which fits the drug deductible rather than the medical one."],"sbcUrl":"https://www.ibx.com/pdfs/custom/ffm/2027/hmobronzeproactive2027.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":256.32,"tobaccoFactor":1.125,"tobaccoFactorByAge":{"21":1.125,"22":1.125,"23":1.125,"24":1.125,"25":1.124966,"26":1.125005,"27":1.125009,"28":1.125009,"29":1.124991,"30":1.174997,"31":1.175009,"32":1.174983,"33":1.175009,"34":1.175017,"35":1.175021,"36":1.175025,"37":1.175028,"38":1.175032,"39":1.174972,"40":1.224983,"41":1.225002,"42":1.225016,"43":1.224995,"44":1.225006,"45":1.224975,"46":1.225005,"47":1.224996,"48":1.225017,"49":1.225005,"50":1.374997,"51":1.37499,"52":1.374985,"53":1.375012,"54":1.375009,"55":1.375007,"56":1.375006,"57":1.37501,"58":1.375011,"59":1.375,"60":1.375002,"61":1.375003,"62":1.374995,"63":1.37499,"64+":1.375}}}}},{"market":"pennie","id":"45127PA0020008-01","standardId":"45127PA0020008","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Silver PPO 4000/0/45 Rx 250","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN006","referral":false,"tiers":true,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Lehigh","Mifflin","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Union","York"],"rates":{"6":{"base21":815.1,"tobaccoFactor":1.024991,"tobaccoFactorByAge":{"21":1.024991,"22":1.024991,"23":1.024991,"24":1.024991,"25":1.024989,"26":1.024992,"27":1.025005,"28":1.025,"29":1.024998,"30":1.025002,"31":1.024992,"32":1.024993,"33":1.025008,"34":1.024992,"35":1.024999,"36":1.024996,"37":1.025003,"38":1.025,"39":1.025004,"40":1.075003,"41":1.075006,"42":1.075,"43":1.075004,"44":1.074998,"45":1.1,"46":1.100005,"47":1.100001,"48":1.100002,"49":1.100004,"50":1.149997,"51":1.150005,"52":1.15,"53":1.150001,"54":1.149997,"55":1.200004,"56":1.199998,"57":1.199996,"58":1.200004,"59":1.200001,"60":1.249999,"61":1.249998,"62":1.249999,"63":1.25,"64+":1.249999}},"7":{"base21":908.98,"tobaccoFactor":1.024995,"tobaccoFactorByAge":{"21":1.024995,"22":1.024995,"23":1.024995,"24":1.024995,"25":1.025005,"26":1.025,"27":1.024994,"28":1.024998,"29":1.025001,"30":1.024998,"31":1.025002,"32":1.024997,"33":1.025006,"34":1.024993,"35":1.025001,"36":1.024999,"37":1.025006,"38":1.025005,"39":1.025002,"40":1.075004,"41":1.074999,"42":1.075001,"43":1.074999,"44":1.075002,"45":1.100003,"46":1.100003,"47":1.099998,"48":1.099995,"49":1.099999,"50":1.150003,"51":1.150002,"52":1.150001,"53":1.150002,"54":1.150001,"55":1.199998,"56":1.200001,"57":1.200003,"58":1.200003,"59":1.200003,"60":1.25,"61":1.250002,"62":1.249999,"63":1.249998,"64+":1.249999}},"9":{"base21":907.22,"tobaccoFactor":1.024999,"tobaccoFactorByAge":{"21":1.024999,"22":1.024999,"23":1.024999,"24":1.024999,"25":1.024999,"26":1.025006,"27":1.025001,"28":1.024996,"29":1.025,"30":1.024998,"31":1.025003,"32":1.024999,"33":1.024999,"34":1.024996,"35":1.025004,"36":1.025003,"37":1.025001,"38":1.025,"39":1.025006,"40":1.075002,"41":1.075,"42":1.074996,"43":1.074998,"44":1.074997,"45":1.099998,"46":1.100005,"47":1.100001,"48":1.099999,"49":1.099999,"50":1.149997,"51":1.149997,"52":1.149997,"53":1.15,"54":1.149996,"55":1.2,"56":1.2,"57":1.2,"58":1.2,"59":1.2,"60":1.25,"61":1.249999,"62":1.249999,"63":1.25,"64+":1.250006}}},"ded":{"ind":4000,"fam":8000,"embedded":true},"drugDed":{"ind":250,"fam":500,"embedded":true},"oop":{"ind":10700,"fam":21400},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":25,"ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":45,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":800}},"outpatientFacility":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $400 copay per visit, waived if you are admitted as an inpatient.","Hospital stay: $150 copay per day (no limit on days shown).","Delivery facility: $150 copay per day (no limit on days shown).","Lab tests: $25 copay per visit at an independent lab (used here); $75 copay per visit at a facility-owned lab (hospital or outpatient facility).","Mental health: office visits $45 copay per visit (used here); other outpatient mental health services no charge.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $10 copay per prescription (used here), non-preferred generics $25 copay per prescription, for a 30-day retail supply.","Generic drugs: this SBC prints each generic cost followed by a comma and nothing else (\"$10 copayment/prescription, preferred and ...\"), where most of Capital's 2027 SBCs (those dated June 2026) print \", Deductible does not apply\". This SBC does not say the deductible does not apply, so generic drugs are charged after the deductible here (the cautious reading of a silent copay). If Capital confirms the missing words, they are free of the deductible instead.","Mental health office visits: this SBC does not mark the office-visit copay \"Deductible does not apply\", as most of Capital's 2027 SBCs (those dated June 2026) do. It is charged after the deductible here (the cautious reading of a silent copay). If Capital confirms the missing words, it is free of the deductible instead.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $25 copay per prescription, non-preferred generic $63 copay per prescription; preferred brand $138 copay per prescription; non-preferred brand $200 copay per prescription.","Specialty drugs: 50% coinsurance, at most $800 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Separate prescription drug deductible ($250 individual / $500 family): the SBC exempts no drug tier from it, so every tier is charged after that drug deductible.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Silver-PPO-4000_0_45-Rx-250.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":723.83,"tobaccoFactor":1.024992,"tobaccoFactorByAge":{"21":1.024992,"22":1.024992,"23":1.024992,"24":1.024992,"25":1.025003,"26":1.025,"27":1.025008,"28":1.025,"29":1.025001,"30":1.025002,"31":1.024996,"32":1.024992,"33":1.02499,"34":1.024991,"35":1.024997,"36":1.025003,"37":1.024997,"38":1.025003,"39":1.025004,"40":1.075001,"41":1.074998,"42":1.075,"43":1.075003,"44":1.075001,"45":1.099999,"46":1.099996,"47":1.100005,"48":1.099995,"49":1.099996,"50":1.149997,"51":1.149999,"52":1.150002,"53":1.149999,"54":1.150003,"55":1.200002,"56":1.200001,"57":1.199998,"58":1.199999,"59":1.200003,"60":1.249996,"61":1.250001,"62":1.249995,"63":1.249998,"64+":1.25}},"7":{"base21":807.07,"tobaccoFactor":1.024992,"tobaccoFactorByAge":{"21":1.024992,"22":1.024992,"23":1.024992,"24":1.024992,"25":1.024991,"26":1.024999,"27":1.024994,"28":1.024998,"29":1.025002,"30":1.024999,"31":1.025006,"32":1.025001,"33":1.024998,"34":1.024995,"35":1.024994,"36":1.025003,"37":1.025001,"38":1.025,"39":1.024997,"40":1.075003,"41":1.075,"42":1.075007,"43":1.075001,"44":1.075,"45":1.099999,"46":1.1,"47":1.099996,"48":1.099995,"49":1.099996,"50":1.150005,"51":1.150002,"52":1.149994,"53":1.149998,"54":1.149998,"55":1.199999,"56":1.200001,"57":1.200003,"58":1.199999,"59":1.2,"60":1.250002,"61":1.249998,"62":1.250002,"63":1.250002,"64+":1.25}},"9":{"base21":781.73,"tobaccoFactor":1.025009,"tobaccoFactorByAge":{"21":1.025009,"22":1.025009,"23":1.025009,"24":1.025009,"25":1.024998,"26":1.024997,"27":1.024998,"28":1.025008,"29":1.025001,"30":1.024998,"31":1.024999,"32":1.025,"33":1.024997,"34":1.025005,"35":1.024998,"36":1.025002,"37":1.024995,"38":1.024999,"39":1.024996,"40":1.07499,"41":1.074994,"42":1.074995,"43":1.074999,"44":1.075004,"45":1.100007,"46":1.1,"47":1.099996,"48":1.100005,"49":1.099997,"50":1.149995,"51":1.15,"52":1.150006,"53":1.149999,"54":1.15,"55":1.199998,"56":1.200002,"57":1.200002,"58":1.199999,"59":1.2,"60":1.250002,"61":1.250001,"62":1.25,"63":1.25,"64+":1.250005}}}}},{"market":"pennie","id":"45127PA0020008-04","standardId":"45127PA0020008","variant":"csr73","issuer":"Capital Advantage Assurance Company","name":"Silver PPO 4000/0/45 Rx 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room: $375 copay per visit, waived if you are admitted as an inpatient.","Hospital stay: $125 copay per day (no limit on days shown).","Delivery facility: $125 copay per day (no limit on days shown).","Lab tests: $20 copay per visit at an independent lab (used here); $60 copay per visit at a facility-owned lab (hospital or outpatient facility).","Mental health: office visits $40 copay per visit (used here); other outpatient mental health services no charge.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $5 copay per prescription (used here), non-preferred generics $15 copay per prescription, for a 30-day retail supply.","Generic drugs: this SBC prints each generic cost followed by a comma and nothing else (\"$5 copayment/prescription, preferred and ...\"), where most of Capital's 2027 SBCs (those dated June 2026) print \", Deductible does not apply\". This SBC does not say the deductible does not apply, so generic drugs are charged after the deductible here (the cautious reading of a silent copay). If Capital confirms the missing words, they are free of the deductible instead.","Mental health office visits: this SBC does not mark the office-visit copay \"Deductible does not apply\", as most of Capital's 2027 SBCs (those dated June 2026) do. It is charged after the deductible here (the cautious reading of a silent copay). If Capital confirms the missing words, it is free of the deductible instead.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $13 copay per prescription, non-preferred generic $38 copay per prescription; preferred brand $113 copay per prescription; non-preferred brand $188 copay per prescription.","Specialty drugs: 40% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $800 for a non-preferred one.","Separate prescription drug deductible ($200 individual / $400 family): the SBC exempts no drug tier from it, so every tier is charged after that drug deductible.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Silver-PPO-3900_0_40-Rx-200-CSR73.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":723.83,"tobaccoFactor":1.024992,"tobaccoFactorByAge":{"21":1.024992,"22":1.024992,"23":1.024992,"24":1.024992,"25":1.025003,"26":1.025,"27":1.025008,"28":1.025,"29":1.025001,"30":1.025002,"31":1.024996,"32":1.024992,"33":1.02499,"34":1.024991,"35":1.024997,"36":1.025003,"37":1.024997,"38":1.025003,"39":1.025004,"40":1.075001,"41":1.074998,"42":1.075,"43":1.075003,"44":1.075001,"45":1.099999,"46":1.099996,"47":1.100005,"48":1.099995,"49":1.099996,"50":1.149997,"51":1.149999,"52":1.150002,"53":1.149999,"54":1.150003,"55":1.200002,"56":1.200001,"57":1.199998,"58":1.199999,"59":1.200003,"60":1.249996,"61":1.250001,"62":1.249995,"63":1.249998,"64+":1.25}},"7":{"base21":807.07,"tobaccoFactor":1.024992,"tobaccoFactorByAge":{"21":1.024992,"22":1.024992,"23":1.024992,"24":1.024992,"25":1.024991,"26":1.024999,"27":1.024994,"28":1.024998,"29":1.025002,"30":1.024999,"31":1.025006,"32":1.025001,"33":1.024998,"34":1.024995,"35":1.024994,"36":1.025003,"37":1.025001,"38":1.025,"39":1.024997,"40":1.075003,"41":1.075,"42":1.075007,"43":1.075001,"44":1.075,"45":1.099999,"46":1.1,"47":1.099996,"48":1.099995,"49":1.099996,"50":1.150005,"51":1.150002,"52":1.149994,"53":1.149998,"54":1.149998,"55":1.199999,"56":1.200001,"57":1.200003,"58":1.199999,"59":1.2,"60":1.250002,"61":1.249998,"62":1.250002,"63":1.250002,"64+":1.25}},"9":{"base21":781.73,"tobaccoFactor":1.025009,"tobaccoFactorByAge":{"21":1.025009,"22":1.025009,"23":1.025009,"24":1.025009,"25":1.024998,"26":1.024997,"27":1.024998,"28":1.025008,"29":1.025001,"30":1.024998,"31":1.024999,"32":1.025,"33":1.024997,"34":1.025005,"35":1.024998,"36":1.025002,"37":1.024995,"38":1.024999,"39":1.024996,"40":1.07499,"41":1.074994,"42":1.074995,"43":1.074999,"44":1.075004,"45":1.100007,"46":1.1,"47":1.099996,"48":1.100005,"49":1.099997,"50":1.149995,"51":1.15,"52":1.150006,"53":1.149999,"54":1.15,"55":1.199998,"56":1.200002,"57":1.200002,"58":1.199999,"59":1.2,"60":1.250002,"61":1.250001,"62":1.25,"63":1.25,"64+":1.250005}}}}},{"market":"pennie","id":"45127PA0020008-05","standardId":"45127PA0020008","variant":"csr87","issuer":"Capital 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room: $75 copay per visit, waived if you are admitted as an inpatient.","Hospital stay: $100 copay per day (no limit on days shown).","Delivery facility: $100 copay per day (no limit on days shown).","Lab tests: $15 copay per visit at an independent lab (used here); $40 copay per visit at a facility-owned lab (hospital or outpatient facility).","Mental health: office visits $5 copay per visit (used here); other outpatient mental health services no charge.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $3 copay per prescription (used here), non-preferred generics $10 copay per prescription, for a 30-day retail supply.","Generic drugs: this SBC prints each generic cost followed by a comma and nothing else (\"$3 copayment/prescription, preferred and ...\"), where most of Capital's 2027 SBCs (those dated June 2026) print \", Deductible does not apply\". This SBC does not say the deductible does not apply, so generic drugs are charged after the deductible here (the cautious reading of a silent copay). If Capital confirms the missing words, they are free of the deductible instead.","Mental health office visits: this SBC does not mark the office-visit copay \"Deductible does not apply\", as most of Capital's 2027 SBCs (those dated June 2026) do. It is charged after the deductible here (the cautious reading of a silent copay). If Capital confirms the missing words, it is free of the deductible instead.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $8 copay per prescription, non-preferred generic $25 copay per prescription; preferred brand $38 copay per prescription; non-preferred brand $100 copay per prescription.","Specialty drugs: 30% coinsurance, at most $400 per 30-day prescription for a preferred specialty drug (modelled here) and at most $500 for a non-preferred one.","Separate prescription drug deductible ($150 individual / $300 family): the SBC exempts no drug tier from it, so every tier is charged after that drug deductible.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states 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room: $50 copay per visit, waived if you are admitted as an inpatient.","Hospital stay: $75 copay per day (no limit on days shown).","Delivery facility: $75 copay per day (no limit on days shown).","Lab tests: $10 copay per visit at an independent lab (used here); $20 copay per visit at a facility-owned lab (hospital or outpatient facility).","Mental health: office visits $3 copay per visit (used here); other outpatient mental health services no charge.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $2 copay per prescription (used here), non-preferred generics $5 copay per prescription, for a 30-day retail supply.","Generic drugs: this SBC prints each generic cost followed by a comma and nothing else (\"$2 copayment/prescription, preferred and ...\"), where most of Capital's 2027 SBCs (those dated June 2026) print \", Deductible does not apply\". This SBC does not say the deductible does not apply, so generic drugs are charged after the deductible here (the cautious reading of a silent copay). If Capital confirms the missing words, they are free of the deductible instead.","Mental health office visits: this SBC does not mark the office-visit copay \"Deductible does not apply\", as most of Capital's 2027 SBCs (those dated June 2026) do. It is charged after the deductible here (the cautious reading of a silent copay). If Capital confirms the missing words, it is free of the deductible instead.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $5 copay per prescription, non-preferred generic $13 copay per prescription; preferred brand $25 copay per prescription; non-preferred brand $63 copay per prescription.","Specialty drugs: 10% coinsurance, at most $200 per 30-day prescription for a preferred specialty drug (modelled here) and at most $300 for a non-preferred one.","Separate prescription drug deductible ($100 individual / $200 family): the SBC exempts no drug tier from it, so every tier is charged after that drug deductible.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Silver-PPO-550_0_3-Rx-100-CSR94.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":723.83,"tobaccoFactor":1.024992,"tobaccoFactorByAge":{"21":1.024992,"22":1.024992,"23":1.024992,"24":1.024992,"25":1.025003,"26":1.025,"27":1.025008,"28":1.025,"29":1.025001,"30":1.025002,"31":1.024996,"32":1.024992,"33":1.02499,"34":1.024991,"35":1.024997,"36":1.025003,"37":1.024997,"38":1.025003,"39":1.025004,"40":1.075001,"41":1.074998,"42":1.075,"43":1.075003,"44":1.075001,"45":1.099999,"46":1.099996,"47":1.100005,"48":1.099995,"49":1.099996,"50":1.149997,"51":1.149999,"52":1.150002,"53":1.149999,"54":1.150003,"55":1.200002,"56":1.200001,"57":1.199998,"58":1.199999,"59":1.200003,"60":1.249996,"61":1.250001,"62":1.249995,"63":1.249998,"64+":1.25}},"7":{"base21":807.07,"tobaccoFactor":1.024992,"tobaccoFactorByAge":{"21":1.024992,"22":1.024992,"23":1.024992,"24":1.024992,"25":1.024991,"26":1.024999,"27":1.024994,"28":1.024998,"29":1.025002,"30":1.024999,"31":1.025006,"32":1.025001,"33":1.024998,"34":1.024995,"35":1.024994,"36":1.025003,"37":1.025001,"38":1.025,"39":1.024997,"40":1.075003,"41":1.075,"42":1.075007,"43":1.075001,"44":1.075,"45":1.099999,"46":1.1,"47":1.099996,"48":1.099995,"49":1.099996,"50":1.150005,"51":1.150002,"52":1.149994,"53":1.149998,"54":1.149998,"55":1.199999,"56":1.200001,"57":1.200003,"58":1.199999,"59":1.2,"60":1.250002,"61":1.249998,"62":1.250002,"63":1.250002,"64+":1.25}},"9":{"base21":781.73,"tobaccoFactor":1.025009,"tobaccoFactorByAge":{"21":1.025009,"22":1.025009,"23":1.025009,"24":1.025009,"25":1.024998,"26":1.024997,"27":1.024998,"28":1.025008,"29":1.025001,"30":1.024998,"31":1.024999,"32":1.025,"33":1.024997,"34":1.025005,"35":1.024998,"36":1.025002,"37":1.024995,"38":1.024999,"39":1.024996,"40":1.07499,"41":1.074994,"42":1.074995,"43":1.074999,"44":1.075004,"45":1.100007,"46":1.1,"47":1.099996,"48":1.100005,"49":1.099997,"50":1.149995,"51":1.15,"52":1.150006,"53":1.149999,"54":1.15,"55":1.199998,"56":1.200002,"57":1.200002,"58":1.199999,"59":1.2,"60":1.250002,"61":1.250001,"62":1.25,"63":1.25,"64+":1.250005}}}}},{"market":"pennie","id":"45127PA0020013-01","standardId":"45127PA0020013","variant":"standard","issuer":"Capital 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room: $300 copay per visit, waived if you are admitted as an inpatient.","Lab tests: $25 copay per visit at an independent lab (used here); $75 copay per visit at a facility-owned lab (hospital or outpatient facility).","Mental health: office visits $20 copay per visit (used here); other outpatient mental health services 10% coinsurance.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $10 copay per prescription (used here), non-preferred generics $20 copay per prescription, for a 30-day retail supply.","Generic drugs: this SBC prints each generic cost followed by a comma and nothing else (\"$10 copayment/prescription, preferred and ...\"), where most of Capital's 2027 SBCs (those dated June 2026) print \", Deductible does not apply\". This SBC does not say the deductible does not apply, so generic drugs are charged after the deductible here (the cautious reading of a silent copay). If Capital confirms the missing words, they are free of the deductible instead.","Mental health office visits: this SBC does not mark the office-visit copay \"Deductible does not apply\", as most of Capital's 2027 SBCs (those dated June 2026) do. It is charged after the deductible here (the cautious reading of a silent copay). If Capital confirms the missing words, it is free of the deductible instead.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $25 copay per prescription, non-preferred generic $50 copay per prescription; preferred brand $113 copay per prescription; non-preferred brand $188 copay per prescription.","Specialty drugs: 50% coinsurance, at most $800 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states 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Prices for a 90-day home-delivery fill: preferred generic $10 copay per prescription, non-preferred generic $38 copay per prescription; preferred brand $175 copay per prescription; non-preferred brand $263 copay per prescription.","Specialty drugs: 50% coinsurance, at most $800 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred 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Prices for a 90-day home-delivery fill: preferred generic $25 copay per prescription, non-preferred generic $50 copay per prescription; preferred brand $113 copay per prescription; non-preferred brand $188 copay per prescription.","Specialty drugs: 50% coinsurance, at most $800 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states 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Prices for a 90-day home-delivery fill: preferred generic no charge, non-preferred generic no charge; preferred brand no charge; non-preferred brand no charge.","Specialty drugs: 50% coinsurance, at most $800 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","High-deductible plan: the deductible applies to all services, including prescriptions, before any copay or coinsurance (SBC page 1). The family deductible is an aggregate: it must be met by the family as a whole, not per 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room: $400 copay per visit, waived if you are admitted as an inpatient.","Lab tests: $25 copay per visit at an independent lab (used here); $75 copay per visit at a facility-owned lab (hospital or outpatient facility).","Mental health: office visits $75 copay per visit (used here); other outpatient mental health services no charge.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $25 copay per prescription (used here), non-preferred generics $50 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $63 copay per prescription, non-preferred generic $125 copay per prescription; preferred brand no charge; non-preferred brand no charge.","Specialty drugs: 50% coinsurance, at most $800 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Bronze-PPO-10000_0_75-HSA.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":417.15,"tobaccoFactor":1.025003,"tobaccoFactorByAge":{"21":1.025003,"22":1.025003,"23":1.025003,"24":1.025003,"25":1.024999,"26":1.025002,"27":1.025002,"28":1.025009,"29":1.025001,"30":1.024986,"31":1.024986,"32":1.025006,"33":1.024992,"34":1.024999,"35":1.024992,"36":1.025005,"37":1.024999,"38":1.024992,"39":1.024998,"40":1.074992,"41":1.074991,"42":1.075011,"43":1.075008,"44":1.075005,"45":1.100007,"46":1.100013,"47":1.099998,"48":1.099994,"49":1.099992,"50":1.149994,"51":1.150004,"52":1.149998,"53":1.14999,"54":1.15001,"55":1.200002,"56":1.199998,"57":1.200002,"58":1.2,"59":1.200002,"60":1.250004,"61":1.250002,"62":1.250002,"63":1.249994,"64+":1.250008}},"7":{"base21":465.12,"tobaccoFactor":1.025004,"tobaccoFactorByAge":{"21":1.025004,"22":1.025004,"23":1.025004,"24":1.025004,"25":1.025012,"26":1.025006,"27":1.024987,"28":1.025,"29":1.024997,"30":1.025004,"31":1.024987,"32":1.025007,"33":1.024999,"34":1.024988,"35":1.025001,"36":1.024996,"37":1.025008,"38":1.025003,"39":1.025009,"40":1.074996,"41":1.075001,"42":1.074997,"43":1.075004,"44":1.074995,"45":1.099994,"46":1.100003,"47":1.099988,"48":1.100004,"49":1.1,"50":1.149992,"51":1.150003,"52":1.150002,"53":1.150003,"54":1.149994,"55":1.200006,"56":1.200004,"57":1.2,"58":1.200003,"59":1.200007,"60":1.250004,"61":1.250002,"62":1.249996,"63":1.25,"64+":1.250007}},"9":{"base21":450.52,"tobaccoFactor":1.024993,"tobaccoFactorByAge":{"21":1.024993,"22":1.024993,"23":1.024993,"24":1.024993,"25":1.025004,"26":1.025015,"27":1.024992,"28":1.024994,"29":1.025013,"30":1.025013,"31":1.025012,"32":1.024992,"33":1.024994,"34":1.025012,"35":1.024994,"36":1.025012,"37":1.024993,"38":1.024993,"39":1.024993,"40":1.074995,"41":1.074994,"42":1.074999,"43":1.074997,"44":1.074994,"45":1.100008,"46":1.100003,"47":1.09999,"48":1.1,"49":1.100001,"50":1.150007,"51":1.150008,"52":1.149997,"53":1.150001,"54":1.150001,"55":1.200008,"56":1.199996,"57":1.200005,"58":1.200003,"59":1.199998,"60":1.25,"61":1.249998,"62":1.250002,"63":1.250004,"64+":1.250007}}}}},{"market":"pennie","id":"45127PA0020047-01","standardId":"45127PA0020047","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Bronze Advance PPO 9000/0/75 + HSA","metal":"Bronze","network":"PPO","hsaEligible":true,"networkId":"PAN007","referral":false,"tiers":true,"counties":["Lancaster"],"rates":{"7":{"base21":546.94,"tobaccoFactor":1.024994,"tobaccoFactorByAge":{"21":1.024994,"22":1.024994,"23":1.024994,"24":1.024994,"25":1.025004,"26":1.024997,"27":1.025,"28":1.024995,"29":1.024999,"30":1.025001,"31":1.025004,"32":1.025007,"33":1.024999,"34":1.025001,"35":1.024987,"36":1.025003,"37":1.024989,"38":1.025004,"39":1.025006,"40":1.075009,"41":1.075002,"42":1.074998,"43":1.075008,"44":1.074993,"45":1.100004,"46":1.1,"47":1.100005,"48":1.099996,"49":1.100003,"50":1.149995,"51":1.150005,"52":1.149997,"53":1.149998,"54":1.149994,"55":1.199997,"56":1.2,"57":1.200003,"58":1.200001,"59":1.200004,"60":1.250003,"61":1.249998,"62":1.249995,"63":1.250002,"64+":1.249998}}},"ded":{"ind":9000,"fam":18000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":800}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $400 copay per visit, waived if you are admitted as an inpatient.","Lab tests: no charge at independent and facility-owned labs.","Mental health: office visits $75 copay per visit (used here); other outpatient mental health services no charge.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $25 copay per prescription (used here), non-preferred generics $50 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $63 copay per prescription, non-preferred generic $125 copay per prescription; preferred brand no charge; non-preferred brand no charge.","Specialty drugs: 50% coinsurance, at most $800 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $100 copay per visit; specialist $125 copay per visit; prenatal visits $125 copay per visit; rehabilitation $125 copay per visit."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Bronze-Advance-PPO-9000_0_75-HSA.pdf","prev":{"planYear":2026,"rates":{"7":{"base21":455.27,"tobaccoFactor":1.024996,"tobaccoFactorByAge":{"21":1.024996,"22":1.024996,"23":1.024996,"24":1.024996,"25":1.025006,"26":1.024989,"27":1.025004,"28":1.024996,"29":1.024988,"30":1.025003,"31":1.024997,"32":1.02501,"33":1.025009,"34":1.024986,"35":1.025003,"36":1.025001,"37":1.024999,"38":1.025015,"39":1.024993,"40":1.075005,"41":1.075005,"42":1.074996,"43":1.074992,"44":1.074999,"45":1.099998,"46":1.1,"47":1.099987,"48":1.100005,"49":1.100001,"50":1.150004,"51":1.149998,"52":1.150009,"53":1.149997,"54":1.15,"55":1.2,"56":1.200002,"57":1.200002,"58":1.200005,"59":1.200007,"60":1.25,"61":1.249994,"62":1.249994,"63":1.250002,"64+":1.250007}}}}},{"market":"pennie","id":"45127PA0020048-01","standardId":"45127PA0020048","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Bronze Capital Advantage PPO 9000/0/75 + HSA","metal":"Bronze","network":"PPO","hsaEligible":true,"networkId":"PAN005","referral":false,"tiers":true,"counties":["Cumberland","Dauphin","Perry"],"rates":{"9":{"base21":458.99,"tobaccoFactor":1.025011,"tobaccoFactorByAge":{"21":1.025011,"22":1.025011,"23":1.025011,"24":1.025011,"25":1.024998,"26":1.024999,"27":1.025009,"28":1.025014,"29":1.025,"30":1.024992,"31":1.025001,"32":1.024991,"33":1.025006,"34":1.024999,"35":1.024996,"36":1.024993,"37":1.025007,"38":1.025004,"39":1.024998,"40":1.07501,"41":1.074999,"42":1.074995,"43":1.07501,"44":1.074999,"45":1.099986,"46":1.100001,"47":1.099999,"48":1.100007,"49":1.100008,"50":1.149995,"51":1.149996,"52":1.150008,"53":1.15001,"54":1.149997,"55":1.2,"56":1.200004,"57":1.200007,"58":1.200007,"59":1.199998,"60":1.249994,"61":1.249998,"62":1.249998,"63":1.249994,"64+":1.250005}}},"ded":{"ind":9000,"fam":18000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":800}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $400 copay per visit, waived if you are admitted as an inpatient.","Lab tests: no charge at independent and facility-owned labs.","Mental health: office visits $75 copay per visit (used here); other outpatient mental health services no charge.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $25 copay per prescription (used here), non-preferred generics $50 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $63 copay per prescription, non-preferred generic $125 copay per prescription; preferred brand no charge; non-preferred brand no charge.","Specialty drugs: 50% coinsurance, at most $800 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $100 copay per visit; specialist $125 copay per visit; prenatal visits $125 copay per visit; rehabilitation $125 copay per visit."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Bronze-Capital-Advantage-PPO-9000_0_75-HSA.pdf","prev":{"planYear":2026,"rates":{"9":{"base21":373.84,"tobaccoFactor":1.025011,"tobaccoFactorByAge":{"21":1.025011,"22":1.025011,"23":1.025011,"24":1.025011,"25":1.024991,"26":1.024999,"27":1.024988,"28":1.025002,"29":1.025004,"30":1.025005,"31":1.024995,"32":1.025008,"33":1.025008,"34":1.025009,"35":1.024998,"36":1.02501,"37":1.025021,"38":1.024989,"39":1.02499,"40":1.074994,"41":1.075009,"42":1.074999,"43":1.075005,"44":1.074982,"45":1.099994,"46":1.100007,"47":1.099998,"48":1.099995,"49":1.100005,"50":1.149997,"51":1.149998,"52":1.149999,"53":1.149992,"54":1.149997,"55":1.20001,"56":1.199995,"57":1.2,"58":1.2,"59":1.199998,"60":1.25,"61":1.250007,"62":1.250009,"63":1.249995,"64+":1.250011}}}}},{"market":"pennie","id":"45127PA0020049-01","standardId":"45127PA0020049","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Bronze Convenience PPO 9000/0/75 + HSA","metal":"Bronze","network":"PPO","hsaEligible":true,"networkId":"PAN009","referral":false,"tiers":true,"counties":["Adams","Franklin","Lebanon","Lehigh","Northampton","York"],"rates":{"6":{"base21":430.75,"tobaccoFactor":1.025003,"tobaccoFactorByAge":{"21":1.025003,"22":1.025003,"23":1.025003,"24":1.025003,"25":1.024996,"26":1.024984,"27":1.024987,"28":1.02501,"29":1.024999,"30":1.024995,"31":1.024998,"32":1.025001,"33":1.024998,"34":1.024994,"35":1.025001,"36":1.025008,"37":1.024997,"38":1.025004,"39":1.025,"40":1.075005,"41":1.074995,"42":1.075008,"43":1.075,"44":1.074997,"45":1.1,"46":1.100012,"47":1.100006,"48":1.099989,"49":1.099992,"50":1.150003,"51":1.149997,"52":1.150008,"53":1.150001,"54":1.150003,"55":1.200006,"56":1.200002,"57":1.199992,"58":1.2,"59":1.200002,"60":1.250006,"61":1.249998,"62":1.250004,"63":1.250006,"64+":1.250008}},"7":{"base21":480.36,"tobaccoFactor":1.025002,"tobaccoFactorByAge":{"21":1.025002,"22":1.025002,"23":1.025002,"24":1.025002,"25":1.025006,"26":1.025006,"27":1.024989,"28":1.025012,"29":1.024985,"30":1.025,"31":1.025003,"32":1.025006,"33":1.025006,"34":1.025002,"35":1.025009,"36":1.024998,"37":1.025005,"38":1.024995,"39":1.024991,"40":1.075012,"41":1.075004,"42":1.075006,"43":1.075002,"44":1.075,"45":1.100009,"46":1.100008,"47":1.099999,"48":1.100001,"49":1.1,"50":1.150001,"51":1.149998,"52":1.149999,"53":1.149999,"54":1.150004,"55":1.199998,"56":1.200004,"57":1.200002,"58":1.200007,"59":1.200003,"60":1.250004,"61":1.249996,"62":1.25,"63":1.250002,"64+":1.250007}},"9":{"base21":479.43,"tobaccoFactor":1.025009,"tobaccoFactorByAge":{"21":1.025009,"22":1.025009,"23":1.025009,"24":1.025009,"25":1.025013,"26":1.024993,"27":1.024998,"28":1.024983,"29":1.024996,"30":1.024993,"31":1.025015,"32":1.025001,"33":1.025002,"34":1.024999,"35":1.025006,"36":1.025013,"37":1.025003,"38":1.024992,"39":1.02499,"40":1.074993,"41":1.075006,"42":1.074994,"43":1.075009,"44":1.074996,"45":1.1,"46":1.100007,"47":1.099992,"48":1.09999,"49":1.099998,"50":1.149999,"51":1.149997,"52":1.150001,"53":1.149992,"54":1.150001,"55":1.200002,"56":1.200005,"57":1.200003,"58":1.2,"59":1.199997,"60":1.249994,"61":1.249998,"62":1.249996,"63":1.249998,"64+":1.250012}}},"ded":{"ind":9000,"fam":18000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":25,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":800}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $400 copay per visit, waived if you are admitted as an inpatient.","Lab tests: no charge at independent and facility-owned labs.","Mental health: office visits $75 copay per visit (used here); other outpatient mental health services no charge.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $25 copay per prescription (used here), non-preferred generics $50 copay per prescription, for a 30-day retail supply.","Generic drugs: this SBC prints each generic cost followed by a comma and nothing else (\"$25 copayment/prescription, preferred and ...\"), where most of Capital's 2027 SBCs (those dated June 2026) print \", Deductible does not apply\". This SBC does not say the deductible does not apply, so generic drugs are charged after the deductible here (the cautious reading of a silent copay). If Capital confirms the missing words, they are free of the deductible instead.","Mental health office visits: this SBC does not mark the office-visit copay \"Deductible does not apply\", as most of Capital's 2027 SBCs (those dated June 2026) do. It is charged after the deductible here (the cautious reading of a silent copay). If Capital confirms the missing words, it is free of the deductible instead.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $63 copay per prescription, non-preferred generic $125 copay per prescription; preferred brand no charge; non-preferred brand no charge.","Specialty drugs: 50% coinsurance, at most $800 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $100 copay per visit; specialist $125 copay per visit; prenatal visits $125 copay per visit; rehabilitation $125 copay per visit."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Bronze-Convenience-PPO-9000_0_75-HSA.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":361.69,"tobaccoFactor":1.024994,"tobaccoFactorByAge":{"21":1.024994,"22":1.024994,"23":1.024994,"24":1.024994,"25":1.025004,"26":1.025002,"27":1.02501,"28":1.025003,"29":1.025004,"30":1.024993,"31":1.025,"32":1.025007,"33":1.025017,"34":1.025006,"35":1.025001,"36":1.024996,"37":1.025013,"38":1.024985,"39":1.024997,"40":1.075004,"41":1.075002,"42":1.074994,"43":1.074998,"44":1.075008,"45":1.100004,"46":1.100013,"47":1.099996,"48":1.100007,"49":1.10001,"50":1.149989,"51":1.149996,"52":1.149996,"53":1.14999,"54":1.149998,"55":1.199995,"56":1.200007,"57":1.200002,"58":1.199991,"59":1.199994,"60":1.249992,"61":1.250002,"62":1.250007,"63":1.250002,"64+":1.250014}},"7":{"base21":403.28,"tobaccoFactor":1.02502,"tobaccoFactorByAge":{"21":1.02502,"22":1.02502,"23":1.02502,"24":1.02502,"25":1.024994,"26":1.025015,"27":1.025009,"28":1.025002,"29":1.025018,"30":1.024993,"31":1.024989,"32":1.024985,"33":1.025004,"34":1.025001,"35":1.024999,"36":1.024998,"37":1.024996,"38":1.024996,"39":1.025013,"40":1.07499,"41":1.074998,"42":1.075007,"43":1.074992,"44":1.074992,"45":1.10001,"46":1.099995,"47":1.100011,"48":1.100005,"49":1.1,"50":1.149999,"51":1.150003,"52":1.149998,"53":1.149994,"54":1.149998,"55":1.200007,"56":1.199998,"57":1.2,"58":1.199996,"59":1.2,"60":1.250002,"61":1.250002,"62":1.249991,"63":1.250006,"64+":1.250017}},"9":{"base21":390.63,"tobaccoFactor":1.024985,"tobaccoFactorByAge":{"21":1.024985,"22":1.024985,"23":1.024985,"24":1.024985,"25":1.024988,"26":1.025,"27":1.024989,"28":1.024988,"29":1.025005,"30":1.024991,"31":1.025004,"32":1.024994,"33":1.025002,"34":1.024988,"35":1.025014,"36":1.024996,"37":1.025001,"38":1.025004,"39":1.024991,"40":1.074997,"41":1.075011,"42":1.075003,"43":1.074989,"44":1.075005,"45":1.100007,"46":1.099993,"47":1.099992,"48":1.100005,"49":1.099998,"50":1.149987,"51":1.149989,"52":1.150007,"53":1.149997,"54":1.150004,"55":1.200002,"56":1.199993,"57":1.2,"58":1.200008,"59":1.2,"60":1.25,"61":1.249995,"62":1.249993,"63":1.249998,"64+":1.249991}}}}},{"market":"pennie","id":"45127PA0020050-01","standardId":"45127PA0020050","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Gold Advance PPO 1700/0/25","metal":"Gold","network":"PPO","hsaEligible":false,"networkId":"PAN007","referral":false,"tiers":true,"counties":["Lancaster"],"rates":{"7":{"base21":778.57,"tobaccoFactor":1.025007,"tobaccoFactorByAge":{"21":1.025007,"22":1.025007,"23":1.025007,"24":1.025007,"25":1.024997,"26":1.024998,"27":1.024989,"28":1.025003,"29":1.024999,"30":1.024998,"31":1.025001,"32":1.025004,"33":1.025002,"34":1.025,"35":1.024994,"36":1.024999,"37":1.024993,"38":1.025008,"39":1.025006,"40":1.074993,"41":1.075002,"42":1.074999,"43":1.075,"44":1.074995,"45":1.100004,"46":1.100003,"47":1.099999,"48":1.100002,"49":1.099996,"50":1.15,"51":1.150003,"52":1.149995,"53":1.150004,"54":1.150001,"55":1.200003,"56":1.200004,"57":1.199996,"58":1.199999,"59":1.200002,"60":1.249999,"61":1.250001,"62":1.249999,"63":1.250001,"64+":1.25001}}},"ded":{"ind":1700,"fam":3400,"embedded":true},"drugDed":null,"oop":{"ind":9000,"fam":18000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":800}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $200 copay per visit, waived if you are admitted as an inpatient.","Lab tests: no charge at independent and facility-owned labs.","Mental health: office visits $25 copay per visit (used here); other outpatient mental health services no charge.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $10 copay per prescription (used here), non-preferred generics $20 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $25 copay per prescription, non-preferred generic $50 copay per prescription; preferred brand $113 copay per prescription; non-preferred brand $188 copay per prescription.","Specialty drugs: 50% coinsurance, at most $800 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $50 copay per visit; specialist $75 copay per visit; imaging 30% coinsurance; outpatient surgery facility 30% coinsurance; outpatient surgeon 30% coinsurance; hospital stay facility 30% coinsurance; hospital stay physician 30% coinsurance; prenatal visits $75 copay per visit; delivery professional 30% coinsurance; delivery facility 30% coinsurance; rehabilitation $75 copay per visit; lab tests 30% coinsurance."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Gold-Advance-PPO-1700_0_25.pdf","prev":{"planYear":2026,"rates":{"7":{"base21":691.14,"tobaccoFactor":1.025002,"tobaccoFactorByAge":{"21":1.025002,"22":1.025002,"23":1.025002,"24":1.025002,"25":1.024989,"26":1.024995,"27":1.025003,"28":1.024998,"29":1.024994,"30":1.024998,"31":1.025005,"32":1.024999,"33":1.025,"34":1.024993,"35":1.024995,"36":1.024997,"37":1.025011,"38":1.025001,"39":1.025005,"40":1.075005,"41":1.075,"42":1.075009,"43":1.074999,"44":1.074995,"45":1.099999,"46":1.100009,"47":1.099994,"48":1.099998,"49":1.100001,"50":1.150002,"51":1.150002,"52":1.150003,"53":1.15,"54":1.150001,"55":1.2,"56":1.199995,"57":1.200005,"58":1.200002,"59":1.200001,"60":1.25,"61":1.250001,"62":1.250004,"63":1.250004,"64+":1.250002}}}}},{"market":"pennie","id":"45127PA0020051-01","standardId":"45127PA0020051","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Gold Advance PPO 2700/0/30","metal":"Gold","network":"PPO","hsaEligible":false,"networkId":"PAN007","referral":false,"tiers":true,"counties":["Lancaster"],"rates":{"7":{"base21":722.9,"tobaccoFactor":1.024997,"tobaccoFactorByAge":{"21":1.024997,"22":1.024997,"23":1.024997,"24":1.024997,"25":1.025007,"26":1.025005,"27":1.025,"28":1.025007,"29":1.024996,"30":1.024997,"31":1.025005,"32":1.025,"33":1.025011,"34":1.025,"35":1.025006,"36":1.025001,"37":1.024996,"38":1.025002,"39":1.025003,"40":1.075,"41":1.074998,"42":1.075002,"43":1.074996,"44":1.074998,"45":1.099993,"46":1.100005,"47":1.100001,"48":1.100005,"49":1.099994,"50":1.149996,"51":1.149999,"52":1.150004,"53":1.149995,"54":1.150001,"55":1.199998,"56":1.199996,"57":1.199999,"58":1.2,"59":1.199999,"60":1.250001,"61":1.250001,"62":1.249999,"63":1.25,"64+":1.250008}}},"ded":{"ind":2700,"fam":5400,"embedded":true},"drugDed":null,"oop":{"ind":9000,"fam":18000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":800}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $250 copay per visit, waived if you are admitted as an inpatient.","Lab tests: no charge at independent and facility-owned labs.","Mental health: office visits $30 copay per visit (used here); other outpatient mental health services no charge.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $10 copay per prescription (used here), non-preferred generics $20 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $25 copay per prescription, non-preferred generic $50 copay per prescription; preferred brand $113 copay per prescription; non-preferred brand $188 copay per prescription.","Specialty drugs: 50% coinsurance, at most $800 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $60 copay per visit; specialist $85 copay per visit; imaging 30% coinsurance; outpatient surgery facility 30% coinsurance; outpatient surgeon 30% coinsurance; hospital stay facility 30% coinsurance; hospital stay physician 30% coinsurance; prenatal visits $85 copay per visit; delivery professional 30% coinsurance; delivery facility 30% coinsurance; rehabilitation $85 copay per visit; lab tests 30% coinsurance."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Gold-Advance-PPO-2700_0_30.pdf","prev":{"planYear":2026,"rates":{"7":{"base21":652.28,"tobaccoFactor":1.025005,"tobaccoFactorByAge":{"21":1.025005,"22":1.025005,"23":1.025005,"24":1.025005,"25":1.024997,"26":1.024987,"27":1.025,"28":1.025006,"29":1.025003,"30":1.025002,"31":1.025,"32":1.024998,"33":1.025005,"34":1.025004,"35":1.025003,"36":1.02499,"37":1.025002,"38":1.025002,"39":1.025001,"40":1.074998,"41":1.075006,"42":1.075,"43":1.074993,"44":1.074997,"45":1.100001,"46":1.099998,"47":1.099998,"48":1.100002,"49":1.100001,"50":1.150004,"51":1.149995,"52":1.150002,"53":1.150002,"54":1.149998,"55":1.200001,"56":1.200004,"57":1.199999,"58":1.200005,"59":1.200001,"60":1.250004,"61":1.250001,"62":1.250005,"63":1.249997,"64+":1.250011}}}}},{"market":"pennie","id":"45127PA0020052-01","standardId":"45127PA0020052","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Silver Advance PPO 4500/20/35","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN007","referral":false,"tiers":true,"counties":["Lancaster"],"rates":{"7":{"base21":860.77,"tobaccoFactor":1.025001,"tobaccoFactorByAge":{"21":1.025001,"22":1.025001,"23":1.025001,"24":1.025001,"25":1.025005,"26":1.025005,"27":1.024998,"28":1.024998,"29":1.025,"30":1.024995,"31":1.024999,"32":1.025003,"33":1.025,"34":1.024996,"35":1.025003,"36":1.025001,"37":1.025009,"38":1.024997,"39":1.025003,"40":1.074995,"41":1.075005,"42":1.075001,"43":1.074996,"44":1.074994,"45":1.100004,"46":1.099995,"47":1.099993,"48":1.100003,"49":1.099995,"50":1.149999,"51":1.149999,"52":1.150004,"53":1.150003,"54":1.149999,"55":1.199998,"56":1.199997,"57":1.2,"58":1.200001,"59":1.199996,"60":1.250003,"61":1.249999,"62":1.250001,"63":1.249996,"64+":1.250006}}},"ded":{"ind":4500,"fam":9000,"embedded":true},"drugDed":null,"oop":{"ind":10000,"fam":20000},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":800}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Emergency room: $400 copay per visit, waived if you are admitted as an inpatient.","Lab tests: 20% coinsurance at independent and facility-owned labs.","Mental health: office visits $35 copay per visit (used here); other outpatient mental health services 20% coinsurance.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $10 copay per prescription (used here), non-preferred generics $20 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $25 copay per prescription, non-preferred generic $50 copay per prescription; preferred brand $125 copay per prescription; non-preferred brand $250 copay per prescription.","Specialty drugs: 50% coinsurance, at most $800 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $60 copay per visit; specialist $85 copay per visit; prenatal visits $85 copay per visit; rehabilitation $85 copay per visit."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Silver-Advance-PPO-4500_20_35.pdf","prev":{"planYear":2026,"rates":{"7":{"base21":756.35,"tobaccoFactor":1.024988,"tobaccoFactorByAge":{"21":1.024988,"22":1.024988,"23":1.024988,"24":1.024988,"25":1.025008,"26":1.024997,"27":1.025005,"28":1.024995,"29":1.025001,"30":1.024999,"31":1.024994,"32":1.025001,"33":1.025008,"34":1.025005,"35":1.024993,"36":1.024992,"37":1.025001,"38":1.025,"39":1.024997,"40":1.075004,"41":1.075003,"42":1.074998,"43":1.075003,"44":1.074994,"45":1.100004,"46":1.099998,"47":1.100003,"48":1.099998,"49":1.099998,"50":1.150004,"51":1.149994,"52":1.150001,"53":1.149998,"54":1.15,"55":1.2,"56":1.199999,"57":1.199998,"58":1.199998,"59":1.199998,"60":1.25,"61":1.250004,"62":1.250002,"63":1.250003,"64+":1.25}}}}},{"market":"pennie","id":"45127PA0020052-04","standardId":"45127PA0020052","variant":"csr73","issuer":"Capital Advantage Assurance Company","name":"Silver Advance PPO 4500/20/35","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN007","referral":false,"tiers":true,"counties":["Lancaster"],"rates":{"7":{"base21":860.77,"tobaccoFactor":1.025001,"tobaccoFactorByAge":{"21":1.025001,"22":1.025001,"23":1.025001,"24":1.025001,"25":1.025005,"26":1.025005,"27":1.024998,"28":1.024998,"29":1.025,"30":1.024995,"31":1.024999,"32":1.025003,"33":1.025,"34":1.024996,"35":1.025003,"36":1.025001,"37":1.025009,"38":1.024997,"39":1.025003,"40":1.074995,"41":1.075005,"42":1.075001,"43":1.074996,"44":1.074994,"45":1.100004,"46":1.099995,"47":1.099993,"48":1.100003,"49":1.099995,"50":1.149999,"51":1.149999,"52":1.150004,"53":1.150003,"54":1.149999,"55":1.199998,"56":1.199997,"57":1.2,"58":1.200001,"59":1.199996,"60":1.250003,"61":1.249999,"62":1.250001,"63":1.249996,"64+":1.250006}}},"ded":{"ind":4100,"fam":8200,"embedded":true},"drugDed":null,"oop":{"ind":9600,"fam":19200},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.15,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.15,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.15,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":55,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":25,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded","max":700}},"outpatientFacility":{"base":{"kind":"coins","rate":0.15,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.15,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.15,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.15,"ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.15,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.15,"ded":"after_ded"}}},"notes":["Emergency room: $200 copay per visit, waived if you are admitted as an inpatient.","Lab tests: 15% coinsurance at independent and facility-owned labs.","Mental health: office visits $25 copay per visit (used here); other outpatient mental health services 15% coinsurance.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $5 copay per prescription (used here), non-preferred generics $10 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $13 copay per prescription, non-preferred generic $26 copay per prescription; preferred brand $63 copay per prescription; non-preferred brand $138 copay per prescription.","Specialty drugs: 40% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $800 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $50 copay per visit; specialist $75 copay per visit; prenatal visits $75 copay per visit; rehabilitation $75 copay per visit."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Silver-Advance-PPO-4100_15_25-CSR73.pdf","prev":{"planYear":2026,"rates":{"7":{"base21":756.35,"tobaccoFactor":1.024988,"tobaccoFactorByAge":{"21":1.024988,"22":1.024988,"23":1.024988,"24":1.024988,"25":1.025008,"26":1.024997,"27":1.025005,"28":1.024995,"29":1.025001,"30":1.024999,"31":1.024994,"32":1.025001,"33":1.025008,"34":1.025005,"35":1.024993,"36":1.024992,"37":1.025001,"38":1.025,"39":1.024997,"40":1.075004,"41":1.075003,"42":1.074998,"43":1.075003,"44":1.074994,"45":1.100004,"46":1.099998,"47":1.100003,"48":1.099998,"49":1.099998,"50":1.150004,"51":1.149994,"52":1.150001,"53":1.149998,"54":1.15,"55":1.2,"56":1.199999,"57":1.199998,"58":1.199998,"59":1.199998,"60":1.25,"61":1.250004,"62":1.250002,"63":1.250003,"64+":1.25}}}}},{"market":"pennie","id":"45127PA0020052-05","standardId":"45127PA0020052","variant":"csr87","issuer":"Capital Advantage Assurance Company","name":"Silver Advance PPO 4500/20/35","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN007","referral":false,"tiers":true,"counties":["Lancaster"],"rates":{"7":{"base21":860.77,"tobaccoFactor":1.025001,"tobaccoFactorByAge":{"21":1.025001,"22":1.025001,"23":1.025001,"24":1.025001,"25":1.025005,"26":1.025005,"27":1.024998,"28":1.024998,"29":1.025,"30":1.024995,"31":1.024999,"32":1.025003,"33":1.025,"34":1.024996,"35":1.025003,"36":1.025001,"37":1.025009,"38":1.024997,"39":1.025003,"40":1.074995,"41":1.075005,"42":1.075001,"43":1.074996,"44":1.074994,"45":1.100004,"46":1.099995,"47":1.099993,"48":1.100003,"49":1.099995,"50":1.149999,"51":1.149999,"52":1.150004,"53":1.150003,"54":1.149999,"55":1.199998,"56":1.199997,"57":1.2,"58":1.200001,"59":1.199996,"60":1.250003,"61":1.249999,"62":1.250001,"63":1.249996,"64+":1.250006}}},"ded":{"ind":1300,"fam":2600,"embedded":true},"drugDed":null,"oop":{"ind":3800,"fam":7600},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":30,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded","max":400}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $75 copay per visit, waived if you are admitted as an inpatient.","Lab tests: no charge at independent and facility-owned labs.","Mental health: office visits $15 copay per visit (used here); other outpatient mental health services no charge.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $3 copay per prescription (used here), non-preferred generics $6 copay per prescription, for a 30-day retail supply.","Generic drugs: this SBC prints each generic cost followed by a comma and nothing else (\"$3 copayment/prescription, preferred and ...\"), where most of Capital's 2027 SBCs (those dated June 2026) print \", Deductible does not apply\". This SBC does not say the deductible does not apply, so generic drugs are charged after the deductible here (the cautious reading of a silent copay). If Capital confirms the missing words, they are free of the deductible instead.","Mental health office visits: this SBC does not mark the office-visit copay \"Deductible does not apply\", as most of Capital's 2027 SBCs (those dated June 2026) do. It is charged after the deductible here (the cautious reading of a silent copay). If Capital confirms the missing words, it is free of the deductible instead.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $8 copay per prescription, non-preferred generic $16 copay per prescription; preferred brand $38 copay per prescription; non-preferred brand $100 copay per prescription.","Specialty drugs: 30% coinsurance, at most $400 per 30-day prescription for a preferred specialty drug (modelled here) and at most $500 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $30 copay per visit; specialist $60 copay per visit; prenatal visits $60 copay per visit; rehabilitation $60 copay per visit."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Silver-Advance-PPO-1300_0_15-CSR87.pdf","prev":{"planYear":2026,"rates":{"7":{"base21":756.35,"tobaccoFactor":1.024988,"tobaccoFactorByAge":{"21":1.024988,"22":1.024988,"23":1.024988,"24":1.024988,"25":1.025008,"26":1.024997,"27":1.025005,"28":1.024995,"29":1.025001,"30":1.024999,"31":1.024994,"32":1.025001,"33":1.025008,"34":1.025005,"35":1.024993,"36":1.024992,"37":1.025001,"38":1.025,"39":1.024997,"40":1.075004,"41":1.075003,"42":1.074998,"43":1.075003,"44":1.074994,"45":1.100004,"46":1.099998,"47":1.100003,"48":1.099998,"49":1.099998,"50":1.150004,"51":1.149994,"52":1.150001,"53":1.149998,"54":1.15,"55":1.2,"56":1.199999,"57":1.199998,"58":1.199998,"59":1.199998,"60":1.25,"61":1.250004,"62":1.250002,"63":1.250003,"64+":1.25}}}}},{"market":"pennie","id":"45127PA0020052-06","standardId":"45127PA0020052","variant":"csr94","issuer":"Capital Advantage Assurance Company","name":"Silver Advance PPO 4500/20/35","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN007","referral":false,"tiers":true,"counties":["Lancaster"],"rates":{"7":{"base21":860.77,"tobaccoFactor":1.025001,"tobaccoFactorByAge":{"21":1.025001,"22":1.025001,"23":1.025001,"24":1.025001,"25":1.025005,"26":1.025005,"27":1.024998,"28":1.024998,"29":1.025,"30":1.024995,"31":1.024999,"32":1.025003,"33":1.025,"34":1.024996,"35":1.025003,"36":1.025001,"37":1.025009,"38":1.024997,"39":1.025003,"40":1.074995,"41":1.075005,"42":1.075001,"43":1.074996,"44":1.074994,"45":1.100004,"46":1.099995,"47":1.099993,"48":1.100003,"49":1.099995,"50":1.149999,"51":1.149999,"52":1.150004,"53":1.150003,"54":1.149999,"55":1.199998,"56":1.199997,"57":1.2,"58":1.200001,"59":1.199996,"60":1.250003,"61":1.249999,"62":1.250001,"63":1.249996,"64+":1.250006}}},"ded":{"ind":575,"fam":1150,"embedded":true},"drugDed":null,"oop":{"ind":1750,"fam":3500},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":2,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":10,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":25,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded","max":200}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $50 copay per visit, waived if you are admitted as an inpatient.","Lab tests: no charge at independent and facility-owned labs.","The SBC text for independent labs is incomplete (\"No Charge for Facility Owned labs, for Independent Labs and No Charge for tests\"); read as no charge for independent labs.","Mental health: office visits $10 copay per visit (used here); other outpatient mental health services no charge.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $2 copay per prescription (used here), non-preferred generics $4 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $5 copay per prescription, non-preferred generic $10 copay per prescription; preferred brand $25 copay per prescription; non-preferred brand $63 copay per prescription.","Specialty drugs: 10% coinsurance, at most $200 per 30-day prescription for a preferred specialty drug (modelled here) and at most $300 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $20 copay per visit; specialist $40 copay per visit; prenatal visits $40 copay per visit; rehabilitation $40 copay per visit."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Silver-Advance-PPO-575_0_10-CSR94.pdf","prev":{"planYear":2026,"rates":{"7":{"base21":756.35,"tobaccoFactor":1.024988,"tobaccoFactorByAge":{"21":1.024988,"22":1.024988,"23":1.024988,"24":1.024988,"25":1.025008,"26":1.024997,"27":1.025005,"28":1.024995,"29":1.025001,"30":1.024999,"31":1.024994,"32":1.025001,"33":1.025008,"34":1.025005,"35":1.024993,"36":1.024992,"37":1.025001,"38":1.025,"39":1.024997,"40":1.075004,"41":1.075003,"42":1.074998,"43":1.075003,"44":1.074994,"45":1.100004,"46":1.099998,"47":1.100003,"48":1.099998,"49":1.099998,"50":1.150004,"51":1.149994,"52":1.150001,"53":1.149998,"54":1.15,"55":1.2,"56":1.199999,"57":1.199998,"58":1.199998,"59":1.199998,"60":1.25,"61":1.250004,"62":1.250002,"63":1.250003,"64+":1.25}}}}},{"market":"pennie","id":"45127PA0020054-01","standardId":"45127PA0020054","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Bronze Advance PPO 7200/0/50 + HSA","metal":"Bronze","network":"PPO","hsaEligible":true,"networkId":"PAN007","referral":false,"tiers":true,"counties":["Lancaster"],"rates":{"7":{"base21":571.91,"tobaccoFactor":1.025004,"tobaccoFactorByAge":{"21":1.025004,"22":1.025004,"23":1.025004,"24":1.025004,"25":1.025009,"26":1.024998,"27":1.024993,"28":1.024997,"29":1.025001,"30":1.025003,"31":1.024998,"32":1.025008,"33":1.025002,"34":1.025004,"35":1.024997,"36":1.025005,"37":1.024999,"38":1.025007,"39":1.025009,"40":1.074989,"41":1.075004,"42":1.074994,"43":1.074991,"44":1.07501,"45":1.100007,"46":1.100003,"47":1.1,"48":1.100002,"49":1.100002,"50":1.149994,"51":1.149997,"52":1.149994,"53":1.150004,"54":1.149995,"55":1.199997,"56":1.200004,"57":1.2,"58":1.199995,"59":1.200001,"60":1.250005,"61":1.25,"62":1.249995,"63":1.249999,"64+":1.25001}}},"ded":{"ind":7200,"fam":14400,"embedded":true},"drugDed":null,"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":85,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":800}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $400 copay per visit, waived if you are admitted as an inpatient.","Lab tests: no charge at independent and facility-owned labs.","Mental health: office visits $50 copay per visit (used here); other outpatient mental health services no charge.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $10 copay per prescription (used here), non-preferred generics $30 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $25 copay per prescription, non-preferred generic $75 copay per prescription; preferred brand no charge; non-preferred brand no charge.","Specialty drugs: 50% coinsurance, at most $800 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $75 copay per visit; specialist $110 copay per visit; prenatal visits $110 copay per visit; rehabilitation $110 copay per visit."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Bronze-Advance-PPO-7200_0_50-HSA.pdf","prev":{"planYear":2026,"rates":{"7":{"base21":480.15,"tobaccoFactor":1.024992,"tobaccoFactorByAge":{"21":1.024992,"22":1.024992,"23":1.024992,"24":1.024992,"25":1.024996,"26":1.024996,"27":1.025,"28":1.025004,"29":1.025015,"30":1.024992,"31":1.024996,"32":1.025,"33":1.024999,"34":1.024996,"35":1.025003,"36":1.024992,"37":1.024999,"38":1.025006,"39":1.025002,"40":1.074996,"41":1.075006,"42":1.075009,"43":1.075005,"44":1.075004,"45":1.099996,"46":1.099997,"47":1.100004,"48":1.099995,"49":1.099996,"50":1.149999,"51":1.149999,"52":1.149992,"53":1.149995,"54":1.150003,"55":1.199994,"56":1.200004,"57":1.199997,"58":1.200007,"59":1.199997,"60":1.25,"61":1.249998,"62":1.250004,"63":1.250002,"64+":1.25}}}}},{"market":"pennie","id":"45127PA0020057-01","standardId":"45127PA0020057","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Bronze Advance PPO 6600/0/50 + HSA","metal":"Bronze","network":"PPO","hsaEligible":true,"networkId":"PAN007","referral":false,"tiers":true,"counties":["Lancaster"],"rates":{"7":{"base21":566.65,"tobaccoFactor":1.025007,"tobaccoFactorByAge":{"21":1.025007,"22":1.025007,"23":1.025007,"24":1.025007,"25":1.024995,"26":1.025006,"27":1.025006,"28":1.025002,"29":1.024997,"30":1.025002,"31":1.025002,"32":1.025002,"33":1.024998,"34":1.025003,"35":1.024998,"36":1.024994,"37":1.025003,"38":1.024998,"39":1.025003,"40":1.074995,"41":1.074995,"42":1.074999,"43":1.075012,"44":1.074999,"45":1.100007,"46":1.099991,"47":1.100003,"48":1.100003,"49":1.099999,"50":1.149994,"51":1.15,"52":1.150005,"53":1.149995,"54":1.15,"55":1.200003,"56":1.199992,"57":1.199996,"58":1.199996,"59":1.200001,"60":1.249998,"61":1.249998,"62":1.249995,"63":1.250001,"64+":1.250009}}},"ded":{"ind":6600,"fam":13200,"embedded":false},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":85,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":800}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $400 copay per visit, waived if you are admitted as an inpatient.","Lab tests: no charge at independent and facility-owned labs.","Mental health: office visits $50 copay per visit (used here); other outpatient mental health services no charge.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics no charge (used here), non-preferred generics no charge, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic no charge, non-preferred generic no charge; preferred brand no charge; non-preferred brand no charge.","Specialty drugs: 50% coinsurance, at most $800 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","High-deductible plan: the deductible applies to all services, including prescriptions, before any copay or coinsurance (SBC page 1). The family deductible is an aggregate: it must be met by the family as a whole, not per person.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $75 copay per visit; specialist $110 copay per visit; prenatal visits $110 copay per visit; rehabilitation $110 copay per visit."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Bronze-Advance-PPO-6600_0_50-HSA.pdf","prev":{"planYear":2026,"rates":{"7":{"base21":471.37,"tobaccoFactor":1.024991,"tobaccoFactorByAge":{"21":1.024991,"22":1.024991,"23":1.024991,"24":1.024991,"25":1.024997,"26":1.025006,"27":1.025001,"28":1.025001,"29":1.024988,"30":1.024991,"31":1.025004,"32":1.024999,"33":1.024987,"34":1.02499,"35":1.025,"36":1.024992,"37":1.025002,"38":1.024995,"39":1.024997,"40":1.075017,"41":1.075002,"42":1.074997,"43":1.075011,"44":1.074989,"45":1.100007,"46":1.099993,"47":1.100008,"48":1.100003,"49":1.099994,"50":1.150001,"51":1.149994,"52":1.149993,"53":1.149991,"54":1.150006,"55":1.200002,"56":1.199991,"57":1.199997,"58":1.200002,"59":1.200007,"60":1.249998,"61":1.249996,"62":1.250002,"63":1.250002,"64+":1.249996}}}}},{"market":"pennie","id":"45127PA0020058-01","standardId":"45127PA0020058","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Gold Capital Advantage PPO 1700/0/25","metal":"Gold","network":"PPO","hsaEligible":false,"networkId":"PAN005","referral":false,"tiers":true,"counties":["Cumberland","Dauphin","Perry"],"rates":{"9":{"base21":651,"tobaccoFactor":1.024992,"tobaccoFactorByAge":{"21":1.024992,"22":1.024992,"23":1.024992,"24":1.024992,"25":1.025,"26":1.025007,"27":1.025006,"28":1.024999,"29":1.025012,"30":1.024997,"31":1.02501,"32":1.024996,"33":1.025004,"34":1.025003,"35":1.025003,"36":1.02499,"37":1.025002,"38":1.025002,"39":1.025001,"40":1.075003,"41":1.075,"42":1.074997,"43":1.075006,"44":1.075002,"45":1.099996,"46":1.100001,"47":1.099999,"48":1.100002,"49":1.1,"50":1.149998,"51":1.149995,"52":1.150007,"53":1.150004,"54":1.149999,"55":1.200004,"56":1.200004,"57":1.199996,"58":1.200001,"59":1.200001,"60":1.25,"61":1.249997,"62":1.250001,"63":1.250003,"64+":1.250001}}},"ded":{"ind":1700,"fam":3400,"embedded":true},"drugDed":null,"oop":{"ind":9000,"fam":18000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":800}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $200 copay per visit, waived if you are admitted as an inpatient.","Lab tests: no charge at independent and facility-owned labs.","Mental health: office visits $25 copay per visit (used here); other outpatient mental health services no charge.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $10 copay per prescription (used here), non-preferred generics $20 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $25 copay per prescription, non-preferred generic $50 copay per prescription; preferred brand $113 copay per prescription; non-preferred brand $188 copay per prescription.","Specialty drugs: 50% coinsurance, at most $800 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $50 copay per visit; specialist $75 copay per visit; imaging 30% coinsurance; outpatient surgery facility 30% coinsurance; outpatient surgeon 30% coinsurance; hospital stay facility 30% coinsurance; hospital stay physician 30% coinsurance; prenatal visits $75 copay per visit; delivery professional 30% coinsurance; delivery facility 30% coinsurance; rehabilitation $75 copay per visit; lab tests 30% coinsurance."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Gold-Capital-Advantage-PPO-1700_0_25.pdf","prev":{"planYear":2026,"rates":{"9":{"base21":565.09,"tobaccoFactor":1.025005,"tobaccoFactorByAge":{"21":1.025005,"22":1.025005,"23":1.025005,"24":1.025005,"25":1.025011,"26":1.025006,"27":1.024991,"28":1.025006,"29":1.025002,"30":1.024993,"31":1.024995,"32":1.025011,"33":1.024993,"34":1.024999,"35":1.024995,"36":1.025005,"37":1.025001,"38":1.025011,"39":1.025002,"40":1.074994,"41":1.074998,"42":1.074992,"43":1.074997,"44":1.075003,"45":1.100001,"46":1.099995,"47":1.099995,"48":1.100009,"49":1.099995,"50":1.150002,"51":1.150006,"52":1.150001,"53":1.149993,"54":1.15,"55":1.2,"56":1.199998,"57":1.199996,"58":1.2,"59":1.200003,"60":1.249997,"61":1.249995,"62":1.249995,"63":1.250001,"64+":1.250009}}}}},{"market":"pennie","id":"45127PA0020059-01","standardId":"45127PA0020059","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Gold Capital Advantage PPO 2700/0/30","metal":"Gold","network":"PPO","hsaEligible":false,"networkId":"PAN005","referral":false,"tiers":true,"counties":["Cumberland","Dauphin","Perry"],"rates":{"9":{"base21":604.46,"tobaccoFactor":1.024998,"tobaccoFactorByAge":{"21":1.024998,"22":1.024998,"23":1.024998,"24":1.024998,"25":1.025014,"26":1.02501,"27":1.025005,"28":1.025006,"29":1.025,"30":1.024998,"31":1.025009,"32":1.025005,"33":1.024995,"34":1.024993,"35":1.025005,"36":1.025004,"37":1.024989,"38":1.025002,"39":1.024999,"40":1.075004,"41":1.075006,"42":1.075003,"43":1.074989,"44":1.07501,"45":1.100008,"46":1.100002,"47":1.100004,"48":1.099991,"49":1.1,"50":1.149996,"51":1.150003,"52":1.149996,"53":1.149997,"54":1.150003,"55":1.199994,"56":1.199993,"57":1.199999,"58":1.2,"59":1.2,"60":1.250005,"61":1.25,"62":1.25,"63":1.250001,"64+":1.249999}}},"ded":{"ind":2700,"fam":5400,"embedded":true},"drugDed":null,"oop":{"ind":9000,"fam":18000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":800}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $250 copay per visit, waived if you are admitted as an inpatient.","Lab tests: no charge at independent and facility-owned labs.","Mental health: office visits $30 copay per visit (used here); other outpatient mental health services no charge.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $10 copay per prescription (used here), non-preferred generics $20 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $25 copay per prescription, non-preferred generic $50 copay per prescription; preferred brand $113 copay per prescription; non-preferred brand $188 copay per prescription.","Specialty drugs: 50% coinsurance, at most $800 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $60 copay per visit; specialist $85 copay per visit; imaging 30% coinsurance; outpatient surgery facility 30% coinsurance; outpatient surgeon 30% coinsurance; hospital stay facility 30% coinsurance; hospital stay physician 30% coinsurance; prenatal visits $85 copay per visit; delivery professional 30% coinsurance; delivery facility 30% coinsurance; rehabilitation $85 copay per visit; lab tests 30% coinsurance."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Gold-Capital-Advantage-PPO-2700_0_30.pdf","prev":{"planYear":2026,"rates":{"9":{"base21":533.2,"tobaccoFactor":1.025,"tobaccoFactorByAge":{"21":1.025,"22":1.025,"23":1.025,"24":1.025,"25":1.024994,"26":1.025,"27":1.025,"28":1.025,"29":1.025006,"30":1.025001,"31":1.025001,"32":1.025001,"33":1.025001,"34":1.025012,"35":1.025001,"36":1.025006,"37":1.024996,"38":1.024986,"39":1.024996,"40":1.075004,"41":1.075005,"42":1.07499,"43":1.075005,"44":1.074992,"45":1.099995,"46":1.1,"47":1.100001,"48":1.100002,"49":1.099996,"50":1.150007,"51":1.149997,"52":1.15,"53":1.149991,"54":1.150003,"55":1.200003,"56":1.2,"57":1.199998,"58":1.200001,"59":1.199997,"60":1.250003,"61":1.249998,"62":1.25,"63":1.25,"64+":1.250008}}}}},{"market":"pennie","id":"45127PA0020060-01","standardId":"45127PA0020060","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Silver Capital Advantage PPO 4500/20/35","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN005","referral":false,"tiers":true,"counties":["Cumberland","Dauphin","Perry"],"rates":{"9":{"base21":718.43,"tobaccoFactor":1.024999,"tobaccoFactorByAge":{"21":1.024999,"22":1.024999,"23":1.024999,"24":1.024999,"25":1.024996,"26":1.024997,"27":1.024996,"28":1.024996,"29":1.025002,"30":1.025006,"31":1.025004,"32":1.024991,"33":1.025003,"34":1.024995,"35":1.024991,"36":1.025009,"37":1.025005,"38":1.025001,"39":1.025004,"40":1.074998,"41":1.075005,"42":1.075006,"43":1.075002,"44":1.075006,"45":1.099998,"46":1.100005,"47":1.099999,"48":1.099997,"49":1.099996,"50":1.150002,"51":1.149999,"52":1.150002,"53":1.150007,"54":1.149994,"55":1.199999,"56":1.199999,"57":1.200003,"58":1.199998,"59":1.200002,"60":1.250001,"61":1.25,"62":1.249998,"63":1.249998,"64+":1.250008}}},"ded":{"ind":4500,"fam":9000,"embedded":true},"drugDed":null,"oop":{"ind":10000,"fam":20000},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":800}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Emergency room: $400 copay per visit, waived if you are admitted as an inpatient.","Lab tests: 20% coinsurance at independent and facility-owned labs.","Mental health: office visits $35 copay per visit (used here); other outpatient mental health services 20% coinsurance.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $10 copay per prescription (used here), non-preferred generics $20 copay per prescription, for a 30-day retail supply.","Generic drugs: this SBC prints each generic cost followed by a comma and nothing else (\"$10 copayment/prescription, preferred and ...\"), where most of Capital's 2027 SBCs (those dated June 2026) print \", Deductible does not apply\". This SBC does not say the deductible does not apply, so generic drugs are charged after the deductible here (the cautious reading of a silent copay). If Capital confirms the missing words, they are free of the deductible instead.","Mental health office visits: this SBC does not mark the office-visit copay \"Deductible does not apply\", as most of Capital's 2027 SBCs (those dated June 2026) do. It is charged after the deductible here (the cautious reading of a silent copay). If Capital confirms the missing words, it is free of the deductible instead.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $25 copay per prescription, non-preferred generic $50 copay per prescription; preferred brand $125 copay per prescription; non-preferred brand $250 copay per prescription.","Specialty drugs: 50% coinsurance, at most $800 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $60 copay per visit; specialist $85 copay per visit; prenatal visits $85 copay per visit; rehabilitation $85 copay per visit."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Silver-Capital-Advantage-PPO-4500_20_35.pdf","prev":{"planYear":2026,"rates":{"9":{"base21":617.37,"tobaccoFactor":1.024993,"tobaccoFactorByAge":{"21":1.024993,"22":1.024993,"23":1.024993,"24":1.024993,"25":1.02499,"26":1.025009,"27":1.025008,"28":1.02499,"29":1.024999,"30":1.025003,"31":1.025002,"32":1.024988,"33":1.025,"34":1.025004,"35":1.024999,"36":1.025008,"37":1.025003,"38":1.024999,"39":1.02499,"40":1.075007,"41":1.075005,"42":1.074999,"43":1.074997,"44":1.075006,"45":1.100002,"46":1.100005,"47":1.100006,"48":1.100001,"49":1.099997,"50":1.149997,"51":1.150001,"52":1.150004,"53":1.149996,"54":1.149998,"55":1.199996,"56":1.199997,"57":1.200004,"58":1.2,"59":1.199999,"60":1.250004,"61":1.25,"62":1.249997,"63":1.249996,"64+":1.250003}}}}},{"market":"pennie","id":"45127PA0020060-04","standardId":"45127PA0020060","variant":"csr73","issuer":"Capital Advantage Assurance Company","name":"Silver Capital Advantage PPO 4500/20/35","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN005","referral":false,"tiers":true,"counties":["Cumberland","Dauphin","Perry"],"rates":{"9":{"base21":718.43,"tobaccoFactor":1.024999,"tobaccoFactorByAge":{"21":1.024999,"22":1.024999,"23":1.024999,"24":1.024999,"25":1.024996,"26":1.024997,"27":1.024996,"28":1.024996,"29":1.025002,"30":1.025006,"31":1.025004,"32":1.024991,"33":1.025003,"34":1.024995,"35":1.024991,"36":1.025009,"37":1.025005,"38":1.025001,"39":1.025004,"40":1.074998,"41":1.075005,"42":1.075006,"43":1.075002,"44":1.075006,"45":1.099998,"46":1.100005,"47":1.099999,"48":1.099997,"49":1.099996,"50":1.150002,"51":1.149999,"52":1.150002,"53":1.150007,"54":1.149994,"55":1.199999,"56":1.199999,"57":1.200003,"58":1.199998,"59":1.200002,"60":1.250001,"61":1.25,"62":1.249998,"63":1.249998,"64+":1.250008}}},"ded":{"ind":4100,"fam":8200,"embedded":true},"drugDed":null,"oop":{"ind":9600,"fam":19200},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.15,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.15,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.15,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":55,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":25,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded","max":700}},"outpatientFacility":{"base":{"kind":"coins","rate":0.15,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.15,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.15,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.15,"ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.15,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.15,"ded":"after_ded"}}},"notes":["Emergency room: $200 copay per visit, waived if you are admitted as an inpatient.","Lab tests: 15% coinsurance at independent and facility-owned labs.","Mental health: office visits $25 copay per visit (used here); other outpatient mental health services 15% coinsurance.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $5 copay per prescription (used here), non-preferred generics $10 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $13 copay per prescription, non-preferred generic $26 copay per prescription; preferred brand $63 copay per prescription; non-preferred brand $138 copay per prescription.","Specialty drugs: 40% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $800 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $50 copay per visit; specialist $75 copay per visit; prenatal visits $75 copay per visit; rehabilitation $75 copay per visit."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Silver-Capital-Advantage-PPO-4100_15_25-CSR73.pdf","prev":{"planYear":2026,"rates":{"9":{"base21":617.37,"tobaccoFactor":1.024993,"tobaccoFactorByAge":{"21":1.024993,"22":1.024993,"23":1.024993,"24":1.024993,"25":1.02499,"26":1.025009,"27":1.025008,"28":1.02499,"29":1.024999,"30":1.025003,"31":1.025002,"32":1.024988,"33":1.025,"34":1.025004,"35":1.024999,"36":1.025008,"37":1.025003,"38":1.024999,"39":1.02499,"40":1.075007,"41":1.075005,"42":1.074999,"43":1.074997,"44":1.075006,"45":1.100002,"46":1.100005,"47":1.100006,"48":1.100001,"49":1.099997,"50":1.149997,"51":1.150001,"52":1.150004,"53":1.149996,"54":1.149998,"55":1.199996,"56":1.199997,"57":1.200004,"58":1.2,"59":1.199999,"60":1.250004,"61":1.25,"62":1.249997,"63":1.249996,"64+":1.250003}}}}},{"market":"pennie","id":"45127PA0020060-05","standardId":"45127PA0020060","variant":"csr87","issuer":"Capital Advantage Assurance Company","name":"Silver Capital Advantage PPO 4500/20/35","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN005","referral":false,"tiers":true,"counties":["Cumberland","Dauphin","Perry"],"rates":{"9":{"base21":718.43,"tobaccoFactor":1.024999,"tobaccoFactorByAge":{"21":1.024999,"22":1.024999,"23":1.024999,"24":1.024999,"25":1.024996,"26":1.024997,"27":1.024996,"28":1.024996,"29":1.025002,"30":1.025006,"31":1.025004,"32":1.024991,"33":1.025003,"34":1.024995,"35":1.024991,"36":1.025009,"37":1.025005,"38":1.025001,"39":1.025004,"40":1.074998,"41":1.075005,"42":1.075006,"43":1.075002,"44":1.075006,"45":1.099998,"46":1.100005,"47":1.099999,"48":1.099997,"49":1.099996,"50":1.150002,"51":1.149999,"52":1.150002,"53":1.150007,"54":1.149994,"55":1.199999,"56":1.199999,"57":1.200003,"58":1.199998,"59":1.200002,"60":1.250001,"61":1.25,"62":1.249998,"63":1.249998,"64+":1.250008}}},"ded":{"ind":1300,"fam":2600,"embedded":true},"drugDed":null,"oop":{"ind":3800,"fam":7600},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":30,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded","max":400}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $75 copay per visit, waived if you are admitted as an inpatient.","Lab tests: no charge at independent and facility-owned labs.","Mental health: office visits $15 copay per visit (used here); other outpatient mental health services no charge.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $3 copay per prescription (used here), non-preferred generics $6 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $8 copay per prescription, non-preferred generic $16 copay per prescription; preferred brand $38 copay per prescription; non-preferred brand $100 copay per prescription.","Specialty drugs: 30% coinsurance, at most $400 per 30-day prescription for a preferred specialty drug (modelled here) and at most $500 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $30 copay per visit; specialist $60 copay per visit; prenatal visits $60 copay per visit; rehabilitation $60 copay per visit."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Silver-Capital-Advantage-PPO-1300_0_15-CSR87.pdf","prev":{"planYear":2026,"rates":{"9":{"base21":617.37,"tobaccoFactor":1.024993,"tobaccoFactorByAge":{"21":1.024993,"22":1.024993,"23":1.024993,"24":1.024993,"25":1.02499,"26":1.025009,"27":1.025008,"28":1.02499,"29":1.024999,"30":1.025003,"31":1.025002,"32":1.024988,"33":1.025,"34":1.025004,"35":1.024999,"36":1.025008,"37":1.025003,"38":1.024999,"39":1.02499,"40":1.075007,"41":1.075005,"42":1.074999,"43":1.074997,"44":1.075006,"45":1.100002,"46":1.100005,"47":1.100006,"48":1.100001,"49":1.099997,"50":1.149997,"51":1.150001,"52":1.150004,"53":1.149996,"54":1.149998,"55":1.199996,"56":1.199997,"57":1.200004,"58":1.2,"59":1.199999,"60":1.250004,"61":1.25,"62":1.249997,"63":1.249996,"64+":1.250003}}}}},{"market":"pennie","id":"45127PA0020060-06","standardId":"45127PA0020060","variant":"csr94","issuer":"Capital Advantage Assurance Company","name":"Silver Capital Advantage PPO 4500/20/35","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN005","referral":false,"tiers":true,"counties":["Cumberland","Dauphin","Perry"],"rates":{"9":{"base21":718.43,"tobaccoFactor":1.024999,"tobaccoFactorByAge":{"21":1.024999,"22":1.024999,"23":1.024999,"24":1.024999,"25":1.024996,"26":1.024997,"27":1.024996,"28":1.024996,"29":1.025002,"30":1.025006,"31":1.025004,"32":1.024991,"33":1.025003,"34":1.024995,"35":1.024991,"36":1.025009,"37":1.025005,"38":1.025001,"39":1.025004,"40":1.074998,"41":1.075005,"42":1.075006,"43":1.075002,"44":1.075006,"45":1.099998,"46":1.100005,"47":1.099999,"48":1.099997,"49":1.099996,"50":1.150002,"51":1.149999,"52":1.150002,"53":1.150007,"54":1.149994,"55":1.199999,"56":1.199999,"57":1.200003,"58":1.199998,"59":1.200002,"60":1.250001,"61":1.25,"62":1.249998,"63":1.249998,"64+":1.250008}}},"ded":{"ind":575,"fam":1150,"embedded":true},"drugDed":null,"oop":{"ind":1750,"fam":3500},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":2,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":10,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":25,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded","max":200}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $50 copay per visit, waived if you are admitted as an inpatient.","Lab tests: no charge at independent and facility-owned labs.","The SBC text for independent labs is incomplete (\"No Charge for Facility Owned labs, for Independent Labs and No Charge for tests\"); read as no charge for independent labs.","Mental health: office visits $10 copay per visit (used here); other outpatient mental health services no charge.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $2 copay per prescription (used here), non-preferred generics $4 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $5 copay per prescription, non-preferred generic $10 copay per prescription; preferred brand $25 copay per prescription; non-preferred brand $63 copay per prescription.","Specialty drugs: 10% coinsurance, at most $200 per 30-day prescription for a preferred specialty drug (modelled here) and at most $300 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $20 copay per visit; specialist $40 copay per visit; prenatal visits $40 copay per visit; rehabilitation $40 copay per visit."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Silver-Capital-Advantage-PPO-575_0_10-CSR94.pdf","prev":{"planYear":2026,"rates":{"9":{"base21":617.37,"tobaccoFactor":1.024993,"tobaccoFactorByAge":{"21":1.024993,"22":1.024993,"23":1.024993,"24":1.024993,"25":1.02499,"26":1.025009,"27":1.025008,"28":1.02499,"29":1.024999,"30":1.025003,"31":1.025002,"32":1.024988,"33":1.025,"34":1.025004,"35":1.024999,"36":1.025008,"37":1.025003,"38":1.024999,"39":1.02499,"40":1.075007,"41":1.075005,"42":1.074999,"43":1.074997,"44":1.075006,"45":1.100002,"46":1.100005,"47":1.100006,"48":1.100001,"49":1.099997,"50":1.149997,"51":1.150001,"52":1.150004,"53":1.149996,"54":1.149998,"55":1.199996,"56":1.199997,"57":1.200004,"58":1.2,"59":1.199999,"60":1.250004,"61":1.25,"62":1.249997,"63":1.249996,"64+":1.250003}}}}},{"market":"pennie","id":"45127PA0020062-01","standardId":"45127PA0020062","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Bronze Capital Advantage PPO 7200/0/50 + HSA","metal":"Bronze","network":"PPO","hsaEligible":true,"networkId":"PAN005","referral":false,"tiers":true,"counties":["Cumberland","Dauphin","Perry"],"rates":{"9":{"base21":479.64,"tobaccoFactor":1.024998,"tobaccoFactorByAge":{"21":1.024998,"22":1.024998,"23":1.024998,"24":1.024998,"25":1.025002,"26":1.025003,"27":1.025007,"28":1.024992,"29":1.025004,"30":1.025,"31":1.025004,"32":1.02499,"33":1.025008,"34":1.025005,"35":1.025012,"36":1.025002,"37":1.024992,"38":1.024999,"39":1.024995,"40":1.075011,"41":1.075005,"42":1.074993,"43":1.075007,"44":1.074993,"45":1.1,"46":1.100006,"47":1.100003,"48":1.100011,"49":1.100004,"50":1.150005,"51":1.150001,"52":1.150001,"53":1.149999,"54":1.150005,"55":1.2,"56":1.2,"57":1.199993,"58":1.199995,"59":1.199998,"60":1.249994,"61":1.250002,"62":1.249998,"63":1.250004,"64+":1.250016}}},"ded":{"ind":7200,"fam":14400,"embedded":true},"drugDed":null,"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":85,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":800}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $400 copay per visit, waived if you are admitted as an inpatient.","Lab tests: no charge at independent and facility-owned labs.","Mental health: office visits $50 copay per visit (used here); other outpatient mental health services no charge.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $10 copay per prescription (used here), non-preferred generics $30 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $25 copay per prescription, non-preferred generic $75 copay per prescription; preferred brand no charge; non-preferred brand no charge.","Specialty drugs: 50% coinsurance, at most $800 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $75 copay per visit; specialist $110 copay per visit; prenatal visits $110 copay per visit; rehabilitation $110 copay per visit."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Bronze-Capital-Advantage-PPO-7200_0_50-HSA.pdf","prev":{"planYear":2026,"rates":{"9":{"base21":393.97,"tobaccoFactor":1.025002,"tobaccoFactorByAge":{"21":1.025002,"22":1.025002,"23":1.025002,"24":1.025002,"25":1.025004,"26":1.025011,"27":1.024995,"28":1.025009,"29":1.024997,"30":1.025003,"31":1.024989,"32":1.025018,"33":1.025002,"34":1.024985,"35":1.024988,"36":1.024991,"37":1.025014,"38":1.025016,"39":1.025001,"40":1.074997,"41":1.074998,"42":1.074999,"43":1.075008,"44":1.075004,"45":1.100002,"46":1.100008,"47":1.100005,"48":1.099994,"49":1.099999,"50":1.149994,"51":1.149997,"52":1.150009,"53":1.150008,"54":1.150002,"55":1.2,"56":1.199993,"57":1.2,"58":1.199994,"59":1.2,"60":1.249993,"61":1.249998,"62":1.250002,"63":1.250002,"64+":1.250004}}}}},{"market":"pennie","id":"45127PA0020063-01","standardId":"45127PA0020063","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Gold Convenience PPO 1700/0/25","metal":"Gold","network":"PPO","hsaEligible":false,"networkId":"PAN009","referral":false,"tiers":true,"counties":["Adams","Franklin","Lebanon","Lehigh","Northampton","York"],"rates":{"6":{"base21":611.67,"tobaccoFactor":1.024997,"tobaccoFactorByAge":{"21":1.024997,"22":1.024997,"23":1.024997,"24":1.024997,"25":1.024995,"26":1.025002,"27":1.025007,"28":1.024997,"29":1.024998,"30":1.024991,"31":1.024995,"32":1.025,"33":1.025001,"34":1.024994,"35":1.025005,"36":1.025001,"37":1.024998,"38":1.025009,"39":1.025002,"40":1.075001,"41":1.075,"42":1.074994,"43":1.074996,"44":1.07499,"45":1.100006,"46":1.099999,"47":1.100006,"48":1.100002,"49":1.099999,"50":1.149993,"51":1.149995,"52":1.150003,"53":1.149999,"54":1.150002,"55":1.199996,"56":1.200003,"57":1.199993,"58":1.200001,"59":1.200003,"60":1.25,"61":1.25,"62":1.250004,"63":1.249997,"64+":1.250004}},"7":{"base21":682.12,"tobaccoFactor":1.02501,"tobaccoFactorByAge":{"21":1.02501,"22":1.02501,"23":1.02501,"24":1.02501,"25":1.024998,"26":1.025011,"27":1.024998,"28":1.024991,"29":1.024997,"30":1.024993,"31":1.025007,"32":1.025008,"33":1.025001,"34":1.024997,"35":1.025001,"36":1.025006,"37":1.024998,"38":1.02499,"39":1.024999,"40":1.074999,"41":1.075001,"42":1.075005,"43":1.074997,"44":1.075,"45":1.099991,"46":1.100002,"47":1.099994,"48":1.100003,"49":1.1,"50":1.15,"51":1.149997,"52":1.150004,"53":1.15,"54":1.15,"55":1.200003,"56":1.200001,"57":1.200002,"58":1.2,"59":1.199998,"60":1.25,"61":1.249999,"62":1.249997,"63":1.249996,"64+":1.250005}},"9":{"base21":680.81,"tobaccoFactor":1.025,"tobaccoFactorByAge":{"21":1.025,"22":1.025,"23":1.025,"24":1.025,"25":1.025003,"26":1.024987,"27":1.025004,"28":1.024999,"29":1.025006,"30":1.02499,"31":1.025005,"32":1.025007,"33":1.025,"34":1.024997,"35":1.024989,"36":1.025006,"37":1.024999,"38":1.025004,"39":1.025001,"40":1.075005,"41":1.074999,"42":1.074994,"43":1.075001,"44":1.074998,"45":1.100002,"46":1.099999,"47":1.1,"48":1.099998,"49":1.099995,"50":1.150002,"51":1.150004,"52":1.15,"53":1.150003,"54":1.150001,"55":1.2,"56":1.200004,"57":1.200004,"58":1.200001,"59":1.200001,"60":1.250001,"61":1.249996,"62":1.25,"63":1.250002,"64+":1.249998}}},"ded":{"ind":1700,"fam":3400,"embedded":true},"drugDed":null,"oop":{"ind":9000,"fam":18000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":800}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $200 copay per visit, waived if you are admitted as an inpatient.","Lab tests: no charge at independent and facility-owned labs.","Mental health: office visits $25 copay per visit (used here); other outpatient mental health services no charge.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $10 copay per prescription (used here), non-preferred generics $20 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $25 copay per prescription, non-preferred generic $50 copay per prescription; preferred brand $113 copay per prescription; non-preferred brand $188 copay per prescription.","Specialty drugs: 50% coinsurance, at most $800 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $50 copay per visit; specialist $75 copay per visit; imaging 30% coinsurance; outpatient surgery facility 30% coinsurance; outpatient surgeon 30% coinsurance; hospital stay facility 30% coinsurance; hospital stay physician 30% coinsurance; prenatal visits $75 copay per visit; delivery professional 30% coinsurance; delivery facility 30% coinsurance; rehabilitation $75 copay per visit; lab tests 30% coinsurance."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Gold-Convenience-PPO-1700_0_25.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":547.52,"tobaccoFactor":1.025004,"tobaccoFactorByAge":{"21":1.025004,"22":1.025004,"23":1.025004,"24":1.025004,"25":1.025013,"26":1.024988,"27":1.024991,"28":1.025002,"29":1.025005,"30":1.025006,"31":1.025009,"32":1.024995,"33":1.025003,"34":1.025004,"35":1.02499,"36":1.02499,"37":1.024991,"38":1.024992,"39":1.024993,"40":1.074999,"41":1.074992,"42":1.075,"43":1.075008,"44":1.075004,"45":1.099996,"46":1.100001,"47":1.100002,"48":1.1,"49":1.099991,"50":1.149998,"51":1.15,"52":1.149995,"53":1.149998,"54":1.149995,"55":1.200003,"56":1.200005,"57":1.199997,"58":1.200001,"59":1.199999,"60":1.250003,"61":1.250003,"62":1.25,"63":1.250005,"64+":1.250012}},"7":{"base21":610.49,"tobaccoFactor":1.024996,"tobaccoFactorByAge":{"21":1.024996,"22":1.024996,"23":1.024996,"24":1.024996,"25":1.025011,"26":1.025002,"27":1.025008,"28":1.025,"29":1.025002,"30":1.024996,"31":1.025001,"32":1.024993,"33":1.024994,"34":1.025002,"35":1.024999,"36":1.02501,"37":1.024994,"38":1.025004,"39":1.024999,"40":1.074993,"41":1.074994,"42":1.075003,"43":1.075009,"44":1.075007,"45":1.099994,"46":1.100008,"47":1.1,"48":1.100005,"49":1.1,"50":1.149999,"51":1.150005,"52":1.149998,"53":1.15,"54":1.15,"55":1.200001,"56":1.200004,"57":1.200005,"58":1.199996,"59":1.199999,"60":1.250002,"61":1.25,"62":1.249997,"63":1.249999,"64+":1.250008}},"9":{"base21":591.33,"tobaccoFactor":1.024995,"tobaccoFactorByAge":{"21":1.024995,"22":1.024995,"23":1.024995,"24":1.024995,"25":1.024996,"26":1.025003,"27":1.024996,"28":1.025001,"29":1.025012,"30":1.024987,"31":1.024995,"32":1.025002,"33":1.025,"34":1.025005,"35":1.025007,"36":1.025009,"37":1.024998,"38":1.025,"39":1.025005,"40":1.074988,"41":1.074996,"42":1.074996,"43":1.074997,"44":1.075005,"45":1.099991,"46":1.100001,"47":1.100006,"48":1.099998,"49":1.1,"50":1.150003,"51":1.150006,"52":1.15,"53":1.149995,"54":1.149998,"55":1.199998,"56":1.200006,"57":1.200006,"58":1.2,"59":1.200004,"60":1.250003,"61":1.249995,"62":1.25,"63":1.25,"64+":1.249997}}}}},{"market":"pennie","id":"45127PA0020064-01","standardId":"45127PA0020064","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Gold Convenience PPO 2700/0/30","metal":"Gold","network":"PPO","hsaEligible":false,"networkId":"PAN009","referral":false,"tiers":true,"counties":["Adams","Franklin","Lebanon","Lehigh","Northampton","York"],"rates":{"6":{"base21":567.81,"tobaccoFactor":1.025008,"tobaccoFactorByAge":{"21":1.025008,"22":1.025008,"23":1.025008,"24":1.025008,"25":1.024996,"26":1.025007,"27":1.025005,"28":1.025,"29":1.025009,"30":1.024997,"31":1.024996,"32":1.02501,"33":1.025006,"34":1.024995,"35":1.025005,"36":1.025,"37":1.025009,"38":1.024989,"39":1.025008,"40":1.074993,"41":1.075004,"42":1.075005,"43":1.075001,"44":1.074996,"45":1.10001,"46":1.099998,"47":1.100001,"48":1.099991,"49":1.100001,"50":1.149992,"51":1.150004,"52":1.150004,"53":1.149999,"54":1.150007,"55":1.199995,"56":1.199998,"57":1.200006,"58":1.200001,"59":1.199997,"60":1.249998,"61":1.25,"62":1.249998,"63":1.249996,"64+":1.250007}},"7":{"base21":633.21,"tobaccoFactor":1.025,"tobaccoFactorByAge":{"21":1.025,"22":1.025,"23":1.025,"24":1.025,"25":1.024994,"26":1.025,"27":1.025,"28":1.025004,"29":1.024994,"30":1.02499,"31":1.025004,"32":1.025004,"33":1.024994,"34":1.025003,"35":1.024994,"36":1.024998,"37":1.025003,"38":1.025007,"39":1.02499,"40":1.074995,"41":1.075008,"42":1.074993,"43":1.075006,"44":1.074994,"45":1.100004,"46":1.099998,"47":1.099999,"48":1.1,"49":1.100004,"50":1.150002,"51":1.149999,"52":1.150004,"53":1.149997,"54":1.150003,"55":1.199997,"56":1.199995,"57":1.200001,"58":1.199996,"59":1.200006,"60":1.250003,"61":1.249999,"62":1.250003,"63":1.249999,"64+":1.250007}},"9":{"base21":631.99,"tobaccoFactor":1.025,"tobaccoFactorByAge":{"21":1.025,"22":1.025,"23":1.025,"24":1.025,"25":1.024995,"26":1.025002,"27":1.024988,"28":1.025008,"29":1.025,"30":1.024996,"31":1.024997,"32":1.024998,"33":1.024989,"34":1.024999,"35":1.025004,"36":1.024995,"37":1.025,"38":1.025004,"39":1.025001,"40":1.075005,"41":1.075008,"42":1.074995,"43":1.074999,"44":1.075004,"45":1.099989,"46":1.100001,"47":1.1,"48":1.099999,"49":1.099993,"50":1.149999,"51":1.150001,"52":1.149994,"53":1.150001,"54":1.150004,"55":1.200001,"56":1.199995,"57":1.199999,"58":1.200005,"59":1.200004,"60":1.250003,"61":1.249997,"62":1.250001,"63":1.25,"64+":1.250011}}},"ded":{"ind":2700,"fam":5400,"embedded":true},"drugDed":null,"oop":{"ind":9000,"fam":18000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":800}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $250 copay per visit, waived if you are admitted as an inpatient.","Lab tests: no charge at independent and facility-owned labs.","Mental health: office visits $30 copay per visit (used here); other outpatient mental health services no charge.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $10 copay per prescription (used here), non-preferred generics $20 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $25 copay per prescription, non-preferred generic $50 copay per prescription; preferred brand $113 copay per prescription; non-preferred brand $188 copay per prescription.","Specialty drugs: 50% coinsurance, at most $800 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $60 copay per visit; specialist $85 copay per visit; imaging 30% coinsurance; outpatient surgery facility 30% coinsurance; outpatient surgeon 30% coinsurance; hospital stay facility 30% coinsurance; hospital stay physician 30% coinsurance; prenatal visits $85 copay per visit; delivery professional 30% coinsurance; delivery facility 30% coinsurance; rehabilitation $85 copay per visit; lab tests 30% coinsurance."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Gold-Convenience-PPO-2700_0_30.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":516.53,"tobaccoFactor":1.024994,"tobaccoFactorByAge":{"21":1.024994,"22":1.024994,"23":1.024994,"24":1.024994,"25":1.02501,"26":1.024994,"27":1.024994,"28":1.024988,"29":1.025,"30":1.025006,"31":1.024989,"32":1.025006,"33":1.025,"34":1.024989,"35":1.025,"36":1.024995,"37":1.025005,"38":1.025,"39":1.025005,"40":1.075002,"41":1.075001,"42":1.075,"43":1.075,"44":1.075001,"45":1.099991,"46":1.100001,"47":1.100009,"48":1.100009,"49":1.1,"50":1.150002,"51":1.14999,"52":1.150001,"53":1.150002,"54":1.150001,"55":1.199998,"56":1.199998,"57":1.200003,"58":1.200006,"59":1.200004,"60":1.249996,"61":1.250007,"62":1.249995,"63":1.250002,"64+":1.250003}},"7":{"base21":575.93,"tobaccoFactor":1.025003,"tobaccoFactorByAge":{"21":1.025003,"22":1.025003,"23":1.025003,"24":1.025003,"25":1.025007,"26":1.025011,"27":1.025001,"28":1.025015,"29":1.025013,"30":1.024997,"31":1.025004,"32":1.02501,"33":1.025001,"34":1.025001,"35":1.024993,"36":1.025,"37":1.025007,"38":1.025,"39":1.024999,"40":1.074996,"41":1.075001,"42":1.074996,"43":1.074993,"44":1.075009,"45":1.100007,"46":1.100001,"47":1.099991,"48":1.100006,"49":1.099996,"50":1.149999,"51":1.149994,"52":1.150008,"53":1.149996,"54":1.149999,"55":1.200005,"56":1.200001,"57":1.200001,"58":1.199997,"59":1.200001,"60":1.250002,"61":1.25,"62":1.250006,"63":1.250003,"64+":1.250003}},"9":{"base21":557.85,"tobaccoFactor":1.025007,"tobaccoFactorByAge":{"21":1.025007,"22":1.025007,"23":1.025007,"24":1.025007,"25":1.024996,"26":1.024998,"27":1.02499,"28":1.025001,"29":1.025007,"30":1.025002,"31":1.024994,"32":1.025002,"33":1.024988,"34":1.024999,"35":1.025011,"36":1.024994,"37":1.024992,"38":1.025004,"39":1.025,"40":1.075,"41":1.075008,"42":1.075005,"43":1.075007,"44":1.075001,"45":1.099995,"46":1.09999,"47":1.099998,"48":1.09999,"49":1.100001,"50":1.150002,"51":1.150001,"52":1.150002,"53":1.149997,"54":1.149999,"55":1.199998,"56":1.199997,"57":1.200003,"58":1.2,"59":1.199994,"60":1.249998,"61":1.25,"62":1.250003,"63":1.249997,"64+":1.250009}}}}},{"market":"pennie","id":"45127PA0020065-01","standardId":"45127PA0020065","variant":"standard","issuer":"Capital 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room: $400 copay per visit, waived if you are admitted as an inpatient.","Lab tests: 20% coinsurance at independent and facility-owned labs.","Mental health: office visits $35 copay per visit (used here); other outpatient mental health services 20% coinsurance.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $10 copay per prescription (used here), non-preferred generics $20 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $25 copay per prescription, non-preferred generic $50 copay per prescription; preferred brand $125 copay per prescription; non-preferred brand $250 copay per prescription.","Specialty drugs: 50% coinsurance, at most $800 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $60 copay per visit; specialist $85 copay per visit; prenatal visits $85 copay per visit; rehabilitation $85 copay per visit."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Silver-Convenience-PPO-4500_20_35.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":598.31,"tobaccoFactor":1.025004,"tobaccoFactorByAge":{"21":1.025004,"22":1.025004,"23":1.025004,"24":1.025004,"25":1.025004,"26":1.025005,"27":1.024991,"28":1.025002,"29":1.025003,"30":1.025004,"31":1.025006,"32":1.024993,"33":1.025001,"34":1.025002,"35":1.025002,"36":1.025003,"37":1.02499,"38":1.025004,"39":1.024991,"40":1.075003,"41":1.074994,"42":1.075004,"43":1.074996,"44":1.075002,"45":1.099993,"46":1.100004,"47":1.099994,"48":1.099996,"49":1.099998,"50":1.150003,"51":1.149993,"52":1.149996,"53":1.149998,"54":1.150001,"55":1.199996,"56":1.200007,"57":1.199996,"58":1.200001,"59":1.2,"60":1.249998,"61":1.249999,"62":1.250003,"63":1.249999,"64+":1.250006}},"7":{"base21":667.11,"tobaccoFactor":1.025003,"tobaccoFactorByAge":{"21":1.025003,"22":1.025003,"23":1.025003,"24":1.025003,"25":1.025008,"26":1.024988,"27":1.024988,"28":1.025002,"29":1.024997,"30":1.025001,"31":1.025,"32":1.025,"33":1.025,"34":1.024991,"35":1.025,"36":1.024995,"37":1.024991,"38":1.025011,"39":1.025003,"40":1.075009,"41":1.075007,"42":1.074995,"43":1.075005,"44":1.075003,"45":1.099999,"46":1.100003,"47":1.1,"48":1.100006,"49":1.1,"50":1.15,"51":1.149996,"52":1.149999,"53":1.150003,"54":1.149998,"55":1.199997,"56":1.199996,"57":1.199999,"58":1.199999,"59":1.2,"60":1.250001,"61":1.250001,"62":1.250003,"63":1.25,"64+":1.250009}},"9":{"base21":646.17,"tobaccoFactor":1.025009,"tobaccoFactorByAge":{"21":1.025009,"22":1.025009,"23":1.025009,"24":1.025009,"25":1.025002,"26":1.024997,"27":1.025,"28":1.025,"29":1.025004,"30":1.024993,"31":1.024996,"32":1.024999,"33":1.024996,"34":1.025011,"35":1.024999,"36":1.025,"37":1.025001,"38":1.025002,"39":1.025004,"40":1.075005,"41":1.075001,"42":1.074996,"43":1.074995,"44":1.075008,"45":1.100003,"46":1.100004,"47":1.100003,"48":1.100001,"49":1.100003,"50":1.15,"51":1.150003,"52":1.15,"53":1.150001,"54":1.150002,"55":1.199997,"56":1.200004,"57":1.199996,"58":1.2,"59":1.200001,"60":1.249994,"61":1.250001,"62":1.249997,"63":1.250003,"64+":1.250006}}}}},{"market":"pennie","id":"45127PA0020065-04","standardId":"45127PA0020065","variant":"csr73","issuer":"Capital 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room: $200 copay per visit, waived if you are admitted as an inpatient.","Lab tests: 15% coinsurance at independent and facility-owned labs.","Mental health: office visits $25 copay per visit (used here); other outpatient mental health services 15% coinsurance.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $5 copay per prescription (used here), non-preferred generics $10 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $13 copay per prescription, non-preferred generic $26 copay per prescription; preferred brand $63 copay per prescription; non-preferred brand $138 copay per prescription.","Specialty drugs: 40% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $800 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $50 copay per visit; specialist $75 copay per visit; prenatal visits $75 copay per visit; rehabilitation $75 copay per 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Prices for a 90-day home-delivery fill: preferred generic $8 copay per prescription, non-preferred generic $16 copay per prescription; preferred brand $38 copay per prescription; non-preferred brand $100 copay per prescription.","Specialty drugs: 30% coinsurance, at most $400 per 30-day prescription for a preferred specialty drug (modelled here) and at most $500 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $30 copay per visit; specialist $60 copay per visit; prenatal visits $60 copay per visit; rehabilitation $60 copay per 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Prices for a 90-day home-delivery fill: preferred generic $5 copay per prescription, non-preferred generic $10 copay per prescription; preferred brand $25 copay per prescription; non-preferred brand $63 copay per prescription.","Specialty drugs: 10% coinsurance, at most $200 per 30-day prescription for a preferred specialty drug (modelled here) and at most $300 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $20 copay per visit; specialist $40 copay per visit; prenatal visits $40 copay per visit; rehabilitation $40 copay per 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Prices for a 90-day home-delivery fill: preferred generic $25 copay per prescription, non-preferred generic $75 copay per prescription; preferred brand no charge; non-preferred brand no charge.","Specialty drugs: 50% coinsurance, at most $800 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $75 copay per visit; specialist $110 copay per visit; prenatal visits $110 copay per visit; rehabilitation $110 copay per visit."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Bronze-Convenience-PPO-7200_0_50-HSA.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":381.24,"tobaccoFactor":1.024997,"tobaccoFactorByAge":{"21":1.024997,"22":1.024997,"23":1.024997,"24":1.024997,"25":1.025003,"26":1.025001,"27":1.025004,"28":1.024999,"29":1.024988,"30":1.024982,"31":1.024985,"32":1.024988,"33":1.024982,"34":1.024998,"35":1.024985,"36":1.024993,"37":1.025002,"38":1.025009,"39":1.025004,"40":1.075017,"41":1.075005,"42":1.075009,"43":1.074999,"44":1.075011,"45":1.099998,"46":1.100007,"47":1.100003,"48":1.099995,"49":1.099985,"50":1.15001,"51":1.149998,"52":1.150004,"53":1.150001,"54":1.149997,"55":1.200009,"56":1.200004,"57":1.200004,"58":1.2,"59":1.199996,"60":1.25001,"61":1.250009,"62":1.250005,"63":1.250004,"64+":1.250011}},"7":{"base21":425.08,"tobaccoFactor":1.025007,"tobaccoFactorByAge":{"21":1.025007,"22":1.025007,"23":1.025007,"24":1.025007,"25":1.025001,"26":1.025018,"27":1.024984,"28":1.025018,"29":1.024996,"30":1.024996,"31":1.025007,"32":1.024997,"33":1.024998,"34":1.024998,"35":1.025007,"36":1.024998,"37":1.025007,"38":1.024998,"39":1.025016,"40":1.074992,"41":1.075001,"42":1.075014,"43":1.074995,"44":1.075003,"45":1.099997,"46":1.100013,"47":1.1,"48":1.099999,"49":1.100001,"50":1.15,"51":1.150004,"52":1.150007,"53":1.149994,"54":1.149997,"55":1.200004,"56":1.199996,"57":1.199994,"58":1.199998,"59":1.200002,"60":1.250002,"61":1.25,"62":1.250004,"63":1.25,"64+":1.250008}},"9":{"base21":411.74,"tobaccoFactor":1.024991,"tobaccoFactorByAge":{"21":1.024991,"22":1.024991,"23":1.024991,"24":1.024991,"25":1.024989,"26":1.024999,"27":1.025006,"28":1.025002,"29":1.024982,"30":1.025015,"31":1.024999,"32":1.024985,"33":1.024997,"34":1.025008,"35":1.024983,"36":1.024998,"37":1.025013,"38":1.024989,"39":1.025019,"40":1.07501,"41":1.075007,"42":1.075007,"43":1.074991,"44":1.075,"45":1.100008,"46":1.099998,"47":1.099992,"48":1.100001,"49":1.099996,"50":1.149993,"51":1.150008,"52":1.150004,"53":1.149997,"54":1.150001,"55":1.199993,"56":1.199992,"57":1.199998,"58":1.199998,"59":1.199998,"60":1.249996,"61":1.249994,"62":1.249998,"63":1.250006,"64+":1.250006}}}}},{"market":"pennie","id":"45127PA0020069-01","standardId":"45127PA0020069","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Bronze Capital Advantage PPO 6600/0/50 + HSA","metal":"Bronze","network":"PPO","hsaEligible":true,"counties":["Cumberland","Dauphin","Perry"],"rates":{"9":{"base21":477.24,"tobaccoFactor":1.024998,"tobaccoFactorByAge":{"21":1.024998,"22":1.024998,"23":1.024998,"24":1.024998,"25":1.025003,"26":1.024985,"27":1.024993,"28":1.025002,"29":1.025017,"30":1.024997,"31":1.025004,"32":1.024992,"33":1.024994,"34":1.02501,"35":1.025,"36":1.024991,"37":1.024999,"38":1.025007,"39":1.025005,"40":1.074993,"41":1.074996,"42":1.07499,"43":1.074998,"44":1.074995,"45":1.099994,"46":1.100006,"47":1.099996,"48":1.100001,"49":1.09999,"50":1.149995,"51":1.150001,"52":1.149992,"53":1.149993,"54":1.150003,"55":1.2,"56":1.199998,"57":1.200002,"58":1.200007,"59":1.200006,"60":1.25,"61":1.249998,"62":1.25,"63":1.250004,"64+":1.250007}}},"ded":{"ind":6600,"fam":13200,"embedded":false},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":85,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":800}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $400 copay per visit, waived if you are admitted as an inpatient.","Lab tests: no charge at independent and facility-owned labs.","Mental health: office visits $50 copay per visit (used here); 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Prices for a 90-day home-delivery fill: preferred generic no charge, non-preferred generic no charge; preferred brand no charge; non-preferred brand no charge.","Specialty drugs: 50% coinsurance, at most $800 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","High-deductible plan: the deductible applies to all services, including prescriptions, before any copay or coinsurance (SBC page 1). The family deductible is an aggregate: it must be met by the family as a whole, not per person.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $75 copay per visit; specialist $110 copay per visit; prenatal visits $110 copay per visit; rehabilitation $110 copay per visit."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Bronze-Capital-Advantage-PPO-6600_0_50-HSA.pdf"},{"market":"pennie","id":"45127PA0020071-01","standardId":"45127PA0020071","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Bronze Convenience PPO 6600/0/50 + HSA","metal":"Bronze","network":"PPO","hsaEligible":true,"counties":["Adams","Franklin","Lebanon","Lehigh","Northampton","York"],"rates":{"6":{"base21":447.95,"tobaccoFactor":1.02498,"tobaccoFactorByAge":{"21":1.02498,"22":1.02498,"23":1.02498,"24":1.02498,"25":1.024992,"26":1.024984,"27":1.024987,"28":1.024994,"29":1.024998,"30":1.024999,"31":1.025001,"32":1.025004,"33":1.024989,"34":1.02499,"35":1.024991,"36":1.02501,"37":1.024993,"38":1.024994,"39":1.024995,"40":1.075008,"41":1.075015,"42":1.074992,"43":1.075001,"44":1.074994,"45":1.100011,"46":1.099997,"47":1.099994,"48":1.100001,"49":1.100001,"50":1.149994,"51":1.149996,"52":1.150002,"53":1.149998,"54":1.150006,"55":1.199996,"56":1.199998,"57":1.200002,"58":1.200007,"59":1.2,"60":1.25,"61":1.249998,"62":1.249994,"63":1.250006,"64+":1.249993}},"7":{"base21":499.54,"tobaccoFactor":1.025003,"tobaccoFactorByAge":{"21":1.025003,"22":1.025003,"23":1.025003,"24":1.025003,"25":1.025003,"26":1.025003,"27":1.024985,"28":1.024991,"29":1.02501,"30":1.024992,"31":1.024993,"32":1.025011,"33":1.024998,"34":1.024998,"35":1.024998,"36":1.024999,"37":1.024999,"38":1.025015,"39":1.024999,"40":1.074999,"41":1.075,"42":1.074997,"43":1.075,"44":1.074986,"45":1.10001,"46":1.099999,"47":1.100003,"48":1.099994,"49":1.099999,"50":1.149992,"51":1.150004,"52":1.149995,"53":1.150001,"54":1.150003,"55":1.199996,"56":1.200005,"57":1.199995,"58":1.200005,"59":1.2,"60":1.249994,"61":1.250004,"62":1.250005,"63":1.25,"64+":1.250005}},"9":{"base21":498.57,"tobaccoFactor":1.025012,"tobaccoFactorByAge":{"21":1.025012,"22":1.025012,"23":1.025012,"24":1.025012,"25":1.024992,"26":1.024993,"27":1.024995,"28":1.025002,"29":1.025004,"30":1.025005,"31":1.024989,"32":1.025008,"33":1.024996,"34":1.024997,"35":1.024998,"36":1.024998,"37":1.025015,"38":1.024999,"39":1.025,"40":1.075002,"41":1.075007,"42":1.075006,"43":1.074996,"44":1.075003,"45":1.100008,"46":1.100005,"47":1.100004,"48":1.100004,"49":1.099992,"50":1.150003,"51":1.150004,"52":1.149997,"53":1.149997,"54":1.149992,"55":1.199996,"56":1.200005,"57":1.199995,"58":1.199997,"59":1.200002,"60":1.249998,"61":1.250002,"62":1.25,"63":1.250002,"64+":1.250008}}},"ded":{"ind":6600,"fam":13200,"embedded":false},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":85,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":800}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $400 copay per visit, waived if you are admitted as an inpatient.","Lab tests: no charge at independent and facility-owned labs.","Mental health: office visits $50 copay per visit (used here); other outpatient mental health services no charge.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics no charge (used here), non-preferred generics no charge, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic no charge, non-preferred generic no charge; preferred brand no charge; non-preferred brand no charge.","Specialty drugs: 50% coinsurance, at most $800 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","High-deductible plan: the deductible applies to all services, including prescriptions, before any copay or coinsurance (SBC page 1). The family deductible is an aggregate: it must be met by the family as a whole, not per person.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $75 copay per visit; specialist $110 copay per visit; prenatal visits $110 copay per visit; rehabilitation $110 copay per visit."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Bronze-Convenience-PPO-6600_0_50-HSA.pdf"},{"market":"pennie","id":"52899PA0030129-01","standardId":"52899PA0030129","variant":"standard","issuer":"UPMC Health Plan","name":"UPMC Advantage Gold $1,000/$20 - Standard Network","metal":"Gold","network":"HMO","hsaEligible":false,"networkId":"PAN002","referral":true,"tiers":false,"counties":["Clearfield","Crawford"],"rates":{"1":{"base21":578.09,"tobaccoFactor":1.024996},"5":{"base21":623.48,"tobaccoFactor":1.025005}},"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":20,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($50 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 30% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $20 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($20 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAHB3_HMO_RX1N95_IDA5_2027_52899PA003012901.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":505.35,"tobaccoFactor":1.024993},"5":{"base21":545.02,"tobaccoFactor":1.025008}}}},{"market":"pennie","id":"52899PA0030130-01","standardId":"52899PA0030130","variant":"standard","issuer":"UPMC Health Plan","name":"UPMC Advantage Gold HSA $2,900/10% - Standard Network","metal":"Gold","network":"HMO","hsaEligible":true,"networkId":"PAN002","referral":true,"tiers":false,"counties":["Clearfield","Crawford"],"rates":{"1":{"base21":506.77,"tobaccoFactor":1.025001},"5":{"base21":546.55,"tobaccoFactor":1.024993}},"ded":{"ind":2900,"fam":5800,"embedded":false},"drugDed":null,"oop":{"ind":6000,"fam":12000,"famPerPerson":12000},"rules":{"pcp":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests (10% coinsurance), used for both, and says certain diagnostic services may have additional cost sharing.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy 10% coinsurance; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share (10% coinsurance) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","The SBC says the overall family deductible must be met before the plan begins to pay (a family deductible, not one per person), and the estimate uses the aggregate family deductible.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XASH6_HMO_RX1N97_IDA5_2027_52899PA003013001.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":447.64,"tobaccoFactor":1.024998},"5":{"base21":482.78,"tobaccoFactor":1.025001}}}},{"market":"pennie","id":"52899PA0030133-01","standardId":"52899PA0030133","variant":"standard","issuer":"UPMC Health Plan","name":"UPMC Advantage Silver $7,000/$45 - Standard Network","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN002","referral":true,"tiers":false,"counties":["Clearfield","Crawford"],"rates":{"1":{"base21":667.43,"tobaccoFactor":1.025006},"5":{"base21":719.83,"tobaccoFactor":1.025006}},"ded":{"ind":7000,"fam":14000,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":45,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($65 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $45 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($45 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAHB6_HMO_RX1N88_IDA5_2027_52899PA003013301.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":583.56,"tobaccoFactor":1.025002},"5":{"base21":629.38,"tobaccoFactor":1.024993}}}},{"market":"pennie","id":"52899PA0030133-04","standardId":"52899PA0030133","variant":"csr73","issuer":"UPMC Health Plan","name":"UPMC Advantage Silver $7,000/$45 - Standard Network","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN002","referral":true,"tiers":false,"counties":["Clearfield","Crawford"],"rates":{"1":{"base21":667.43,"tobaccoFactor":1.025006},"5":{"base21":719.83,"tobaccoFactor":1.025006}},"ded":{"ind":2800,"fam":5600,"embedded":true},"drugDed":null,"oop":{"ind":9500,"fam":19000},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":45,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($65 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance after deductible; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $45 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($45 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAHB8_HMO_RX1N88_IDA5_2027_52899PA003013304.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":583.56,"tobaccoFactor":1.025002},"5":{"base21":629.38,"tobaccoFactor":1.024993}}}},{"market":"pennie","id":"52899PA0030133-05","standardId":"52899PA0030133","variant":"csr87","issuer":"UPMC Health Plan","name":"UPMC Advantage Silver $7,000/$45 - Standard Network","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN002","referral":true,"tiers":false,"counties":["Clearfield","Crawford"],"rates":{"1":{"base21":667.43,"tobaccoFactor":1.025006},"5":{"base21":719.83,"tobaccoFactor":1.025006}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":4000,"fam":8000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":45,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":30,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests ($45 copay per visit), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy $30 copay per visit; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Prenatal visits: the SBC says the office-visit cost share ($30 copay per visit) applies to the first visit only; later prenatal visits are priced as free here, and the delivery rows carry the rest of the maternity cost.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAHB7_HMO_RX1N90_IDA5_2027_52899PA003013305.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":583.56,"tobaccoFactor":1.025002},"5":{"base21":629.38,"tobaccoFactor":1.024993}}}},{"market":"pennie","id":"52899PA0030133-06","standardId":"52899PA0030133","variant":"csr94","issuer":"UPMC Health Plan","name":"UPMC Advantage Silver $7,000/$45 - Standard Network","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN002","referral":true,"tiers":false,"counties":["Clearfield","Crawford"],"rates":{"1":{"base21":667.43,"tobaccoFactor":1.025006},"5":{"base21":719.83,"tobaccoFactor":1.025006}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":2300,"fam":4600},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"free","ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests (no cost), used for both, and says certain diagnostic services may have additional cost sharing.","The benefit details Pennie lists for this plan show X-rays and diagnostic imaging at 40% coinsurance; this record follows the SBC, so X-rays may cost more than shown.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy no cost; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAHB5_HMO_RX1N90_IDA5_2027_52899PA003013306.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":583.56,"tobaccoFactor":1.025002},"5":{"base21":629.38,"tobaccoFactor":1.024993}}}},{"market":"pennie","id":"52899PA0030135-01","standardId":"52899PA0030135","variant":"standard","issuer":"UPMC Health Plan","name":"UPMC Advantage Bronze $6,700/$0 - Standard Network","metal":"Bronze","network":"HMO","hsaEligible":false,"networkId":"PAN002","referral":true,"tiers":false,"counties":["Clearfield","Crawford"],"rates":{"1":{"base21":409.52,"tobaccoFactor":1.025005},"5":{"base21":441.67,"tobaccoFactor":1.024996}},"ded":{"ind":6700,"fam":13400,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests (40% coinsurance), used for both, and says certain diagnostic services may have additional cost sharing.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy no cost; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","The SBC does not say whether the deductible applies to generic drugs; the benefit details Pennie lists for this plan show no deductible, so they are treated as before the deductible.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAHB4_HMO_RX1N93_IDA5_2027_52899PA003013501.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":364.62,"tobaccoFactor":1.025012},"5":{"base21":393.24,"tobaccoFactor":1.024997}}}},{"market":"pennie","id":"52899PA0030136-01","standardId":"52899PA0030136","variant":"standard","issuer":"UPMC Health Plan","name":"UPMC Advantage Catastrophic $12,000/$0 - Standard Network","metal":"Catastrophic","network":"HMO","hsaEligible":false,"networkId":"PAN002","referral":true,"tiers":false,"counties":["Clearfield","Crawford"],"rates":{"1":{"base21":383.67,"tobaccoFactor":1.024995},"5":{"base21":413.79,"tobaccoFactor":1.024989}},"ded":{"ind":12000,"fam":24000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Lab tests and X-rays: the SBC gives one cost share for diagnostic tests (no cost), used for both, and says certain diagnostic services may have additional cost sharing.","Prescription drugs: retail (not mail-order) cost shares are used.","Mental health: outpatient office visits and therapy no cost; other services (intensive outpatient, partial hospitalization) may have additional cost sharing.","Physical and occupational therapy: covered up to 30 visits per benefit period (speech therapy has its own 30-visit limit); visits above the limit are not covered, and the limit does not apply to mental and behavioral health services.","Where the SBC does not say whether the deductible applies, the cost is treated as after the deductible, as the SBC banner says; the benefit details Pennie lists for this plan agree."],"sbcUrl":"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/XAHB9_HMO_RX1N91_IDA6_2027_52899PA003013601.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":347.95,"tobaccoFactor":1.025004},"5":{"base21":375.27,"tobaccoFactor":1.024995}}}},{"market":"pennie","id":"75729PA0012647-01","standardId":"75729PA0012647","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger Marketplace All-Access PPO 20/50/3250","metal":"Gold","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bedford","Blair","Cambria","Cameron","Clearfield","Elk","Huntingdon","Jefferson","Potter","Somerset"],"rates":{"2":{"base21":639.78,"tobaccoFactor":1.099987},"5":{"base21":607.79,"tobaccoFactor":1.100002}},"ded":{"ind":3250,"fam":6500,"embedded":true},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794597, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Access PPO 20 50 3250\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 75729PA0012655, 75729PA0012651, 75729PA0012657 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $15 copay.","Specialty drugs: 40% coinsurance up to $150 per fill (the cap is modelled here).","Costs and limits here are for in-network (preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794597/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"2":{"base21":580.55,"tobaccoFactor":1.099991},"5":{"base21":551.52,"tobaccoFactor":1.099996}}}},{"market":"pennie","id":"75729PA0012651-01","standardId":"75729PA0012651","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger Marketplace All-Access PPO 20/50/3250","metal":"Gold","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Adams","Berks","Cumberland","Dauphin","Franklin","Fulton","Lancaster","Lebanon","Perry","York"],"rates":{"7":{"base21":799.72,"tobaccoFactor":1.099997},"9":{"base21":767.73,"tobaccoFactor":1.099996}},"ded":{"ind":3250,"fam":6500,"embedded":true},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794597, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Access PPO 20 50 3250\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 75729PA0012647, 75729PA0012655, 75729PA0012657 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $15 copay.","Specialty drugs: 40% coinsurance up to $150 per fill (the cap is modelled here).","Costs and limits here are for in-network (preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794597/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"7":{"base21":725.68,"tobaccoFactor":1.100003},"9":{"base21":696.65,"tobaccoFactor":1.100007}}}},{"market":"pennie","id":"75729PA0012655-01","standardId":"75729PA0012655","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger Marketplace All-Access PPO 20/50/3250","metal":"Gold","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bradford","Carbon","Centre","Clinton","Columbia","Juniata","Lackawanna","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northumberland","Pike","Schuylkill","Snyder","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming"],"rates":{"3":{"base21":607.79,"tobaccoFactor":1.100002},"6":{"base21":639.78,"tobaccoFactor":1.099987},"9":{"base21":767.73,"tobaccoFactor":1.099996}},"ded":{"ind":3250,"fam":6500,"embedded":true},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794597, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Access PPO 20 50 3250\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 75729PA0012647, 75729PA0012651, 75729PA0012657 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $15 copay.","Specialty drugs: 40% coinsurance up to $150 per fill (the cap is modelled here).","Costs and limits here are for in-network (preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794597/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"3":{"base21":551.52,"tobaccoFactor":1.099996},"6":{"base21":580.55,"tobaccoFactor":1.099991},"9":{"base21":696.65,"tobaccoFactor":1.100007}}}},{"market":"pennie","id":"75729PA0012657-01","standardId":"75729PA0012657","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger Marketplace All-Access PPO 20/50/3250","metal":"Gold","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Lehigh","Northampton"],"rates":{"6":{"base21":639.78,"tobaccoFactor":1.099987}},"ded":{"ind":3250,"fam":6500,"embedded":true},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794597, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Access PPO 20 50 3250\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 75729PA0012647, 75729PA0012655, 75729PA0012651 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $15 copay.","Specialty drugs: 40% coinsurance up to $150 per fill (the cap is modelled here).","Costs and limits here are for in-network (preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794597/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"6":{"base21":580.55,"tobaccoFactor":1.099991}}}},{"market":"pennie","id":"75729PA0012664-01","standardId":"75729PA0012664","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger Marketplace All-Access PPO 30/60/4900","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bedford","Blair","Cambria","Cameron","Clearfield","Elk","Huntingdon","Jefferson","Potter","Somerset"],"rates":{"2":{"base21":713.76,"tobaccoFactor":1.099992},"5":{"base21":678.07,"tobaccoFactor":1.09999}},"ded":{"ind":4900,"fam":9800,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family. Drug rows that say \"Deductible does not apply\" (generic drugs) are charged from the first fill; the others (preferred brand drugs, non-preferred brand drugs, specialty drugs) do not say, so they are read as after the drug deductible.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","Geisinger has not published its 2027 SBCs yet; this is the 2027 SBC it filed with the PA Insurance Department in SERFF form filing GSHP-134794597 (\"2027 - 75729PA0012664 - All-Access PPO (Silver) 30_60_4900 v2 (1).pdf\") for this plan.","The SBC equals the filing's benefit summary (sheet \"All-Access PPO 30 60 4900\") on the deductible, out-of-pocket limit, drug deductible, coverage examples and every cost used here, and the rate decision's rate pages on the deductible, coinsurance, primary care and specialist copays and out-of-pocket maximum."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794597/2027 - 75729PA0012664 - All-Access PPO (Silver) 30_60_4900 v2 (1).pdf","prev":{"planYear":2026,"rates":{"2":{"base21":666.54,"tobaccoFactor":1.099994},"5":{"base21":633.21,"tobaccoFactor":1.099998}}}},{"market":"pennie","id":"75729PA0012664-04","standardId":"75729PA0012664","variant":"csr73","issuer":"Geisinger Quality Options","name":"Geisinger Marketplace All-Access PPO 30/60/4900","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bedford","Blair","Cambria","Cameron","Clearfield","Elk","Huntingdon","Jefferson","Potter","Somerset"],"rates":{"2":{"base21":713.76,"tobaccoFactor":1.099992},"5":{"base21":678.07,"tobaccoFactor":1.09999}},"ded":{"ind":4000,"fam":8000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":9000,"fam":18000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794597, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"PPO 30 60 4900 (.73)\", in-network column; each rule's page is the sheet row); the rate decision prints no cost-sharing reduction amounts.","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with the same cost-sharing version of 75729PA0012672, 75729PA0012668, 75729PA0012674 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family; it applies to preferred brand drugs, non-preferred brand drugs, specialty drugs (the filed summary says \"after deductible\" there).","Costs and limits here are for in-network (preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794597/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"2":{"base21":666.54,"tobaccoFactor":1.099994},"5":{"base21":633.21,"tobaccoFactor":1.099998}}}},{"market":"pennie","id":"75729PA0012664-05","standardId":"75729PA0012664","variant":"csr87","issuer":"Geisinger Quality Options","name":"Geisinger Marketplace All-Access PPO 30/60/4900","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bedford","Blair","Cambria","Cameron","Clearfield","Elk","Huntingdon","Jefferson","Potter","Somerset"],"rates":{"2":{"base21":713.76,"tobaccoFactor":1.099992},"5":{"base21":678.07,"tobaccoFactor":1.09999}},"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":null,"oop":{"ind":4000,"fam":8000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794597, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"PPO 30 60 4900 (.87)\", in-network column; each rule's page is the sheet row); the rate decision prints no cost-sharing reduction amounts.","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with the same cost-sharing version of 75729PA0012672, 75729PA0012668, 75729PA0012674 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $15 copay.","Specialty drugs: 40% coinsurance up to $150 per fill (the cap is modelled here).","Costs and limits here are for in-network (preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794597/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"2":{"base21":666.54,"tobaccoFactor":1.099994},"5":{"base21":633.21,"tobaccoFactor":1.099998}}}},{"market":"pennie","id":"75729PA0012664-06","standardId":"75729PA0012664","variant":"csr94","issuer":"Geisinger Quality Options","name":"Geisinger Marketplace All-Access PPO 30/60/4900","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bedford","Blair","Cambria","Cameron","Clearfield","Elk","Huntingdon","Jefferson","Potter","Somerset"],"rates":{"2":{"base21":713.76,"tobaccoFactor":1.099992},"5":{"base21":678.07,"tobaccoFactor":1.09999}},"ded":{"ind":800,"fam":1600,"embedded":true},"drugDed":null,"oop":{"ind":3000,"fam":6000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":7,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":75}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794597, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"PPO 30604900 (.94)\", in-network column; each rule's page is the sheet row); the rate decision prints no cost-sharing reduction amounts.","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with the same cost-sharing version of 75729PA0012672, 75729PA0012668, 75729PA0012674 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $1 copay.","Specialty drugs: 20% coinsurance up to $75 per fill (the cap is modelled here).","Costs and limits here are for in-network (preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794597/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"2":{"base21":666.54,"tobaccoFactor":1.099994},"5":{"base21":633.21,"tobaccoFactor":1.099998}}}},{"market":"pennie","id":"75729PA0012668-01","standardId":"75729PA0012668","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger Marketplace All-Access PPO 30/60/4900","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Adams","Berks","Cumberland","Dauphin","Franklin","Fulton","Lancaster","Lebanon","Perry","York"],"rates":{"7":{"base21":892.19,"tobaccoFactor":1.100001},"9":{"base21":856.51,"tobaccoFactor":1.099999}},"ded":{"ind":4900,"fam":9800,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family. Drug rows that say \"Deductible does not apply\" (generic drugs) are charged from the first fill; the others (preferred brand drugs, non-preferred brand drugs, specialty drugs) do not say, so they are read as after the drug deductible.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","Geisinger has not published its 2027 SBCs yet; this is the 2027 SBC it filed with the PA Insurance Department in SERFF form filing GSHP-134794597 (\"2027 - 75729PA0012664 - All-Access PPO (Silver) 30_60_4900 v2 (1).pdf\") for 75729PA0012664-01. The filing's benefit summary (PY2027_Individual_6.3.2026.xlsx, sheet \"All-Access PPO 30 60 4900\") lists this plan in one design with 75729PA0012664, 75729PA0012672, 75729PA0012674; they differ only in service area, and Geisinger's SBCs print no plan ID.","The SBC equals the filing's benefit summary (sheet \"All-Access PPO 30 60 4900\") on the deductible, out-of-pocket limit, drug deductible, coverage examples and every cost used here, and the rate decision's rate pages on the deductible, coinsurance, primary care and specialist copays and out-of-pocket maximum."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794597/2027 - 75729PA0012664 - All-Access PPO (Silver) 30_60_4900 v2 (1).pdf","prev":{"planYear":2026,"rates":{"7":{"base21":833.17,"tobaccoFactor":1.100004},"9":{"base21":799.84,"tobaccoFactor":1.100008}}}},{"market":"pennie","id":"75729PA0012668-04","standardId":"75729PA0012668","variant":"csr73","issuer":"Geisinger Quality Options","name":"Geisinger Marketplace All-Access PPO 30/60/4900","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Adams","Berks","Cumberland","Dauphin","Franklin","Fulton","Lancaster","Lebanon","Perry","York"],"rates":{"7":{"base21":892.19,"tobaccoFactor":1.100001},"9":{"base21":856.51,"tobaccoFactor":1.099999}},"ded":{"ind":4000,"fam":8000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":9000,"fam":18000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794597, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"PPO 30 60 4900 (.73)\", in-network column; each rule's page is the sheet row); the rate decision prints no cost-sharing reduction amounts.","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with the same cost-sharing version of 75729PA0012664, 75729PA0012672, 75729PA0012674 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family; it applies to preferred brand drugs, non-preferred brand drugs, specialty drugs (the filed summary says \"after deductible\" there).","Costs and limits here are for in-network (preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794597/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"7":{"base21":833.17,"tobaccoFactor":1.100004},"9":{"base21":799.84,"tobaccoFactor":1.100008}}}},{"market":"pennie","id":"75729PA0012668-05","standardId":"75729PA0012668","variant":"csr87","issuer":"Geisinger Quality Options","name":"Geisinger Marketplace All-Access PPO 30/60/4900","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Adams","Berks","Cumberland","Dauphin","Franklin","Fulton","Lancaster","Lebanon","Perry","York"],"rates":{"7":{"base21":892.19,"tobaccoFactor":1.100001},"9":{"base21":856.51,"tobaccoFactor":1.099999}},"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":null,"oop":{"ind":4000,"fam":8000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794597, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"PPO 30 60 4900 (.87)\", in-network column; each rule's page is the sheet row); the rate decision prints no cost-sharing reduction amounts.","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with the same cost-sharing version of 75729PA0012664, 75729PA0012672, 75729PA0012674 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $15 copay.","Specialty drugs: 40% coinsurance up to $150 per fill (the cap is modelled here).","Costs and limits here are for in-network (preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794597/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"7":{"base21":833.17,"tobaccoFactor":1.100004},"9":{"base21":799.84,"tobaccoFactor":1.100008}}}},{"market":"pennie","id":"75729PA0012668-06","standardId":"75729PA0012668","variant":"csr94","issuer":"Geisinger Quality Options","name":"Geisinger Marketplace All-Access PPO 30/60/4900","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Adams","Berks","Cumberland","Dauphin","Franklin","Fulton","Lancaster","Lebanon","Perry","York"],"rates":{"7":{"base21":892.19,"tobaccoFactor":1.100001},"9":{"base21":856.51,"tobaccoFactor":1.099999}},"ded":{"ind":800,"fam":1600,"embedded":true},"drugDed":null,"oop":{"ind":3000,"fam":6000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":7,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":75}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794597, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"PPO 30604900 (.94)\", in-network column; each rule's page is the sheet row); the rate decision prints no cost-sharing reduction amounts.","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with the same cost-sharing version of 75729PA0012664, 75729PA0012672, 75729PA0012674 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $1 copay.","Specialty drugs: 20% coinsurance up to $75 per fill (the cap is modelled here).","Costs and limits here are for in-network (preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794597/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"7":{"base21":833.17,"tobaccoFactor":1.100004},"9":{"base21":799.84,"tobaccoFactor":1.100008}}}},{"market":"pennie","id":"75729PA0012672-01","standardId":"75729PA0012672","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger Marketplace All-Access PPO 30/60/4900","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bradford","Carbon","Centre","Clinton","Columbia","Juniata","Lackawanna","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northumberland","Pike","Schuylkill","Snyder","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming"],"rates":{"3":{"base21":678.07,"tobaccoFactor":1.09999},"6":{"base21":713.76,"tobaccoFactor":1.099992},"9":{"base21":856.51,"tobaccoFactor":1.099999}},"ded":{"ind":4900,"fam":9800,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family. Drug rows that say \"Deductible does not apply\" (generic drugs) are charged from the first fill; the others (preferred brand drugs, non-preferred brand drugs, specialty drugs) do not say, so they are read as after the drug deductible.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","Geisinger has not published its 2027 SBCs yet; this is the 2027 SBC it filed with the PA Insurance Department in SERFF form filing GSHP-134794597 (\"2027 - 75729PA0012664 - All-Access PPO (Silver) 30_60_4900 v2 (1).pdf\") for 75729PA0012664-01. The filing's benefit summary (PY2027_Individual_6.3.2026.xlsx, sheet \"All-Access PPO 30 60 4900\") lists this plan in one design with 75729PA0012664, 75729PA0012668, 75729PA0012674; they differ only in service area, and Geisinger's SBCs print no plan ID.","The SBC equals the filing's benefit summary (sheet \"All-Access PPO 30 60 4900\") on the deductible, out-of-pocket limit, drug deductible, coverage examples and every cost used here, and the rate decision's rate pages on the deductible, coinsurance, primary care and specialist copays and out-of-pocket maximum."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794597/2027 - 75729PA0012664 - All-Access PPO (Silver) 30_60_4900 v2 (1).pdf","prev":{"planYear":2026,"rates":{"3":{"base21":633.21,"tobaccoFactor":1.099998},"6":{"base21":666.54,"tobaccoFactor":1.099994},"9":{"base21":799.84,"tobaccoFactor":1.100008}}}},{"market":"pennie","id":"75729PA0012672-04","standardId":"75729PA0012672","variant":"csr73","issuer":"Geisinger Quality Options","name":"Geisinger Marketplace All-Access PPO 30/60/4900","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bradford","Carbon","Centre","Clinton","Columbia","Juniata","Lackawanna","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northumberland","Pike","Schuylkill","Snyder","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming"],"rates":{"3":{"base21":678.07,"tobaccoFactor":1.09999},"6":{"base21":713.76,"tobaccoFactor":1.099992},"9":{"base21":856.51,"tobaccoFactor":1.099999}},"ded":{"ind":4000,"fam":8000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":9000,"fam":18000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794597, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"PPO 30 60 4900 (.73)\", in-network column; each rule's page is the sheet row); the rate decision prints no cost-sharing reduction amounts.","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with the same cost-sharing version of 75729PA0012664, 75729PA0012668, 75729PA0012674 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family; it applies to preferred brand drugs, non-preferred brand drugs, specialty drugs (the filed summary says \"after deductible\" there).","Costs and limits here are for in-network (preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794597/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"3":{"base21":633.21,"tobaccoFactor":1.099998},"6":{"base21":666.54,"tobaccoFactor":1.099994},"9":{"base21":799.84,"tobaccoFactor":1.100008}}}},{"market":"pennie","id":"75729PA0012672-05","standardId":"75729PA0012672","variant":"csr87","issuer":"Geisinger Quality Options","name":"Geisinger Marketplace All-Access PPO 30/60/4900","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bradford","Carbon","Centre","Clinton","Columbia","Juniata","Lackawanna","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northumberland","Pike","Schuylkill","Snyder","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming"],"rates":{"3":{"base21":678.07,"tobaccoFactor":1.09999},"6":{"base21":713.76,"tobaccoFactor":1.099992},"9":{"base21":856.51,"tobaccoFactor":1.099999}},"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":null,"oop":{"ind":4000,"fam":8000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794597, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"PPO 30 60 4900 (.87)\", in-network column; each rule's page is the sheet row); the rate decision prints no cost-sharing reduction amounts.","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with the same cost-sharing version of 75729PA0012664, 75729PA0012668, 75729PA0012674 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $15 copay.","Specialty drugs: 40% coinsurance up to $150 per fill (the cap is modelled here).","Costs and limits here are for in-network (preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794597/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"3":{"base21":633.21,"tobaccoFactor":1.099998},"6":{"base21":666.54,"tobaccoFactor":1.099994},"9":{"base21":799.84,"tobaccoFactor":1.100008}}}},{"market":"pennie","id":"75729PA0012672-06","standardId":"75729PA0012672","variant":"csr94","issuer":"Geisinger Quality Options","name":"Geisinger Marketplace All-Access PPO 30/60/4900","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bradford","Carbon","Centre","Clinton","Columbia","Juniata","Lackawanna","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northumberland","Pike","Schuylkill","Snyder","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming"],"rates":{"3":{"base21":678.07,"tobaccoFactor":1.09999},"6":{"base21":713.76,"tobaccoFactor":1.099992},"9":{"base21":856.51,"tobaccoFactor":1.099999}},"ded":{"ind":800,"fam":1600,"embedded":true},"drugDed":null,"oop":{"ind":3000,"fam":6000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":7,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":75}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794597, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"PPO 30604900 (.94)\", in-network column; each rule's page is the sheet row); the rate decision prints no cost-sharing reduction amounts.","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with the same cost-sharing version of 75729PA0012664, 75729PA0012668, 75729PA0012674 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $1 copay.","Specialty drugs: 20% coinsurance up to $75 per fill (the cap is modelled here).","Costs and limits here are for in-network (preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794597/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"3":{"base21":633.21,"tobaccoFactor":1.099998},"6":{"base21":666.54,"tobaccoFactor":1.099994},"9":{"base21":799.84,"tobaccoFactor":1.100008}}}},{"market":"pennie","id":"75729PA0012674-01","standardId":"75729PA0012674","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger Marketplace All-Access PPO 30/60/4900","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Lehigh","Northampton"],"rates":{"6":{"base21":713.76,"tobaccoFactor":1.099992}},"ded":{"ind":4900,"fam":9800,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family. Drug rows that say \"Deductible does not apply\" (generic drugs) are charged from the first fill; the others (preferred brand drugs, non-preferred brand drugs, specialty drugs) do not say, so they are read as after the drug deductible.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","Geisinger has not published its 2027 SBCs yet; this is the 2027 SBC it filed with the PA Insurance Department in SERFF form filing GSHP-134794597 (\"2027 - 75729PA0012664 - All-Access PPO (Silver) 30_60_4900 v2 (1).pdf\") for 75729PA0012664-01. The filing's benefit summary (PY2027_Individual_6.3.2026.xlsx, sheet \"All-Access PPO 30 60 4900\") lists this plan in one design with 75729PA0012664, 75729PA0012672, 75729PA0012668; they differ only in service area, and Geisinger's SBCs print no plan ID.","The SBC equals the filing's benefit summary (sheet \"All-Access PPO 30 60 4900\") on the deductible, out-of-pocket limit, drug deductible, coverage examples and every cost used here, and the rate decision's rate pages on the deductible, coinsurance, primary care and specialist copays and out-of-pocket maximum."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794597/2027 - 75729PA0012664 - All-Access PPO (Silver) 30_60_4900 v2 (1).pdf","prev":{"planYear":2026,"rates":{"6":{"base21":666.54,"tobaccoFactor":1.099994}}}},{"market":"pennie","id":"75729PA0012674-04","standardId":"75729PA0012674","variant":"csr73","issuer":"Geisinger Quality Options","name":"Geisinger Marketplace All-Access PPO 30/60/4900","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Lehigh","Northampton"],"rates":{"6":{"base21":713.76,"tobaccoFactor":1.099992}},"ded":{"ind":4000,"fam":8000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":9000,"fam":18000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794597, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"PPO 30 60 4900 (.73)\", in-network column; each rule's page is the sheet row); the rate decision prints no cost-sharing reduction amounts.","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with the same cost-sharing version of 75729PA0012664, 75729PA0012672, 75729PA0012668 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family; it applies to preferred brand drugs, non-preferred brand drugs, specialty drugs (the filed summary says \"after deductible\" there).","Costs and limits here are for in-network (preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794597/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"6":{"base21":666.54,"tobaccoFactor":1.099994}}}},{"market":"pennie","id":"75729PA0012674-05","standardId":"75729PA0012674","variant":"csr87","issuer":"Geisinger Quality Options","name":"Geisinger Marketplace All-Access PPO 30/60/4900","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Lehigh","Northampton"],"rates":{"6":{"base21":713.76,"tobaccoFactor":1.099992}},"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":null,"oop":{"ind":4000,"fam":8000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794597, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"PPO 30 60 4900 (.87)\", in-network column; each rule's page is the sheet row); the rate decision prints no cost-sharing reduction amounts.","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with the same cost-sharing version of 75729PA0012664, 75729PA0012672, 75729PA0012668 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $15 copay.","Specialty drugs: 40% coinsurance up to $150 per fill (the cap is modelled here).","Costs and limits here are for in-network (preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794597/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"6":{"base21":666.54,"tobaccoFactor":1.099994}}}},{"market":"pennie","id":"75729PA0012674-06","standardId":"75729PA0012674","variant":"csr94","issuer":"Geisinger Quality Options","name":"Geisinger Marketplace All-Access PPO 30/60/4900","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Lehigh","Northampton"],"rates":{"6":{"base21":713.76,"tobaccoFactor":1.099992}},"ded":{"ind":800,"fam":1600,"embedded":true},"drugDed":null,"oop":{"ind":3000,"fam":6000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":7,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":75}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794597, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"PPO 30604900 (.94)\", in-network column; each rule's page is the sheet row); the rate decision prints no cost-sharing reduction amounts.","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with the same cost-sharing version of 75729PA0012664, 75729PA0012672, 75729PA0012668 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $1 copay.","Specialty drugs: 20% coinsurance up to $75 per fill (the cap is modelled here).","Costs and limits here are for in-network (preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794597/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"6":{"base21":666.54,"tobaccoFactor":1.099994}}}},{"market":"pennie","id":"75729PA0012681-01","standardId":"75729PA0012681","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger Marketplace All-Access PPO 40/80/8400","metal":"Bronze","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bedford","Blair","Cambria","Cameron","Clearfield","Elk","Huntingdon","Jefferson","Potter","Somerset"],"rates":{"2":{"base21":480.08,"tobaccoFactor":1.099983},"5":{"base21":456.07,"tobaccoFactor":1.100007}},"ded":{"ind":8400,"fam":16800,"embedded":true},"drugDed":null,"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794597, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Access PPO 40 80 8400\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 75729PA0012689, 75729PA0012685, 75729PA0012691 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill. Tier 1 generics are $0 and Tier 3 non-preferred generics are no charge after the deductible.","Prescription drugs share the medical deductible (the filed summary says the drug deductible is combined with medical).","Costs and limits here are for in-network (preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794597/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"2":{"base21":427.83,"tobaccoFactor":1.099993},"5":{"base21":406.44,"tobaccoFactor":1.09999}}}},{"market":"pennie","id":"75729PA0012685-01","standardId":"75729PA0012685","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger Marketplace All-Access PPO 40/80/8400","metal":"Bronze","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Adams","Berks","Cumberland","Dauphin","Franklin","Fulton","Lancaster","Lebanon","Perry","York"],"rates":{"7":{"base21":600.09,"tobaccoFactor":1.100002},"9":{"base21":576.09,"tobaccoFactor":1.100002}},"ded":{"ind":8400,"fam":16800,"embedded":true},"drugDed":null,"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794597, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Access PPO 40 80 8400\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 75729PA0012681, 75729PA0012689, 75729PA0012691 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill. Tier 1 generics are $0 and Tier 3 non-preferred generics are no charge after the deductible.","Prescription drugs share the medical deductible (the filed summary says the drug deductible is combined with medical).","Costs and limits here are for in-network (preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794597/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"7":{"base21":534.78,"tobaccoFactor":1.100004},"9":{"base21":513.39,"tobaccoFactor":1.100002}}}},{"market":"pennie","id":"75729PA0012689-01","standardId":"75729PA0012689","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger Marketplace All-Access PPO 40/80/8400","metal":"Bronze","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bradford","Carbon","Centre","Clinton","Columbia","Juniata","Lackawanna","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northumberland","Pike","Schuylkill","Snyder","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming"],"rates":{"3":{"base21":456.07,"tobaccoFactor":1.100007},"6":{"base21":480.08,"tobaccoFactor":1.099983},"9":{"base21":576.09,"tobaccoFactor":1.100002}},"ded":{"ind":8400,"fam":16800,"embedded":true},"drugDed":null,"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794597, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Access PPO 40 80 8400\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 75729PA0012681, 75729PA0012685, 75729PA0012691 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill. Tier 1 generics are $0 and Tier 3 non-preferred generics are no charge after the deductible.","Prescription drugs share the medical deductible (the filed summary says the drug deductible is combined with medical).","Costs and limits here are for in-network (preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794597/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"3":{"base21":406.44,"tobaccoFactor":1.09999},"6":{"base21":427.83,"tobaccoFactor":1.099993},"9":{"base21":513.39,"tobaccoFactor":1.100002}}}},{"market":"pennie","id":"75729PA0012691-01","standardId":"75729PA0012691","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger Marketplace All-Access PPO 40/80/8400","metal":"Bronze","network":"PPO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Lehigh","Northampton"],"rates":{"6":{"base21":480.08,"tobaccoFactor":1.099983}},"ded":{"ind":8400,"fam":16800,"embedded":true},"drugDed":null,"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794597, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"All-Access PPO 40 80 8400\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 75729PA0012681, 75729PA0012689, 75729PA0012685 (they differ only in service area).","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill. Tier 1 generics are $0 and Tier 3 non-preferred generics are no charge after the deductible.","Prescription drugs share the medical deductible (the filed summary says the drug deductible is combined with medical).","Costs and limits here are for in-network (preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794597/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"6":{"base21":427.83,"tobaccoFactor":1.099993}}}},{"market":"pennie","id":"75729PA0012702-01","standardId":"75729PA0012702","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger Marketplace All-Access QHDHP PPO 8000","metal":"Bronze","network":"PPO","hsaEligible":true,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bedford","Blair","Cambria","Cameron","Clearfield","Elk","Huntingdon","Jefferson","Potter","Somerset"],"rates":{"2":{"base21":484.44,"tobaccoFactor":1.099992},"5":{"base21":460.22,"tobaccoFactor":1.099996}},"ded":{"ind":8000,"fam":16000,"embedded":true},"drugDed":null,"oop":{"ind":8000,"fam":16000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"}},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are no charge after the deductible.","Prescription drugs share the medical deductible (the SBC says the drug deductible is combined with medical).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (primary care visits, specialist visits, urgent care, emergency room care, lab tests, x-rays, imaging, rehabilitation therapy, outpatient mental health visits, generic drugs, preferred brand drugs, non-preferred brand drugs, specialty drugs, outpatient surgery facility fees, outpatient surgeon fees, hospital stay facility fees, hospital stay physician fees, delivery facility fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","Geisinger has not published its 2027 SBCs yet; this is the 2027 SBC it filed with the PA Insurance Department in SERFF form filing GSHP-134794605 (\"2027 - 75729PA0012702 - All-Access QHDHP PPO 8000 (Expanded Bronze).pdf\") for this plan.","The SBC equals the filing's benefit summary (sheet \"All-Access QHDHP PPO 8000\") on the deductible, out-of-pocket limit, drug deductible, coverage examples and every cost used here, which also writes the \"No charge\" rows \"0% after deductible\", and the rate decision's rate pages on the deductible, coinsurance, primary care and specialist copays and out-of-pocket maximum."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794605/2027 - 75729PA0012702 - All-Access QHDHP PPO 8000 (Expanded Bronze).pdf","prev":{"planYear":2026,"rates":{"2":{"base21":443.58,"tobaccoFactor":1.100005},"5":{"base21":421.4,"tobaccoFactor":1.1}}}},{"market":"pennie","id":"75729PA0012706-01","standardId":"75729PA0012706","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger Marketplace All-Access QHDHP PPO 8000","metal":"Bronze","network":"PPO","hsaEligible":true,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Adams","Berks","Cumberland","Dauphin","Franklin","Fulton","Lancaster","Lebanon","Perry","York"],"rates":{"7":{"base21":605.54,"tobaccoFactor":1.10001},"9":{"base21":581.32,"tobaccoFactor":1.100014}},"ded":{"ind":8000,"fam":16000,"embedded":true},"drugDed":null,"oop":{"ind":8000,"fam":16000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"}},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are no charge after the deductible.","Prescription drugs share the medical deductible (the SBC says the drug deductible is combined with medical).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (primary care visits, specialist visits, urgent care, emergency room care, lab tests, x-rays, imaging, rehabilitation therapy, outpatient mental health visits, generic drugs, preferred brand drugs, non-preferred brand drugs, specialty drugs, outpatient surgery facility fees, outpatient surgeon fees, hospital stay facility fees, hospital stay physician fees, delivery facility fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","Geisinger has not published its 2027 SBCs yet; this is the 2027 SBC it filed with the PA Insurance Department in SERFF form filing GSHP-134794605 (\"2027 - 75729PA0012702 - All-Access QHDHP PPO 8000 (Expanded Bronze).pdf\") for 75729PA0012702-01. The filing's benefit summary (PY2027_Individual_6.3.2026.xlsx, sheet \"All-Access QHDHP PPO 8000\") lists this plan in one design with 75729PA0012702, 75729PA0012710, 75729PA0012712; they differ only in service area, and Geisinger's SBCs print no plan ID.","The SBC equals the filing's benefit summary (sheet \"All-Access QHDHP PPO 8000\") on the deductible, out-of-pocket limit, drug deductible, coverage examples and every cost used here, which also writes the \"No charge\" rows \"0% after deductible\", and the rate decision's rate pages on the deductible, coinsurance, primary care and specialist copays and out-of-pocket maximum."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794605/2027 - 75729PA0012702 - All-Access QHDHP PPO 8000 (Expanded Bronze).pdf","prev":{"planYear":2026,"rates":{"7":{"base21":554.47,"tobaccoFactor":1.100005},"9":{"base21":532.29,"tobaccoFactor":1.100002}}}},{"market":"pennie","id":"75729PA0012710-01","standardId":"75729PA0012710","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger Marketplace All-Access QHDHP PPO 8000","metal":"Bronze","network":"PPO","hsaEligible":true,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Bradford","Carbon","Centre","Clinton","Columbia","Juniata","Lackawanna","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northumberland","Pike","Schuylkill","Snyder","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming"],"rates":{"3":{"base21":460.22,"tobaccoFactor":1.099996},"6":{"base21":484.44,"tobaccoFactor":1.099992},"9":{"base21":581.32,"tobaccoFactor":1.100014}},"ded":{"ind":8000,"fam":16000,"embedded":true},"drugDed":null,"oop":{"ind":8000,"fam":16000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"}},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are no charge after the deductible.","Prescription drugs share the medical deductible (the SBC says the drug deductible is combined with medical).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (primary care visits, specialist visits, urgent care, emergency room care, lab tests, x-rays, imaging, rehabilitation therapy, outpatient mental health visits, generic drugs, preferred brand drugs, non-preferred brand drugs, specialty drugs, outpatient surgery facility fees, outpatient surgeon fees, hospital stay facility fees, hospital stay physician fees, delivery facility fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","Geisinger has not published its 2027 SBCs yet; this is the 2027 SBC it filed with the PA Insurance Department in SERFF form filing GSHP-134794605 (\"2027 - 75729PA0012702 - All-Access QHDHP PPO 8000 (Expanded Bronze).pdf\") for 75729PA0012702-01. The filing's benefit summary (PY2027_Individual_6.3.2026.xlsx, sheet \"All-Access QHDHP PPO 8000\") lists this plan in one design with 75729PA0012702, 75729PA0012706, 75729PA0012712; they differ only in service area, and Geisinger's SBCs print no plan ID.","The SBC equals the filing's benefit summary (sheet \"All-Access QHDHP PPO 8000\") on the deductible, out-of-pocket limit, drug deductible, coverage examples and every cost used here, which also writes the \"No charge\" rows \"0% after deductible\", and the rate decision's rate pages on the deductible, coinsurance, primary care and specialist copays and out-of-pocket maximum."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794605/2027 - 75729PA0012702 - All-Access QHDHP PPO 8000 (Expanded Bronze).pdf","prev":{"planYear":2026,"rates":{"3":{"base21":421.4,"tobaccoFactor":1.1},"6":{"base21":443.58,"tobaccoFactor":1.100005},"9":{"base21":532.29,"tobaccoFactor":1.100002}}}},{"market":"pennie","id":"75729PA0012712-01","standardId":"75729PA0012712","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger Marketplace All-Access QHDHP PPO 8000","metal":"Bronze","network":"PPO","hsaEligible":true,"networkId":"PAN001","referral":false,"tiers":false,"counties":["Lehigh","Northampton"],"rates":{"6":{"base21":484.44,"tobaccoFactor":1.099992}},"ded":{"ind":8000,"fam":16000,"embedded":true},"drugDed":null,"oop":{"ind":8000,"fam":16000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"}},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are no charge after the deductible.","Prescription drugs share the medical deductible (the SBC says the drug deductible is combined with medical).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (primary care visits, specialist visits, urgent care, emergency room care, lab tests, x-rays, imaging, rehabilitation therapy, outpatient mental health visits, generic drugs, preferred brand drugs, non-preferred brand drugs, specialty drugs, outpatient surgery facility fees, outpatient surgeon fees, hospital stay facility fees, hospital stay physician fees, delivery facility fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","Geisinger has not published its 2027 SBCs yet; this is the 2027 SBC it filed with the PA Insurance Department in SERFF form filing GSHP-134794605 (\"2027 - 75729PA0012702 - All-Access QHDHP PPO 8000 (Expanded Bronze).pdf\") for 75729PA0012702-01. The filing's benefit summary (PY2027_Individual_6.3.2026.xlsx, sheet \"All-Access QHDHP PPO 8000\") lists this plan in one design with 75729PA0012702, 75729PA0012710, 75729PA0012706; they differ only in service area, and Geisinger's SBCs print no plan ID.","The SBC equals the filing's benefit summary (sheet \"All-Access QHDHP PPO 8000\") on the deductible, out-of-pocket limit, drug deductible, coverage examples and every cost used here, which also writes the \"No charge\" rows \"0% after deductible\", and the rate decision's rate pages on the deductible, coinsurance, primary care and specialist copays and out-of-pocket maximum."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794605/2027 - 75729PA0012702 - All-Access QHDHP PPO 8000 (Expanded Bronze).pdf","prev":{"planYear":2026,"rates":{"6":{"base21":443.58,"tobaccoFactor":1.100005}}}},{"market":"pennie","id":"79962PA0270001-01","standardId":"79962PA0270001","variant":"standard","issuer":"Highmark Benefits Group","name":"my Priority Blue Flex PPO Bronze 3800 HSA","metal":"Bronze","network":"PPO","hsaEligible":true,"networkId":"PAN002","referral":false,"tiers":true,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":473,"tobaccoFactor":1.025011,"tobaccoFactorByAge":{"21":1.025011,"22":1.025011,"23":1.025011,"24":1.025011,"25":1.024995,"26":1.025003,"27":1.024995,"28":1.024993,"29":1.024996,"30":1.024997,"31":1.025009,"32":1.025002,"33":1.025007,"34":1.025008,"35":1.025,"36":1.024992,"37":1.025001,"38":1.024993,"39":1.024995,"40":1.100002,"41":1.104993,"42":1.111994,"43":1.121008,"44":1.131996,"45":1.145005,"46":1.16,"47":1.177005,"48":1.196002,"49":1.217005,"50":1.225005,"51":1.224996,"52":1.224997,"53":1.225003,"54":1.225001,"55":1.225002,"56":1.225,"57":1.225002,"58":1.225,"59":1.224996,"60":1.225002,"61":1.224997,"62":1.225001,"63":1.225002,"64+":1.225004}}},"ded":{"ind":3800,"fam":7600,"embedded":true},"drugDed":null,"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":180,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":550,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":550,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: pcp $90 copay; specialist $90 copay; lab and x-ray $95 copay (blood work/lab) $225 copay (x-ray); imaging 60% coinsurance; outpatient surgery facility fee $600 copay; outpatient surgeon fees $600 copay; hospital facility fee 60% coinsurance; hospital physician fees 60% coinsurance; prenatal office visits 60% coinsurance; delivery physician fees 60% coinsurance; delivery facility fee 60% coinsurance; rehabilitation $90 copay. Deductible and out-of-pocket limits are the same in both and are shared.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 1 $15/$30/$45, mail order $30.","Tier 1 drugs are not subject to the deductible; other drug tiers are.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, and tier 1 prescription drug benefits. Every other service, including those the SBC prices at \"No charge\", is treated as after the deductible.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (50% coinsurance) is for the other prenatal visits. It is applied after the deductible because the SBC says a copayment, coinsurance or deductible may apply depending on the type of service and page 1 does not list pregnancy visits as covered before the deductible."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/NEPA/Individual/I_79962PA0270001-01_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":418.83,"tobaccoFactor":1.024998,"tobaccoFactorByAge":{"21":1.024998,"22":1.024998,"23":1.024998,"24":1.024998,"25":1.024993,"26":1.024995,"27":1.024993,"28":1.024996,"29":1.025007,"30":1.024991,"31":1.025009,"32":1.025006,"33":1.024992,"34":1.024997,"35":1.025009,"36":1.025002,"37":1.024995,"38":1.025007,"39":1.024992,"40":1.100007,"41":1.105003,"42":1.111992,"43":1.120999,"44":1.131992,"45":1.144992,"46":1.16,"47":1.177001,"48":1.196002,"49":1.216999,"50":1.225004,"51":1.224997,"52":1.224999,"53":1.224997,"54":1.225006,"55":1.225002,"56":1.224996,"57":1.225005,"58":1.225004,"59":1.225003,"60":1.225002,"61":1.224996,"62":1.224998,"63":1.225002,"64+":1.225}}}}},{"market":"pennie","id":"79962PA0270002-01","standardId":"79962PA0270002","variant":"standard","issuer":"Highmark Benefits Group","name":"my Priority Blue Flex PPO Bronze 9500 HSA","metal":"Bronze","network":"PPO","hsaEligible":true,"networkId":"PAN002","referral":false,"tiers":true,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":449.75,"tobaccoFactor":1.024992,"tobaccoFactorByAge":{"21":1.024992,"22":1.024992,"23":1.024992,"24":1.024992,"25":1.025003,"26":1.024992,"27":1.024993,"28":1.024996,"29":1.024997,"30":1.024997,"31":1.024997,"32":1.024998,"33":1.025,"34":1.025,"35":1.025,"36":1.025,"37":1.025,"38":1.025,"39":1.025001,"40":1.100003,"41":1.104992,"42":1.111995,"43":1.121004,"44":1.132007,"45":1.145002,"46":1.159999,"47":1.176994,"48":1.196005,"49":1.217003,"50":1.224998,"51":1.225005,"52":1.225,"53":1.225005,"54":1.225001,"55":1.224999,"56":1.225004,"57":1.225001,"58":1.224999,"59":1.225002,"60":1.225,"61":1.225004,"62":1.225001,"63":1.224997,"64+":1.224999}}},"ded":{"ind":9500,"fam":19000,"embedded":true},"drugDed":null,"oop":{"ind":9500,"fam":19000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: none. Deductible and out-of-pocket limits are the same in both and are shared.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","SBC page 1 lists these as covered before the deductible: Preventive care services and pediatric vision care. Every other service, including those the SBC prices at \"No charge\", is treated as after the deductible.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (no charge) is for the other prenatal visits. It is applied after the deductible because the SBC says a copayment, coinsurance or deductible may apply depending on the type of service and page 1 does not list pregnancy visits as covered before the deductible."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/NEPA/Individual/I_79962PA0270002-01_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":383.17,"tobaccoFactor":1.025002,"tobaccoFactorByAge":{"21":1.025002,"22":1.025002,"23":1.025002,"24":1.025002,"25":1.025006,"26":1.025002,"27":1.025002,"28":1.024993,"29":1.025002,"30":1.024994,"31":1.024995,"32":1.024995,"33":1.025009,"34":1.025002,"35":1.025009,"36":1.024995,"37":1.025002,"38":1.025009,"39":1.025002,"40":1.100002,"41":1.104993,"42":1.111995,"43":1.121009,"44":1.132003,"45":1.145003,"46":1.159997,"47":1.176994,"48":1.196,"49":1.216999,"50":1.225005,"51":1.225004,"52":1.225002,"53":1.225005,"54":1.225005,"55":1.225005,"56":1.225004,"57":1.224997,"58":1.224998,"59":1.224997,"60":1.224998,"61":1.225,"62":1.224999,"63":1.224998,"64+":1.225}}}}},{"market":"pennie","id":"79962PA0270003-01","standardId":"79962PA0270003","variant":"standard","issuer":"Highmark Benefits Group","name":"my Priority Blue Flex PPO Silver 6000","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN002","referral":false,"tiers":true,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":756.3,"tobaccoFactor":1.025003,"tobaccoFactorByAge":{"21":1.025003,"22":1.025003,"23":1.025003,"24":1.025003,"25":1.024996,"26":1.024998,"27":1.025006,"28":1.024997,"29":1.025003,"30":1.025,"31":1.024996,"32":1.025003,"33":1.024999,"34":1.024996,"35":1.025005,"36":1.025004,"37":1.025003,"38":1.025001,"39":1.024999,"40":1.100005,"41":1.104996,"42":1.112005,"43":1.120998,"44":1.131996,"45":1.144996,"46":1.159998,"47":1.176999,"48":1.195997,"49":1.216997,"50":1.225001,"51":1.224998,"52":1.225002,"53":1.224999,"54":1.225002,"55":1.224998,"56":1.224999,"57":1.225001,"58":1.225002,"59":1.225002,"60":1.225002,"61":1.225,"62":1.224999,"63":1.225002,"64+":1.224999}}},"ded":{"ind":6000,"fam":12000,"embedded":true},"drugDed":null,"oop":{"ind":9200,"fam":18400},"rules":{"pcp":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":750,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":600,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":55,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":1125,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":1125,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: pcp $65 copay; specialist $65 copay; lab and x-ray $70 copay (blood work/lab) $150 copay (x-ray); imaging $750 copay; outpatient surgery facility fee $625 copay; outpatient surgeon fees $625 copay; hospital facility fee $1,375 copay; prenatal office visits 50% coinsurance; delivery facility fee $1,375 copay; rehabilitation $65 copay. Deductible and out-of-pocket limits are the same in both and are shared.","Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $1,000 per 31-day retail prescription (60-day: $500 min / $2,000 max; 90-day: $750 min / $3,000 max; mail order: $500 min / $2,000 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 1 $10/$20/$30, mail order $20; Tier 2 $30/$60/$90, mail order $60; Tier 3 $250/$500/$750, mail order $500.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, urgent care, rehabilitation services, habilitation services, outpatient mental health, outpatient substance abuse, pediatric vision services, and tier 1&2 prescription drug expenses. Every other service, including those the SBC prices at \"No charge\", is treated as after the deductible.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (30% coinsurance) is for the other prenatal visits. It is applied after the deductible because the SBC says a copayment, coinsurance or deductible may apply depending on the type of service and page 1 does not list pregnancy visits as covered before the deductible.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $1,125 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth. The other days of the stay count toward the deductible until it is met, then cost nothing more."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/NEPA/Individual/I_79962PA0270003-01_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":637.37,"tobaccoFactor":1.024993,"tobaccoFactorByAge":{"21":1.024993,"22":1.024993,"23":1.024993,"24":1.024993,"25":1.025003,"26":1.025005,"27":1.025001,"28":1.024999,"29":1.024999,"30":1.025007,"31":1.025003,"32":1.025,"33":1.025001,"34":1.024995,"35":1.024998,"36":1.025001,"37":1.025004,"38":1.024995,"39":1.025001,"40":1.100005,"41":1.105006,"42":1.112004,"43":1.120995,"44":1.131995,"45":1.144998,"46":1.16,"47":1.177001,"48":1.195998,"49":1.216995,"50":1.225003,"51":1.225002,"52":1.224997,"53":1.224999,"54":1.225003,"55":1.224999,"56":1.225,"57":1.225003,"58":1.224997,"59":1.225,"60":1.225,"61":1.225002,"62":1.224999,"63":1.224999,"64+":1.224998}}}}},{"market":"pennie","id":"79962PA0270003-04","standardId":"79962PA0270003","variant":"csr73","issuer":"Highmark Benefits Group","name":"my Priority Blue Flex PPO Silver 6000","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN002","referral":false,"tiers":true,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":756.3,"tobaccoFactor":1.025003,"tobaccoFactorByAge":{"21":1.025003,"22":1.025003,"23":1.025003,"24":1.025003,"25":1.024996,"26":1.024998,"27":1.025006,"28":1.024997,"29":1.025003,"30":1.025,"31":1.024996,"32":1.025003,"33":1.024999,"34":1.024996,"35":1.025005,"36":1.025004,"37":1.025003,"38":1.025001,"39":1.024999,"40":1.100005,"41":1.104996,"42":1.112005,"43":1.120998,"44":1.131996,"45":1.144996,"46":1.159998,"47":1.176999,"48":1.195997,"49":1.216997,"50":1.225001,"51":1.224998,"52":1.225002,"53":1.224999,"54":1.225002,"55":1.224998,"56":1.224999,"57":1.225001,"58":1.225002,"59":1.225002,"60":1.225002,"61":1.225,"62":1.224999,"63":1.225002,"64+":1.224999}}},"ded":{"ind":3000,"fam":6000,"embedded":true},"drugDed":null,"oop":{"ind":7600,"fam":15200},"rules":{"pcp":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":750,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":600,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":55,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":1125,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":1125,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: pcp $65 copay; specialist $65 copay; lab and x-ray $70 copay (blood work/lab) $150 copay (x-ray); imaging $750 copay; outpatient surgery facility fee $625 copay; outpatient surgeon fees $625 copay; hospital facility fee $1,375 copay; prenatal office visits 50% coinsurance; delivery facility fee $1,375 copay; rehabilitation $65 copay. Deductible and out-of-pocket limits are the same in both and are shared.","Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $1,000 per 31-day retail prescription (60-day: $500 min / $2,000 max; 90-day: $750 min / $3,000 max; mail order: $500 min / $2,000 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 1 $10/$20/$30, mail order $20; Tier 2 $30/$60/$90, mail order $60; Tier 3 $250/$500/$750, mail order $500.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, urgent care, rehabilitation services, habilitation services, outpatient mental health, outpatient substance abuse, pediatric vision services, and tier 1&2 prescription drug expenses. Every other service, including those the SBC prices at \"No charge\", is treated as after the deductible.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (30% coinsurance) is for the other prenatal visits. It is applied after the deductible because the SBC says a copayment, coinsurance or deductible may apply depending on the type of service and page 1 does not list pregnancy visits as covered before the deductible.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $1,125 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth. The other days of the stay count toward the deductible until it is met, then cost nothing more."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/NEPA/Individual/I_79962PA0270003-04_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":637.37,"tobaccoFactor":1.024993,"tobaccoFactorByAge":{"21":1.024993,"22":1.024993,"23":1.024993,"24":1.024993,"25":1.025003,"26":1.025005,"27":1.025001,"28":1.024999,"29":1.024999,"30":1.025007,"31":1.025003,"32":1.025,"33":1.025001,"34":1.024995,"35":1.024998,"36":1.025001,"37":1.025004,"38":1.024995,"39":1.025001,"40":1.100005,"41":1.105006,"42":1.112004,"43":1.120995,"44":1.131995,"45":1.144998,"46":1.16,"47":1.177001,"48":1.195998,"49":1.216995,"50":1.225003,"51":1.225002,"52":1.224997,"53":1.224999,"54":1.225003,"55":1.224999,"56":1.225,"57":1.225003,"58":1.224997,"59":1.225,"60":1.225,"61":1.225002,"62":1.224999,"63":1.224999,"64+":1.224998}}}}},{"market":"pennie","id":"79962PA0270003-05","standardId":"79962PA0270003","variant":"csr87","issuer":"Highmark Benefits Group","name":"my Priority Blue Flex PPO Silver 6000","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN002","referral":false,"tiers":true,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":756.3,"tobaccoFactor":1.025003,"tobaccoFactorByAge":{"21":1.025003,"22":1.025003,"23":1.025003,"24":1.025003,"25":1.024996,"26":1.024998,"27":1.025006,"28":1.024997,"29":1.025003,"30":1.025,"31":1.024996,"32":1.025003,"33":1.024999,"34":1.024996,"35":1.025005,"36":1.025004,"37":1.025003,"38":1.025001,"39":1.024999,"40":1.100005,"41":1.104996,"42":1.112005,"43":1.120998,"44":1.131996,"45":1.144996,"46":1.159998,"47":1.176999,"48":1.195997,"49":1.216997,"50":1.225001,"51":1.224998,"52":1.225002,"53":1.224999,"54":1.225002,"55":1.224998,"56":1.224999,"57":1.225001,"58":1.225002,"59":1.225002,"60":1.225002,"61":1.225,"62":1.224999,"63":1.225002,"64+":1.224999}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":3800,"fam":7600},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":15,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":450,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: pcp $25 copay; specialist $25 copay; lab and x-ray $35 copay (blood work/lab) $60 copay (x-ray); imaging $600 copay; outpatient surgery facility fee $550 copay; outpatient surgeon fees $550 copay; hospital facility fee $650 copay; prenatal office visits 30% coinsurance; delivery facility fee $650 copay; rehabilitation $30 copay. Deductible and out-of-pocket limits are the same in both and are shared.","Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $1,000 per 31-day retail prescription (60-day: $500 min / $2,000 max; 90-day: $750 min / $3,000 max; mail order: $500 min / $2,000 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 2 $10/$20/$30, mail order $20; Tier 3 $50/$100/$150, mail order $100.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (10% coinsurance) is for the other prenatal visits.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $450 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/NEPA/Individual/I_79962PA0270003-05_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":637.37,"tobaccoFactor":1.024993,"tobaccoFactorByAge":{"21":1.024993,"22":1.024993,"23":1.024993,"24":1.024993,"25":1.025003,"26":1.025005,"27":1.025001,"28":1.024999,"29":1.024999,"30":1.025007,"31":1.025003,"32":1.025,"33":1.025001,"34":1.024995,"35":1.024998,"36":1.025001,"37":1.025004,"38":1.024995,"39":1.025001,"40":1.100005,"41":1.105006,"42":1.112004,"43":1.120995,"44":1.131995,"45":1.144998,"46":1.16,"47":1.177001,"48":1.195998,"49":1.216995,"50":1.225003,"51":1.225002,"52":1.224997,"53":1.224999,"54":1.225003,"55":1.224999,"56":1.225,"57":1.225003,"58":1.224997,"59":1.225,"60":1.225,"61":1.225002,"62":1.224999,"63":1.224999,"64+":1.224998}}}}},{"market":"pennie","id":"79962PA0270003-06","standardId":"79962PA0270003","variant":"csr94","issuer":"Highmark Benefits Group","name":"my Priority Blue Flex PPO Silver 6000","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN002","referral":false,"tiers":true,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":756.3,"tobaccoFactor":1.025003,"tobaccoFactorByAge":{"21":1.025003,"22":1.025003,"23":1.025003,"24":1.025003,"25":1.024996,"26":1.024998,"27":1.025006,"28":1.024997,"29":1.025003,"30":1.025,"31":1.024996,"32":1.025003,"33":1.024999,"34":1.024996,"35":1.025005,"36":1.025004,"37":1.025003,"38":1.025001,"39":1.024999,"40":1.100005,"41":1.104996,"42":1.112005,"43":1.120998,"44":1.131996,"45":1.144996,"46":1.159998,"47":1.176999,"48":1.195997,"49":1.216997,"50":1.225001,"51":1.224998,"52":1.225002,"53":1.224999,"54":1.225002,"55":1.224998,"56":1.224999,"57":1.225001,"58":1.225002,"59":1.225002,"60":1.225002,"61":1.225,"62":1.224999,"63":1.225002,"64+":1.224999}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":2600,"fam":5200},"rules":{"pcp":{"base":{"kind":"copay","amount":1,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":1,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":1,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":1,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":1,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":1,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":1,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":750}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":175,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: pcp $5 copay; specialist $5 copay; lab and x-ray $5 copay; imaging $150 copay; outpatient surgery facility fee $300 copay; outpatient surgeon fees $300 copay; hospital facility fee $275 copay; prenatal office visits 30% coinsurance; delivery facility fee $275 copay; rehabilitation $5 copay. Deductible and out-of-pocket limits are the same in both and are shared.","Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $750 per 31-day retail prescription (60-day: $500 min / $1,500 max; 90-day: $750 min / $2,250 max; mail order: $500 min / $1,500 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 2 $1/$2/$3, mail order $2; Tier 3 $5/$10/$15, mail order $10.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (10% coinsurance) is for the other prenatal visits.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $175 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/NEPA/Individual/I_79962PA0270003-06_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":637.37,"tobaccoFactor":1.024993,"tobaccoFactorByAge":{"21":1.024993,"22":1.024993,"23":1.024993,"24":1.024993,"25":1.025003,"26":1.025005,"27":1.025001,"28":1.024999,"29":1.024999,"30":1.025007,"31":1.025003,"32":1.025,"33":1.025001,"34":1.024995,"35":1.024998,"36":1.025001,"37":1.025004,"38":1.024995,"39":1.025001,"40":1.100005,"41":1.105006,"42":1.112004,"43":1.120995,"44":1.131995,"45":1.144998,"46":1.16,"47":1.177001,"48":1.195998,"49":1.216995,"50":1.225003,"51":1.225002,"52":1.224997,"53":1.224999,"54":1.225003,"55":1.224999,"56":1.225,"57":1.225003,"58":1.224997,"59":1.225,"60":1.225,"61":1.225002,"62":1.224999,"63":1.224999,"64+":1.224998}}}}},{"market":"pennie","id":"79962PA0270005-01","standardId":"79962PA0270005","variant":"standard","issuer":"Highmark Benefits Group","name":"my Priority Blue Flex PPO Gold 0","metal":"Gold","network":"PPO","hsaEligible":false,"networkId":"PAN002","referral":false,"tiers":true,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":662.93,"tobaccoFactor":1.024995,"tobaccoFactorByAge":{"21":1.024995,"22":1.024995,"23":1.024995,"24":1.024995,"25":1.025001,"26":1.024999,"27":1.025002,"28":1.025007,"29":1.025006,"30":1.024999,"31":1.025002,"32":1.025005,"33":1.024994,"34":1.025,"35":1.024997,"36":1.025006,"37":1.025003,"38":1.025,"39":1.025005,"40":1.099998,"41":1.105002,"42":1.112002,"43":1.120998,"44":1.132004,"45":1.144996,"46":1.159996,"47":1.177,"48":1.195998,"49":1.217001,"50":1.225002,"51":1.224999,"52":1.225001,"53":1.225003,"54":1.225003,"55":1.224997,"56":1.225,"57":1.224999,"58":1.225001,"59":1.224999,"60":1.225001,"61":1.225002,"62":1.225003,"63":1.225001,"64+":1.225001}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":725,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":725,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: pcp $35 copay; specialist $35 copay; lab and x-ray $70 copay (blood work lab) $90 copay (x-ray); imaging $600 copay; outpatient surgery facility fee $750 copay; outpatient surgeon fees $750 copay; hospital facility fee $1,000 copay; prenatal office visits 50% coinsurance; delivery facility fee $1,000 copay; rehabilitation $35 copay. Deductible and out-of-pocket limits are the same in both and are shared.","Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $1,000 per 31-day retail prescription (60-day: $500 min / $2,000 max; 90-day: $750 min / $3,000 max; mail order: $500 min / $2,000 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 2 $30/$60/$90, mail order $60; Tier 3 $100/$200/$300, mail order $200.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (30% coinsurance) is for the other prenatal visits.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $725 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/NEPA/Individual/I_79962PA0270005-01_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":556.18,"tobaccoFactor":1.024992,"tobaccoFactorByAge":{"21":1.024992,"22":1.024992,"23":1.024992,"24":1.024992,"25":1.025,"26":1.025003,"27":1.024997,"28":1.024993,"29":1.025001,"30":1.024998,"31":1.025007,"32":1.025002,"33":1.025004,"34":1.025,"35":1.024998,"36":1.024996,"37":1.024995,"38":1.025007,"39":1.025004,"40":1.1,"41":1.105006,"42":1.112004,"43":1.120995,"44":1.131998,"45":1.144997,"46":1.159996,"47":1.177002,"48":1.195997,"49":1.217002,"50":1.224998,"51":1.225002,"52":1.224997,"53":1.225002,"54":1.224997,"55":1.224998,"56":1.224997,"57":1.225002,"58":1.225001,"59":1.224999,"60":1.225,"61":1.225003,"62":1.225,"63":1.224998,"64+":1.224999}}}}},{"market":"pennie","id":"79962PA0270006-01","standardId":"79962PA0270006","variant":"standard","issuer":"Highmark Benefits Group","name":"my Priority Blue Flex PPO Gold 1000","metal":"Gold","network":"PPO","hsaEligible":false,"networkId":"PAN002","referral":false,"tiers":true,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":596.94,"tobaccoFactor":1.024994,"tobaccoFactorByAge":{"21":1.024994,"22":1.024994,"23":1.024994,"24":1.024994,"25":1.024995,"26":1.024997,"27":1.025,"28":1.024997,"29":1.025001,"30":1.025003,"31":1.025005,"32":1.024994,"33":1.025002,"34":1.025004,"35":1.025005,"36":1.025005,"37":1.025006,"38":1.024994,"39":1.024995,"40":1.100001,"41":1.105002,"42":1.112005,"43":1.121005,"44":1.132001,"45":1.145003,"46":1.160005,"47":1.176995,"48":1.196004,"49":1.217002,"50":1.225001,"51":1.225,"52":1.225003,"53":1.225003,"54":1.225003,"55":1.225003,"56":1.225001,"57":1.225002,"58":1.225003,"59":1.224999,"60":1.224998,"61":1.225003,"62":1.225002,"63":1.225001,"64+":1.224997}}},"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":8000,"fam":16000},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":35,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":625,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":625,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":725,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":725,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: pcp $50 copay; specialist $50 copay; lab and x-ray $90 copay (blood work lab) $150 copay (x-ray); imaging 50% coinsurance; outpatient surgery facility fee $900 copay; outpatient surgeon fees $900 copay; hospital facility fee $1,000 copay; prenatal office visits 50% coinsurance; delivery facility fee $1,000 copay; rehabilitation $50 copay. Deductible and out-of-pocket limits are the same in both and are shared.","Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $1,000 per 31-day retail prescription (60-day: $500 min / $2,000 max; 90-day: $750 min / $3,000 max; mail order: $500 min / $2,000 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 2 $35/$70/$105, mail order $70; Tier 3 $200/$400/$600, mail order $400.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, outpatient facility services, outpatient surgery fees, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, and prescription drug benefits. Every other service, including those the SBC prices at \"No charge\", is treated as after the deductible.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (30% coinsurance) is for the other prenatal visits. It is applied after the deductible because the SBC says a copayment, coinsurance or deductible may apply depending on the type of service and page 1 does not list pregnancy visits as covered before the deductible.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $725 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth. The other days of the stay count toward the deductible until it is met, then cost nothing more."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/NEPA/Individual/I_79962PA0270006-01_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":513.53,"tobaccoFactor":1.025003,"tobaccoFactorByAge":{"21":1.025003,"22":1.025003,"23":1.025003,"24":1.025003,"25":1.025001,"26":1.025007,"27":1.024992,"28":1.025009,"29":1.025007,"30":1.024997,"31":1.025001,"32":1.025004,"33":1.025,"34":1.025007,"35":1.025003,"36":1.024998,"37":1.024994,"38":1.025005,"39":1.024997,"40":1.100002,"41":1.105007,"42":1.112003,"43":1.121,"44":1.132004,"45":1.144996,"46":1.160003,"47":1.177001,"48":1.196005,"49":1.217001,"50":1.224999,"51":1.225001,"52":1.224998,"53":1.225,"54":1.225002,"55":1.224997,"56":1.225004,"57":1.224999,"58":1.225003,"59":1.224999,"60":1.225002,"61":1.225,"62":1.225001,"63":1.225002,"64+":1.224998}}}}},{"market":"pennie","id":"79962PA0270007-01","standardId":"79962PA0270007","variant":"standard","issuer":"Highmark Benefits Group","name":"my Priority Blue Flex PPO Bronze 0 HSA","metal":"Bronze","network":"PPO","hsaEligible":true,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":519.82,"tobaccoFactor":1.025009,"tobaccoFactorByAge":{"21":1.025009,"22":1.025009,"23":1.025009,"24":1.025009,"25":1.025005,"26":1.025005,"27":1.025001,"28":1.025007,"29":1.024997,"30":1.025,"31":1.024997,"32":1.024994,"33":1.025002,"34":1.025006,"35":1.024999,"36":1.024993,"37":1.025002,"38":1.024996,"39":1.025,"40":1.099995,"41":1.105007,"42":1.111998,"43":1.120995,"44":1.132004,"45":1.145,"46":1.160004,"47":1.177001,"48":1.195997,"49":1.217003,"50":1.225,"51":1.225002,"52":1.225005,"53":1.225003,"54":1.225,"55":1.225,"56":1.225003,"57":1.225,"58":1.224998,"59":1.225004,"60":1.225002,"61":1.225003,"62":1.224997,"63":1.224997,"64+":1.225001}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":11600,"fam":23200},"rules":{"pcp":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":2750,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":75,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":600,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":600,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":2750,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":2750,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: pcp $100 copay; specialist $100 copay; lab and x-ray $140 copay (blood work lab) $250 copay (x-ray); imaging $1,250 copay; outpatient surgery facility fee $725 copay; outpatient surgeon fees $725 copay; hospital facility fee $3,500 copay; prenatal office visits 60% coinsurance; delivery facility fee $3,500 copay; rehabilitation $100 copay. Deductible and out-of-pocket limits are the same in both and are shared.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 1 $15/$30/$45, mail order $30; Tier 2 $50/$100/$150, mail order $100; Tier 3 $250/$500/$750, mail order $500.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (50% coinsurance) is for the other prenatal visits.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,750 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/NEPA/Individual/I_79962PA0270007-01_20270101_SBC.pdf"},{"market":"pennie","id":"79962PA0270008-01","standardId":"79962PA0270008","variant":"standard","issuer":"Highmark Benefits Group","name":"my Priority Blue Flex PPO Choice Silver 0","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":844.81,"tobaccoFactor":1.025,"tobaccoFactorByAge":{"21":1.025,"22":1.025,"23":1.025,"24":1.025,"25":1.024994,"26":1.025003,"27":1.024995,"28":1.025002,"29":1.024996,"30":1.024998,"31":1.025002,"32":1.025005,"33":1.024998,"34":1.025,"35":1.025001,"36":1.025002,"37":1.025003,"38":1.025004,"39":1.024996,"40":1.100003,"41":1.104997,"42":1.112001,"43":1.121004,"44":1.132003,"45":1.145003,"46":1.160004,"47":1.177002,"48":1.196002,"49":1.216999,"50":1.225002,"51":1.224998,"52":1.225,"53":1.225002,"54":1.225002,"55":1.224998,"56":1.224999,"57":1.225,"58":1.225,"59":1.224998,"60":1.224999,"61":1.224999,"62":1.225001,"63":1.224999,"64+":1.225001}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":10700,"fam":21400},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":1250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":800,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":2500,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":2500,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: pcp $70 copay; specialist $70 copay; lab and x-ray $80 copay (blood work/lab) $225 copay (x-ray); imaging $1,000 copay; outpatient surgery facility fee $1,250 copay; outpatient surgeon fees $1,250 copay; hospital facility fee $3,000 copay; prenatal office visits 50% coinsurance; delivery facility fee $3,000 copay; rehabilitation $70 copay. Deductible and out-of-pocket limits are the same in both and are shared.","Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $1,000 per 31-day retail prescription (60-day: $500 min / $2,000 max; 90-day: $750 min / $3,000 max; mail order: $500 min / $2,000 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 1 $5/$10/$15, mail order $10; Tier 2 $30/$60/$90, mail order $60; Tier 3 $250/$500/$750, mail order $500.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (30% coinsurance) is for the other prenatal visits.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,500 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/NEPA/Individual/I_79962PA0270008-01_20270101_SBC.pdf"},{"market":"pennie","id":"79962PA0270008-04","standardId":"79962PA0270008","variant":"csr73","issuer":"Highmark Benefits Group","name":"my Priority Blue Flex PPO Choice Silver 0","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":844.81,"tobaccoFactor":1.025,"tobaccoFactorByAge":{"21":1.025,"22":1.025,"23":1.025,"24":1.025,"25":1.024994,"26":1.025003,"27":1.024995,"28":1.025002,"29":1.024996,"30":1.024998,"31":1.025002,"32":1.025005,"33":1.024998,"34":1.025,"35":1.025001,"36":1.025002,"37":1.025003,"38":1.025004,"39":1.024996,"40":1.100003,"41":1.104997,"42":1.112001,"43":1.121004,"44":1.132003,"45":1.145003,"46":1.160004,"47":1.177002,"48":1.196002,"49":1.216999,"50":1.225002,"51":1.224998,"52":1.225,"53":1.225002,"54":1.225002,"55":1.224998,"56":1.224999,"57":1.225,"58":1.225,"59":1.224998,"60":1.224999,"61":1.224999,"62":1.225001,"63":1.224999,"64+":1.225001}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":8775,"fam":17550},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":1250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":800,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":2500,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":2500,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: pcp $70 copay; specialist $70 copay; lab and x-ray $80 copay (blood work/lab) $225 copay (x-ray); imaging $1,000 copay; outpatient surgery facility fee $1,250 copay; outpatient surgeon fees $1,250 copay; hospital facility fee $3,000 copay; prenatal office visits 50% coinsurance; delivery facility fee $3,000 copay; rehabilitation $70 copay. Deductible and out-of-pocket limits are the same in both and are shared.","Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $1,000 per 31-day retail prescription (60-day: $500 min / $2,000 max; 90-day: $750 min / $3,000 max; mail order: $500 min / $2,000 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 1 $5/$10/$15, mail order $10; Tier 2 $30/$60/$90, mail order $60; Tier 3 $250/$500/$750, mail order $500.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (30% coinsurance) is for the other prenatal visits.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,500 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/NEPA/Individual/I_79962PA0270008-04_20270101_SBC.pdf"},{"market":"pennie","id":"79962PA0270008-05","standardId":"79962PA0270008","variant":"csr87","issuer":"Highmark Benefits Group","name":"my Priority Blue Flex PPO Choice Silver 0","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":844.81,"tobaccoFactor":1.025,"tobaccoFactorByAge":{"21":1.025,"22":1.025,"23":1.025,"24":1.025,"25":1.024994,"26":1.025003,"27":1.024995,"28":1.025002,"29":1.024996,"30":1.024998,"31":1.025002,"32":1.025005,"33":1.024998,"34":1.025,"35":1.025001,"36":1.025002,"37":1.025003,"38":1.025004,"39":1.024996,"40":1.100003,"41":1.104997,"42":1.112001,"43":1.121004,"44":1.132003,"45":1.145003,"46":1.160004,"47":1.177002,"48":1.196002,"49":1.216999,"50":1.225002,"51":1.224998,"52":1.225,"53":1.225002,"54":1.225002,"55":1.224998,"56":1.224999,"57":1.225,"58":1.225,"59":1.224998,"60":1.224999,"61":1.224999,"62":1.225001,"63":1.224999,"64+":1.225001}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":3800,"fam":7600},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":550,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":550,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: pcp $10 copay; specialist $10 copay; lab and x-ray $80 copay (blood work/lab) $150 copay (x-ray); imaging $525 copay; outpatient surgery facility fee $500 copay; outpatient surgeon fees $500 copay; hospital facility fee $750 copay; prenatal office visits 50% coinsurance; delivery facility fee $750 copay; rehabilitation $10 copay. Deductible and out-of-pocket limits are the same in both and are shared.","Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $1,000 per 31-day retail prescription (60-day: $500 min / $2,000 max; 90-day: $750 min / $3,000 max; mail order: $500 min / $2,000 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 2 $10/$20/$30, mail order $20; Tier 3 $50/$100/$150, mail order $100.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (10% coinsurance) is for the other prenatal visits.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $550 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/NEPA/Individual/I_79962PA0270008-05_20270101_SBC.pdf"},{"market":"pennie","id":"79962PA0270008-06","standardId":"79962PA0270008","variant":"csr94","issuer":"Highmark Benefits Group","name":"my Priority Blue Flex PPO Choice Silver 0","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":844.81,"tobaccoFactor":1.025,"tobaccoFactorByAge":{"21":1.025,"22":1.025,"23":1.025,"24":1.025,"25":1.024994,"26":1.025003,"27":1.024995,"28":1.025002,"29":1.024996,"30":1.024998,"31":1.025002,"32":1.025005,"33":1.024998,"34":1.025,"35":1.025001,"36":1.025002,"37":1.025003,"38":1.025004,"39":1.024996,"40":1.100003,"41":1.104997,"42":1.112001,"43":1.121004,"44":1.132003,"45":1.145003,"46":1.160004,"47":1.177002,"48":1.196002,"49":1.216999,"50":1.225002,"51":1.224998,"52":1.225,"53":1.225002,"54":1.225002,"55":1.224998,"56":1.224999,"57":1.225,"58":1.225,"59":1.224998,"60":1.224999,"61":1.224999,"62":1.225001,"63":1.224999,"64+":1.225001}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":2500,"fam":5000},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":1,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":750}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":175,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: pcp $5 copay; specialist $5 copay; lab and x-ray $10 copay; imaging $150 copay; outpatient surgery facility fee $300 copay; outpatient surgeon fees $300 copay; hospital facility fee $300 copay; prenatal office visits 50% coinsurance; delivery facility fee $300 copay; rehabilitation $5 copay. Deductible and out-of-pocket limits are the same in both and are shared.","Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $750 per 31-day retail prescription (60-day: $500 min / $1,500 max; 90-day: $750 min / $2,250 max; mail order: $500 min / $1,500 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 2 $1/$2/$3, mail order $2; Tier 3 $5/$10/$15, mail order $10.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (10% coinsurance) is for the other prenatal visits.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $175 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/NEPA/Individual/I_79962PA0270008-06_20270101_SBC.pdf"},{"market":"pennie","id":"79962PA0270009-01","standardId":"79962PA0270009","variant":"standard","issuer":"Highmark Benefits Group","name":"my Priority Blue Flex PPO Platinum 0","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":733.09,"tobaccoFactor":1.025004,"tobaccoFactorByAge":{"21":1.025004,"22":1.025004,"23":1.025004,"24":1.025004,"25":1.024999,"26":1.025004,"27":1.025004,"28":1.024998,"29":1.025002,"30":1.024998,"31":1.024999,"32":1.024999,"33":1.025005,"34":1.025001,"35":1.025004,"36":1.024997,"37":1.025001,"38":1.025005,"39":1.025001,"40":1.100001,"41":1.105,"42":1.112,"43":1.120999,"44":1.132005,"45":1.144996,"46":1.159998,"47":1.177,"48":1.196004,"49":1.216999,"50":1.224998,"51":1.224998,"52":1.224998,"53":1.225002,"54":1.225001,"55":1.225001,"56":1.225001,"57":1.224999,"58":1.225,"59":1.224999,"60":1.224999,"61":1.225002,"62":1.225001,"63":1.225001,"64+":1.225002}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":5300,"fam":10600},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":325,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":325,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: pcp $15 copay; specialist $15 copay; lab and x-ray $15 copay; imaging $350 copay; outpatient surgery facility fee $400 copay; outpatient surgeon fees $400 copay; hospital facility fee $500 copay; prenatal office visits 50% coinsurance; delivery facility fee $500 copay; rehabilitation $15 copay. Deductible and out-of-pocket limits are the same in both and are shared.","Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $1,000 per 31-day retail prescription (60-day: $500 min / $2,000 max; 90-day: $750 min / $3,000 max; mail order: $500 min / $2,000 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 2 $10/$20/$30, mail order $20; Tier 3 $50/$100/$150, mail order $100.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (10% coinsurance) is for the other prenatal visits.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $325 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/NEPA/Individual/I_79962PA0270009-01_20270101_SBC.pdf"},{"market":"pennie","id":"79962PA0280001-01","standardId":"79962PA0280001","variant":"standard","issuer":"Highmark Benefits Group","name":"my Priority Blue Flex PPO Bronze 3800 HSA + Adult Dental and Vision","metal":"Bronze","network":"PPO","hsaEligible":true,"networkId":"PAN002","referral":false,"tiers":true,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":489.67,"tobaccoFactor":1.024996,"tobaccoFactorByAge":{"21":1.024996,"22":1.024996,"23":1.024996,"24":1.024996,"25":1.024998,"26":1.025009,"27":1.025001,"28":1.025006,"29":1.025003,"30":1.024992,"31":1.025003,"32":1.024997,"33":1.025008,"34":1.024997,"35":1.025001,"36":1.025005,"37":1.025008,"38":1.024995,"39":1.025002,"40":1.1,"41":1.104996,"42":1.112005,"43":1.120997,"44":1.132004,"45":1.145005,"46":1.159998,"47":1.177004,"48":1.196001,"49":1.217003,"50":1.224996,"51":1.225004,"52":1.224996,"53":1.225001,"54":1.225004,"55":1.224999,"56":1.225,"57":1.225001,"58":1.225002,"59":1.225002,"60":1.225003,"61":1.224998,"62":1.224997,"63":1.225,"64+":1.225002}}},"ded":{"ind":3800,"fam":7600,"embedded":true},"drugDed":null,"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":180,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":550,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":550,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: pcp $90 copay; specialist $90 copay; lab and x-ray $95 copay (blood work/lab) $225 copay (x-ray); imaging 60% coinsurance; outpatient surgery facility fee $600 copay; outpatient surgeon fees $600 copay; hospital facility fee 60% coinsurance; hospital physician fees 60% coinsurance; prenatal office visits 60% coinsurance; delivery physician fees 60% coinsurance; delivery facility fee 60% coinsurance; rehabilitation $90 copay. Deductible and out-of-pocket limits are the same in both and are shared.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 1 $15/$30/$45, mail order $30.","Tier 1 drugs are not subject to the deductible; other drug tiers are.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exam, and tier 1 prescription drug benefits. Every other service, including those the SBC prices at \"No charge\", is treated as after the deductible.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (50% coinsurance) is for the other prenatal visits. It is applied after the deductible because the SBC says a copayment, coinsurance or deductible may apply depending on the type of service and page 1 does not list pregnancy visits as covered before the deductible."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/NEPA/Individual/I_79962PA0280001-01_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":435.23,"tobaccoFactor":1.024998,"tobaccoFactorByAge":{"21":1.024998,"22":1.024998,"23":1.024998,"24":1.024998,"25":1.02499,"26":1.024996,"27":1.024993,"28":1.025005,"29":1.025009,"30":1.025001,"31":1.024999,"32":1.024996,"33":1.025009,"34":1.025001,"35":1.025007,"36":1.024994,"37":1.025,"38":1.025005,"39":1.024997,"40":1.099996,"41":1.104999,"42":1.112003,"43":1.120994,"44":1.132002,"45":1.145003,"46":1.160006,"47":1.177006,"48":1.195995,"49":1.216997,"50":1.225004,"51":1.224997,"52":1.224996,"53":1.224999,"54":1.224995,"55":1.225004,"56":1.224997,"57":1.225001,"58":1.225002,"59":1.224998,"60":1.224998,"61":1.225004,"62":1.224996,"63":1.225,"64+":1.225}}}}},{"market":"pennie","id":"79962PA0280003-01","standardId":"79962PA0280003","variant":"standard","issuer":"Highmark Benefits Group","name":"my Priority Blue Flex PPO Gold 0 + Adult Dental and Vision","metal":"Gold","network":"PPO","hsaEligible":false,"networkId":"PAN002","referral":false,"tiers":true,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":679.61,"tobaccoFactor":1.025,"tobaccoFactorByAge":{"21":1.025,"22":1.025,"23":1.025,"24":1.025,"25":1.025003,"26":1.025003,"27":1.025006,"28":1.025002,"29":1.024997,"30":1.024995,"31":1.024998,"32":1.025001,"33":1.024995,"34":1.025005,"35":1.024998,"36":1.025002,"37":1.024995,"38":1.025,"39":1.024998,"40":1.099995,"41":1.105001,"42":1.111996,"43":1.121,"44":1.131996,"45":1.145003,"46":1.160003,"47":1.176996,"48":1.196002,"49":1.216998,"50":1.225,"51":1.224999,"52":1.225004,"53":1.225,"54":1.225001,"55":1.224997,"56":1.224997,"57":1.225002,"58":1.224999,"59":1.225,"60":1.224998,"61":1.224999,"62":1.225002,"63":1.225001,"64+":1.225002}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":725,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":725,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: pcp $35 copay; specialist $35 copay; lab and x-ray $70 copay (blood work lab) $90 copay (x-ray); imaging $600 copay; outpatient surgery facility fee $750 copay; outpatient surgeon fees $750 copay; hospital facility fee $1,000 copay; prenatal office visits 50% coinsurance; delivery facility fee $1,000 copay; rehabilitation $35 copay. Deductible and out-of-pocket limits are the same in both and are shared.","Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $1,000 per 31-day retail prescription (60-day: $500 min / $2,000 max; 90-day: $750 min / $3,000 max; mail order: $500 min / $2,000 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 2 $30/$60/$90, mail order $60; Tier 3 $100/$200/$300, mail order $200.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (30% coinsurance) is for the other prenatal visits.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $725 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/NEPA/Individual/I_79962PA0280003-01_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":572.58,"tobaccoFactor":1.024992,"tobaccoFactorByAge":{"21":1.024992,"22":1.024992,"23":1.024992,"24":1.024992,"25":1.024997,"26":1.025003,"27":1.024998,"28":1.025,"29":1.025003,"30":1.025005,"31":1.024999,"32":1.024994,"33":1.025002,"34":1.025003,"35":1.024997,"36":1.025005,"37":1.024998,"38":1.025006,"39":1.025007,"40":1.100005,"41":1.105003,"42":1.111999,"43":1.121005,"44":1.132006,"45":1.145003,"46":1.160001,"47":1.176995,"48":1.196001,"49":1.217,"50":1.224998,"51":1.225001,"52":1.225002,"53":1.224997,"54":1.224997,"55":1.224999,"56":1.224999,"57":1.225,"58":1.225001,"59":1.225002,"60":1.225003,"61":1.224998,"62":1.225,"63":1.225001,"64+":1.224999}}}}},{"market":"pennie","id":"79962PA0280004-01","standardId":"79962PA0280004","variant":"standard","issuer":"Highmark Benefits Group","name":"my Priority Blue Flex PPO Gold 1000 + Adult Dental and Vision","metal":"Gold","network":"PPO","hsaEligible":false,"networkId":"PAN002","referral":false,"tiers":true,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":613.61,"tobaccoFactor":1.025,"tobaccoFactorByAge":{"21":1.025,"22":1.025,"23":1.025,"24":1.025,"25":1.024998,"26":1.025002,"27":1.025005,"28":1.024993,"29":1.025006,"30":1.024998,"31":1.025001,"32":1.025003,"33":1.025003,"34":1.024996,"35":1.025006,"36":1.025002,"37":1.024998,"38":1.024995,"39":1.025001,"40":1.100001,"41":1.105004,"42":1.112001,"43":1.120996,"44":1.131998,"45":1.145003,"46":1.160003,"47":1.177005,"48":1.196003,"49":1.217,"50":1.225,"51":1.225004,"52":1.225001,"53":1.225003,"54":1.224997,"55":1.225001,"56":1.225001,"57":1.225001,"58":1.224998,"59":1.225002,"60":1.224999,"61":1.224998,"62":1.224999,"63":1.225,"64+":1.225002}}},"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":8000,"fam":16000},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":35,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":625,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":625,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":725,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":725,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: pcp $50 copay; specialist $50 copay; lab and x-ray $90 copay (blood work lab) $150 copay (x-ray); imaging 50% coinsurance; outpatient surgery facility fee $900 copay; outpatient surgeon fees $900 copay; hospital facility fee $1,000 copay; prenatal office visits 50% coinsurance; delivery facility fee $1,000 copay; rehabilitation $50 copay. Deductible and out-of-pocket limits are the same in both and are shared.","Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $1,000 per 31-day retail prescription (60-day: $500 min / $2,000 max; 90-day: $750 min / $3,000 max; mail order: $500 min / $2,000 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 2 $35/$70/$105, mail order $70; Tier 3 $200/$400/$600, mail order $400.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, outpatient facility services, outpatient surgery fees, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exam, and prescription drug benefits. Every other service, including those the SBC prices at \"No charge\", is treated as after the deductible.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (30% coinsurance) is for the other prenatal visits. It is applied after the deductible because the SBC says a copayment, coinsurance or deductible may apply depending on the type of service and page 1 does not list pregnancy visits as covered before the deductible.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $725 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth. The other days of the stay count toward the deductible until it is met, then cost nothing more."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/NEPA/Individual/I_79962PA0280004-01_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":529.94,"tobaccoFactor":1.025003,"tobaccoFactorByAge":{"21":1.025003,"22":1.025003,"23":1.025003,"24":1.025003,"25":1.024997,"26":1.025006,"27":1.024992,"28":1.024998,"29":1.025008,"30":1.025005,"31":1.025008,"32":1.024995,"33":1.024997,"34":1.024994,"35":1.025,"36":1.025007,"37":1.024997,"38":1.025003,"39":1.025001,"40":1.100006,"41":1.105003,"42":1.111996,"43":1.120993,"44":1.131995,"45":1.145002,"46":1.160006,"47":1.177001,"48":1.195995,"49":1.217005,"50":1.225004,"51":1.225004,"52":1.225001,"53":1.224997,"54":1.225,"55":1.225001,"56":1.225001,"57":1.225001,"58":1.225004,"59":1.224999,"60":1.225001,"61":1.224997,"62":1.225002,"63":1.225003,"64+":1.225}}}}},{"market":"pennie","id":"79962PA0280005-01","standardId":"79962PA0280005","variant":"standard","issuer":"Highmark Benefits Group","name":"my Priority Blue Flex PPO Bronze 0 HSA + Adult Dental and Vision","metal":"Bronze","network":"PPO","hsaEligible":true,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":536.49,"tobaccoFactor":1.024996,"tobaccoFactorByAge":{"21":1.024996,"22":1.024996,"23":1.024996,"24":1.024996,"25":1.025007,"26":1.024992,"27":1.025007,"28":1.025002,"29":1.025003,"30":1.024995,"31":1.024992,"32":1.025005,"33":1.025003,"34":1.024996,"35":1.025,"36":1.025005,"37":1.024994,"38":1.024997,"39":1.025006,"40":1.099996,"41":1.104995,"42":1.112007,"43":1.120999,"44":1.131998,"45":1.145,"46":1.160002,"47":1.177,"48":1.195996,"49":1.217001,"50":1.225002,"51":1.224996,"52":1.225003,"53":1.225001,"54":1.225002,"55":1.224997,"56":1.225003,"57":1.224999,"58":1.225,"59":1.225001,"60":1.225002,"61":1.225002,"62":1.224999,"63":1.225002,"64+":1.225}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":11600,"fam":23200},"rules":{"pcp":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":2750,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":75,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":600,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":600,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":2750,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":2750,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: pcp $100 copay; specialist $100 copay; lab and x-ray $140 copay (blood work lab) $250 copay (x-ray); imaging $1,250 copay; outpatient surgery facility fee $725 copay; outpatient surgeon fees $725 copay; hospital facility fee $3,500 copay; prenatal office visits 60% coinsurance; delivery facility fee $3,500 copay; rehabilitation $100 copay. Deductible and out-of-pocket limits are the same in both and are shared.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 1 $15/$30/$45, mail order $30; Tier 2 $50/$100/$150, mail order $100; Tier 3 $250/$500/$750, mail order $500.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (50% coinsurance) is for the other prenatal visits.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,750 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/NEPA/Individual/I_79962PA0280005-01_20270101_SBC.pdf"},{"market":"pennie","id":"79962PA0280006-01","standardId":"79962PA0280006","variant":"standard","issuer":"Highmark Benefits Group","name":"my Priority Blue Flex PPO Choice Silver 0 + Adult Dental and Vision","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":861.48,"tobaccoFactor":1.025003,"tobaccoFactorByAge":{"21":1.025003,"22":1.025003,"23":1.025003,"24":1.025003,"25":1.024996,"26":1.024995,"27":1.024999,"28":1.024999,"29":1.025,"30":1.024995,"31":1.024998,"32":1.025002,"33":1.024999,"34":1.025004,"35":1.025002,"36":1.025,"37":1.024997,"38":1.025005,"39":1.025,"40":1.100003,"41":1.104997,"42":1.111997,"43":1.120998,"44":1.131999,"45":1.145002,"46":1.160004,"47":1.177001,"48":1.196,"49":1.217,"50":1.225003,"51":1.225001,"52":1.224999,"53":1.225,"54":1.224998,"55":1.225001,"56":1.224999,"57":1.224999,"58":1.225002,"59":1.225001,"60":1.224999,"61":1.225,"62":1.224999,"63":1.225002,"64+":1.225}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":10700,"fam":21400},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":1250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":800,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":2500,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":2500,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: pcp $70 copay; specialist $70 copay; lab and x-ray $80 copay (blood work/lab) $225 copay (x-ray); imaging $1,000 copay; outpatient surgery facility fee $1,250 copay; outpatient surgeon fees $1,250 copay; hospital facility fee $3,000 copay; prenatal office visits 50% coinsurance; delivery facility fee $3,000 copay; rehabilitation $70 copay. Deductible and out-of-pocket limits are the same in both and are shared.","Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $1,000 per 31-day retail prescription (60-day: $500 min / $2,000 max; 90-day: $750 min / $3,000 max; mail order: $500 min / $2,000 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 1 $5/$10/$15, mail order $10; Tier 2 $30/$60/$90, mail order $60; Tier 3 $250/$500/$750, mail order $500.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (30% coinsurance) is for the other prenatal visits.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,500 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/NEPA/Individual/I_79962PA0280006-01_20270101_SBC.pdf"},{"market":"pennie","id":"79962PA0280006-04","standardId":"79962PA0280006","variant":"csr73","issuer":"Highmark Benefits Group","name":"my Priority Blue Flex PPO Choice Silver 0 + Adult Dental and Vision","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":861.48,"tobaccoFactor":1.025003,"tobaccoFactorByAge":{"21":1.025003,"22":1.025003,"23":1.025003,"24":1.025003,"25":1.024996,"26":1.024995,"27":1.024999,"28":1.024999,"29":1.025,"30":1.024995,"31":1.024998,"32":1.025002,"33":1.024999,"34":1.025004,"35":1.025002,"36":1.025,"37":1.024997,"38":1.025005,"39":1.025,"40":1.100003,"41":1.104997,"42":1.111997,"43":1.120998,"44":1.131999,"45":1.145002,"46":1.160004,"47":1.177001,"48":1.196,"49":1.217,"50":1.225003,"51":1.225001,"52":1.224999,"53":1.225,"54":1.224998,"55":1.225001,"56":1.224999,"57":1.224999,"58":1.225002,"59":1.225001,"60":1.224999,"61":1.225,"62":1.224999,"63":1.225002,"64+":1.225}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":8775,"fam":17550},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":1250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":800,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":2500,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":2500,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: pcp $70 copay; specialist $70 copay; lab and x-ray $80 copay (blood work/lab) $225 copay (x-ray); imaging $1,000 copay; outpatient surgery facility fee $1,250 copay; outpatient surgeon fees $1,250 copay; hospital facility fee $3,000 copay; prenatal office visits 50% coinsurance; delivery facility fee $3,000 copay; rehabilitation $70 copay. Deductible and out-of-pocket limits are the same in both and are shared.","Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $1,000 per 31-day retail prescription (60-day: $500 min / $2,000 max; 90-day: $750 min / $3,000 max; mail order: $500 min / $2,000 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 1 $5/$10/$15, mail order $10; Tier 2 $30/$60/$90, mail order $60; Tier 3 $250/$500/$750, mail order $500.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (30% coinsurance) is for the other prenatal visits.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,500 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/NEPA/Individual/I_79962PA0280006-04_20270101_SBC.pdf"},{"market":"pennie","id":"79962PA0280006-05","standardId":"79962PA0280006","variant":"csr87","issuer":"Highmark Benefits Group","name":"my Priority Blue Flex PPO Choice Silver 0 + Adult Dental and Vision","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":861.48,"tobaccoFactor":1.025003,"tobaccoFactorByAge":{"21":1.025003,"22":1.025003,"23":1.025003,"24":1.025003,"25":1.024996,"26":1.024995,"27":1.024999,"28":1.024999,"29":1.025,"30":1.024995,"31":1.024998,"32":1.025002,"33":1.024999,"34":1.025004,"35":1.025002,"36":1.025,"37":1.024997,"38":1.025005,"39":1.025,"40":1.100003,"41":1.104997,"42":1.111997,"43":1.120998,"44":1.131999,"45":1.145002,"46":1.160004,"47":1.177001,"48":1.196,"49":1.217,"50":1.225003,"51":1.225001,"52":1.224999,"53":1.225,"54":1.224998,"55":1.225001,"56":1.224999,"57":1.224999,"58":1.225002,"59":1.225001,"60":1.224999,"61":1.225,"62":1.224999,"63":1.225002,"64+":1.225}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":3800,"fam":7600},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":550,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":550,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: pcp $10 copay; specialist $10 copay; lab and x-ray $80 copay (blood work/lab) $150 copay (x-ray); imaging $525 copay; outpatient surgery facility fee $500 copay; outpatient surgeon fees $500 copay; hospital facility fee $750 copay; prenatal office visits 50% coinsurance; delivery facility fee $750 copay; rehabilitation $10 copay. Deductible and out-of-pocket limits are the same in both and are shared.","Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $1,000 per 31-day retail prescription (60-day: $500 min / $2,000 max; 90-day: $750 min / $3,000 max; mail order: $500 min / $2,000 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 2 $10/$20/$30, mail order $20; Tier 3 $50/$100/$150, mail order $100.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (10% coinsurance) is for the other prenatal visits.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $550 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/NEPA/Individual/I_79962PA0280006-05_20270101_SBC.pdf"},{"market":"pennie","id":"79962PA0280006-06","standardId":"79962PA0280006","variant":"csr94","issuer":"Highmark Benefits Group","name":"my Priority Blue Flex PPO Choice Silver 0 + Adult Dental and Vision","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":861.48,"tobaccoFactor":1.025003,"tobaccoFactorByAge":{"21":1.025003,"22":1.025003,"23":1.025003,"24":1.025003,"25":1.024996,"26":1.024995,"27":1.024999,"28":1.024999,"29":1.025,"30":1.024995,"31":1.024998,"32":1.025002,"33":1.024999,"34":1.025004,"35":1.025002,"36":1.025,"37":1.024997,"38":1.025005,"39":1.025,"40":1.100003,"41":1.104997,"42":1.111997,"43":1.120998,"44":1.131999,"45":1.145002,"46":1.160004,"47":1.177001,"48":1.196,"49":1.217,"50":1.225003,"51":1.225001,"52":1.224999,"53":1.225,"54":1.224998,"55":1.225001,"56":1.224999,"57":1.224999,"58":1.225002,"59":1.225001,"60":1.224999,"61":1.225,"62":1.224999,"63":1.225002,"64+":1.225}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":2500,"fam":5000},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":1,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":750}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":175,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: pcp $5 copay; specialist $5 copay; lab and x-ray $10 copay; imaging $150 copay; outpatient surgery facility fee $300 copay; outpatient surgeon fees $300 copay; hospital facility fee $300 copay; prenatal office visits 50% coinsurance; delivery facility fee $300 copay; rehabilitation $5 copay. Deductible and out-of-pocket limits are the same in both and are shared.","Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $750 per 31-day retail prescription (60-day: $500 min / $1,500 max; 90-day: $750 min / $2,250 max; mail order: $500 min / $1,500 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 2 $1/$2/$3, mail order $2; Tier 3 $5/$10/$15, mail order $10.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (10% coinsurance) is for the other prenatal visits.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $175 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/NEPA/Individual/I_79962PA0280006-06_20270101_SBC.pdf"},{"market":"pennie","id":"79962PA0280007-01","standardId":"79962PA0280007","variant":"standard","issuer":"Highmark Benefits Group","name":"my Priority Blue Flex PPO Platinum 0 + Adult Dental and Vision","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":749.77,"tobaccoFactor":1.024994,"tobaccoFactorByAge":{"21":1.024994,"22":1.024994,"23":1.024994,"24":1.024994,"25":1.025001,"26":1.024995,"27":1.024995,"28":1.025006,"29":1.024994,"30":1.024994,"31":1.024995,"32":1.024995,"33":1.025005,"34":1.025005,"35":1.025005,"36":1.025005,"37":1.025005,"38":1.025005,"39":1.025005,"40":1.099999,"41":1.104999,"42":1.112004,"43":1.121,"44":1.131999,"45":1.145003,"46":1.160004,"47":1.176996,"48":1.196,"49":1.217002,"50":1.225004,"51":1.224999,"52":1.225001,"53":1.224997,"54":1.224999,"55":1.225001,"56":1.224999,"57":1.225001,"58":1.224999,"59":1.224999,"60":1.225001,"61":1.224999,"62":1.225,"63":1.225001,"64+":1.224998}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":5300,"fam":10600},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":325,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":325,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: pcp $15 copay; specialist $15 copay; lab and x-ray $15 copay; imaging $350 copay; outpatient surgery facility fee $400 copay; outpatient surgeon fees $400 copay; hospital facility fee $500 copay; prenatal office visits 50% coinsurance; delivery facility fee $500 copay; rehabilitation $15 copay. Deductible and out-of-pocket limits are the same in both and are shared.","Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $1,000 per 31-day retail prescription (60-day: $500 min / $2,000 max; 90-day: $750 min / $3,000 max; mail order: $500 min / $2,000 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 2 $10/$20/$30, mail order $20; Tier 3 $50/$100/$150, mail order $100.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (10% coinsurance) is for the other prenatal visits.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $325 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/NEPA/Individual/I_79962PA0280007-01_20270101_SBC.pdf"},{"market":"pennie","id":"79962PA0290002-01","standardId":"79962PA0290002","variant":"standard","issuer":"Highmark Benefits Group","name":"my Priority Blue Flex PPO Gold 1800 HSA","metal":"Gold","network":"PPO","hsaEligible":true,"networkId":"PAN002","referral":false,"tiers":true,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":609.14,"tobaccoFactor":1.025002,"tobaccoFactorByAge":{"21":1.025002,"22":1.025002,"23":1.025002,"24":1.025002,"25":1.025001,"26":1.024994,"27":1.025001,"28":1.024995,"29":1.024999,"30":1.024994,"31":1.025,"32":1.025007,"33":1.024995,"34":1.025003,"35":1.025001,"36":1.024999,"37":1.024996,"38":1.024994,"39":1.025002,"40":1.100003,"41":1.105006,"42":1.112005,"43":1.121002,"44":1.132002,"45":1.144998,"46":1.159996,"47":1.177,"48":1.195996,"49":1.216996,"50":1.224998,"51":1.224999,"52":1.224997,"53":1.225003,"54":1.224996,"55":1.225003,"56":1.224999,"57":1.225003,"58":1.225,"59":1.225001,"60":1.224999,"61":1.225001,"62":1.224998,"63":1.225,"64+":1.225}}},"ded":{"ind":1800,"fam":3600,"embedded":false},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":175,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":15,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":130,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":130,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":450,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":450,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: pcp $20 copay; specialist $20 copay; lab and x-ray $20 copay; imaging $225 copay; outpatient surgery facility fee $250 copay; outpatient surgeon fees $250 copay; hospital facility fee $650 copay; prenatal office visits 50% coinsurance; delivery facility fee $650 copay; rehabilitation $20 copay. Deductible and out-of-pocket limits are the same in both and are shared.","Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $1,000 per 31-day retail prescription (60-day: $500 min / $2,000 max; 90-day: $750 min / $3,000 max; mail order: $500 min / $2,000 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 2 $30/$60/$90, mail order $60; Tier 3 $150/$300/$450, mail order $300.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","SBC page 1 lists these as covered before the deductible: Preventive care services and pediatric eye exams. Every other service, including those the SBC prices at \"No charge\", is treated as after the deductible.","Family deductible: the SBC says the overall family deductible must be met before the plan begins to pay (an aggregate family deductible), and the estimate uses the aggregate family deductible.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (20% coinsurance) is for the other prenatal visits. It is applied after the deductible because the SBC says a copayment, coinsurance or deductible may apply depending on the type of service and page 1 does not list pregnancy visits as covered before the deductible.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $450 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth. The other days of the stay count toward the deductible until it is met, then cost nothing more."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/NEPA/Individual/I_79962PA0290002-01_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":509.89,"tobaccoFactor":1.025005,"tobaccoFactorByAge":{"21":1.025005,"22":1.025005,"23":1.025005,"24":1.025005,"25":1.025003,"26":1.024994,"27":1.025002,"28":1.025007,"29":1.024993,"30":1.025003,"31":1.024993,"32":1.025,"33":1.024998,"34":1.025008,"35":1.025004,"36":1.025002,"37":1.024998,"38":1.024995,"39":1.025005,"40":1.099994,"41":1.105004,"42":1.112004,"43":1.120997,"44":1.132005,"45":1.144999,"46":1.159994,"47":1.176998,"48":1.196001,"49":1.216998,"50":1.225002,"51":1.224998,"52":1.224995,"53":1.225,"54":1.225,"55":1.225003,"56":1.224997,"57":1.225004,"58":1.225,"59":1.225001,"60":1.224997,"61":1.225002,"62":1.224997,"63":1.225,"64+":1.225003}}}}},{"market":"pennie","id":"79962PA0320001-01","standardId":"79962PA0320001","variant":"standard","issuer":"Highmark Benefits Group","name":"my Priority Blue Major Events PPO Catastrophic 12000 HSA - 3 Free PCP Visits","metal":"Catastrophic","network":"PPO","hsaEligible":true,"networkId":"PAN002","referral":false,"tiers":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":373.09,"tobaccoFactor":1.025007,"tobaccoFactorByAge":{"21":1.025007,"22":1.025007,"23":1.025007,"24":1.025007,"25":1.024988,"26":1.024997,"27":1.025013,"28":1.025003,"29":1.025007,"30":1.025008,"31":1.024999,"32":1.02499,"33":1.024991,"34":1.024993,"35":1.025004,"36":1.024995,"37":1.025006,"38":1.024996,"39":1.024998,"40":1.099998,"41":1.10499,"42":1.112008,"43":1.121,"44":1.132001,"45":1.145005,"46":1.159996,"47":1.177007,"48":1.196,"49":1.217003,"50":1.225005,"51":1.225004,"52":1.224999,"53":1.225003,"54":1.224995,"55":1.225003,"56":1.224995,"57":1.224995,"58":1.224998,"59":1.225001,"60":1.225002,"61":1.225004,"62":1.225004,"63":1.225004,"64+":1.225004}}},"ded":{"ind":12000,"fam":24000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":3,"rule":{"kind":"free","ded":"no_ded"}}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["The first 3 primary care visits of the year are free before the deductible; after that, primary care is covered at no charge only after the deductible.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","SBC page 1 lists these as covered before the deductible: Preventive care services. Every other service, including those the SBC prices at \"No charge\", is treated as after the deductible.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (no charge) is for the other prenatal visits. It is applied after the deductible because the SBC says a copayment, coinsurance or deductible may apply depending on the type of service and page 1 does not list pregnancy visits as covered before the deductible."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/NEPA/Individual/I_79962PA0320001-01_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":317.08,"tobaccoFactor":1.025009,"tobaccoFactorByAge":{"21":1.025009,"22":1.025009,"23":1.025009,"24":1.025009,"25":1.025004,"26":1.025008,"27":1.025008,"28":1.025009,"29":1.024999,"30":1.025008,"31":1.025007,"32":1.025006,"33":1.025009,"34":1.024991,"35":1.025008,"36":1.024999,"37":1.02499,"38":1.025008,"39":1.024991,"40":1.099993,"41":1.105004,"42":1.111989,"43":1.120991,"44":1.131998,"45":1.145001,"46":1.160002,"47":1.176998,"48":1.195996,"49":1.216993,"50":1.225004,"51":1.224994,"52":1.224998,"53":1.225002,"54":1.225003,"55":1.225007,"56":1.224995,"57":1.224997,"58":1.224998,"59":1.225005,"60":1.225005,"61":1.224997,"62":1.225002,"63":1.224995,"64+":1.225001}}}}},{"market":"pennie","id":"79962PA0330001-01","standardId":"79962PA0330001","variant":"standard","issuer":"Highmark Benefits Group","name":"my Blue Access PPO Bronze 3800 HSA","metal":"Bronze","network":"PPO","hsaEligible":true,"networkId":"PAN003","referral":false,"tiers":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":529.22,"tobaccoFactor":1.024999,"tobaccoFactorByAge":{"21":1.024999,"22":1.024999,"23":1.024999,"24":1.024999,"25":1.024993,"26":1.025004,"27":1.025008,"28":1.024997,"29":1.025008,"30":1.025006,"31":1.024993,"32":1.024997,"33":1.025,"34":1.024997,"35":1.025003,"36":1.024995,"37":1.025001,"38":1.025007,"39":1.025004,"40":1.099994,"41":1.105001,"42":1.112005,"43":1.121005,"44":1.132,"45":1.145003,"46":1.159996,"47":1.177001,"48":1.195997,"49":1.217002,"50":1.225002,"51":1.225005,"52":1.224996,"53":1.224998,"54":1.224997,"55":1.225003,"56":1.224999,"57":1.224996,"58":1.224999,"59":1.224999,"60":1.225002,"61":1.225,"62":1.224999,"63":1.225001,"64+":1.224998}}},"ded":{"ind":3800,"fam":7600,"embedded":true},"drugDed":null,"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":180,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":550,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":550,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}}},"notes":["Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 1 $15/$30/$45, mail order $30.","Tier 1 retail drugs are not subject to the deductible; other drug tiers are.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, and tier 1 retail prescription drug benefits. Every other service, including those the SBC prices at \"No charge\", is treated as after the deductible.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (50% coinsurance) is for the other prenatal visits. It is applied after the deductible because the SBC says a copayment, coinsurance or deductible may apply depending on the type of service and page 1 does not list pregnancy visits as covered before the deductible."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/SEPA/Individual/I_79962PA0330001-01_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":430.24,"tobaccoFactor":1.025009,"tobaccoFactorByAge":{"21":1.025009,"22":1.025009,"23":1.025009,"24":1.025009,"25":1.025002,"26":1.02499,"27":1.024995,"28":1.024996,"29":1.025008,"30":1.025004,"31":1.025008,"32":1.024992,"33":1.025008,"34":1.025004,"35":1.024993,"36":1.025,"37":1.025008,"38":1.024996,"39":1.024993,"40":1.100009,"41":1.105004,"42":1.112004,"43":1.120992,"44":1.132002,"45":1.144993,"46":1.160004,"47":1.177004,"48":1.195994,"49":1.217006,"50":1.224997,"51":1.225,"52":1.224998,"53":1.225,"54":1.225004,"55":1.224996,"56":1.224996,"57":1.225,"58":1.225003,"59":1.225,"60":1.225004,"61":1.225001,"62":1.225002,"63":1.225003,"64+":1.224998}}}}},{"market":"pennie","id":"79962PA0330002-01","standardId":"79962PA0330002","variant":"standard","issuer":"Highmark Benefits Group","name":"my Blue Access PPO Bronze 9500 HSA","metal":"Bronze","network":"PPO","hsaEligible":true,"networkId":"PAN003","referral":false,"tiers":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":504.34,"tobaccoFactor":1.025003,"tobaccoFactorByAge":{"21":1.025003,"22":1.025003,"23":1.025003,"24":1.025003,"25":1.025002,"26":1.024998,"27":1.024993,"28":1.025008,"29":1.025002,"30":1.024999,"31":1.024994,"32":1.025007,"33":1.025008,"34":1.025005,"35":1.025004,"36":1.025002,"37":1.025001,"38":1.025,"39":1.024997,"40":1.100008,"41":1.105003,"42":1.111994,"43":1.120998,"44":1.131997,"45":1.145001,"46":1.159998,"47":1.177006,"48":1.195998,"49":1.217004,"50":1.225001,"51":1.224997,"52":1.225004,"53":1.224999,"54":1.224997,"55":1.224997,"56":1.224999,"57":1.224998,"58":1.225001,"59":1.225,"60":1.225003,"61":1.225,"62":1.225001,"63":1.224998,"64+":1.225}}},"ded":{"ind":9500,"fam":19000,"embedded":true},"drugDed":null,"oop":{"ind":9500,"fam":19000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","SBC page 1 lists these as covered before the deductible: Preventive care services and pediatric vision exams. Every other service, including those the SBC prices at \"No charge\", is treated as after the deductible.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (no charge) is for the other prenatal visits. It is applied after the deductible because the SBC says a copayment, coinsurance or deductible may apply depending on the type of service and page 1 does not list pregnancy visits as covered before the deductible."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/SEPA/Individual/I_79962PA0330002-01_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":389.65,"tobaccoFactor":1.024997,"tobaccoFactorByAge":{"21":1.024997,"22":1.024997,"23":1.024997,"24":1.024997,"25":1.024999,"26":1.025013,"27":1.025003,"28":1.025003,"29":1.024999,"30":1.025008,"31":1.025,"32":1.024991,"33":1.025,"34":1.025008,"35":1.024992,"36":1.024996,"37":1.025001,"38":1.025005,"39":1.024993,"40":1.100006,"41":1.105003,"42":1.111991,"43":1.121,"44":1.131995,"45":1.144992,"46":1.160005,"47":1.177006,"48":1.196004,"49":1.217002,"50":1.225,"51":1.225003,"52":1.225007,"53":1.225,"54":1.225003,"55":1.225003,"56":1.225004,"57":1.225005,"58":1.225003,"59":1.225001,"60":1.225,"61":1.225003,"62":1.225001,"63":1.225003,"64+":1.224997}}}}},{"market":"pennie","id":"79962PA0330003-01","standardId":"79962PA0330003","variant":"standard","issuer":"Highmark Benefits Group","name":"my Blue Access PPO Silver 6000","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN003","referral":false,"tiers":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":798.08,"tobaccoFactor":1.024997,"tobaccoFactorByAge":{"21":1.024997,"22":1.024997,"23":1.024997,"24":1.024997,"25":1.024998,"26":1.024999,"27":1.025,"28":1.025003,"29":1.025004,"30":1.025005,"31":1.024995,"32":1.024997,"33":1.024997,"34":1.024998,"35":1.024999,"36":1.024999,"37":1.024999,"38":1.025,"39":1.025,"40":1.100005,"41":1.105004,"42":1.112004,"43":1.120998,"44":1.132001,"45":1.144998,"46":1.160001,"47":1.177,"48":1.195998,"49":1.217,"50":1.225001,"51":1.224997,"52":1.225002,"53":1.225001,"54":1.225001,"55":1.225002,"56":1.224999,"57":1.225002,"58":1.225,"59":1.225002,"60":1.225001,"61":1.225002,"62":1.225001,"63":1.224998,"64+":1.224998}}},"ded":{"ind":6000,"fam":12000,"embedded":true},"drugDed":null,"oop":{"ind":9350,"fam":18700},"rules":{"pcp":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":750,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":600,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":55,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":1125,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":1125,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $1,000 per 31-day retail prescription (60-day: $500 min / $2,000 max; 90-day: $750 min / $3,000 max; mail order: $500 min / $2,000 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 1 $10/$20/$30, mail order $20; Tier 2 $30/$60/$90, mail order $60; Tier 3 $250/$500/$750, mail order $500.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, urgent care, rehabilitation services, habilitation services, outpatient mental health, outpatient substance abuse, pediatric vision services, and tier 1, tier 2 prescription drug expenses. Every other service, including those the SBC prices at \"No charge\", is treated as after the deductible.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (30% coinsurance) is for the other prenatal visits. It is applied after the deductible because the SBC says a copayment, coinsurance or deductible may apply depending on the type of service and page 1 does not list pregnancy visits as covered before the deductible.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $1,125 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth. The other days of the stay count toward the deductible until it is met, then cost nothing more."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/SEPA/Individual/I_79962PA0330003-01_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":627.41,"tobaccoFactor":1.025008,"tobaccoFactorByAge":{"21":1.025008,"22":1.025008,"23":1.025008,"24":1.025008,"25":1.025003,"26":1.024997,"27":1.025003,"28":1.025,"29":1.024998,"30":1.024996,"31":1.025001,"32":1.025006,"33":1.024999,"34":1.024997,"35":1.025003,"36":1.024996,"37":1.025002,"38":1.024995,"39":1.024994,"40":1.099996,"41":1.104996,"42":1.112003,"43":1.121001,"44":1.132004,"45":1.145003,"46":1.160001,"47":1.176997,"48":1.195999,"49":1.217002,"50":1.224997,"51":1.225003,"52":1.225002,"53":1.224998,"54":1.224999,"55":1.224999,"56":1.224997,"57":1.225003,"58":1.224997,"59":1.225001,"60":1.225001,"61":1.225,"62":1.224998,"63":1.224997,"64+":1.224999}}}}},{"market":"pennie","id":"79962PA0330003-04","standardId":"79962PA0330003","variant":"csr73","issuer":"Highmark Benefits Group","name":"my Blue Access PPO Silver 6000","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN003","referral":false,"tiers":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":798.08,"tobaccoFactor":1.024997,"tobaccoFactorByAge":{"21":1.024997,"22":1.024997,"23":1.024997,"24":1.024997,"25":1.024998,"26":1.024999,"27":1.025,"28":1.025003,"29":1.025004,"30":1.025005,"31":1.024995,"32":1.024997,"33":1.024997,"34":1.024998,"35":1.024999,"36":1.024999,"37":1.024999,"38":1.025,"39":1.025,"40":1.100005,"41":1.105004,"42":1.112004,"43":1.120998,"44":1.132001,"45":1.144998,"46":1.160001,"47":1.177,"48":1.195998,"49":1.217,"50":1.225001,"51":1.224997,"52":1.225002,"53":1.225001,"54":1.225001,"55":1.225002,"56":1.224999,"57":1.225002,"58":1.225,"59":1.225002,"60":1.225001,"61":1.225002,"62":1.225001,"63":1.224998,"64+":1.224998}}},"ded":{"ind":3000,"fam":6000,"embedded":true},"drugDed":null,"oop":{"ind":7800,"fam":15600},"rules":{"pcp":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":750,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":600,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":55,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":1125,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":1125,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $1,000 per 31-day retail prescription (60-day: $500 min / $2,000 max; 90-day: $750 min / $3,000 max; mail order: $500 min / $2,000 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 1 $10/$20/$30, mail order $20; Tier 2 $30/$60/$90, mail order $60; Tier 3 $250/$500/$750, mail order $500.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, urgent care, rehabilitation services, habilitation services, outpatient mental health, outpatient substance abuse, pediatric vision services, and tier 1, tier 2 prescription drug expenses. Every other service, including those the SBC prices at \"No charge\", is treated as after the deductible.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (30% coinsurance) is for the other prenatal visits. It is applied after the deductible because the SBC says a copayment, coinsurance or deductible may apply depending on the type of service and page 1 does not list pregnancy visits as covered before the deductible.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $1,125 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth. The other days of the stay count toward the deductible until it is met, then cost nothing more."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/SEPA/Individual/I_79962PA0330003-04_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":627.41,"tobaccoFactor":1.025008,"tobaccoFactorByAge":{"21":1.025008,"22":1.025008,"23":1.025008,"24":1.025008,"25":1.025003,"26":1.024997,"27":1.025003,"28":1.025,"29":1.024998,"30":1.024996,"31":1.025001,"32":1.025006,"33":1.024999,"34":1.024997,"35":1.025003,"36":1.024996,"37":1.025002,"38":1.024995,"39":1.024994,"40":1.099996,"41":1.104996,"42":1.112003,"43":1.121001,"44":1.132004,"45":1.145003,"46":1.160001,"47":1.176997,"48":1.195999,"49":1.217002,"50":1.224997,"51":1.225003,"52":1.225002,"53":1.224998,"54":1.224999,"55":1.224999,"56":1.224997,"57":1.225003,"58":1.224997,"59":1.225001,"60":1.225001,"61":1.225,"62":1.224998,"63":1.224997,"64+":1.224999}}}}},{"market":"pennie","id":"79962PA0330003-05","standardId":"79962PA0330003","variant":"csr87","issuer":"Highmark Benefits Group","name":"my Blue Access PPO Silver 6000","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN003","referral":false,"tiers":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":798.08,"tobaccoFactor":1.024997,"tobaccoFactorByAge":{"21":1.024997,"22":1.024997,"23":1.024997,"24":1.024997,"25":1.024998,"26":1.024999,"27":1.025,"28":1.025003,"29":1.025004,"30":1.025005,"31":1.024995,"32":1.024997,"33":1.024997,"34":1.024998,"35":1.024999,"36":1.024999,"37":1.024999,"38":1.025,"39":1.025,"40":1.100005,"41":1.105004,"42":1.112004,"43":1.120998,"44":1.132001,"45":1.144998,"46":1.160001,"47":1.177,"48":1.195998,"49":1.217,"50":1.225001,"51":1.224997,"52":1.225002,"53":1.225001,"54":1.225001,"55":1.225002,"56":1.224999,"57":1.225002,"58":1.225,"59":1.225002,"60":1.225001,"61":1.225002,"62":1.225001,"63":1.224998,"64+":1.224998}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":3800,"fam":7600},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":15,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":450,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $1,000 per 31-day retail prescription (60-day: $500 min / $2,000 max; 90-day: $750 min / $3,000 max; mail order: $500 min / $2,000 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 2 $10/$20/$30, mail order $20; Tier 3 $50/$100/$150, mail order $100.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (10% coinsurance) is for the other prenatal visits.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $450 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/SEPA/Individual/I_79962PA0330003-05_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":627.41,"tobaccoFactor":1.025008,"tobaccoFactorByAge":{"21":1.025008,"22":1.025008,"23":1.025008,"24":1.025008,"25":1.025003,"26":1.024997,"27":1.025003,"28":1.025,"29":1.024998,"30":1.024996,"31":1.025001,"32":1.025006,"33":1.024999,"34":1.024997,"35":1.025003,"36":1.024996,"37":1.025002,"38":1.024995,"39":1.024994,"40":1.099996,"41":1.104996,"42":1.112003,"43":1.121001,"44":1.132004,"45":1.145003,"46":1.160001,"47":1.176997,"48":1.195999,"49":1.217002,"50":1.224997,"51":1.225003,"52":1.225002,"53":1.224998,"54":1.224999,"55":1.224999,"56":1.224997,"57":1.225003,"58":1.224997,"59":1.225001,"60":1.225001,"61":1.225,"62":1.224998,"63":1.224997,"64+":1.224999}}}}},{"market":"pennie","id":"79962PA0330003-06","standardId":"79962PA0330003","variant":"csr94","issuer":"Highmark Benefits Group","name":"my Blue Access PPO Silver 6000","metal":"Silver","network":"PPO","hsaEligible":false,"networkId":"PAN003","referral":false,"tiers":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":798.08,"tobaccoFactor":1.024997,"tobaccoFactorByAge":{"21":1.024997,"22":1.024997,"23":1.024997,"24":1.024997,"25":1.024998,"26":1.024999,"27":1.025,"28":1.025003,"29":1.025004,"30":1.025005,"31":1.024995,"32":1.024997,"33":1.024997,"34":1.024998,"35":1.024999,"36":1.024999,"37":1.024999,"38":1.025,"39":1.025,"40":1.100005,"41":1.105004,"42":1.112004,"43":1.120998,"44":1.132001,"45":1.144998,"46":1.160001,"47":1.177,"48":1.195998,"49":1.217,"50":1.225001,"51":1.224997,"52":1.225002,"53":1.225001,"54":1.225001,"55":1.225002,"56":1.224999,"57":1.225002,"58":1.225,"59":1.225002,"60":1.225001,"61":1.225002,"62":1.225001,"63":1.224998,"64+":1.224998}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":2600,"fam":5200},"rules":{"pcp":{"base":{"kind":"copay","amount":1,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":1,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":1,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":1,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":1,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":1,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":1,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":750}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":175,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $750 per 31-day retail prescription (60-day: $500 min / $1,500 max; 90-day: $750 min / $2,250 max; mail order: $500 min / $1,500 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 2 $1/$2/$3, mail order $2; Tier 3 $5/$10/$15, mail order $10.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (10% coinsurance) is for the other prenatal visits.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $175 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/SEPA/Individual/I_79962PA0330003-06_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":627.41,"tobaccoFactor":1.025008,"tobaccoFactorByAge":{"21":1.025008,"22":1.025008,"23":1.025008,"24":1.025008,"25":1.025003,"26":1.024997,"27":1.025003,"28":1.025,"29":1.024998,"30":1.024996,"31":1.025001,"32":1.025006,"33":1.024999,"34":1.024997,"35":1.025003,"36":1.024996,"37":1.025002,"38":1.024995,"39":1.024994,"40":1.099996,"41":1.104996,"42":1.112003,"43":1.121001,"44":1.132004,"45":1.145003,"46":1.160001,"47":1.176997,"48":1.195999,"49":1.217002,"50":1.224997,"51":1.225003,"52":1.225002,"53":1.224998,"54":1.224999,"55":1.224999,"56":1.224997,"57":1.225003,"58":1.224997,"59":1.225001,"60":1.225001,"61":1.225,"62":1.224998,"63":1.224997,"64+":1.224999}}}}},{"market":"pennie","id":"79962PA0330004-01","standardId":"79962PA0330004","variant":"standard","issuer":"Highmark Benefits Group","name":"my Blue Access PPO Gold 0","metal":"Gold","network":"PPO","hsaEligible":false,"networkId":"PAN003","referral":false,"tiers":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":699.22,"tobaccoFactor":1.024999,"tobaccoFactorByAge":{"21":1.024999,"22":1.024999,"23":1.024999,"24":1.024999,"25":1.024999,"26":1.025,"27":1.025001,"28":1.024998,"29":1.024999,"30":1.025,"31":1.025,"32":1.025001,"33":1.024998,"34":1.024999,"35":1.024999,"36":1.024999,"37":1.024999,"38":1.024999,"39":1.024999,"40":1.1,"41":1.105,"42":1.111995,"43":1.121,"44":1.132001,"45":1.144998,"46":1.159997,"47":1.177,"48":1.195999,"49":1.216998,"50":1.224998,"51":1.224999,"52":1.225001,"53":1.224998,"54":1.225002,"55":1.224998,"56":1.225001,"57":1.225,"58":1.224999,"59":1.225002,"60":1.225001,"61":1.224999,"62":1.224998,"63":1.224999,"64+":1.224998}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":725,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":725,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $1,000 per 31-day retail prescription (60-day: $500 min / $2,000 max; 90-day: $750 min / $3,000 max; mail order: $500 min / $2,000 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 2 $30/$60/$90, mail order $60; Tier 3 $100/$200/$300, mail order $200.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (30% coinsurance) is for the other prenatal visits.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $725 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/SEPA/Individual/I_79962PA0330004-01_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":546.84,"tobaccoFactor":1.024998,"tobaccoFactorByAge":{"21":1.024998,"22":1.024998,"23":1.024998,"24":1.024998,"25":1.025008,"26":1.025002,"27":1.025005,"28":1.024999,"29":1.025004,"30":1.025006,"31":1.024993,"32":1.024996,"33":1.025003,"34":1.025005,"35":1.025006,"36":1.025007,"37":1.024993,"38":1.024994,"39":1.024996,"40":1.100006,"41":1.105001,"42":1.111999,"43":1.121001,"44":1.132,"45":1.145003,"46":1.159998,"47":1.176996,"48":1.196,"49":1.216998,"50":1.225002,"51":1.225001,"52":1.224998,"53":1.225001,"54":1.225002,"55":1.225003,"56":1.225,"57":1.225003,"58":1.224997,"59":1.225,"60":1.225002,"61":1.225,"62":1.225,"63":1.225,"64+":1.225002}}}}},{"market":"pennie","id":"79962PA0330005-01","standardId":"79962PA0330005","variant":"standard","issuer":"Highmark Benefits Group","name":"my Blue Access PPO Gold 1000","metal":"Gold","network":"PPO","hsaEligible":false,"networkId":"PAN003","referral":false,"tiers":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":636.55,"tobaccoFactor":1.024994,"tobaccoFactorByAge":{"21":1.024994,"22":1.024994,"23":1.024994,"24":1.024994,"25":1.025004,"26":1.025007,"27":1.025004,"28":1.025003,"29":1.025004,"30":1.024997,"31":1.024995,"32":1.025005,"33":1.024994,"34":1.025001,"35":1.025004,"36":1.024995,"37":1.024998,"38":1.025002,"39":1.024996,"40":1.099999,"41":1.104996,"42":1.111995,"43":1.121,"44":1.131997,"45":1.144999,"46":1.159997,"47":1.176997,"48":1.196001,"49":1.216999,"50":1.225002,"51":1.224997,"52":1.224997,"53":1.225003,"54":1.224999,"55":1.225,"56":1.224999,"57":1.225003,"58":1.224997,"59":1.224999,"60":1.225,"61":1.225,"62":1.224999,"63":1.225001,"64+":1.224999}}},"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":8000,"fam":16000},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":35,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":625,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":625,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":725,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":725,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $1,000 per 31-day retail prescription (60-day: $500 min / $2,000 max; 90-day: $750 min / $3,000 max; mail order: $500 min / $2,000 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 2 $35/$70/$105, mail order $70; Tier 3 $200/$400/$600, mail order $400.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, outpatient facility services, outpatient physician fees, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision exams, and prescription drug benefits. Every other service, including those the SBC prices at \"No charge\", is treated as after the deductible.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (30% coinsurance) is for the other prenatal visits. It is applied after the deductible because the SBC says a copayment, coinsurance or deductible may apply depending on the type of service and page 1 does not list pregnancy visits as covered before the deductible.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $725 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth. The other days of the stay count toward the deductible until it is met, then cost nothing more.","The chart says the emergency room copay is not subject to the deductible (\"Deductible does not apply.\"), but page 1 of this 2027 SBC no longer lists emergency room care among the services covered before the deductible (the 2026 SBC did). The chart cell is used: the ER copay applies before the deductible.","The only SBC Highmark publishes for this plan is the off-exchange copy (footer \"OFFX Base\"); where both copies exist for other plans the network cells are identical, so it is used here."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/SEPA/Individual/I_79962PA0330005-01_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":507.07,"tobaccoFactor":1.025006,"tobaccoFactorByAge":{"21":1.025006,"22":1.025006,"23":1.025006,"24":1.025006,"25":1.025005,"26":1.024998,"27":1.025009,"28":1.025,"29":1.025008,"30":1.025003,"31":1.024996,"32":1.025006,"33":1.025005,"34":1.025001,"35":1.024998,"36":1.024996,"37":1.024994,"38":1.025008,"39":1.025003,"40":1.099994,"41":1.104997,"42":1.112001,"43":1.121002,"44":1.132005,"45":1.144999,"46":1.160003,"47":1.176998,"48":1.196005,"49":1.217002,"50":1.225004,"51":1.225,"52":1.225005,"53":1.224996,"54":1.224997,"55":1.224997,"56":1.224998,"57":1.225001,"58":1.224998,"59":1.225002,"60":1.224998,"61":1.225003,"62":1.224998,"63":1.225003,"64+":1.224999}}}}},{"market":"pennie","id":"79962PA0330007-01","standardId":"79962PA0330007","variant":"standard","issuer":"Highmark Benefits Group","name":"my Blue Access PPO Bronze 0 HSA","metal":"Bronze","network":"PPO","hsaEligible":true,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":580.34,"tobaccoFactor":1.025003,"tobaccoFactorByAge":{"21":1.025003,"22":1.025003,"23":1.025003,"24":1.025003,"25":1.025006,"26":1.025005,"27":1.025008,"28":1.024999,"29":1.025008,"30":1.025004,"31":1.025007,"32":1.024995,"33":1.024998,"34":1.024995,"35":1.025001,"36":1.025006,"37":1.024998,"38":1.025003,"39":1.025,"40":1.100004,"41":1.105003,"42":1.111997,"43":1.121,"44":1.132004,"45":1.144998,"46":1.159998,"47":1.176998,"48":1.196004,"49":1.216997,"50":1.225,"51":1.224996,"52":1.224996,"53":1.225004,"54":1.224999,"55":1.225003,"56":1.224997,"57":1.225003,"58":1.225,"59":1.224999,"60":1.224997,"61":1.224999,"62":1.225002,"63":1.224999,"64+":1.225}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":11600,"fam":23200},"rules":{"pcp":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":2750,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":75,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":600,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":600,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":2750,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":2750,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 1 $15/$30/$45, mail order $30; Tier 2 $50/$100/$150, mail order $100; Tier 3 $250/$500/$750, mail order $500.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (50% coinsurance) is for the other prenatal visits.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,750 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/SEPA/Individual/I_79962PA0330007-01_20270101_SBC.pdf"},{"market":"pennie","id":"79962PA0330008-01","standardId":"79962PA0330008","variant":"standard","issuer":"Highmark Benefits Group","name":"my Blue Access PPO Choice Silver 0","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":881.36,"tobaccoFactor":1.024995,"tobaccoFactorByAge":{"21":1.024995,"22":1.024995,"23":1.024995,"24":1.024995,"25":1.024997,"26":1.024997,"27":1.024998,"28":1.024999,"29":1.025004,"30":1.025001,"31":1.025002,"32":1.025004,"33":1.025003,"34":1.025001,"35":1.025004,"36":1.024998,"37":1.025002,"38":1.024996,"39":1.025003,"40":1.100002,"41":1.104999,"42":1.111997,"43":1.121002,"44":1.132003,"45":1.145001,"46":1.160003,"47":1.177,"48":1.196,"49":1.216999,"50":1.224997,"51":1.224999,"52":1.224999,"53":1.224998,"54":1.224999,"55":1.224999,"56":1.225001,"57":1.225,"58":1.224998,"59":1.225,"60":1.224999,"61":1.225,"62":1.224999,"63":1.225001,"64+":1.225001}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":10700,"fam":21400},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":1250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":800,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":2500,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":2500,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $1,000 per 31-day retail prescription (60-day: $500 min / $2,000 max; 90-day: $750 min / $3,000 max; mail order: $500 min / $2,000 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 1 $5/$10/$15, mail order $10; Tier 2 $30/$60/$90, mail order $60; Tier 3 $250/$500/$750, mail order $500.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (30% coinsurance) is for the other prenatal visits.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,500 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/SEPA/Individual/I_79962PA0330008-01_20270101_SBC.pdf"},{"market":"pennie","id":"79962PA0330008-04","standardId":"79962PA0330008","variant":"csr73","issuer":"Highmark Benefits Group","name":"my Blue Access PPO Choice Silver 0","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":881.36,"tobaccoFactor":1.024995,"tobaccoFactorByAge":{"21":1.024995,"22":1.024995,"23":1.024995,"24":1.024995,"25":1.024997,"26":1.024997,"27":1.024998,"28":1.024999,"29":1.025004,"30":1.025001,"31":1.025002,"32":1.025004,"33":1.025003,"34":1.025001,"35":1.025004,"36":1.024998,"37":1.025002,"38":1.024996,"39":1.025003,"40":1.100002,"41":1.104999,"42":1.111997,"43":1.121002,"44":1.132003,"45":1.145001,"46":1.160003,"47":1.177,"48":1.196,"49":1.216999,"50":1.224997,"51":1.224999,"52":1.224999,"53":1.224998,"54":1.224999,"55":1.224999,"56":1.225001,"57":1.225,"58":1.224998,"59":1.225,"60":1.224999,"61":1.225,"62":1.224999,"63":1.225001,"64+":1.225001}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":8775,"fam":17550},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":1250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":800,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":2500,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":2500,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $1,000 per 31-day retail prescription (60-day: $500 min / $2,000 max; 90-day: $750 min / $3,000 max; mail order: $500 min / $2,000 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 1 $5/$10/$15, mail order $10; Tier 2 $30/$60/$90, mail order $60; Tier 3 $250/$500/$750, mail order $500.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (30% coinsurance) is for the other prenatal visits.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,500 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/SEPA/Individual/I_79962PA0330008-04_20270101_SBC.pdf"},{"market":"pennie","id":"79962PA0330008-05","standardId":"79962PA0330008","variant":"csr87","issuer":"Highmark Benefits Group","name":"my Blue Access PPO Choice Silver 0","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":881.36,"tobaccoFactor":1.024995,"tobaccoFactorByAge":{"21":1.024995,"22":1.024995,"23":1.024995,"24":1.024995,"25":1.024997,"26":1.024997,"27":1.024998,"28":1.024999,"29":1.025004,"30":1.025001,"31":1.025002,"32":1.025004,"33":1.025003,"34":1.025001,"35":1.025004,"36":1.024998,"37":1.025002,"38":1.024996,"39":1.025003,"40":1.100002,"41":1.104999,"42":1.111997,"43":1.121002,"44":1.132003,"45":1.145001,"46":1.160003,"47":1.177,"48":1.196,"49":1.216999,"50":1.224997,"51":1.224999,"52":1.224999,"53":1.224998,"54":1.224999,"55":1.224999,"56":1.225001,"57":1.225,"58":1.224998,"59":1.225,"60":1.224999,"61":1.225,"62":1.224999,"63":1.225001,"64+":1.225001}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":3800,"fam":7600},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":550,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":550,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $1,000 per 31-day retail prescription (60-day: $500 min / $2,000 max; 90-day: $750 min / $3,000 max; mail order: $500 min / $2,000 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 2 $10/$20/$30, mail order $20; Tier 3 $50/$100/$150, mail order $100.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (10% coinsurance) is for the other prenatal visits.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $550 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/SEPA/Individual/I_79962PA0330008-05_20270101_SBC.pdf"},{"market":"pennie","id":"79962PA0330008-06","standardId":"79962PA0330008","variant":"csr94","issuer":"Highmark Benefits Group","name":"my Blue Access PPO Choice Silver 0","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":881.36,"tobaccoFactor":1.024995,"tobaccoFactorByAge":{"21":1.024995,"22":1.024995,"23":1.024995,"24":1.024995,"25":1.024997,"26":1.024997,"27":1.024998,"28":1.024999,"29":1.025004,"30":1.025001,"31":1.025002,"32":1.025004,"33":1.025003,"34":1.025001,"35":1.025004,"36":1.024998,"37":1.025002,"38":1.024996,"39":1.025003,"40":1.100002,"41":1.104999,"42":1.111997,"43":1.121002,"44":1.132003,"45":1.145001,"46":1.160003,"47":1.177,"48":1.196,"49":1.216999,"50":1.224997,"51":1.224999,"52":1.224999,"53":1.224998,"54":1.224999,"55":1.224999,"56":1.225001,"57":1.225,"58":1.224998,"59":1.225,"60":1.224999,"61":1.225,"62":1.224999,"63":1.225001,"64+":1.225001}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":2500,"fam":5000},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":1,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":750}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":175,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $750 per 31-day retail prescription (60-day: $500 min / $1,500 max; 90-day: $750 min / $2,250 max; mail order: $500 min / $1,500 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 2 $1/$2/$3, mail order $2; Tier 3 $5/$10/$15, mail order $10.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (10% coinsurance) is for the other prenatal visits.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $175 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/SEPA/Individual/I_79962PA0330008-06_20270101_SBC.pdf"},{"market":"pennie","id":"79962PA0340001-01","standardId":"79962PA0340001","variant":"standard","issuer":"Highmark Benefits Group","name":"my Blue Access PPO Bronze 3800 HSA + Adult Dental and Vision","metal":"Bronze","network":"PPO","hsaEligible":true,"networkId":"PAN003","referral":false,"tiers":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":547.28,"tobaccoFactor":1.024996,"tobaccoFactorByAge":{"21":1.024996,"22":1.024996,"23":1.024996,"24":1.024996,"25":1.025006,"26":1.025,"27":1.025002,"28":1.024996,"29":1.025,"30":1.025002,"31":1.025004,"32":1.025007,"33":1.024998,"34":1.025,"35":1.025001,"36":1.025002,"37":1.025003,"38":1.025003,"39":1.025005,"40":1.099997,"41":1.105002,"42":1.112004,"43":1.120997,"44":1.131999,"45":1.145001,"46":1.160003,"47":1.177005,"48":1.195999,"49":1.216995,"50":1.224996,"51":1.224997,"52":1.225004,"53":1.224999,"54":1.225001,"55":1.225003,"56":1.225,"57":1.225002,"58":1.225003,"59":1.225001,"60":1.225002,"61":1.225001,"62":1.225002,"63":1.224998,"64+":1.224998}}},"ded":{"ind":3800,"fam":7600,"embedded":true},"drugDed":null,"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":180,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":550,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":550,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}}},"notes":["Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 1 $15/$30/$45, mail order $30.","Tier 1 retail drugs are not subject to the deductible; other drug tiers are.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exam, and tier 1 retail prescription drug benefits. Every other service, including those the SBC prices at \"No charge\", is treated as after the deductible.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (50% coinsurance) is for the other prenatal visits. It is applied after the deductible because the SBC says a copayment, coinsurance or deductible may apply depending on the type of service and page 1 does not list pregnancy visits as covered before the deductible."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/SEPA/Individual/I_79962PA0340001-01_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":446.65,"tobaccoFactor":1.025008,"tobaccoFactorByAge":{"21":1.025008,"22":1.025008,"23":1.025008,"24":1.025008,"25":1.024998,"26":1.024991,"27":1.024995,"28":1.025005,"29":1.02501,"30":1.024993,"31":1.024997,"32":1.025,"33":1.025005,"34":1.025008,"35":1.025009,"36":1.024992,"37":1.024993,"38":1.024994,"39":1.024997,"40":1.099996,"41":1.104997,"42":1.111995,"43":1.121003,"44":1.131994,"45":1.145001,"46":1.160005,"47":1.177006,"48":1.195996,"49":1.217,"50":1.225004,"51":1.225006,"52":1.225002,"53":1.224996,"54":1.225,"55":1.225003,"56":1.225003,"57":1.225,"58":1.224997,"59":1.224998,"60":1.225002,"61":1.225004,"62":1.225003,"63":1.224996,"64+":1.225001}}}}},{"market":"pennie","id":"79962PA0340002-01","standardId":"79962PA0340002","variant":"standard","issuer":"Highmark Benefits Group","name":"my Blue Access PPO Gold 0 + Adult Dental and Vision","metal":"Gold","network":"PPO","hsaEligible":false,"networkId":"PAN003","referral":false,"tiers":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":717.27,"tobaccoFactor":1.024998,"tobaccoFactorByAge":{"21":1.024998,"22":1.024998,"23":1.024998,"24":1.024998,"25":1.024995,"26":1.024997,"27":1.024997,"28":1.024998,"29":1.025005,"30":1.024997,"31":1.024996,"32":1.024996,"33":1.024997,"34":1.025001,"35":1.024997,"36":1.025005,"37":1.025001,"38":1.024997,"39":1.025,"40":1.100003,"41":1.105002,"42":1.111997,"43":1.120996,"44":1.132002,"45":1.144998,"46":1.160004,"47":1.176997,"48":1.196003,"49":1.216997,"50":1.224997,"51":1.224996,"52":1.224997,"53":1.225002,"54":1.225001,"55":1.225,"56":1.224998,"57":1.225001,"58":1.225,"59":1.225002,"60":1.225,"61":1.224998,"62":1.224999,"63":1.225,"64+":1.225001}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":725,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":725,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $1,000 per 31-day retail prescription (60-day: $500 min / $2,000 max; 90-day: $750 min / $3,000 max; mail order: $500 min / $2,000 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 2 $30/$60/$90, mail order $60; Tier 3 $100/$200/$300, mail order $200.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (30% coinsurance) is for the other prenatal visits.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $725 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/SEPA/Individual/I_79962PA0340002-01_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":563.24,"tobaccoFactor":1.024998,"tobaccoFactorByAge":{"21":1.024998,"22":1.024998,"23":1.024998,"24":1.024998,"25":1.025005,"26":1.025002,"27":1.025005,"28":1.025007,"29":1.025005,"30":1.024997,"31":1.025,"32":1.025003,"33":1.025001,"34":1.024994,"35":1.025004,"36":1.025,"37":1.024997,"38":1.025007,"39":1.025,"40":1.099997,"41":1.104999,"42":1.111994,"43":1.120996,"44":1.131995,"45":1.144998,"46":1.160003,"47":1.177,"48":1.196004,"49":1.216997,"50":1.225001,"51":1.225001,"52":1.224996,"53":1.225002,"54":1.225002,"55":1.225003,"56":1.225001,"57":1.225,"58":1.225002,"59":1.224997,"60":1.224999,"61":1.225002,"62":1.224998,"63":1.224998,"64+":1.225002}}}}},{"market":"pennie","id":"79962PA0340004-01","standardId":"79962PA0340004","variant":"standard","issuer":"Highmark Benefits Group","name":"my Blue Access PPO Gold 1000 + Adult Dental and Vision","metal":"Gold","network":"PPO","hsaEligible":false,"networkId":"PAN003","referral":false,"tiers":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":654.6,"tobaccoFactor":1.025008,"tobaccoFactorByAge":{"21":1.025008,"22":1.025008,"23":1.025008,"24":1.025008,"25":1.024999,"26":1.025003,"27":1.024999,"28":1.025002,"29":1.024997,"30":1.024994,"31":1.025004,"32":1.025,"33":1.025006,"34":1.025004,"35":1.025003,"36":1.025001,"37":1.025,"38":1.024999,"39":1.024997,"40":1.100002,"41":1.104999,"42":1.111996,"43":1.120997,"44":1.131999,"45":1.145,"46":1.159996,"47":1.177004,"48":1.195997,"49":1.216996,"50":1.224998,"51":1.225003,"52":1.225,"53":1.225,"54":1.224998,"55":1.225003,"56":1.225003,"57":1.224998,"58":1.224999,"59":1.224999,"60":1.225,"61":1.224999,"62":1.225,"63":1.225002,"64+":1.225003}}},"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":8000,"fam":16000},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":35,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":625,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":625,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":725,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":725,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $1,000 per 31-day retail prescription (60-day: $500 min / $2,000 max; 90-day: $750 min / $3,000 max; mail order: $500 min / $2,000 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 2 $35/$70/$105, mail order $70; Tier 3 $200/$400/$600, mail order $400.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, outpatient facility services, outpatient physician fees, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision exams, pediatric dental exams, and prescription drug benefits. Every other service, including those the SBC prices at \"No charge\", is treated as after the deductible.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (30% coinsurance) is for the other prenatal visits. It is applied after the deductible because the SBC says a copayment, coinsurance or deductible may apply depending on the type of service and page 1 does not list pregnancy visits as covered before the deductible.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $725 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth. The other days of the stay count toward the deductible until it is met, then cost nothing more.","The chart says the emergency room copay is not subject to the deductible (\"Deductible does not apply.\"), but page 1 of this 2027 SBC no longer lists emergency room care among the services covered before the deductible (the 2026 SBC did). The chart cell is used: the ER copay applies before the deductible.","The only SBC Highmark publishes for this plan is the off-exchange copy (footer \"OFFX Base\"); where both copies exist for other plans the network cells are identical, so it is used here."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/SEPA/Individual/I_79962PA0340004-01_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":523.48,"tobaccoFactor":1.025006,"tobaccoFactorByAge":{"21":1.025006,"22":1.025006,"23":1.025006,"24":1.025006,"25":1.025001,"26":1.024998,"27":1.025009,"28":1.025008,"29":1.024993,"30":1.024994,"31":1.025004,"32":1.024997,"33":1.025003,"34":1.025004,"35":1.024996,"36":1.025005,"37":1.024997,"38":1.025005,"39":1.025006,"40":1.099999,"41":1.104993,"42":1.111994,"43":1.120995,"44":1.131998,"45":1.145004,"46":1.160006,"47":1.176998,"48":1.195995,"49":1.216995,"50":1.224998,"51":1.225005,"52":1.224998,"53":1.225002,"54":1.225003,"55":1.225003,"56":1.225002,"57":1.225002,"58":1.224999,"59":1.225,"60":1.224999,"61":1.225,"62":1.224999,"63":1.224997,"64+":1.225001}}}}},{"market":"pennie","id":"79962PA0340005-01","standardId":"79962PA0340005","variant":"standard","issuer":"Highmark Benefits Group","name":"my Blue Access PPO Bronze 0 HSA + Adult Dental and Vision","metal":"Bronze","network":"PPO","hsaEligible":true,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":598.4,"tobaccoFactor":1.025,"tobaccoFactorByAge":{"21":1.025,"22":1.025,"23":1.025,"24":1.025,"25":1.025,"26":1.025002,"27":1.025003,"28":1.024998,"29":1.025,"30":1.025001,"31":1.025002,"32":1.025003,"33":1.024997,"34":1.024998,"35":1.024999,"36":1.024999,"37":1.024999,"38":1.025,"39":1.025001,"40":1.100005,"41":1.105003,"42":1.111997,"43":1.121005,"44":1.132004,"45":1.144996,"46":1.160004,"47":1.177002,"48":1.195997,"49":1.217001,"50":1.225003,"51":1.224996,"52":1.225002,"53":1.225003,"54":1.225004,"55":1.225002,"56":1.225003,"57":1.225002,"58":1.224999,"59":1.225001,"60":1.224998,"61":1.225001,"62":1.225,"63":1.225001,"64+":1.225}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":11600,"fam":23200},"rules":{"pcp":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":2750,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":75,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":600,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":600,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":2750,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":2750,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 1 $15/$30/$45, mail order $30; Tier 2 $50/$100/$150, mail order $100; Tier 3 $250/$500/$750, mail order $500.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (50% coinsurance) is for the other prenatal visits.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,750 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/SEPA/Individual/I_79962PA0340005-01_20270101_SBC.pdf"},{"market":"pennie","id":"79962PA0340006-01","standardId":"79962PA0340006","variant":"standard","issuer":"Highmark Benefits Group","name":"my Blue Access PPO Choice Silver 0 + Adult Dental and Vision","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":899.42,"tobaccoFactor":1.025005,"tobaccoFactorByAge":{"21":1.025005,"22":1.025005,"23":1.025005,"24":1.025005,"25":1.025005,"26":1.025005,"27":1.024995,"28":1.024998,"29":1.024999,"30":1.024999,"31":1.024999,"32":1.025,"33":1.025002,"34":1.025002,"35":1.025003,"36":1.025002,"37":1.025003,"38":1.025003,"39":1.025003,"40":1.100003,"41":1.105001,"42":1.111997,"43":1.120999,"44":1.132003,"45":1.145,"46":1.159999,"47":1.176997,"48":1.196001,"49":1.217002,"50":1.224999,"51":1.225,"52":1.225002,"53":1.224998,"54":1.225001,"55":1.224998,"56":1.225001,"57":1.225002,"58":1.225001,"59":1.225001,"60":1.224999,"61":1.225001,"62":1.225001,"63":1.225002,"64+":1.225001}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":10700,"fam":21400},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":1250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":800,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":2500,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":2500,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $1,000 per 31-day retail prescription (60-day: $500 min / $2,000 max; 90-day: $750 min / $3,000 max; mail order: $500 min / $2,000 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 1 $5/$10/$15, mail order $10; Tier 2 $30/$60/$90, mail order $60; Tier 3 $250/$500/$750, mail order $500.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (30% coinsurance) is for the other prenatal visits.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,500 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/SEPA/Individual/I_79962PA0340006-01_20270101_SBC.pdf"},{"market":"pennie","id":"79962PA0340006-04","standardId":"79962PA0340006","variant":"csr73","issuer":"Highmark Benefits Group","name":"my Blue Access PPO Choice Silver 0 + Adult Dental and Vision","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":899.42,"tobaccoFactor":1.025005,"tobaccoFactorByAge":{"21":1.025005,"22":1.025005,"23":1.025005,"24":1.025005,"25":1.025005,"26":1.025005,"27":1.024995,"28":1.024998,"29":1.024999,"30":1.024999,"31":1.024999,"32":1.025,"33":1.025002,"34":1.025002,"35":1.025003,"36":1.025002,"37":1.025003,"38":1.025003,"39":1.025003,"40":1.100003,"41":1.105001,"42":1.111997,"43":1.120999,"44":1.132003,"45":1.145,"46":1.159999,"47":1.176997,"48":1.196001,"49":1.217002,"50":1.224999,"51":1.225,"52":1.225002,"53":1.224998,"54":1.225001,"55":1.224998,"56":1.225001,"57":1.225002,"58":1.225001,"59":1.225001,"60":1.224999,"61":1.225001,"62":1.225001,"63":1.225002,"64+":1.225001}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":8775,"fam":17550},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":1250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":800,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":2500,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":2500,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $1,000 per 31-day retail prescription (60-day: $500 min / $2,000 max; 90-day: $750 min / $3,000 max; mail order: $500 min / $2,000 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 1 $5/$10/$15, mail order $10; Tier 2 $30/$60/$90, mail order $60; Tier 3 $250/$500/$750, mail order $500.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (30% coinsurance) is for the other prenatal visits.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,500 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/SEPA/Individual/I_79962PA0340006-04_20270101_SBC.pdf"},{"market":"pennie","id":"79962PA0340006-05","standardId":"79962PA0340006","variant":"csr87","issuer":"Highmark Benefits Group","name":"my Blue Access PPO Choice Silver 0 + Adult Dental and Vision","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":899.42,"tobaccoFactor":1.025005,"tobaccoFactorByAge":{"21":1.025005,"22":1.025005,"23":1.025005,"24":1.025005,"25":1.025005,"26":1.025005,"27":1.024995,"28":1.024998,"29":1.024999,"30":1.024999,"31":1.024999,"32":1.025,"33":1.025002,"34":1.025002,"35":1.025003,"36":1.025002,"37":1.025003,"38":1.025003,"39":1.025003,"40":1.100003,"41":1.105001,"42":1.111997,"43":1.120999,"44":1.132003,"45":1.145,"46":1.159999,"47":1.176997,"48":1.196001,"49":1.217002,"50":1.224999,"51":1.225,"52":1.225002,"53":1.224998,"54":1.225001,"55":1.224998,"56":1.225001,"57":1.225002,"58":1.225001,"59":1.225001,"60":1.224999,"61":1.225001,"62":1.225001,"63":1.225002,"64+":1.225001}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":3800,"fam":7600},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":550,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":550,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $1,000 per 31-day retail prescription (60-day: $500 min / $2,000 max; 90-day: $750 min / $3,000 max; mail order: $500 min / $2,000 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 2 $10/$20/$30, mail order $20; Tier 3 $50/$100/$150, mail order $100.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (10% coinsurance) is for the other prenatal visits.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $550 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/SEPA/Individual/I_79962PA0340006-05_20270101_SBC.pdf"},{"market":"pennie","id":"79962PA0340006-06","standardId":"79962PA0340006","variant":"csr94","issuer":"Highmark Benefits Group","name":"my Blue Access PPO Choice Silver 0 + Adult Dental and Vision","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":899.42,"tobaccoFactor":1.025005,"tobaccoFactorByAge":{"21":1.025005,"22":1.025005,"23":1.025005,"24":1.025005,"25":1.025005,"26":1.025005,"27":1.024995,"28":1.024998,"29":1.024999,"30":1.024999,"31":1.024999,"32":1.025,"33":1.025002,"34":1.025002,"35":1.025003,"36":1.025002,"37":1.025003,"38":1.025003,"39":1.025003,"40":1.100003,"41":1.105001,"42":1.111997,"43":1.120999,"44":1.132003,"45":1.145,"46":1.159999,"47":1.176997,"48":1.196001,"49":1.217002,"50":1.224999,"51":1.225,"52":1.225002,"53":1.224998,"54":1.225001,"55":1.224998,"56":1.225001,"57":1.225002,"58":1.225001,"59":1.225001,"60":1.224999,"61":1.225001,"62":1.225001,"63":1.225002,"64+":1.225001}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":2500,"fam":5000},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":1,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":750}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":175,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $750 per 31-day retail prescription (60-day: $500 min / $1,500 max; 90-day: $750 min / $2,250 max; mail order: $500 min / $1,500 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 2 $1/$2/$3, mail order $2; Tier 3 $5/$10/$15, mail order $10.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (10% coinsurance) is for the other prenatal visits.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $175 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/SEPA/Individual/I_79962PA0340006-06_20270101_SBC.pdf"},{"market":"pennie","id":"79962PA0370002-01","standardId":"79962PA0370002","variant":"standard","issuer":"Highmark Benefits Group","name":"my Blue Access PPO Gold 1800 HSA","metal":"Gold","network":"PPO","hsaEligible":true,"networkId":"PAN003","referral":false,"tiers":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":647.34,"tobaccoFactor":1.024995,"tobaccoFactorByAge":{"21":1.024995,"22":1.024995,"23":1.024995,"24":1.024995,"25":1.025003,"26":1.024997,"27":1.025,"28":1.024998,"29":1.025001,"30":1.025002,"31":1.025004,"32":1.025007,"33":1.025003,"34":1.025004,"35":1.025005,"36":1.025005,"37":1.025006,"38":1.024994,"39":1.024996,"40":1.1,"41":1.105002,"42":1.112005,"43":1.120999,"44":1.131998,"45":1.145,"46":1.159998,"47":1.177003,"48":1.196003,"49":1.217004,"50":1.224997,"51":1.225,"52":1.224998,"53":1.225001,"54":1.225003,"55":1.224998,"56":1.224997,"57":1.224998,"58":1.225,"59":1.224999,"60":1.225001,"61":1.224999,"62":1.225001,"63":1.224998,"64+":1.224998}}},"ded":{"ind":1800,"fam":3600,"embedded":false},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":175,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":15,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":130,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":130,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":450,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":450,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $1,000 per 31-day retail prescription (60-day: $500 min / $2,000 max; 90-day: $750 min / $3,000 max; mail order: $500 min / $2,000 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 2 $30/$60/$90, mail order $60; Tier 3 $150/$300/$450, mail order $300.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","SBC page 1 lists these as covered before the deductible: Preventive care services and pediatric vision exams. Every other service, including those the SBC prices at \"No charge\", is treated as after the deductible.","Family deductible: the SBC says the overall family deductible must be met before the plan begins to pay (an aggregate family deductible), and the estimate uses the aggregate family deductible.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (20% coinsurance) is for the other prenatal visits. It is applied after the deductible because the SBC says a copayment, coinsurance or deductible may apply depending on the type of service and page 1 does not list pregnancy visits as covered before the deductible.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $450 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth. The other days of the stay count toward the deductible until it is met, then cost nothing more."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/SEPA/Individual/I_79962PA0370002-01_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":497.65,"tobaccoFactor":1.024997,"tobaccoFactorByAge":{"21":1.024997,"22":1.024997,"23":1.024997,"24":1.024997,"25":1.024998,"26":1.025,"27":1.025003,"28":1.024993,"29":1.024997,"30":1.024999,"31":1.025001,"32":1.025003,"33":1.024992,"34":1.024994,"35":1.024995,"36":1.024996,"37":1.024996,"38":1.024997,"39":1.024999,"40":1.1,"41":1.104994,"42":1.111997,"43":1.120996,"44":1.132001,"45":1.145002,"46":1.160004,"47":1.177005,"48":1.196003,"49":1.216999,"50":1.225,"51":1.225003,"52":1.225003,"53":1.224998,"54":1.225002,"55":1.225004,"56":1.225,"57":1.224997,"58":1.224998,"59":1.225,"60":1.225,"61":1.225,"62":1.224997,"63":1.225001,"64+":1.224997}}}}},{"market":"pennie","id":"79962PA0380001-01","standardId":"79962PA0380001","variant":"standard","issuer":"Highmark Benefits Group","name":"my Blue Access Major Events PPO Catastrophic 12000 HSA - 3 Free PCP Visits","metal":"Catastrophic","network":"PPO","hsaEligible":true,"networkId":"PAN003","referral":false,"tiers":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":398.48,"tobaccoFactor":1.024995,"tobaccoFactorByAge":{"21":1.024995,"22":1.024995,"23":1.024995,"24":1.024995,"25":1.024996,"26":1.024998,"27":1.024999,"28":1.025003,"29":1.025006,"30":1.025007,"31":1.025009,"32":1.025011,"33":1.024991,"34":1.024992,"35":1.024993,"36":1.024993,"37":1.024994,"38":1.024994,"39":1.024996,"40":1.100008,"41":1.105008,"42":1.111991,"43":1.121001,"44":1.131997,"45":1.144992,"46":1.160008,"47":1.177001,"48":1.196006,"49":1.217002,"50":1.225,"51":1.224996,"52":1.224998,"53":1.224997,"54":1.225001,"55":1.225003,"56":1.224999,"57":1.225003,"58":1.225001,"59":1.225001,"60":1.224999,"61":1.225001,"62":1.225003,"63":1.225,"64+":1.224997}}},"ded":{"ind":12000,"fam":24000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":3,"rule":{"kind":"free","ded":"no_ded"}}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["The first 3 primary care visits of the year are free before the deductible; after that, primary care is covered at no charge only after the deductible.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","SBC page 1 lists these as covered before the deductible: Preventive care services. Every other service, including those the SBC prices at \"No charge\", is treated as after the deductible.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (no charge) is for the other prenatal visits. It is applied after the deductible because the SBC says a copayment, coinsurance or deductible may apply depending on the type of service and page 1 does not list pregnancy visits as covered before the deductible."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/SEPA/Individual/I_79962PA0380001-01_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":316.29,"tobaccoFactor":1.025009,"tobaccoFactorByAge":{"21":1.025009,"22":1.025009,"23":1.025009,"24":1.025009,"25":1.025003,"26":1.025009,"27":1.02501,"28":1.025014,"29":1.025005,"30":1.024987,"31":1.024988,"32":1.024989,"33":1.024992,"34":1.025001,"35":1.024993,"36":1.02501,"37":1.025002,"38":1.024994,"39":1.025003,"40":1.099995,"41":1.105,"42":1.112007,"43":1.12099,"44":1.13201,"45":1.14499,"46":1.159999,"47":1.176997,"48":1.196005,"49":1.216998,"50":1.225,"51":1.224995,"52":1.225008,"53":1.225005,"54":1.225003,"55":1.225001,"56":1.225003,"57":1.225,"58":1.225,"59":1.224997,"60":1.224997,"61":1.224996,"62":1.225003,"63":1.225,"64+":1.225004}}}}},{"market":"pennie","id":"93909PA0010001-01","standardId":"93909PA0010001","variant":"standard","issuer":"Jefferson Health Plans (Health Partners Plans)","name":"Jefferson Health Plans + $0 Deductible + Bronze + HMO","metal":"Bronze","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":true,"counties":["Bucks","Carbon","Delaware","Lehigh","Monroe","Montgomery","Northampton","Philadelphia","Schuylkill"],"rates":{"3":{"base21":368.62,"tobaccoFactor":1.099995},"6":{"base21":392.75,"tobaccoFactor":1.100013},"8":{"base21":305.85,"tobaccoFactor":1.100016}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":{"ind":5000,"fam":10000,"embedded":true},"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":1250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":600,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":150,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":2000,"ded":"no_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"prenatal":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":2000,"ded":"no_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}}},"notes":["Physical and occupational therapy: limited to 30 visits per benefit period combined; visits above the limit are priced in full here.","Separate prescription drug deductible: $5,000 individual / $10,000 family. It applies to preferred brand drugs, non-preferred brand drugs, specialty drugs; the other drug tiers are charged their copay from the first fill.","These prices are for In-Network Tier 1 (Enhanced) providers, the \"you pay the least\" column and the one the CMS data uses. In-Network Tier 2 (Standard) providers have a $8,000 individual / $16,000 family deductible and higher prices, for example primary care visit $150 copay; specialist visit $175 copay; emergency room $1250 copay; hospital stay $3000 copay after the deductible (up to 5 days). Out-of-network care is not covered.","Lab work: $150 copay. X-rays: $200 copay.","Mental health: the outpatient services price (an office visit) is used.","Hospital stay and delivery facility fees are a copay per day for up to 5 days per admission.","Visits with Jefferson designated telemedicine providers are covered in full (the prices above are for in-person visits)."],"sbcUrl":"https://www.jeffersonhealthplans.com/content/dam/jeffersonhealthplans/documents/sbc/2027/jefferson-health-plans-zero-deductible-bronze-hmo-on-exchange-pa.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":270.88,"tobaccoFactor":1.100007},"6":{"base21":296.89,"tobaccoFactor":1.100003},"8":{"base21":255.49,"tobaccoFactor":1.100004}}}},{"market":"pennie","id":"93909PA0010002-01","standardId":"93909PA0010002","variant":"standard","issuer":"Jefferson Health Plans (Health Partners Plans)","name":"Jefferson Health Plans + Total + Bronze + HMO","metal":"Bronze","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":true,"counties":["Bucks","Carbon","Delaware","Lehigh","Monroe","Montgomery","Northampton","Philadelphia","Schuylkill"],"rates":{"3":{"base21":346.68,"tobaccoFactor":1.100006},"6":{"base21":369.37,"tobaccoFactor":1.100008},"8":{"base21":287.64,"tobaccoFactor":1.099986}},"ded":{"ind":8500,"fam":17000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":135,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":750,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":850,"ded":"after_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":850,"ded":"after_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 visits per benefit period combined; visits above the limit are priced in full here.","The SBC has no separate drug deductible, so drug tiers marked as subject to the Rx deductible are charged after the plan deductible: non-preferred brand drugs, specialty drugs.","These prices are for In-Network Tier 1 (Enhanced) providers, the \"you pay the least\" column and the one the CMS data uses. In-Network Tier 2 (Standard) providers have a $9,500 individual / $19,000 family deductible and higher prices, for example primary care visit $95 copay; specialist visit $150 copay; emergency room 50% coinsurance after the deductible; hospital stay $1000 copay after the deductible (up to 5 days). Out-of-network care is not covered.","Lab work: $75 copay. X-rays: $200 copay.","Mental health: the outpatient services price (an office visit) is used.","Hospital stay and delivery facility fees are a copay per day for up to 5 days per admission.","Visits with Jefferson designated telemedicine providers are covered in full (the prices above are for in-person visits)."],"sbcUrl":"https://www.jeffersonhealthplans.com/content/dam/jeffersonhealthplans/documents/sbc/2027/jefferson-health-plans-total-bronze-hmo-on-exchange-pa.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":255.96,"tobaccoFactor":1.100016},"6":{"base21":280.54,"tobaccoFactor":1.099986},"8":{"base21":241.42,"tobaccoFactor":1.099992}}}},{"market":"pennie","id":"93909PA0010004-01","standardId":"93909PA0010004","variant":"standard","issuer":"Jefferson Health Plans (Health Partners Plans)","name":"Jefferson Health Plans + Balanced + Silver + HMO","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":true,"counties":["Bucks","Carbon","Delaware","Lehigh","Monroe","Montgomery","Northampton","Philadelphia","Schuylkill"],"rates":{"3":{"base21":493.77,"tobaccoFactor":1.100006},"6":{"base21":526.09,"tobaccoFactor":1.100002},"8":{"base21":409.68,"tobaccoFactor":1.100005}},"ded":{"ind":3000,"fam":6000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":975,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":600,"ded":"after_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":600,"ded":"after_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 visits per benefit period combined; visits above the limit are priced in full here.","Separate prescription drug deductible: $500 individual / $1,000 family. It applies to preferred brand drugs, non-preferred brand drugs, specialty drugs; the other drug tiers are charged their copay from the first fill.","These prices are for In-Network Tier 1 (Enhanced) providers, the \"you pay the least\" column and the one the CMS data uses. In-Network Tier 2 (Standard) providers have a $7,500 individual / $15,000 family deductible and higher prices, for example primary care visit $85 copay; specialist visit $125 copay; emergency room $975 copay; hospital stay $850 copay after the deductible (up to 5 days). Out-of-network care is not covered.","Lab work: $50 copay. X-rays: $125 copay.","Mental health: the outpatient services price (an office visit) is used.","Hospital stay and delivery facility fees are a copay per day for up to 5 days per admission.","Visits with Jefferson designated telemedicine providers are covered in full (the prices above are for in-person visits)."],"sbcUrl":"https://www.jeffersonhealthplans.com/content/dam/jeffersonhealthplans/documents/sbc/2027/jefferson-health-plans-balanced-silver-hmo-on-exchange-pa.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":388.48,"tobaccoFactor":1.100005},"6":{"base21":425.79,"tobaccoFactor":1.100002},"8":{"base21":366.42,"tobaccoFactor":1.099995}}}},{"market":"pennie","id":"93909PA0010004-04","standardId":"93909PA0010004","variant":"csr73","issuer":"Jefferson Health Plans (Health Partners Plans)","name":"Jefferson Health Plans + Balanced + Silver + HMO","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":true,"counties":["Bucks","Carbon","Delaware","Lehigh","Monroe","Montgomery","Northampton","Philadelphia","Schuylkill"],"rates":{"3":{"base21":493.77,"tobaccoFactor":1.100006},"6":{"base21":526.09,"tobaccoFactor":1.100002},"8":{"base21":409.68,"tobaccoFactor":1.100005}},"ded":{"ind":3000,"fam":6000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":9600,"fam":19200},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":975,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":600,"ded":"after_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":600,"ded":"after_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 visits per benefit period combined; visits above the limit are priced in full here.","Separate prescription drug deductible: $500 individual / $1,000 family. It applies to preferred brand drugs, non-preferred brand drugs, specialty drugs; the other drug tiers are charged their copay from the first fill.","These prices are for In-Network Tier 1 (Enhanced) providers, the \"you pay the least\" column and the one the CMS data uses. In-Network Tier 2 (Standard) providers have a $7,500 individual / $15,500 family deductible and higher prices, for example primary care visit $75 copay; specialist visit $120 copay; emergency room $975 copay; hospital stay $800 copay after the deductible (up to 5 days). Out-of-network care is not covered.","Lab work: $50 copay. X-rays: $125 copay.","Mental health: the outpatient services price (an office visit) is used.","Hospital stay and delivery facility fees are a copay per day for up to 5 days per admission.","Visits with Jefferson designated telemedicine providers are covered in full (the prices above are for in-person visits)."],"sbcUrl":"https://www.jeffersonhealthplans.com/content/dam/jeffersonhealthplans/documents/sbc/2027/jefferson-health-plans-balanced-silver-hmo-73-pa.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":388.48,"tobaccoFactor":1.100005},"6":{"base21":425.79,"tobaccoFactor":1.100002},"8":{"base21":366.42,"tobaccoFactor":1.099995}}}},{"market":"pennie","id":"93909PA0010004-05","standardId":"93909PA0010004","variant":"csr87","issuer":"Jefferson Health Plans (Health Partners Plans)","name":"Jefferson Health Plans + Balanced + Silver + HMO","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":true,"counties":["Bucks","Carbon","Delaware","Lehigh","Monroe","Montgomery","Northampton","Philadelphia","Schuylkill"],"rates":{"3":{"base21":493.77,"tobaccoFactor":1.100006},"6":{"base21":526.09,"tobaccoFactor":1.100002},"8":{"base21":409.68,"tobaccoFactor":1.100005}},"ded":{"ind":750,"fam":1500,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":4000,"fam":8000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":8,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.25,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":400,"ded":"after_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":400,"ded":"after_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 visits per benefit period combined; visits above the limit are priced in full here.","Separate prescription drug deductible: $500 individual / $1,000 family. It applies to specialty drugs; the other drug tiers are charged their copay from the first fill.","These prices are for In-Network Tier 1 (Enhanced) providers, the \"you pay the least\" column and the one the CMS data uses. In-Network Tier 2 (Standard) providers have a $2,500 individual / $5,000 family deductible and higher prices, for example primary care visit $45 copay; specialist visit $85 copay; emergency room $500 copay; hospital stay $750 copay after the deductible (up to 5 days). Out-of-network care is not covered.","Lab work: $35 copay. X-rays: $75 copay.","Mental health: the outpatient services price (an office visit) is used.","Hospital stay and delivery facility fees are a copay per day for up to 5 days per admission.","Visits with Jefferson designated telemedicine providers are covered in full (the prices above are for in-person visits).","For preferred brand drugs and non-preferred brand drugs, the SBC cell does not say whether the deductible applies; other drug tiers of the same plan are marked as subject to the drug deductible, or page 1 lists these as covered before the deductible, so they are charged from the first dollar."],"sbcUrl":"https://www.jeffersonhealthplans.com/content/dam/jeffersonhealthplans/documents/sbc/2027/jefferson-health-plans-balanced-silver-hmo-87-pa.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":388.48,"tobaccoFactor":1.100005},"6":{"base21":425.79,"tobaccoFactor":1.100002},"8":{"base21":366.42,"tobaccoFactor":1.099995}}}},{"market":"pennie","id":"93909PA0010004-06","standardId":"93909PA0010004","variant":"csr94","issuer":"Jefferson Health Plans (Health Partners Plans)","name":"Jefferson Health Plans + Balanced + Silver + HMO","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":true,"counties":["Bucks","Carbon","Delaware","Lehigh","Monroe","Montgomery","Northampton","Philadelphia","Schuylkill"],"rates":{"3":{"base21":493.77,"tobaccoFactor":1.100006},"6":{"base21":526.09,"tobaccoFactor":1.100002},"8":{"base21":409.68,"tobaccoFactor":1.100005}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":4000,"fam":8000},"rules":{"pcp":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":0,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":30,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":0,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"no_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"no_ded"}},"prenatal":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":250,"ded":"no_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"coins","rate":0,"ded":"no_ded"}}},"notes":["Physical and occupational therapy: limited to 30 visits per benefit period combined; visits above the limit are priced in full here.","Separate prescription drug deductible: $500 individual / $1,000 family. It applies to specialty drugs; the other drug tiers are charged their copay from the first fill.","These prices are for In-Network Tier 1 (Enhanced) providers, the \"you pay the least\" column and the one the CMS data uses. In-Network Tier 2 (Standard) providers have a $0 individual / $0 family deductible and higher prices, for example primary care visit $20 copay; specialist visit $35 copay; emergency room $300 copay; hospital stay $600 copay (up to 5 days). Out-of-network care is not covered.","Lab work: $0 copay. X-rays: $20 copay.","Mental health: the outpatient services price (an office visit) is used.","Hospital stay and delivery facility fees are a copay per day for up to 5 days per admission.","Visits with Jefferson designated telemedicine providers are covered in full (the prices above are for in-person visits).","For preferred brand drugs and non-preferred brand drugs, the SBC cell does not say whether the deductible applies; other drug tiers of the same plan are marked as subject to the drug deductible, or page 1 lists these as covered before the deductible, so they are charged from the first dollar."],"sbcUrl":"https://www.jeffersonhealthplans.com/content/dam/jeffersonhealthplans/documents/sbc/2027/jefferson-health-plans-balanced-silver-hmo-94-pa.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":388.48,"tobaccoFactor":1.100005},"6":{"base21":425.79,"tobaccoFactor":1.100002},"8":{"base21":366.42,"tobaccoFactor":1.099995}}}},{"market":"pennie","id":"93909PA0010005-01","standardId":"93909PA0010005","variant":"standard","issuer":"Jefferson Health Plans (Health Partners Plans)","name":"Jefferson Health Plans + Total + Silver + HMO","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":true,"counties":["Bucks","Carbon","Delaware","Lehigh","Monroe","Montgomery","Northampton","Philadelphia","Schuylkill"],"rates":{"3":{"base21":478.41,"tobaccoFactor":1.099998},"6":{"base21":509.72,"tobaccoFactor":1.099996},"8":{"base21":396.94,"tobaccoFactor":1.09999}},"ded":{"ind":5500,"fam":11000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":950,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":100,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":5,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"copay","amount":5,"ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"copay","amount":5,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 visits per benefit period combined; visits above the limit are priced in full here.","Separate prescription drug deductible: $500 individual / $1,000 family. It applies to preferred brand drugs, non-preferred brand drugs, specialty drugs; the other drug tiers are charged their copay from the first fill.","These prices are for In-Network Tier 1 (Enhanced) providers, the \"you pay the least\" column and the one the CMS data uses. In-Network Tier 2 (Standard) providers have a $8,000 individual / $16,000 family deductible and higher prices, for example primary care visit $75 copay; specialist visit $125 copay; emergency room $950 copay; hospital stay $800 copay after the deductible (up to 5 days). Out-of-network care is not covered.","Lab work: $40 copay. X-rays: $100 copay.","Mental health: the outpatient services price (an office visit) is used.","Hospital stay and delivery facility fees are a copay per day for up to 5 days per admission.","Visits with Jefferson designated telemedicine providers are covered in full (the prices above are for in-person visits)."],"sbcUrl":"https://www.jeffersonhealthplans.com/content/dam/jeffersonhealthplans/documents/sbc/2027/jefferson-health-plans-total-silver-hmo-on-exchange-pa.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":377.42,"tobaccoFactor":1.099995},"6":{"base21":413.66,"tobaccoFactor":1.10001},"8":{"base21":355.98,"tobaccoFactor":1.100006}}}},{"market":"pennie","id":"93909PA0010005-04","standardId":"93909PA0010005","variant":"csr73","issuer":"Jefferson Health Plans (Health Partners Plans)","name":"Jefferson Health Plans + Total + Silver + HMO","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":true,"counties":["Bucks","Carbon","Delaware","Lehigh","Monroe","Montgomery","Northampton","Philadelphia","Schuylkill"],"rates":{"3":{"base21":478.41,"tobaccoFactor":1.099998},"6":{"base21":509.72,"tobaccoFactor":1.099996},"8":{"base21":396.94,"tobaccoFactor":1.09999}},"ded":{"ind":5500,"fam":11000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":9600,"fam":19200},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":950,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 visits per benefit period combined; visits above the limit are priced in full here.","Separate prescription drug deductible: $500 individual / $1,000 family. It applies to preferred brand drugs, non-preferred brand drugs, specialty drugs; the other drug tiers are charged their copay from the first fill.","These prices are for In-Network Tier 1 (Enhanced) providers, the \"you pay the least\" column and the one the CMS data uses. In-Network Tier 2 (Standard) providers have a $8,000 individual / $16,000 family deductible and higher prices, for example primary care visit $75 copay; specialist visit $125 copay; emergency room $950 copay; hospital stay $800 copay after the deductible (up to 5 days). Out-of-network care is not covered.","Lab work: $40 copay. X-rays: $100 copay.","Mental health: the outpatient services price (an office visit) is used.","Hospital stay and delivery facility fees are a copay per day for up to 5 days per admission.","Visits with Jefferson designated telemedicine providers are covered in full (the prices above are for in-person visits)."],"sbcUrl":"https://www.jeffersonhealthplans.com/content/dam/jeffersonhealthplans/documents/sbc/2027/jefferson-health-plans-total-silver-hmo-73-pa.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":377.42,"tobaccoFactor":1.099995},"6":{"base21":413.66,"tobaccoFactor":1.10001},"8":{"base21":355.98,"tobaccoFactor":1.100006}}}},{"market":"pennie","id":"93909PA0010005-05","standardId":"93909PA0010005","variant":"csr87","issuer":"Jefferson Health Plans (Health Partners Plans)","name":"Jefferson Health Plans + Total + Silver + HMO","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":true,"counties":["Bucks","Carbon","Delaware","Lehigh","Monroe","Montgomery","Northampton","Philadelphia","Schuylkill"],"rates":{"3":{"base21":478.41,"tobaccoFactor":1.099998},"6":{"base21":509.72,"tobaccoFactor":1.099996},"8":{"base21":396.94,"tobaccoFactor":1.09999}},"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":4000,"fam":8000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":35,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":8,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":300,"ded":"no_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":300,"ded":"no_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 visits per benefit period combined; visits above the limit are priced in full here.","Separate prescription drug deductible: $500 individual / $1,000 family. It applies to specialty drugs; the other drug tiers are charged their copay from the first fill.","These prices are for In-Network Tier 1 (Enhanced) providers, the \"you pay the least\" column and the one the CMS data uses. In-Network Tier 2 (Standard) providers have a $2,500 individual / $5,000 family deductible and higher prices, for example primary care visit $40 copay; specialist visit $75 copay; emergency room $400 copay; hospital stay $700 copay (up to 5 days). Out-of-network care is not covered.","Lab work: $30 copay. X-rays: $75 copay.","Mental health: the outpatient services price (an office visit) is used.","Hospital stay and delivery facility fees are a copay per day for up to 5 days per admission.","Visits with Jefferson designated telemedicine providers are covered in full (the prices above are for in-person visits).","For preferred brand drugs and non-preferred brand drugs, the SBC cell does not say whether the deductible applies; other drug tiers of the same plan are marked as subject to the drug deductible, or page 1 lists these as covered before the deductible, so they are charged from the first dollar."],"sbcUrl":"https://www.jeffersonhealthplans.com/content/dam/jeffersonhealthplans/documents/sbc/2027/jefferson-health-plans-total-silver-hmo-87-pa.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":377.42,"tobaccoFactor":1.099995},"6":{"base21":413.66,"tobaccoFactor":1.10001},"8":{"base21":355.98,"tobaccoFactor":1.100006}}}},{"market":"pennie","id":"93909PA0010005-06","standardId":"93909PA0010005","variant":"csr94","issuer":"Jefferson Health Plans (Health Partners Plans)","name":"Jefferson Health Plans + Total + Silver + HMO","metal":"Silver","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":true,"counties":["Bucks","Carbon","Delaware","Lehigh","Monroe","Montgomery","Northampton","Philadelphia","Schuylkill"],"rates":{"3":{"base21":478.41,"tobaccoFactor":1.099998},"6":{"base21":509.72,"tobaccoFactor":1.099996},"8":{"base21":396.94,"tobaccoFactor":1.09999}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":4000,"fam":8000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":0,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":35,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":0,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"no_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"no_ded"}},"prenatal":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":250,"ded":"no_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"coins","rate":0,"ded":"no_ded"}}},"notes":["Physical and occupational therapy: limited to 30 visits per benefit period combined; visits above the limit are priced in full here.","Separate prescription drug deductible: $500 individual / $1,000 family. It applies to specialty drugs; the other drug tiers are charged their copay from the first fill.","These prices are for In-Network Tier 1 (Enhanced) providers, the \"you pay the least\" column and the one the CMS data uses. In-Network Tier 2 (Standard) providers have a $0 individual / $0 family deductible and higher prices, for example primary care visit $20 copay; specialist visit $35 copay; emergency room $300 copay; hospital stay $600 copay (up to 5 days). Out-of-network care is not covered.","Lab work: $0 copay. X-rays: $25 copay.","Mental health: the outpatient services price (an office visit) is used.","Hospital stay and delivery facility fees are a copay per day for up to 5 days per admission.","Visits with Jefferson designated telemedicine providers are covered in full (the prices above are for in-person visits).","For preferred brand drugs and non-preferred brand drugs, the SBC cell does not say whether the deductible applies; other drug tiers of the same plan are marked as subject to the drug deductible, or page 1 lists these as covered before the deductible, so they are charged from the first dollar."],"sbcUrl":"https://www.jeffersonhealthplans.com/content/dam/jeffersonhealthplans/documents/sbc/2027/jefferson-health-plans-total-silver-hmo-94-pa.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":377.42,"tobaccoFactor":1.099995},"6":{"base21":413.66,"tobaccoFactor":1.10001},"8":{"base21":355.98,"tobaccoFactor":1.100006}}}},{"market":"pennie","id":"93909PA0010006-01","standardId":"93909PA0010006","variant":"standard","issuer":"Jefferson Health Plans (Health Partners Plans)","name":"Jefferson Health Plans + $0 Deductible + Gold + HMO","metal":"Gold","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":true,"counties":["Bucks","Carbon","Delaware","Lehigh","Monroe","Montgomery","Northampton","Philadelphia","Schuylkill"],"rates":{"3":{"base21":468.64,"tobaccoFactor":1.099991},"6":{"base21":499.32,"tobaccoFactor":1.099996},"8":{"base21":388.84,"tobaccoFactor":1.09999}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":165,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":85,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":275,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"no_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":350,"ded":"no_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 visits per benefit period combined; visits above the limit are priced in full here.","These prices are for In-Network Tier 1 (Enhanced) providers, the \"you pay the least\" column and the one the CMS data uses. In-Network Tier 2 (Standard) providers have a $1,000 individual / $2,000 family deductible and higher prices, for example primary care visit $75 copay; specialist visit $100 copay; emergency room $450 copay; hospital stay $550 copay after the deductible (up to 5 days). Out-of-network care is not covered.","Lab work: $5 copay. X-rays: $75 copay.","Mental health: the outpatient services price (an office visit) is used.","Hospital stay and delivery facility fees are a copay per day for up to 5 days per admission.","Visits with Jefferson designated telemedicine providers are covered in full (the prices above are for in-person visits).","The medical deductible is $0, so these prices (which the SBC does not tag either way) are charged from the first dollar: preferred brand drugs, non-preferred brand drugs, specialty drugs, hospital stay facility fee and delivery facility fee."],"sbcUrl":"https://www.jeffersonhealthplans.com/content/dam/jeffersonhealthplans/documents/sbc/2027/jefferson-health-plans-zero-deductible-gold-hmo-on-exchange-pa.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":364.55,"tobaccoFactor":1.100014},"6":{"base21":399.55,"tobaccoFactor":1.100013},"8":{"base21":343.84,"tobaccoFactor":1.099988}}}},{"market":"pennie","id":"93909PA0010007-01","standardId":"93909PA0010007","variant":"standard","issuer":"Jefferson Health Plans (Health Partners Plans)","name":"Jefferson Health Plans + Total + Gold + HMO","metal":"Gold","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":true,"counties":["Bucks","Carbon","Delaware","Lehigh","Monroe","Montgomery","Northampton","Philadelphia","Schuylkill"],"rates":{"3":{"base21":450.78,"tobaccoFactor":1.100004},"6":{"base21":480.28,"tobaccoFactor":1.100004},"8":{"base21":374.01,"tobaccoFactor":1.099997}},"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":0,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":75,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":325,"ded":"after_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":325,"ded":"after_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 visits per benefit period combined; visits above the limit are priced in full here.","Separate prescription drug deductible: $500 individual / $1,000 family. It applies to non-preferred brand drugs, specialty drugs; the other drug tiers are charged their copay from the first fill.","These prices are for In-Network Tier 1 (Enhanced) providers, the \"you pay the least\" column and the one the CMS data uses. In-Network Tier 2 (Standard) providers have a $2,000 individual / $4,000 family deductible and higher prices, for example primary care visit $60 copay; specialist visit $100 copay; emergency room $400 copay; hospital stay $500 copay after the deductible (up to 5 days). Out-of-network care is not covered.","Lab work: $0 copay. X-rays: $60 copay.","Mental health: the outpatient services price (an office visit) is used.","Hospital stay and delivery facility fees are a copay per day for up to 5 days per admission.","Visits with Jefferson designated telemedicine providers are covered in full (the prices above are for in-person visits)."],"sbcUrl":"https://www.jeffersonhealthplans.com/content/dam/jeffersonhealthplans/documents/sbc/2027/jefferson-health-plans-total-gold-hmo-on-exchange-pa.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":342.09,"tobaccoFactor":1.100003},"6":{"base21":374.94,"tobaccoFactor":1.099989},"8":{"base21":322.66,"tobaccoFactor":1.100012}}}},{"market":"pennie","id":"93909PA0010011-01","standardId":"93909PA0010011","variant":"standard","issuer":"Jefferson Health Plans (Health Partners Plans)","name":"Jefferson Health Plans + Value + Bronze + HMO","metal":"Bronze","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":true,"counties":["Bucks","Carbon","Delaware","Lehigh","Monroe","Montgomery","Northampton","Philadelphia","Schuylkill"],"rates":{"3":{"base21":339.79,"tobaccoFactor":1.100003},"6":{"base21":362.02,"tobaccoFactor":1.099994},"8":{"base21":281.92,"tobaccoFactor":1.099993}},"ded":{"ind":10000,"fam":20000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"specialist":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 visits per benefit period combined; visits above the limit are priced in full here.","The SBC has no separate drug deductible, so drug tiers marked as subject to the Rx deductible are charged after the plan deductible: preferred brand drugs, non-preferred brand drugs, specialty drugs.","These prices are for In-Network Tier 1 (Enhanced) providers, the \"you pay the least\" column and the one the CMS data uses. In-Network Tier 2 (Standard) providers have a $10,000 individual / $20,000 family deductible and higher prices, for example primary care visit 0% coinsurance after the deductible; specialist visit 0% coinsurance after the deductible; emergency room 0% coinsurance after the deductible; hospital stay 0% coinsurance after the deductible. Out-of-network care is not covered.","Mental health: the outpatient services price (an office visit) is used.","Visits with Jefferson designated telemedicine providers are covered in full (the prices above are for in-person visits).","Page 1 of the SBC lists specialist visits among the services covered before you meet your deductible, but the chart cell says the deductible applies. The chart cell is followed here (the higher cost); the SBC contradicts itself on this point.","Primary care visits: the Tier 1 cell says only \"Subject to 50% coinsurance.\" (no deductible wording, while every other cell of this plan says \"Subject to deductible\"); page 1 lists primary care services as covered before you meet your deductible, so the 50% coinsurance is charged from the first dollar."],"sbcUrl":"https://www.jeffersonhealthplans.com/content/dam/jeffersonhealthplans/documents/sbc/2027/jefferson-health-plans-value-bronze-hmo-on-exchange-pa.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":246.57,"tobaccoFactor":1.100012},"6":{"base21":270.25,"tobaccoFactor":1.100019},"8":{"base21":232.57,"tobaccoFactor":1.100013}}}},{"market":"pennie","id":"93909PA0010012-01","standardId":"93909PA0010012","variant":"standard","issuer":"Jefferson Health Plans (Health Partners Plans)","name":"Jefferson Health Plans + Value + Gold + HMO","metal":"Gold","network":"HMO","hsaEligible":false,"networkId":"PAN001","referral":false,"tiers":true,"counties":["Bucks","Carbon","Delaware","Lehigh","Monroe","Montgomery","Northampton","Philadelphia","Schuylkill"],"rates":{"3":{"base21":441.66,"tobaccoFactor":1.100009},"6":{"base21":470.57,"tobaccoFactor":1.100006},"8":{"base21":366.45,"tobaccoFactor":1.100014}},"ded":{"ind":2000,"fam":4000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":0,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":225,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":275,"ded":"after_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":275,"ded":"after_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 visits per benefit period combined; visits above the limit are priced in full here.","Separate prescription drug deductible: $500 individual / $1,000 family. It applies to non-preferred brand drugs, specialty drugs; the other drug tiers are charged their copay from the first fill.","These prices are for In-Network Tier 1 (Enhanced) providers, the \"you pay the least\" column and the one the CMS data uses. In-Network Tier 2 (Standard) providers have a $2,500 individual / $5,000 family deductible and higher prices, for example primary care visit $60 copay; specialist visit $100 copay; emergency room $350 copay; hospital stay $500 copay after the deductible (up to 5 days). Out-of-network care is not covered.","Lab work: $0 copay. X-rays: $50 copay.","Mental health: the outpatient services price (an office visit) is used.","Hospital stay and delivery facility fees are a copay per day for up to 5 days per admission.","Visits with Jefferson designated telemedicine providers are covered in full (the prices above are for in-person visits)."],"sbcUrl":"https://www.jeffersonhealthplans.com/content/dam/jeffersonhealthplans/documents/sbc/2027/jefferson-health-plans-value-gold-hmo-on-exchange-pa.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":336.73,"tobaccoFactor":1.099991},"6":{"base21":369.06,"tobaccoFactor":1.100011},"8":{"base21":317.6,"tobaccoFactor":1.1}}}},{"market":"pennie","id":"98517PA0010003-01","standardId":"98517PA0010003","variant":"standard","issuer":"Oscar Health Plan of Pennsylvania","name":"Bronze 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the no-charge reading is used here.","Generic drugs: Tier 1A preferred generics no charge (used here); Tier 1B generics $5 copay / prescription; retail fills of up to 30 days.","Preferred brand drugs: $20 copay / prescription at retail (used here); $60 copay / prescription for a 90-day mail-order supply.","Mental health: office visits $5 copay / visit (used here); other outpatient mental health services 10% coinsurance.","Physical and occupational therapy: 30 visits per benefit period combined; visits above the limit are priced in full outside the out-of-pocket maximum (our model). The limit does not apply to a mental health or substance use diagnosis."],"sbcUrl":"https://www.hioscar.com/hx/sbc?year=2027&hios=98517PA0010057-06"},{"market":"pennie","id":"98517PA0010058-01","standardId":"98517PA0010058","variant":"standard","issuer":"Oscar Health Plan of Pennsylvania","name":"Bronze Classic 4700 Rx Ded","metal":"Bronze","network":"HMO","hsaEligible":false,"counties":["Bucks","Carbon","Chester","Delaware","Lackawanna","Lancaster","Lehigh","Luzerne","Monroe","Montgomery","Northampton","Philadelphia","Wyoming"],"rates":{"3":{"base21":403.48,"tobaccoFactor":1,"tobaccoFactorByAge":{"21":1,"22":1,"23":1,"24":1,"25":1.050015,"26":1.050006,"27":1.05002,"28":1.050003,"29":1.049991,"30":1.049985,"31":1.049998,"32":1.05001,"33":1.050005,"34":1.049999,"35":1.089993,"36":1.090013,"37":1.090012,"38":1.08999,"39":1.089988,"40":1.090006,"41":1.090004,"42":1.090013,"43":1.090009,"44":1.090004,"45":1.089992,"46":1.090003,"47":1.089991,"48":1.09,"49":1.090003,"50":1.09001,"51":1.089997,"52":1.089998,"53":1.090004,"54":1.090005,"55":1.125004,"56":1.124999,"57":1.125004,"58":1.125006,"59":1.124992,"60":1.125003,"61":1.125002,"62":1.125004,"63":1.124992,"64+":1.125}},"6":{"base21":479.27,"tobaccoFactor":1,"tobaccoFactorByAge":{"21":1,"22":1,"23":1,"24":1,"25":1.050003,"26":1.050004,"27":1.050014,"28":1.050005,"29":1.049992,"30":1.050004,"31":1.049995,"32":1.050004,"33":1.050004,"34":1.049998,"35":1.090003,"36":1.089993,"37":1.090002,"38":1.089993,"39":1.09001,"40":1.09001,"41":1.090001,"42":1.089997,"43":1.089998,"44":1.090005,"45":1.089993,"46":1.09,"47":1.090004,"48":1.089996,"49":1.090006,"50":1.090005,"51":1.089996,"52":1.090004,"53":1.089998,"54":1.09,"55":1.124996,"56":1.124997,"57":1.125005,"58":1.124997,"59":1.125001,"60":1.124993,"61":1.125001,"62":1.124997,"63":1.125003,"64+":1.125006}},"7":{"base21":379.97,"tobaccoFactor":1,"tobaccoFactorByAge":{"21":1,"22":1,"23":1,"24":1,"25":1.050016,"26":1.050015,"27":1.05,"28":1.049998,"29":1.050002,"30":1.049993,"31":1.050002,"32":1.049989,"33":1.05,"34":1.049991,"35":1.089981,"36":1.089995,"37":1.089987,"38":1.090003,"39":1.090009,"40":1.090014,"41":1.090012,"42":1.089999,"43":1.09001,"44":1.089995,"45":1.089999,"46":1.08999,"47":1.090001,"48":1.089997,"49":1.09,"50":1.089991,"51":1.090005,"52":1.089997,"53":1.089998,"54":1.09,"55":1.124994,"56":1.124992,"57":1.125004,"58":1.125001,"59":1.124999,"60":1.124998,"61":1.124998,"62":1.124995,"63":1.125003,"64+":1.125003}},"8":{"base21":347.41,"tobaccoFactor":1,"tobaccoFactorByAge":{"21":1,"22":1,"23":1,"24":1,"25":1.050001,"26":1.050008,"27":1.049989,"28":1.049996,"29":1.049981,"30":1.050013,"31":1.049995,"32":1.050002,"33":1.050001,"34":1.050006,"35":1.090005,"36":1.089982,"37":1.089981,"38":1.089981,"39":1.090005,"40":1.090004,"41":1.090003,"42":1.090005,"43":1.090003,"44":1.090002,"45":1.090003,"46":1.09,"47":1.090002,"48":1.089998,"49":1.089999,"50":1.090014,"51":1.089997,"52":1.089997,"53":1.09001,"54":1.089995,"55":1.125002,"56":1.125011,"57":1.125003,"58":1.12499,"59":1.125004,"60":1.125004,"61":1.124994,"62":1.124999,"63":1.124998,"64+":1.125004}}},"ded":{"ind":4700,"fam":9400,"embedded":true},"drugDed":{"ind":450,"fam":900,"embedded":true},"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"xray":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":4,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}}},"notes":["Prenatal office visits are listed as no charge, but the SBC adds that the cost sharing of the type of service (primary care or specialist office visit, diagnostic imaging, lab services) applies; the no-charge reading is used here.","Generic drugs: Tier 1A preferred generics $4 copay / prescription (used here); Tier 1B generics $30 copay / prescription; retail fills of up to 30 days.","Mental health: office visits $70 copay / visit (used here); other outpatient mental health services 50% coinsurance.","Physical and occupational therapy: 30 visits per benefit period combined; visits above the limit are priced in full outside the out-of-pocket maximum (our model). The limit does not apply to a mental health or substance use diagnosis.","Separate prescription drug deductible ($450 individual / $900 family) applies only to: Tier 3 non-preferred brand, Tier 4 specialty; Tier 1 generics, Tier 2 preferred brand are charged from the first fill."],"sbcUrl":"https://www.hioscar.com/hx/sbc?year=2027&hios=98517PA0010058-01"},{"market":"off","id":"16481PA0050108-00","standardId":"16481PA0050108-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $0/$70 - Premium Network","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":467.99,"tobaccoFactor":1.025001},"2":{"base21":622.21,"tobaccoFactor":1.025008},"4":{"base21":467.99,"tobaccoFactor":1.025001},"5":{"base21":504.73,"tobaccoFactor":1.025003}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"xray":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":70,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}}},"notes":["Off-Pennie plan. UPMC publishes no SBC for this plan; its cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134925920, \"2027 IND PPO Standard.xlsx\", variant 00 in-network column), checked against the Department's rate decision (upmchn-rate-change-decision-indv-mkt.pdf, rate pages: metal, deductible, out-of-pocket maximum, coinsurance, primary care and specialist copays) and the filing's plan overview. UPMC's matrices agree with its published 2027 SBCs of the Pennie plans they hold.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as UPMC's SBCs of the same designs say (\"Deductible does not apply\").","The rate decision's rate pages print this plan's copays as \"$70 / $10\" (primary care / specialist), as for its Partner, Select and Premium Network twins; the benefit matrix gives a $70 primary care and a $100 specialist copay, and $100 for urgent care, lab tests and physical therapy too. \"$10\" is read as the specialist copay cut short, and the matrix figure is used.","Hospital stay, physician and surgeon fees: surgery $500 copay (the surgical services row, used here, as UPMC's SBCs print it); other physician care in the hospital (inpatient medical care visits, consultations) 40% coinsurance.","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $70 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $100 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: 40% coinsurance (its other imaging row, used here). Other diagnostic testing: 40% coinsurance.","Mental health: office visits, psychotherapy and counseling $70 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) 40% coinsurance.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Prescription drugs: the medical deductible applies (no separate drug deductible), except to generic drugs, which the matrix prices before the deductible.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134925920/2027 IND PPO Standard.xlsx"},{"market":"off","id":"16481PA0050109-00","standardId":"16481PA0050109-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $3,500/$50 - Premium Network","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":457.91,"tobaccoFactor":1.025005},"2":{"base21":608.8,"tobaccoFactor":1.025},"4":{"base21":457.91,"tobaccoFactor":1.025005},"5":{"base21":493.86,"tobaccoFactor":1.025007}},"ded":{"ind":3500,"fam":7000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":50,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Off-Pennie plan. UPMC publishes no SBC for this plan; its cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134925920, \"2027 IND PPO Standard.xlsx\", variant 00 in-network column), checked against the Department's rate decision (upmchn-rate-change-decision-indv-mkt.pdf, rate pages: metal, deductible, out-of-pocket maximum, coinsurance, primary care and specialist copays) and the filing's plan overview. UPMC's matrices agree with its published 2027 SBCs of the Pennie plans they hold.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as UPMC's SBCs of the same designs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $50 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $60 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: 30% coinsurance after the deductible (its other imaging row, used here). Other diagnostic testing: 30% coinsurance after the deductible.","Mental health: office visits, psychotherapy and counseling $50 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) 30% coinsurance after the deductible.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134925920/2027 IND PPO Standard.xlsx"},{"market":"off","id":"16481PA0050110-00","standardId":"16481PA0050110-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $3,500/$50 - Premium Network with Adult Dental and Vision","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":474.62,"tobaccoFactor":1.025009},"2":{"base21":631.03,"tobaccoFactor":1.025007},"4":{"base21":474.62,"tobaccoFactor":1.025009},"5":{"base21":511.88,"tobaccoFactor":1.025006}},"ded":{"ind":3500,"fam":7000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":50,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Off-Pennie plan. UPMC publishes no SBC for this plan; its cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134925920, \"2027 IND PPO Standard.xlsx\", variant 00 in-network column), checked against the Department's rate decision (upmchn-rate-change-decision-indv-mkt.pdf, rate pages: metal, deductible, out-of-pocket maximum, coinsurance, primary care and specialist copays) and the filing's plan overview. UPMC's matrices agree with its published 2027 SBCs of the Pennie plans they hold.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as UPMC's SBCs of the same designs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $50 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $60 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: 30% coinsurance after the deductible (its other imaging row, used here). Other diagnostic testing: 30% coinsurance after the deductible.","Mental health: office visits, psychotherapy and counseling $50 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) 30% coinsurance after the deductible.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134925920/2027 IND PPO Standard.xlsx"},{"market":"off","id":"16481PA0050111-00","standardId":"16481PA0050111-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $3,500/$50 - Premium Network","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Cumberland","Dauphin","Lackawanna","Lebanon","Luzerne","Lycoming","Perry","Sullivan","Tioga","Wyoming"],"rates":{"3":{"base21":582.44,"tobaccoFactor":1.024998},"9":{"base21":646.06,"tobaccoFactor":1.024998}},"ded":{"ind":3500,"fam":7000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":50,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Off-Pennie plan. UPMC publishes no SBC for this plan; its cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134925920, \"2027 IND PPO Standard.xlsx\", variant 00 in-network column), checked against the Department's rate decision (upmchn-rate-change-decision-indv-mkt.pdf, rate pages: metal, deductible, out-of-pocket maximum, coinsurance, primary care and specialist copays) and the filing's plan overview. UPMC's matrices agree with its published 2027 SBCs of the Pennie plans they hold.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as UPMC's SBCs of the same designs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $50 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $60 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: 30% coinsurance after the deductible (its other imaging row, used here). Other diagnostic testing: 30% coinsurance after the deductible.","Mental health: office visits, psychotherapy and counseling $50 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) 30% coinsurance after the deductible.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134925920/2027 IND PPO Standard.xlsx"},{"market":"off","id":"16481PA0050112-00","standardId":"16481PA0050112-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $3,500/$50 - Premium Network with Adult Dental and Vision","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Cumberland","Dauphin","Lackawanna","Lebanon","Luzerne","Lycoming","Perry","Sullivan","Tioga","Wyoming"],"rates":{"3":{"base21":603.71,"tobaccoFactor":1.024995},"9":{"base21":669.64,"tobaccoFactor":1.024999}},"ded":{"ind":3500,"fam":7000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":50,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Off-Pennie plan. UPMC publishes no SBC for this plan; its cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134925920, \"2027 IND PPO Standard.xlsx\", variant 00 in-network column), checked against the Department's rate decision (upmchn-rate-change-decision-indv-mkt.pdf, rate pages: metal, deductible, out-of-pocket maximum, coinsurance, primary care and specialist copays) and the filing's plan overview. UPMC's matrices agree with its published 2027 SBCs of the Pennie plans they hold.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as UPMC's SBCs of the same designs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $50 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $60 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: 30% coinsurance after the deductible (its other imaging row, used here). Other diagnostic testing: 30% coinsurance after the deductible.","Mental health: office visits, psychotherapy and counseling $50 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) 30% coinsurance after the deductible.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134925920/2027 IND PPO Standard.xlsx"},{"market":"off","id":"16481PA0050117-00","standardId":"16481PA0050117-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Silver HSA $4,000/30% - Premium Network","metal":"Silver","network":"PPO","hsaEligible":true,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":421.6,"tobaccoFactor":1.025},"2":{"base21":560.53,"tobaccoFactor":1.024994},"4":{"base21":421.6,"tobaccoFactor":1.025},"5":{"base21":454.7,"tobaccoFactor":1.025005}},"ded":{"ind":4000,"fam":8000,"embedded":true},"drugDed":null,"oop":{"ind":7100,"fam":14200},"rules":{"pcp":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Off-Pennie plan. UPMC publishes no SBC for this plan; its cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134925921, \"2027 IND PPO HSA.xlsx\", variant 00 in-network column), checked against the Department's rate decision (upmchn-rate-change-decision-indv-mkt.pdf, rate pages: metal, deductible, out-of-pocket maximum, coinsurance, primary care and specialist copays) and the filing's plan overview. UPMC's matrices agree with its published 2027 SBCs of the Pennie plans they hold.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as UPMC's SBCs of the same designs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at 30% coinsurance after the deductible; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: 30% coinsurance after the deductible (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: 30% coinsurance after the deductible (its other imaging row, used here). Other diagnostic testing: 30% coinsurance after the deductible.","Mental health: office visits, psychotherapy and counseling 30% coinsurance after the deductible (used here); other outpatient services (intensive outpatient, partial hospitalization) 30% coinsurance after the deductible.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Prescription drugs: the medical deductible applies (no separate drug deductible).","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134925921/2027 IND PPO HSA.xlsx"},{"market":"off","id":"16481PA0120011-00","standardId":"16481PA0120011-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $0/$70 - Partner Network","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Clinton","Erie","Greene","Lawrence","Lycoming","McKean","Mercer","Potter","Somerset","Tioga","Venango","Washington"],"rates":{"1":{"base21":333.19,"tobaccoFactor":1.025001},"2":{"base21":442.98,"tobaccoFactor":1.02499},"3":{"base21":423.8,"tobaccoFactor":1.025012},"4":{"base21":333.19,"tobaccoFactor":1.025001},"5":{"base21":359.34,"tobaccoFactor":1.02499}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"xray":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":70,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}}},"notes":["Off-Pennie plan. UPMC publishes no SBC for this plan; its cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134926032, \"2027 IND EPO Standard.xlsx\", variant 00 in-network column), checked against the Department's rate decision (upmchn-rate-change-decision-indv-mkt.pdf, rate pages: metal, deductible, out-of-pocket maximum, coinsurance, primary care and specialist copays) and the filing's plan overview. UPMC's matrices agree with its published 2027 SBCs of the Pennie plans they hold.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as UPMC's SBCs of the same designs say (\"Deductible does not apply\").","The rate decision's rate pages print this plan's copays as \"$70 / $10\" (primary care / specialist), as for its Partner, Select and Premium Network twins; the benefit matrix gives a $70 primary care and a $100 specialist copay, and $100 for urgent care, lab tests and physical therapy too. \"$10\" is read as the specialist copay cut short, and the matrix figure is used.","Hospital stay, physician and surgeon fees: surgery $500 copay (the surgical services row, used here, as UPMC's SBCs print it); other physician care in the hospital (inpatient medical care visits, consultations) 40% coinsurance.","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $70 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $100 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: 40% coinsurance (its other imaging row, used here). Other diagnostic testing: 40% coinsurance.","Mental health: office visits, psychotherapy and counseling $70 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) 40% coinsurance.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Prescription drugs: the medical deductible applies (no separate drug deductible), except to generic drugs, which the matrix prices before the deductible.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134926032/2027 IND EPO Standard.xlsx"},{"market":"off","id":"16481PA0120012-00","standardId":"16481PA0120012-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $0/$70 - Select Network","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Fayette","Washington","Westmoreland"],"rates":{"4":{"base21":352.19,"tobaccoFactor":1.024987}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"xray":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":70,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}}},"notes":["Off-Pennie plan. UPMC publishes no SBC for this plan; its cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134926032, \"2027 IND EPO Standard.xlsx\", variant 00 in-network column), checked against the Department's rate decision (upmchn-rate-change-decision-indv-mkt.pdf, rate pages: metal, deductible, out-of-pocket maximum, coinsurance, primary care and specialist copays) and the filing's plan overview. UPMC's matrices agree with its published 2027 SBCs of the Pennie plans they hold.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as UPMC's SBCs of the same designs say (\"Deductible does not apply\").","The rate decision's rate pages print this plan's copays as \"$70 / $10\" (primary care / specialist), as for its Partner, Select and Premium Network twins; the benefit matrix gives a $70 primary care and a $100 specialist copay, and $100 for urgent care, lab tests and physical therapy too. \"$10\" is read as the specialist copay cut short, and the matrix figure is used.","Hospital stay, physician and surgeon fees: surgery $500 copay (the surgical services row, used here, as UPMC's SBCs print it); other physician care in the hospital (inpatient medical care visits, consultations) 40% coinsurance.","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $70 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $100 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: 40% coinsurance (its other imaging row, used here). Other diagnostic testing: 40% coinsurance.","Mental health: office visits, psychotherapy and counseling $70 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) 40% coinsurance.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Prescription drugs: the medical deductible applies (no separate drug deductible), except to generic drugs, which the matrix prices before the deductible.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134926032/2027 IND EPO Standard.xlsx"},{"market":"off","id":"16481PA0120013-00","standardId":"16481PA0120013-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $3,500/$50 - Partner Network","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Clinton","Erie","Greene","Lawrence","Lycoming","McKean","Mercer","Potter","Somerset","Tioga","Venango","Washington"],"rates":{"1":{"base21":326.68,"tobaccoFactor":1.025009},"2":{"base21":434.33,"tobaccoFactor":1.025004},"3":{"base21":415.53,"tobaccoFactor":1.025004},"4":{"base21":326.68,"tobaccoFactor":1.025009},"5":{"base21":352.33,"tobaccoFactor":1.025005}},"ded":{"ind":3500,"fam":7000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":50,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Off-Pennie plan. UPMC publishes no SBC for this plan; its cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134926032, \"2027 IND EPO Standard.xlsx\", variant 00 in-network column), checked against the Department's rate decision (upmchn-rate-change-decision-indv-mkt.pdf, rate pages: metal, deductible, out-of-pocket maximum, coinsurance, primary care and specialist copays) and the filing's plan overview. UPMC's matrices agree with its published 2027 SBCs of the Pennie plans they hold.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as UPMC's SBCs of the same designs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $50 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $60 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: 30% coinsurance after the deductible (its other imaging row, used here). Other diagnostic testing: 30% coinsurance after the deductible.","Mental health: office visits, psychotherapy and counseling $50 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) 30% coinsurance after the deductible.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134926032/2027 IND EPO Standard.xlsx"},{"market":"off","id":"16481PA0120014-00","standardId":"16481PA0120014-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $3,500/$50 - Partner Network with Adult Dental and Vision","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Clinton","Erie","Greene","Lawrence","Lycoming","McKean","Mercer","Potter","Somerset","Tioga","Venango","Washington"],"rates":{"1":{"base21":343.4,"tobaccoFactor":1.025015},"2":{"base21":456.56,"tobaccoFactor":1.024991},"3":{"base21":436.79,"tobaccoFactor":1.025001},"4":{"base21":343.4,"tobaccoFactor":1.025015},"5":{"base21":370.36,"tobaccoFactor":1.025003}},"ded":{"ind":3500,"fam":7000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":50,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Off-Pennie plan. UPMC publishes no SBC for this plan; its cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134926032, \"2027 IND EPO Standard.xlsx\", variant 00 in-network column), checked against the Department's rate decision (upmchn-rate-change-decision-indv-mkt.pdf, rate pages: metal, deductible, out-of-pocket maximum, coinsurance, primary care and specialist copays) and the filing's plan overview. UPMC's matrices agree with its published 2027 SBCs of the Pennie plans they hold.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as UPMC's SBCs of the same designs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $50 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $60 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: 30% coinsurance after the deductible (its other imaging row, used here). Other diagnostic testing: 30% coinsurance after the deductible.","Mental health: office visits, psychotherapy and counseling $50 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) 30% coinsurance after the deductible.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134926032/2027 IND EPO Standard.xlsx"},{"market":"off","id":"16481PA0120015-00","standardId":"16481PA0120015-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $3,500/$50 - Select Network","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Fayette","Washington","Westmoreland"],"rates":{"4":{"base21":345.32,"tobaccoFactor":1.024991}},"ded":{"ind":3500,"fam":7000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":50,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Off-Pennie plan. UPMC publishes no SBC for this plan; its cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134926032, \"2027 IND EPO Standard.xlsx\", variant 00 in-network column), checked against the Department's rate decision (upmchn-rate-change-decision-indv-mkt.pdf, rate pages: metal, deductible, out-of-pocket maximum, coinsurance, primary care and specialist copays) and the filing's plan overview. UPMC's matrices agree with its published 2027 SBCs of the Pennie plans they hold.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as UPMC's SBCs of the same designs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $50 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $60 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: 30% coinsurance after the deductible (its other imaging row, used here). Other diagnostic testing: 30% coinsurance after the deductible.","Mental health: office visits, psychotherapy and counseling $50 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) 30% coinsurance after the deductible.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134926032/2027 IND EPO Standard.xlsx"},{"market":"off","id":"16481PA0120016-00","standardId":"16481PA0120016-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Silver $3,500/$50 - Select Network with Adult Dental and Vision","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Fayette","Washington","Westmoreland"],"rates":{"4":{"base21":362.03,"tobaccoFactor":1.024998}},"ded":{"ind":3500,"fam":7000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":50,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Off-Pennie plan. UPMC publishes no SBC for this plan; its cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134926032, \"2027 IND EPO Standard.xlsx\", variant 00 in-network column), checked against the Department's rate decision (upmchn-rate-change-decision-indv-mkt.pdf, rate pages: metal, deductible, out-of-pocket maximum, coinsurance, primary care and specialist copays) and the filing's plan overview. UPMC's matrices agree with its published 2027 SBCs of the Pennie plans they hold.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as UPMC's SBCs of the same designs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $50 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $60 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: 30% coinsurance after the deductible (its other imaging row, used here). Other diagnostic testing: 30% coinsurance after the deductible.","Mental health: office visits, psychotherapy and counseling $50 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) 30% coinsurance after the deductible.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134926032/2027 IND EPO Standard.xlsx"},{"market":"off","id":"16481PA0120021-00","standardId":"16481PA0120021-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Silver HSA $4,000/30% - Partner Network","metal":"Silver","network":"EPO","hsaEligible":true,"counties":["Allegheny","Bedford","Blair","Butler","Clinton","Erie","Greene","Lawrence","Lycoming","McKean","Mercer","Potter","Somerset","Tioga","Venango","Washington"],"rates":{"1":{"base21":300.34,"tobaccoFactor":1.025005},"2":{"base21":399.31,"tobaccoFactor":1.024993},"3":{"base21":382.02,"tobaccoFactor":1.024999},"4":{"base21":300.34,"tobaccoFactor":1.025005},"5":{"base21":323.91,"tobaccoFactor":1.025007}},"ded":{"ind":4000,"fam":8000,"embedded":true},"drugDed":null,"oop":{"ind":7100,"fam":14200},"rules":{"pcp":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Off-Pennie plan. UPMC publishes no SBC for this plan; its cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134926033, \"2027 IND EPO HSA.xlsx\", variant 00 in-network column), checked against the Department's rate decision (upmchn-rate-change-decision-indv-mkt.pdf, rate pages: metal, deductible, out-of-pocket maximum, coinsurance, primary care and specialist copays) and the filing's plan overview. UPMC's matrices agree with its published 2027 SBCs of the Pennie plans they hold.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as UPMC's SBCs of the same designs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at 30% coinsurance after the deductible; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: 30% coinsurance after the deductible (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: 30% coinsurance after the deductible (its other imaging row, used here). Other diagnostic testing: 30% coinsurance after the deductible.","Mental health: office visits, psychotherapy and counseling 30% coinsurance after the deductible (used here); other outpatient services (intensive outpatient, partial hospitalization) 30% coinsurance after the deductible.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Prescription drugs: the medical deductible applies (no separate drug deductible).","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134926033/2027 IND EPO HSA.xlsx"},{"market":"off","id":"16481PA0120022-00","standardId":"16481PA0120022-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Advantage Silver HSA $4,000/30% - Select Network","metal":"Silver","network":"EPO","hsaEligible":true,"counties":["Allegheny","Beaver","Butler","Fayette","Washington","Westmoreland"],"rates":{"4":{"base21":317.47,"tobaccoFactor":1.02501}},"ded":{"ind":4000,"fam":8000,"embedded":true},"drugDed":null,"oop":{"ind":7100,"fam":14200},"rules":{"pcp":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Off-Pennie plan. UPMC publishes no SBC for this plan; its cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134926033, \"2027 IND EPO HSA.xlsx\", variant 00 in-network column), checked against the Department's rate decision (upmchn-rate-change-decision-indv-mkt.pdf, rate pages: metal, deductible, out-of-pocket maximum, coinsurance, primary care and specialist copays) and the filing's plan overview. UPMC's matrices agree with its published 2027 SBCs of the Pennie plans they hold.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as UPMC's SBCs of the same designs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at 30% coinsurance after the deductible; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: 30% coinsurance after the deductible (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: 30% coinsurance after the deductible (its other imaging row, used here). Other diagnostic testing: 30% coinsurance after the deductible.","Mental health: office visits, psychotherapy and counseling 30% coinsurance after the deductible (used here); other outpatient services (intensive outpatient, partial hospitalization) 30% coinsurance after the deductible.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Prescription drugs: the medical deductible applies (no separate drug deductible).","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134926033/2027 IND EPO HSA.xlsx"},{"market":"off","id":"22444PA0010063-00","standardId":"22444PA0010063-00","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 30/60/5000","metal":"Silver","network":"HMO","hsaEligible":false,"counties":["Bradford","Carbon","Centre","Clinton","Columbia","Juniata","Lackawanna","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northumberland","Pike","Schuylkill","Snyder","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming"],"rates":{"3":{"base21":483.69,"tobaccoFactor":1.100002},"6":{"base21":509.15,"tobaccoFactor":1.10001},"9":{"base21":610.98,"tobaccoFactor":1.100003}},"ded":{"ind":5000,"fam":10000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"HMO 30 60 5000 Off Exchng Only\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010090, 22444PA0010064, 22444PA0010065 (they differ only in service area).","This plan is sold only off Pennie.","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family; it applies to preferred brand drugs, non-preferred brand drugs, specialty drugs (the filed summary says \"after deductible\" there)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"3":{"base21":443.47,"tobaccoFactor":1.100007},"6":{"base21":466.81,"tobaccoFactor":1.099998},"9":{"base21":560.17,"tobaccoFactor":1.100005}}}},{"market":"off","id":"22444PA0010064-00","standardId":"22444PA0010064-00","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 30/60/5000","metal":"Silver","network":"HMO","hsaEligible":false,"counties":["Adams","Berks","Cumberland","Dauphin","Franklin","Fulton","Lancaster","Lebanon","Perry","York"],"rates":{"7":{"base21":636.44,"tobaccoFactor":1.099994},"9":{"base21":610.98,"tobaccoFactor":1.100003}},"ded":{"ind":5000,"fam":10000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"HMO 30 60 5000 Off Exchng Only\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010090, 22444PA0010063, 22444PA0010065 (they differ only in service area).","This plan is sold only off Pennie.","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family; it applies to preferred brand drugs, non-preferred brand drugs, specialty drugs (the filed summary says \"after deductible\" there)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"7":{"base21":583.51,"tobaccoFactor":1.099998},"9":{"base21":560.17,"tobaccoFactor":1.100005}}}},{"market":"off","id":"22444PA0010065-00","standardId":"22444PA0010065-00","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 30/60/5000","metal":"Silver","network":"HMO","hsaEligible":false,"counties":["Lehigh","Northampton"],"rates":{"6":{"base21":509.15,"tobaccoFactor":1.10001}},"ded":{"ind":5000,"fam":10000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"HMO 30 60 5000 Off Exchng Only\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010090, 22444PA0010063, 22444PA0010064 (they differ only in service area).","This plan is sold only off Pennie.","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family; it applies to preferred brand drugs, non-preferred brand drugs, specialty drugs (the filed summary says \"after deductible\" there)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"6":{"base21":466.81,"tobaccoFactor":1.099998}}}},{"market":"off","id":"22444PA0010090-00","standardId":"22444PA0010090-00","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Marketplace All-Access HMO 30/60/5000","metal":"Silver","network":"HMO","hsaEligible":false,"counties":["Bedford","Blair","Cambria","Cameron","Clearfield","Elk","Huntingdon","Jefferson","Potter","Somerset"],"rates":{"2":{"base21":509.15,"tobaccoFactor":1.10001},"5":{"base21":483.69,"tobaccoFactor":1.100002}},"ded":{"ind":5000,"fam":10000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794457, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"HMO 30 60 5000 Off Exchng Only\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 22444PA0010063, 22444PA0010064, 22444PA0010065 (they differ only in service area).","This plan is sold only off Pennie.","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family; it applies to preferred brand drugs, non-preferred brand drugs, specialty drugs (the filed summary says \"after deductible\" there)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794457/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"2":{"base21":466.81,"tobaccoFactor":1.099998},"5":{"base21":443.47,"tobaccoFactor":1.100007}}}},{"market":"off","id":"31609PA0180010-00","standardId":"31609PA0180010-00","variant":"standard","issuer":"QCC Insurance Company (Independence Blue Cross)","name":"Personal Choice EPO Silver Basic Virtual Care","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":512.27,"tobaccoFactor":1.124993,"tobaccoFactorByAge":{"21":1.124993,"22":1.124993,"23":1.124993,"24":1.124993,"25":1.125,"26":1.125019,"27":1.125005,"28":1.124991,"29":1.124993,"30":1.175,"31":1.174998,"32":1.174994,"33":1.175004,"34":1.174996,"35":1.175003,"36":1.175007,"37":1.174995,"38":1.174999,"39":1.175009,"40":1.224995,"41":1.224999,"42":1.224999,"43":1.225002,"44":1.225001,"45":1.224991,"46":1.224997,"47":1.224996,"48":1.224999,"49":1.225007,"50":1.37501,"51":1.375003,"52":1.374999,"53":1.375004,"54":1.374993,"55":1.375004,"56":1.374997,"57":1.375,"58":1.375006,"59":1.375,"60":1.374998,"61":1.374997,"62":1.375003,"63":1.374998,"64+":1.374998}}},"ded":{"ind":4000,"fam":8000,"embedded":true},"drugDed":null,"oop":{"ind":9750,"fam":19500},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":600,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":300}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":400}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":750,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":120,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.25,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":80,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.25,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["IBX publishes no SBC for this plan. Its cost sharing comes from the plan grid IBX filed with the PA Insurance Department (SERFF filing INLG-134934709, approved 2026-09-18, \"PA Consumer_ 2027 Plan Grids_(EPO VPCP) (5-13-26).xlsx\", sheet \"EPO Off-Exchange\", form 223 column; each rule's page is the spreadsheet row), checked against IBX's 2027 plan overview brochure (page 40) and the Department's 2027 rate decision (qcc pp. 72, 73, 75, 76, 78, 79, 81): every value they print agrees. The same grid's Silver Classic Virtual Care column gives exactly the rules of that plan's filed SBC.","Primary care visits: $35 copay for office visits (used here) and $25 copay for virtual visits; visits with the plan's virtual primary care provider are no charge.","Specialist visits: $80 copay in the office (used here); $55 copay for virtual visits.","Outpatient lab and pathology: $15 copay at freestanding facilities (used here); $85 copay at hospital-based facilities.","X-rays: $100 copay at freestanding facilities (used here); $150 copay at hospital-based facilities.","Imaging (CT, PET, MRI): $200 copay at freestanding facilities (used here); $250 copay at hospital-based facilities.","Physical and occupational therapy: $80 copay at freestanding facilities (used here); $110 copay at hospital-based facilities.","Mental health: office visits $80 copay (used here); other outpatient services $80 copay.","Low-cost generic drugs: $3 copay per 30-day retail fill; other generics as shown (retail generic, used here).","Preferred brand drugs: the coinsurance is capped at $300 per 30-day retail fill (the cap is modelled here).","Non-preferred brand drugs: the coinsurance is capped at $400 per 30-day retail fill (the cap is modelled here).","Specialty drugs: the coinsurance is capped at $1,000 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill; 31-90 day mail-order fills cost more per fill.","Physical and occupational therapy: limited to 30 visits a year; visits above the limit are not covered.","Prenatal care: the grid prices the first OB visit; later prenatal visits are no charge (part of the delivery fee), as every IBX SBC says (\"Office visit cost share applies to the first OB visit only\").","Delivery professional fees: the grid has no separate row; its inpatient physician/surgeon fee row is used, as IBX's brochure prices inpatient professional services \"includes maternity\".","Virtual care from the designated virtual provider is free.","This plan is sold only off Pennie (directly by IBX)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#INLG-134934709/PA Consumer_ 2027 Plan Grids_(EPO VPCP) (5-13-26).xlsx"},{"market":"off","id":"31609PA0190007-00","standardId":"31609PA0190007-00","variant":"standard","issuer":"QCC Insurance Company (Independence Blue Cross)","name":"Personal Choice PPO Silver Basic","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":550.54,"tobaccoFactor":1.125005,"tobaccoFactorByAge":{"21":1.125005,"22":1.125005,"23":1.125005,"24":1.125005,"25":1.124995,"26":1.125002,"27":1.124998,"28":1.124992,"29":1.125006,"30":1.174999,"31":1.174994,"32":1.174991,"33":1.174998,"34":1.174996,"35":1.174996,"36":1.17501,"37":1.174993,"38":1.175008,"39":1.175005,"40":1.225003,"41":1.225,"42":1.224999,"43":1.225009,"44":1.225003,"45":1.224999,"46":1.225003,"47":1.225011,"48":1.225001,"49":1.225006,"50":1.375008,"51":1.374995,"52":1.375006,"53":1.374998,"54":1.375004,"55":1.375002,"56":1.374997,"57":1.374995,"58":1.374998,"59":1.374995,"60":1.374997,"61":1.374998,"62":1.375002,"63":1.375002,"64+":1.375002}}},"ded":{"ind":4000,"fam":8000,"embedded":true},"drugDed":null,"oop":{"ind":9750,"fam":19500},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":600,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":300}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":400}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":750,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":120,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.25,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":80,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.25,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Prenatal care: the SBC says the office-visit cost share applies to the first OB visit only, so it is charged once here and later prenatal visits are no charge (they are part of the delivery fee); other copays or coinsurance may apply to other services such as ultrasounds.","Imaging (CT, PET, MRI): $200 copay per scan at freestanding facilities (used here); $250 copay per scan at hospital-based facilities.","X-rays: $100 copay per visit at freestanding facilities (used here); $150 copay per visit at hospital-based facilities.","Blood work: $15 copay per visit at freestanding labs (used here); $85 copay per visit at hospital-based facilities.","Preferred brand drugs: 50% coinsurance is capped at $300 per 30-day retail fill (the cap is modelled here).","Non-preferred brand drugs: 50% coinsurance is capped at $400 per 30-day retail fill (the cap is modelled here).","Specialty drugs: 50% coinsurance is capped at $1,000 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill; 31-90 day mail-order fills cost more per fill.","Mental health: office visits $80 copay per visit (used here); other outpatient services $80 copay per visit.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); visits above the limit are not covered. The limit does not apply to therapy prescribed for mental health or substance use treatment.","Physical and occupational therapy: $80 copay per visit at freestanding facilities (used here); $110 copay per visit at hospital-based facilities.","Telemedicine visits with the designated telemedicine provider are free.","This plan is sold only off Pennie (directly by IBX). 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $325 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","No medical deductible: copays and coinsurance apply from the first visit."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/WPA/Individual/I_33709PA1160011-00_20270101_SBC.pdf"},{"market":"off","id":"33709PA1170002-00","standardId":"33709PA1170002-00","variant":"standard","issuer":"Highmark Inc.","name":"my Blue Access PPO Silver 0 + Adult Dental and Vision","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Butler","Erie","Mercer","Washington","Westmoreland"],"rates":{"1":{"base21":492.74,"tobaccoFactor":1.025003,"tobaccoFactorByAge":{"21":1.025003,"22":1.025003,"23":1.025003,"24":1.025003,"25":1.025005,"26":1.024992,"27":1.025,"28":1.025,"29":1.024992,"30":1.024997,"31":1.025005,"32":1.024995,"33":1.025004,"34":1.024992,"35":1.024995,"36":1.024997,"37":1.025,"38":1.025002,"39":1.025006,"40":1.099997,"41":1.104996,"42":1.111996,"43":1.121005,"44":1.131995,"45":1.144999,"46":1.160003,"47":1.177004,"48":1.195996,"49":1.216997,"50":1.225004,"51":1.225004,"52":1.224998,"53":1.225002,"54":1.225,"55":1.224998,"56":1.224999,"57":1.224998,"58":1.225002,"59":1.225004,"60":1.224998,"61":1.225004,"62":1.225001,"63":1.225001,"64+":1.225}},"4":{"base21":492.74,"tobaccoFactor":1.025003,"tobaccoFactorByAge":{"21":1.025003,"22":1.025003,"23":1.025003,"24":1.025003,"25":1.025005,"26":1.024992,"27":1.025,"28":1.025,"29":1.024992,"30":1.024997,"31":1.025005,"32":1.024995,"33":1.025004,"34":1.024992,"35":1.024995,"36":1.024997,"37":1.025,"38":1.025002,"39":1.025006,"40":1.099997,"41":1.104996,"42":1.111996,"43":1.121005,"44":1.131995,"45":1.144999,"46":1.160003,"47":1.177004,"48":1.195996,"49":1.216997,"50":1.225004,"51":1.225004,"52":1.224998,"53":1.225002,"54":1.225,"55":1.224998,"56":1.224999,"57":1.224998,"58":1.225002,"59":1.225004,"60":1.224998,"61":1.225004,"62":1.225001,"63":1.225001,"64+":1.225}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":10700,"fam":21400},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":1250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":800,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":2500,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":2500,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Diagnostic tests: $65 copay for blood work / lab and $175 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): $5 copay for a 31-day retail supply ($10 for 60 days, $15 for 90 days); $10 copay for a 90-day mail-order supply.","Tier 2 drugs (preferred brand): $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $60 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $250 copay for a 31-day retail supply ($500 for 60 days, $750 for 90 days); $500 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,500 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","No medical deductible: copays and coinsurance apply from the first visit."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/WPA/Individual/I_33709PA1170002-00_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":425.33,"tobaccoFactor":1.024992,"tobaccoFactorByAge":{"21":1.024992,"22":1.024992,"23":1.024992,"24":1.024992,"25":1.02501,"26":1.025003,"27":1.024992,"28":1.025004,"29":1.025003,"30":1.025003,"31":1.024992,"32":1.025001,"33":1.025002,"34":1.025002,"35":1.024993,"36":1.025002,"37":1.024992,"38":1.025002,"39":1.025001,"40":1.100006,"41":1.105006,"42":1.112002,"43":1.121004,"44":1.131995,"45":1.145006,"46":1.16,"47":1.177003,"48":1.195999,"49":1.217004,"50":1.225001,"51":1.225001,"52":1.224995,"53":1.225005,"54":1.225002,"55":1.225,"56":1.225005,"57":1.225001,"58":1.224999,"59":1.224996,"60":1.225001,"61":1.225004,"62":1.224997,"63":1.224997,"64+":1.225002}},"4":{"base21":425.33,"tobaccoFactor":1.024992,"tobaccoFactorByAge":{"21":1.024992,"22":1.024992,"23":1.024992,"24":1.024992,"25":1.02501,"26":1.025003,"27":1.024992,"28":1.025004,"29":1.025003,"30":1.025003,"31":1.024992,"32":1.025001,"33":1.025002,"34":1.025002,"35":1.024993,"36":1.025002,"37":1.024992,"38":1.025002,"39":1.025001,"40":1.100006,"41":1.105006,"42":1.112002,"43":1.121004,"44":1.131995,"45":1.145006,"46":1.16,"47":1.177003,"48":1.195999,"49":1.217004,"50":1.225001,"51":1.225001,"52":1.224995,"53":1.225005,"54":1.225002,"55":1.225,"56":1.225005,"57":1.225001,"58":1.224999,"59":1.224996,"60":1.225001,"61":1.225004,"62":1.224997,"63":1.224997,"64+":1.225002}}}}},{"market":"off","id":"33709PA1170009-00","standardId":"33709PA1170009-00","variant":"standard","issuer":"Highmark Inc.","name":"my Blue Access PPO Platinum 0 + Adult Dental and Vision","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Butler","Erie","Mercer","Washington","Westmoreland"],"rates":{"1":{"base21":679.7,"tobaccoFactor":1.024996,"tobaccoFactorByAge":{"21":1.024996,"22":1.024996,"23":1.024996,"24":1.024996,"25":1.024999,"26":1.025,"27":1.025002,"28":1.024999,"29":1.024994,"30":1.025005,"31":1.024995,"32":1.024997,"33":1.025004,"34":1.025001,"35":1.024994,"36":1.024999,"37":1.025004,"38":1.024997,"39":1.024995,"40":1.100005,"41":1.104998,"42":1.112003,"43":1.120995,"44":1.132001,"45":1.145004,"46":1.160002,"47":1.177,"48":1.196003,"49":1.217003,"50":1.225003,"51":1.225001,"52":1.224998,"53":1.224998,"54":1.224999,"55":1.225,"56":1.224999,"57":1.225002,"58":1.224998,"59":1.224998,"60":1.225,"61":1.224999,"62":1.225002,"63":1.225002,"64+":1.225001}},"4":{"base21":679.7,"tobaccoFactor":1.024996,"tobaccoFactorByAge":{"21":1.024996,"22":1.024996,"23":1.024996,"24":1.024996,"25":1.024999,"26":1.025,"27":1.025002,"28":1.024999,"29":1.024994,"30":1.025005,"31":1.024995,"32":1.024997,"33":1.025004,"34":1.025001,"35":1.024994,"36":1.024999,"37":1.025004,"38":1.024997,"39":1.024995,"40":1.100005,"41":1.104998,"42":1.112003,"43":1.120995,"44":1.132001,"45":1.145004,"46":1.160002,"47":1.177,"48":1.196003,"49":1.217003,"50":1.225003,"51":1.225001,"52":1.224998,"53":1.224998,"54":1.224999,"55":1.225,"56":1.224999,"57":1.225002,"58":1.224998,"59":1.224998,"60":1.225,"61":1.224999,"62":1.225002,"63":1.225002,"64+":1.225001}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":5400,"fam":10800},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":325,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":325,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Drug tiers are numbered on the Highmark SBC, not named; 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,500 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,500 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,500 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $325 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. 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The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,500 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","No medical deductible: copays and coinsurance apply from the first visit."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/WPA/Individual/I_33709PA1630006-00_20270101_SBC.pdf"},{"market":"off","id":"33709PA1640004-00","standardId":"33709PA1640004-00","variant":"standard","issuer":"Highmark Inc.","name":"Together Blue with AHN EPO Silver 0 + Adult Dental and Vision","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Erie","Washington","Westmoreland"],"rates":{"1":{"base21":345.82,"tobaccoFactor":1.025013,"tobaccoFactorByAge":{"21":1.025013,"22":1.025013,"23":1.025013,"24":1.025013,"25":1.025,"26":1.024992,"27":1.024999,"28":1.025006,"29":1.024989,"30":1.024993,"31":1.024999,"32":1.025005,"33":1.025007,"34":1.02501,"35":1.024989,"36":1.024991,"37":1.024992,"38":1.024995,"39":1.024999,"40":1.100009,"41":1.105006,"42":1.112001,"43":1.120994,"44":1.131999,"45":1.145006,"46":1.160006,"47":1.176996,"48":1.195996,"49":1.216994,"50":1.225005,"51":1.224994,"52":1.224994,"53":1.224999,"54":1.224994,"55":1.225006,"56":1.225,"57":1.224999,"58":1.225001,"59":1.225002,"60":1.225004,"61":1.224996,"62":1.225004,"63":1.224997,"64+":1.225001}},"4":{"base21":345.82,"tobaccoFactor":1.025013,"tobaccoFactorByAge":{"21":1.025013,"22":1.025013,"23":1.025013,"24":1.025013,"25":1.025,"26":1.024992,"27":1.024999,"28":1.025006,"29":1.024989,"30":1.024993,"31":1.024999,"32":1.025005,"33":1.025007,"34":1.02501,"35":1.024989,"36":1.024991,"37":1.024992,"38":1.024995,"39":1.024999,"40":1.100009,"41":1.105006,"42":1.112001,"43":1.120994,"44":1.131999,"45":1.145006,"46":1.160006,"47":1.176996,"48":1.195996,"49":1.216994,"50":1.225005,"51":1.224994,"52":1.224994,"53":1.224999,"54":1.224994,"55":1.225006,"56":1.225,"57":1.224999,"58":1.225001,"59":1.225002,"60":1.225004,"61":1.224996,"62":1.225004,"63":1.224997,"64+":1.225001}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":10700,"fam":21400},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":1250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":800,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":2500,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":2500,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Diagnostic tests: $65 copay for blood work / lab and $175 copay for x-rays (the two are priced separately here).","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 drugs (generic): $5 copay for a 31-day retail supply ($10 for 60 days, $15 for 90 days); $10 copay for a 90-day mail-order supply.","Tier 2 drugs (preferred brand): $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $60 copay for a 90-day mail-order supply.","Tier 3 drugs (non-preferred brand): $250 copay for a 31-day retail supply ($500 for 60 days, $750 for 90 days); $500 copay for a 90-day mail-order supply.","Tier 4 drugs (specialty): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply. The 31-day retail minimum and maximum are modelled here.","Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,500 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The same applies to the delivery facility.","Pregnancy: the first visit to confirm the pregnancy is covered at no charge; preventive prenatal services have no cost sharing.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); the plan does not pay for visits above the limit. The limit and the copay do not apply to therapy for a mental health or substance use diagnosis.","No medical deductible: copays and coinsurance apply from the first visit."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/WPA/Individual/I_33709PA1640004-00_20270101_SBC.pdf"},{"market":"off","id":"33871PA0120007-00","standardId":"33871PA0120007-00","variant":"standard","issuer":"Keystone Health Plan East","name":"Keystone HMO Silver Proactive Value","metal":"Silver","network":"HMO","hsaEligible":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":407.06,"tobaccoFactor":1.124994,"tobaccoFactorByAge":{"21":1.124994,"22":1.124994,"23":1.124994,"24":1.124994,"25":1.124985,"26":1.124991,"27":1.124988,"28":1.125003,"29":1.125005,"30":1.175018,"31":1.174997,"32":1.174997,"33":1.174999,"34":1.175001,"35":1.174999,"36":1.175002,"37":1.175001,"38":1.175,"39":1.175001,"40":1.225001,"41":1.225004,"42":1.225012,"43":1.225008,"44":1.225003,"45":1.225012,"46":1.224995,"47":1.225013,"48":1.225005,"49":1.225001,"50":1.375002,"51":1.374988,"52":1.375003,"53":1.375,"54":1.37501,"55":1.375008,"56":1.375004,"57":1.374996,"58":1.374994,"59":1.374998,"60":1.375005,"61":1.375,"62":1.375004,"63":1.375004,"64+":1.374998}}},"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":{"ind":225,"fam":450,"embedded":true},"oop":{"ind":10750,"fam":21500},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":950,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":5,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":600,"ded":"after_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":80,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"copay","amount":600,"ded":"after_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prenatal care: the SBC says the office-visit cost share applies to the first OB visit only, so it is charged once here and later prenatal visits are no charge (they are part of the delivery fee); other copays or coinsurance may apply to other services such as ultrasounds.","Non-preferred brand drugs: 50% coinsurance is capped at $500 per 30-day retail fill (the cap is modelled here).","Specialty drugs: 50% coinsurance is capped at $1,000 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill; 31-90 day mail-order fills cost more per fill.","Mental health: office visits $80 copay per visit (used here); other outpatient services $80 copay per visit.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); visits above the limit are not covered. The limit does not apply to therapy prescribed for mental health or substance use treatment.","Telemedicine visits with the designated telemedicine provider are free.","This plan has three provider tiers. The rules use Tier 1 (Preferred), the tier the deductible ($1,500 individual / $3,000 family) and out-of-pocket limit describe. Tier 2 (Enhanced) and Tier 3 (Standard) providers have a higher deductible ($6,000 individual / $12,000 family) and higher cost sharing.","Primary care: Tier 1 $40 copay per visit (used here); Tier 2 $60 copay per visit; Tier 3 $70 copay per visit.","Specialist: Tier 1 $80 copay per visit (used here); Tier 2 $120 copay per visit; Tier 3 $140 copay per visit.","Emergency room: Tier 1 $950 copay per visit (used here); Tier 2 $950 copay per visit; Tier 3 $950 copay per visit.","Hospital stay facility fee: Tier 1 $600 copay per day (up to 5 days per admission) after the deductible (used here); Tier 2 $900 copay per day (up to 5 days per admission) after the deductible; Tier 3 $1,300 copay per day (up to 5 days per admission) after the deductible.","Outpatient surgery facility fee: Tier 1 $350 copay per visit after the deductible (used here); Tier 2 $950 copay per visit after the deductible; Tier 3 $1,500 copay per visit after the deductible.","Separate prescription drug deductible ($225 individual / $450 family) applies to preferred brand, non-preferred brand, specialty drugs; the other drug tiers say the deductible does not apply. The SBC diabetes example shows a $200 deductible, which fits the drug deductible rather than the medical one.","The SBC lists \"No charge\" for some services without saying whether the deductible applies. It is read as no charge after the deductible: the grid's banner says costs shown are after the deductible, and this plan's benefit chart in IBX's 2027 plan overview brochure lists these services as \"0% after ded\".","This plan is sold only off Pennie (directly by IBX). The SBC is IBX's off-exchange copy, which prints no plan ID; its title is the plan name of the filing."],"sbcUrl":"https://www.ibx.com/pdfs/custom/ffm/2027/hmosilverproactivevalue2027-off.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":351.69,"tobaccoFactor":1.124996,"tobaccoFactorByAge":{"21":1.124996,"22":1.124996,"23":1.124996,"24":1.124996,"25":1.124979,"26":1.12501,"27":1.124997,"28":1.124984,"29":1.124994,"30":1.174988,"31":1.174996,"32":1.175003,"33":1.175021,"34":1.175009,"35":1.174977,"36":1.174997,"37":1.175016,"38":1.174985,"39":1.174999,"40":1.225003,"41":1.225005,"42":1.225005,"43":1.225002,"44":1.225011,"45":1.224992,"46":1.224988,"47":1.225,"48":1.225005,"49":1.225008,"50":1.374992,"51":1.375011,"52":1.375004,"53":1.374995,"54":1.374997,"55":1.374998,"56":1.375008,"57":1.374999,"58":1.374999,"59":1.374996,"60":1.374996,"61":1.374996,"62":1.374996,"63":1.374999,"64+":1.374999}}}}},{"market":"off","id":"33871PA0120008-00","standardId":"33871PA0120008-00","variant":"standard","issuer":"Keystone Health Plan East","name":"Keystone HMO Silver Proactive Select","metal":"Silver","network":"HMO","hsaEligible":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":442.37,"tobaccoFactor":1.125008,"tobaccoFactorByAge":{"21":1.125008,"22":1.125008,"23":1.125008,"24":1.125008,"25":1.125006,"26":1.124992,"27":1.125,"28":1.124984,"29":1.125008,"30":1.175008,"31":1.174992,"32":1.175017,"33":1.174994,"34":1.174996,"35":1.174997,"36":1.174998,"37":1.175002,"38":1.175003,"39":1.175005,"40":1.224993,"41":1.224994,"42":1.224997,"43":1.224988,"44":1.225004,"45":1.225007,"46":1.224983,"47":1.225001,"48":1.225006,"49":1.225009,"50":1.375005,"51":1.374997,"52":1.374993,"53":1.37501,"54":1.374997,"55":1.374996,"56":1.375001,"57":1.374998,"58":1.374996,"59":1.375001,"60":1.374999,"61":1.375002,"62":1.375001,"63":1.374996,"64+":1.375003}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":{"ind":225,"fam":450,"embedded":true},"oop":{"ind":10500,"fam":21000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":950,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":375,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":90,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":600,"ded":"no_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":90,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"copay","amount":600,"ded":"no_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Prenatal care: the SBC says the office-visit cost share applies to the first OB visit only, so it is charged once here and later prenatal visits are no charge (they are part of the delivery fee); other copays or coinsurance may apply to other services such as ultrasounds.","Non-preferred brand drugs: 50% coinsurance is capped at $500 per 30-day retail fill (the cap is modelled here).","Specialty drugs: 50% coinsurance is capped at $1,000 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill; 31-90 day mail-order fills cost more per fill.","Mental health: office visits $90 copay per visit (used here); other outpatient services $90 copay per visit.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); visits above the limit are not covered. The limit does not apply to therapy prescribed for mental health or substance use treatment.","Telemedicine visits with the designated telemedicine provider are free.","This plan has three provider tiers. The rules use Tier 1 (Preferred), the tier the deductible ($0 individual / $0 family) and out-of-pocket limit describe. Tier 2 (Enhanced) and Tier 3 (Standard) providers have a higher deductible ($6,000 individual / $12,000 family) and higher cost sharing.","Primary care: Tier 1 $40 copay per visit (used here); Tier 2 $70 copay per visit; Tier 3 $80 copay per visit.","Specialist: Tier 1 $90 copay per visit (used here); Tier 2 $140 copay per visit; Tier 3 $150 copay per visit.","Emergency room: Tier 1 $950 copay per visit (used here); Tier 2 $950 copay per visit; Tier 3 $950 copay per visit.","Hospital stay facility fee: Tier 1 $600 copay per day (up to 5 days per admission) (used here); Tier 2 $900 copay per day (up to 5 days per admission) after the deductible; Tier 3 $1,300 copay per day (up to 5 days per admission) after the deductible.","Outpatient surgery facility fee: Tier 1 $350 copay per visit (used here); Tier 2 $950 copay per visit after the deductible; Tier 3 $1,500 copay per visit after the deductible.","Separate prescription drug deductible ($225 individual / $450 family) applies to preferred brand, non-preferred brand, specialty drugs; the other drug tiers say the deductible does not apply. The SBC diabetes example shows a $200 deductible, which fits the drug deductible rather than the medical one.","This plan is sold only off Pennie (directly by IBX). The SBC is IBX's off-exchange copy, which prints no plan ID; its title is the plan name of the filing."],"sbcUrl":"https://www.ibx.com/pdfs/custom/ffm/2027/hmosilverproactiveselect2027-off.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":380.73,"tobaccoFactor":1.124997,"tobaccoFactorByAge":{"21":1.124997,"22":1.124997,"23":1.124997,"24":1.124997,"25":1.124997,"26":1.12499,"27":1.124984,"28":1.125021,"29":1.124988,"30":1.174994,"31":1.174995,"32":1.175,"33":1.175002,"34":1.174985,"35":1.175003,"36":1.174995,"37":1.175012,"38":1.175004,"39":1.175012,"40":1.225004,"41":1.225011,"42":1.224989,"43":1.225007,"44":1.224994,"45":1.225003,"46":1.224987,"47":1.224995,"48":1.225,"49":1.224993,"50":1.375011,"51":1.374996,"52":1.37501,"53":1.375002,"54":1.374997,"55":1.374993,"56":1.375,"57":1.375,"58":1.375003,"59":1.375,"60":1.375002,"61":1.375006,"62":1.375,"63":1.375003,"64+":1.374999}}}}},{"market":"off","id":"33871PA0120009-00","standardId":"33871PA0120009-00","variant":"standard","issuer":"Keystone Health Plan East","name":"Keystone HMO Silver Essential","metal":"Silver","network":"HMO","hsaEligible":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":445.3,"tobaccoFactor":1.124994,"tobaccoFactorByAge":{"21":1.124994,"22":1.124994,"23":1.124994,"24":1.124994,"25":1.125011,"26":1.125003,"27":1.125013,"28":1.12501,"29":1.125008,"30":1.174983,"31":1.175005,"32":1.175003,"33":1.175005,"34":1.175012,"35":1.174985,"36":1.174998,"37":1.175011,"38":1.175005,"39":1.174992,"40":1.225008,"41":1.224999,"42":1.225009,"43":1.224999,"44":1.225003,"45":1.225004,"46":1.225002,"47":1.225,"48":1.224992,"49":1.225003,"50":1.374998,"51":1.375012,"52":1.374999,"53":1.375007,"54":1.374989,"55":1.374997,"56":1.37501,"57":1.374991,"58":1.375007,"59":1.374991,"60":1.375006,"61":1.375005,"62":1.374995,"63":1.374993,"64+":1.374998}}},"ded":{"ind":5000,"fam":10000,"embedded":true},"drugDed":null,"oop":{"ind":9750,"fam":19500},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":700,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":75,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":300}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":400}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":75,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}}},"notes":["Prenatal care: the SBC says the office-visit cost share applies to the first OB visit only, so it is charged once here and later prenatal visits are no charge (they are part of the delivery fee); other copays or coinsurance may apply to other services such as ultrasounds.","Outpatient surgery facility fee: $500 copay per visit after the deductible at freestanding facilities (used here); $1,000 copay per visit after the deductible at hospital-based facilities.","Preferred brand drugs: 50% coinsurance is capped at $300 per 30-day retail fill (the cap is modelled here).","Non-preferred brand drugs: 50% coinsurance is capped at $400 per 30-day retail fill (the cap is modelled here).","Specialty drugs: 50% coinsurance is capped at $1,000 per 30-day retail fill (the cap is modelled here).","Prescription drug costs shown are for a 30-day retail fill; 31-90 day mail-order fills cost more per fill.","Mental health: office visits $75 copay per visit (used here); other outpatient services $120 copay per visit.","Physical and occupational therapy: limited to 30 visits a year combined (speech therapy has its own 30-visit limit); visits above the limit are not covered. The limit does not apply to therapy prescribed for mental health or substance use treatment.","Telemedicine visits with the designated telemedicine provider are free.","This plan is sold only off Pennie (directly by IBX). The SBC is IBX's off-exchange copy, which prints no plan ID; its title is the plan name of the filing."],"sbcUrl":"https://www.ibx.com/pdfs/custom/ffm/2027/hmosilveressential2027-off.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":381.47,"tobaccoFactor":1.12499,"tobaccoFactorByAge":{"21":1.12499,"22":1.12499,"23":1.12499,"24":1.12499,"25":1.124987,"26":1.124978,"27":1.124994,"28":1.124994,"29":1.125006,"30":1.175001,"31":1.17502,"32":1.174991,"33":1.175011,"34":1.175016,"35":1.174983,"36":1.174996,"37":1.17501,"38":1.175002,"39":1.174982,"40":1.224996,"41":1.225019,"42":1.224988,"43":1.225017,"44":1.22501,"45":1.225002,"46":1.224987,"47":1.224993,"48":1.225012,"49":1.225003,"50":1.374983,"51":1.375,"52":1.375005,"53":1.374994,"54":1.374994,"55":1.374994,"56":1.375001,"57":1.375005,"58":1.374994,"59":1.374996,"60":1.374999,"61":1.374997,"62":1.375005,"63":1.375002,"64+":1.374997}}}}},{"market":"off","id":"35563PA0010001-00","standardId":"35563PA0010001-00","variant":"standard","issuer":"Ambetter Health Solutions of Pennsylvania","name":"Ambetter Health Solutions Silver 3350","metal":"Silver","network":"HMO","hsaEligible":false,"counties":["Berks","Blair","Bradford","Bucks","Cambria","Centre","Chester","Clarion","Clearfield","Clinton","Columbia","Delaware","Elk","Fayette","Huntingdon","Jefferson","Juniata","Lackawanna","Lancaster","Luzerne","Lycoming","Mifflin","Montgomery","Montour","Northumberland","Philadelphia","Snyder","Somerset","Sullivan","Susquehanna","Union","Westmoreland","Wyoming"],"rates":{"1":{"base21":398.19,"tobaccoFactor":1.150004},"2":{"base21":515.44,"tobaccoFactor":1.150008},"3":{"base21":488.72,"tobaccoFactor":1.150004},"4":{"base21":378.47,"tobaccoFactor":1.149999},"5":{"base21":466.68,"tobaccoFactor":1.149996},"6":{"base21":543.89,"tobaccoFactor":1.149994},"7":{"base21":447.5,"tobaccoFactor":1.150011},"8":{"base21":372.06,"tobaccoFactor":1.150003},"9":{"base21":594.38,"tobaccoFactor":1.150005}},"ded":{"ind":3350,"fam":6700,"embedded":true},"drugDed":null,"oop":{"ind":9700,"fam":19400},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":70,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.35,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":70,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.35,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":70,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.35,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.35,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.35,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.35,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.35,"ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.35,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.35,"ded":"after_ded"}}},"notes":["Lab tests: $35 copay / visit at a doctor's office or independent lab (used here); 35% coinsurance at a hospital, emergency room or outpatient facility.","Generic drugs: Tier 1a preferred generics $3 copay / prescription (used here); Tier 1b generics $20 copay / prescription.","Mental health: office visits $35 copay / visit (used here); other outpatient mental health services no charge.","Physical and occupational therapy: limited to 30 visits a year combined; visits above the limit are not covered (the limit does not apply to a mental health or substance use diagnosis).","Virtual 24/7 care visits with Ambetter's telehealth provider are free."],"sbcUrl":"https://api.centene.com/sbc/2027/35563PA0010001-00.pdf"},{"market":"off","id":"35563PA0010003-00","standardId":"35563PA0010003-00","variant":"standard","issuer":"Ambetter Health Solutions of Pennsylvania","name":"Ambetter Health Solutions Bronze HSA 6700","metal":"Bronze","network":"HMO","hsaEligible":true,"counties":["Berks","Blair","Bradford","Bucks","Cambria","Centre","Chester","Clarion","Clearfield","Clinton","Columbia","Delaware","Elk","Fayette","Huntingdon","Jefferson","Juniata","Lackawanna","Lancaster","Luzerne","Lycoming","Mifflin","Montgomery","Montour","Northumberland","Philadelphia","Snyder","Somerset","Sullivan","Susquehanna","Union","Westmoreland","Wyoming"],"rates":{"1":{"base21":388.69,"tobaccoFactor":1.149991},"2":{"base21":503.14,"tobaccoFactor":1.149998},"3":{"base21":477.06,"tobaccoFactor":1.150002},"4":{"base21":369.44,"tobaccoFactor":1.150011},"5":{"base21":455.54,"tobaccoFactor":1.149998},"6":{"base21":530.91,"tobaccoFactor":1.150007},"7":{"base21":436.82,"tobaccoFactor":1.149993},"8":{"base21":363.18,"tobaccoFactor":1.150008},"9":{"base21":580.2,"tobaccoFactor":1.15}},"ded":{"ind":6700,"fam":13400,"embedded":true},"drugDed":null,"oop":{"ind":8250,"fam":16500},"rules":{"pcp":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.25,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Lab tests: 20% coinsurance at a doctor's office or independent lab (used here); 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10% coinsurance at a hospital, emergency room or outpatient facility.","Generic drugs: Tier 1a preferred generics $3 copay / prescription (used here); Tier 1b generics $20 copay / prescription.","Mental health: office visits $10 copay / visit (used here); other outpatient mental health services 10% coinsurance.","Physical and occupational therapy: limited to 30 visits a year combined; visits above the limit are not covered (the limit does not apply to a mental health or substance use diagnosis).","Virtual 24/7 care visits with Ambetter's telehealth provider are free."],"sbcUrl":"https://api.centene.com/sbc/2027/35563PA0020015-00.pdf"},{"market":"off","id":"45127PA0020021-00","standardId":"45127PA0020021-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Silver PPO 3950/0/45 Rx 250","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Lehigh","Mifflin","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Union","York"],"rates":{"6":{"base21":592.17,"tobaccoFactor":1.02501,"tobaccoFactorByAge":{"21":1.02501,"22":1.02501,"23":1.02501,"24":1.02501,"25":1.024994,"26":1.025001,"27":1.024992,"28":1.024997,"29":1.025006,"30":1.024996,"31":1.025003,"32":1.024995,"33":1.025006,"34":1.024997,"35":1.025013,"36":1.025001,"37":1.025003,"38":1.024992,"39":1.024996,"40":1.075,"41":1.074993,"42":1.075004,"43":1.075002,"44":1.075007,"45":1.1,"46":1.099993,"47":1.099992,"48":1.1,"49":1.099995,"50":1.149997,"51":1.15,"52":1.150002,"53":1.150005,"54":1.149997,"55":1.200002,"56":1.200001,"57":1.200004,"58":1.199999,"59":1.200004,"60":1.25,"61":1.250006,"62":1.250001,"63":1.250004,"64+":1.250007}},"7":{"base21":660.38,"tobaccoFactor":1.025001,"tobaccoFactorByAge":{"21":1.025001,"22":1.025001,"23":1.025001,"24":1.025001,"25":1.024992,"26":1.024991,"27":1.024997,"28":1.025006,"29":1.025008,"30":1.025002,"31":1.024994,"32":1.024999,"33":1.025002,"34":1.024997,"35":1.025007,"36":1.025004,"37":1.025002,"38":1.024999,"39":1.024994,"40":1.075004,"41":1.075005,"42":1.075006,"43":1.075,"44":1.074999,"45":1.099991,"46":1.099993,"47":1.100003,"48":1.099998,"49":1.1,"50":1.150005,"51":1.15,"52":1.150001,"53":1.150003,"54":1.149995,"55":1.200001,"56":1.199999,"57":1.200001,"58":1.200001,"59":1.200005,"60":1.250003,"61":1.250003,"62":1.250003,"63":1.250001,"64+":1.250004}},"9":{"base21":659.1,"tobaccoFactor":1.025004,"tobaccoFactorByAge":{"21":1.025004,"22":1.025004,"23":1.025004,"24":1.025004,"25":1.024995,"26":1.024996,"27":1.025002,"28":1.025013,"29":1.024988,"30":1.024997,"31":1.025003,"32":1.024996,"33":1.025013,"34":1.024995,"35":1.025006,"36":1.024991,"37":1.025001,"38":1.024999,"39":1.024994,"40":1.075006,"41":1.074999,"42":1.075002,"43":1.075,"44":1.074992,"45":1.100006,"46":1.100005,"47":1.100002,"48":1.100006,"49":1.099997,"50":1.149997,"51":1.149996,"52":1.149996,"53":1.149996,"54":1.150002,"55":1.2,"56":1.199995,"57":1.200002,"58":1.200001,"59":1.200001,"60":1.250006,"61":1.25,"62":1.25,"63":1.250001,"64+":1.250003}}},"ded":{"ind":3950,"fam":7900,"embedded":true},"drugDed":{"ind":250,"fam":500,"embedded":true},"oop":{"ind":10700,"fam":21400},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":25,"ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":45,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":800}},"outpatientFacility":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $400 copay per visit, waived if you are admitted as an inpatient.","Hospital stay: $150 copay per day (no limit on days shown).","Delivery facility: $150 copay per day (no limit on days shown).","Lab tests: $25 copay per visit at an independent lab (used here); $75 copay per visit at a facility-owned lab (hospital or outpatient facility).","Mental health: office visits $45 copay per visit (used here); other outpatient mental health services no charge.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $10 copay per prescription (used here), non-preferred generics $25 copay per prescription, for a 30-day retail supply.","Generic drugs: this SBC prints each generic cost followed by a comma and nothing else (\"$10 copayment/prescription, preferred and ...\"), where most of Capital's 2027 SBCs (those dated June 2026) print \", Deductible does not apply\". This SBC does not say the deductible does not apply, so generic drugs are charged after the deductible here (the cautious reading of a silent copay). If Capital confirms the missing words, they are free of the deductible instead.","Mental health office visits: this SBC does not mark the office-visit copay \"Deductible does not apply\", as most of Capital's 2027 SBCs (those dated June 2026) do. It is charged after the deductible here (the cautious reading of a silent copay). If Capital confirms the missing words, it is free of the deductible instead.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $25 copay per prescription, non-preferred generic $63 copay per prescription; preferred brand $138 copay per prescription; non-preferred brand $200 copay per prescription.","Specialty drugs: 50% coinsurance, at most $800 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Separate prescription drug deductible ($250 individual / $500 family): the SBC exempts no drug tier from it, so every tier is charged after that drug deductible.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This plan is sold only off Pennie. Capital's SBC prints no plan ID; its title is the plan name of the filing."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Silver-PPO-3950_0_45-Rx-250.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":517.98,"tobaccoFactor":1.025001,"tobaccoFactorByAge":{"21":1.025001,"22":1.025001,"23":1.025001,"24":1.025001,"25":1.024998,"26":1.025,"27":1.024998,"28":1.025007,"29":1.025017,"30":1.025004,"31":1.025003,"32":1.024985,"33":1.024994,"34":1.024999,"35":1.024993,"36":1.025004,"37":1.025014,"38":1.024992,"39":1.024997,"40":1.075003,"41":1.075,"42":1.074994,"43":1.075005,"44":1.074999,"45":1.099992,"46":1.100005,"47":1.1,"48":1.100001,"49":1.099992,"50":1.150005,"51":1.150007,"52":1.149997,"53":1.15,"54":1.149998,"55":1.199993,"56":1.200002,"57":1.199998,"58":1.2,"59":1.200001,"60":1.249995,"61":1.250002,"62":1.250003,"63":1.250003,"64+":1.249998}},"7":{"base21":577.54,"tobaccoFactor":1.025003,"tobaccoFactorByAge":{"21":1.025003,"22":1.025003,"23":1.025003,"24":1.025003,"25":1.025006,"26":1.025008,"27":1.024997,"28":1.024992,"29":1.025005,"30":1.025003,"31":1.025009,"32":1.024999,"33":1.024989,"34":1.025002,"35":1.024994,"36":1.025001,"37":1.024993,"38":1.024999,"39":1.024998,"40":1.075003,"41":1.075004,"42":1.075009,"43":1.075,"44":1.074997,"45":1.100004,"46":1.10001,"47":1.1,"48":1.100002,"49":1.100001,"50":1.150006,"51":1.150002,"52":1.150005,"53":1.150001,"54":1.150002,"55":1.200005,"56":1.199999,"57":1.200004,"58":1.200003,"59":1.200001,"60":1.249998,"61":1.249997,"62":1.25,"63":1.249996,"64+":1.250009}},"9":{"base21":559.41,"tobaccoFactor":1.025008,"tobaccoFactorByAge":{"21":1.025008,"22":1.025008,"23":1.025008,"24":1.025008,"25":1.024998,"26":1.024998,"27":1.024988,"28":1.024997,"29":1.025001,"30":1.025011,"31":1.025002,"32":1.024993,"33":1.024993,"34":1.025003,"35":1.025,"36":1.024997,"37":1.025009,"38":1.025006,"39":1.025001,"40":1.075,"41":1.07499,"42":1.075011,"43":1.075008,"44":1.074997,"45":1.100001,"46":1.099998,"47":1.100005,"48":1.100007,"49":1.100004,"50":1.150004,"51":1.149994,"52":1.149994,"53":1.15,"54":1.149998,"55":1.200002,"56":1.200006,"57":1.200001,"58":1.199994,"59":1.200007,"60":1.249998,"61":1.250002,"62":1.25,"63":1.250002,"64+":1.250007}}}}},{"market":"off","id":"45127PA0020030-00","standardId":"45127PA0020030-00","variant":"standard","issuer":"Capital 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room: $400 copay per visit, waived if you are admitted as an inpatient.","Lab tests: $25 copay per visit at an independent lab (used here); $75 copay per visit at a facility-owned lab (hospital or outpatient facility).","Mental health: office visits $40 copay per visit (used here); other outpatient mental health services 10% coinsurance.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $10 copay per prescription (used here), non-preferred generics $25 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $25 copay per prescription, non-preferred generic $63 copay per prescription; preferred brand $138 copay per prescription; non-preferred brand $200 copay per prescription.","Specialty drugs: 50% coinsurance, at most $800 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","High-deductible plan: the deductible applies to all services, including prescriptions, before any copay or coinsurance (SBC page 1). The family deductible is an aggregate: it must be met by the family as a whole, not per person.","This plan is sold only off Pennie. Capital's SBC prints no plan ID; its title is the plan name of the filing."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Silver-PPO-3200_10_40-HSA.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":504.96,"tobaccoFactor":1.024992,"tobaccoFactorByAge":{"21":1.024992,"22":1.024992,"23":1.024992,"24":1.024992,"25":1.024991,"26":1.024986,"27":1.025,"28":1.024996,"29":1.024989,"30":1.025003,"31":1.024998,"32":1.024993,"33":1.024994,"34":1.024991,"35":1.025006,"36":1.025004,"37":1.025002,"38":1.025001,"39":1.024998,"40":1.074999,"41":1.074986,"42":1.075,"43":1.074997,"44":1.07499,"45":1.100005,"46":1.099995,"47":1.099994,"48":1.099999,"49":1.099993,"50":1.14999,"51":1.149997,"52":1.149998,"53":1.150003,"54":1.149997,"55":1.199998,"56":1.199997,"57":1.200003,"58":1.200003,"59":1.199998,"60":1.249996,"61":1.250005,"62":1.249995,"63":1.25,"64+":1.250002}},"7":{"base21":563.03,"tobaccoFactor":1.02499,"tobaccoFactorByAge":{"21":1.02499,"22":1.02499,"23":1.02499,"24":1.02499,"25":1.024996,"26":1.024994,"27":1.025015,"28":1.025,"29":1.024999,"30":1.024991,"31":1.024994,"32":1.024998,"33":1.024996,"34":1.024988,"35":1.024999,"36":1.024995,"37":1.025006,"38":1.025002,"39":1.025009,"40":1.075005,"41":1.075001,"42":1.074999,"43":1.074997,"44":1.074998,"45":1.099999,"46":1.100007,"47":1.099999,"48":1.100005,"49":1.099997,"50":1.149995,"51":1.150002,"52":1.150005,"53":1.149994,"54":1.15,"55":1.2,"56":1.199992,"57":1.2,"58":1.2,"59":1.200005,"60":1.249997,"61":1.250002,"62":1.250003,"63":1.250003,"64+":1.250006}},"9":{"base21":545.35,"tobaccoFactor":1.025011,"tobaccoFactorByAge":{"21":1.025011,"22":1.025011,"23":1.025011,"24":1.025011,"25":1.024984,"26":1.024998,"27":1.025003,"28":1.025,"29":1.025006,"30":1.024993,"31":1.024997,"32":1.025002,"33":1.024995,"34":1.024998,"35":1.024999,"36":1.025,"37":1.025002,"38":1.025003,"39":1.024991,"40":1.075011,"41":1.075009,"42":1.074993,"43":1.074995,"44":1.075001,"45":1.100001,"46":1.100009,"47":1.100001,"48":1.099993,"49":1.099991,"50":1.15,"51":1.149997,"52":1.15,"53":1.150002,"54":1.15,"55":1.200002,"56":1.200006,"57":1.200003,"58":1.200006,"59":1.199999,"60":1.250005,"61":1.249998,"62":1.250006,"63":1.249998,"64+":1.250011}}}}},{"market":"off","id":"45127PA0020044-00","standardId":"45127PA0020044-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Gold PPO 2000/0/10 + 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room: $175 copay per visit, waived if you are admitted as an inpatient.","Lab tests: $10 copay per visit at an independent lab (used here); $20 copay per visit at a facility-owned lab (hospital or outpatient facility).","Mental health: office visits $10 copay per visit (used here); other outpatient mental health services no charge.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $10 copay per prescription (used here), non-preferred generics $20 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $25 copay per prescription, non-preferred generic $50 copay per prescription; preferred brand $113 copay per prescription; non-preferred brand $188 copay per prescription.","Specialty drugs: 50% coinsurance, at most $800 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","High-deductible plan: the deductible applies to all services, including prescriptions, before any copay or coinsurance (SBC page 1). The family deductible is an aggregate: it must be met by the family as a whole, not per person.","This plan is sold only off Pennie. Capital's SBC prints no plan ID; its title is the plan name of the filing."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Gold-PPO-2000_0_10-HSA.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":633.35,"tobaccoFactor":1.02501,"tobaccoFactorByAge":{"21":1.02501,"22":1.02501,"23":1.02501,"24":1.02501,"25":1.024989,"26":1.02501,"27":1.025009,"28":1.025013,"29":1.025003,"30":1.025012,"31":1.024998,"32":1.024998,"33":1.025001,"34":1.024997,"35":1.025001,"36":1.025006,"37":1.024997,"38":1.025001,"39":1.024997,"40":1.075004,"41":1.075004,"42":1.075001,"43":1.075001,"44":1.075001,"45":1.100004,"46":1.099997,"47":1.099997,"48":1.099997,"49":1.1,"50":1.149995,"51":1.15,"52":1.150004,"53":1.149995,"54":1.149999,"55":1.199996,"56":1.199999,"57":1.200003,"58":1.200002,"59":1.199998,"60":1.25,"61":1.25,"62":1.250003,"63":1.249997,"64+":1.250004}},"7":{"base21":706.19,"tobaccoFactor":1.024993,"tobaccoFactorByAge":{"21":1.024993,"22":1.024993,"23":1.024993,"24":1.024993,"25":1.025007,"26":1.024988,"27":1.025011,"28":1.024999,"29":1.025006,"30":1.025002,"31":1.024998,"32":1.025005,"33":1.025,"34":1.024997,"35":1.025007,"36":1.025005,"37":1.025004,"38":1.025003,"39":1.025,"40":1.075002,"41":1.075001,"42":1.075003,"43":1.074997,"44":1.07501,"45":1.099996,"46":1.100002,"47":1.100003,"48":1.099998,"49":1.099995,"50":1.150002,"51":1.150003,"52":1.149999,"53":1.150005,"54":1.150002,"55":1.2,"56":1.199995,"57":1.200002,"58":1.199998,"59":1.199999,"60":1.250001,"61":1.250001,"62":1.25,"63":1.249996,"64+":1.25}},"9":{"base21":684.02,"tobaccoFactor":1.024999,"tobaccoFactorByAge":{"21":1.024999,"22":1.024999,"23":1.024999,"24":1.024999,"25":1.025001,"26":1.024999,"27":1.024998,"28":1.025002,"29":1.024993,"30":1.025001,"31":1.025001,"32":1.025,"33":1.024992,"34":1.025,"35":1.025004,"36":1.024996,"37":1.024999,"38":1.025003,"39":1.024999,"40":1.074996,"41":1.075006,"42":1.074995,"43":1.074993,"44":1.075002,"45":1.099997,"46":1.099997,"47":1.100007,"48":1.100003,"49":1.099997,"50":1.150001,"51":1.149996,"52":1.149999,"53":1.15,"54":1.150002,"55":1.199997,"56":1.199997,"57":1.199999,"58":1.200002,"59":1.199999,"60":1.250001,"61":1.249997,"62":1.250001,"63":1.250001,"64+":1.250009}}}}},{"market":"off","id":"45127PA0020053-00","standardId":"45127PA0020053-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Silver Advance PPO 4450/20/35","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Lancaster"],"rates":{"7":{"base21":631.29,"tobaccoFactor":1.024996,"tobaccoFactorByAge":{"21":1.024996,"22":1.024996,"23":1.024996,"24":1.024996,"25":1.025007,"26":1.024998,"27":1.025,"28":1.024992,"29":1.025,"30":1.024996,"31":1.024998,"32":1.025,"33":1.025004,"34":1.025001,"35":1.025006,"36":1.024997,"37":1.025002,"38":1.025007,"39":1.025004,"40":1.075002,"41":1.074993,"42":1.075007,"43":1.075001,"44":1.074996,"45":1.100002,"46":1.099997,"47":1.1,"48":1.100005,"49":1.100003,"50":1.149998,"51":1.149998,"52":1.15,"53":1.150005,"54":1.15,"55":1.199997,"56":1.200001,"57":1.199993,"58":1.199998,"59":1.200001,"60":1.250001,"61":1.249994,"62":1.249999,"63":1.25,"64+":1.249997}}},"ded":{"ind":4450,"fam":8900,"embedded":true},"drugDed":null,"oop":{"ind":10000,"fam":20000},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":800}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Emergency room: $400 copay per visit, waived if you are admitted as an inpatient.","Lab tests: 20% coinsurance at independent and facility-owned labs.","Mental health: office visits $35 copay per visit (used here); other outpatient mental health services 20% coinsurance.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $10 copay per prescription (used here), non-preferred generics $20 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $25 copay per prescription, non-preferred generic $50 copay per prescription; preferred brand $125 copay per prescription; non-preferred brand $250 copay per prescription.","Specialty drugs: 50% coinsurance, at most $800 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $60 copay per visit; specialist $85 copay per visit; prenatal visits $85 copay per visit; rehabilitation $85 copay per visit.","This plan is sold only off Pennie. Capital's SBC prints no plan ID; its title is the plan name of the filing."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Silver-Advance-PPO-4450_20_35.pdf","prev":{"planYear":2026,"rates":{"7":{"base21":545.5,"tobaccoFactor":1.025005,"tobaccoFactorByAge":{"21":1.025005,"22":1.025005,"23":1.025005,"24":1.025005,"25":1.024996,"26":1.025009,"27":1.024997,"28":1.024993,"29":1.025,"30":1.025002,"31":1.025007,"32":1.025011,"33":1.024988,"34":1.024991,"35":1.024992,"36":1.025009,"37":1.024995,"38":1.024997,"39":1.024999,"40":1.074991,"41":1.075003,"42":1.074987,"43":1.075003,"44":1.075007,"45":1.1,"46":1.099994,"47":1.100011,"48":1.100001,"49":1.099998,"50":1.150001,"51":1.150007,"52":1.150008,"53":1.149997,"54":1.150003,"55":1.199998,"56":1.2,"57":1.200003,"58":1.200003,"59":1.200003,"60":1.25,"61":1.249998,"62":1.249997,"63":1.250002,"64+":1.250005}}}}},{"market":"off","id":"45127PA0020055-00","standardId":"45127PA0020055-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Gold Advance PPO 2000/0/10 + HSA","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Lancaster"],"rates":{"7":{"base21":756.79,"tobaccoFactor":1.025,"tobaccoFactorByAge":{"21":1.025,"22":1.025,"23":1.025,"24":1.025,"25":1.025006,"26":1.024995,"27":1.025003,"28":1.024993,"29":1.024999,"30":1.025007,"31":1.024991,"32":1.024998,"33":1.025005,"34":1.025002,"35":1.025,"36":1.024999,"37":1.025008,"38":1.024996,"39":1.024993,"40":1.075002,"41":1.074999,"42":1.075004,"43":1.074998,"44":1.074998,"45":1.1,"46":1.100002,"47":1.099995,"48":1.099996,"49":1.100002,"50":1.150005,"51":1.149999,"52":1.150002,"53":1.149995,"54":1.149999,"55":1.199995,"56":1.199995,"57":1.200001,"58":1.200001,"59":1.199998,"60":1.25,"61":1.250004,"62":1.249999,"63":1.25,"64+":1.25}}},"ded":{"ind":2000,"fam":4000,"embedded":false},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":175,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":10,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":800}},"outpatientFacility":{"base":{"kind":"copay","amount":175,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":20,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $175 copay per visit, waived if you are admitted as an inpatient.","Lab tests: no charge at independent and facility-owned labs.","Mental health: office visits $10 copay per visit (used here); other outpatient mental health services no charge.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $10 copay per prescription (used here), non-preferred generics $20 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $25 copay per prescription, non-preferred generic $50 copay per prescription; preferred brand $113 copay per prescription; non-preferred brand $188 copay per prescription.","Specialty drugs: 50% coinsurance, at most $800 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","High-deductible plan: the deductible applies to all services, including prescriptions, before any copay or coinsurance (SBC page 1). The family deductible is an aggregate: it must be met by the family as a whole, not per person.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $20 copay per visit; specialist $40 copay per visit; imaging 30% coinsurance; outpatient surgery facility $350 copay; outpatient surgeon 30% coinsurance; hospital stay facility 30% coinsurance; hospital stay physician 30% coinsurance; prenatal visits $40 copay per visit; delivery professional 30% coinsurance; delivery facility 30% coinsurance; rehabilitation $40 copay per visit; lab tests 30% coinsurance.","This plan is sold only off Pennie. Capital's SBC prints no plan ID; its title is the plan name of the filing."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Gold-Advance-PPO-2000_0_10-HSA.pdf","prev":{"planYear":2026,"rates":{"7":{"base21":691.88,"tobaccoFactor":1.02499,"tobaccoFactorByAge":{"21":1.02499,"22":1.02499,"23":1.02499,"24":1.02499,"25":1.025006,"26":1.024997,"27":1.02499,"28":1.024998,"29":1.024993,"30":1.024997,"31":1.025004,"32":1.024997,"33":1.024998,"34":1.02499,"35":1.025004,"36":1.024994,"37":1.025008,"38":1.024998,"39":1.025001,"40":1.074993,"41":1.074998,"42":1.075006,"43":1.075005,"44":1.074999,"45":1.099993,"46":1.099999,"47":1.1,"48":1.099998,"49":1.099997,"50":1.149997,"51":1.149998,"52":1.149999,"53":1.149997,"54":1.150005,"55":1.200003,"56":1.200001,"57":1.2,"58":1.2,"59":1.2,"60":1.250001,"61":1.249999,"62":1.25,"63":1.249998,"64+":1.249996}}}}},{"market":"off","id":"45127PA0020056-00","standardId":"45127PA0020056-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Silver Advance PPO 3300/10/50 + HSA","metal":"Silver","network":"PPO","hsaEligible":true,"counties":["Lancaster"],"rates":{"7":{"base21":621.11,"tobaccoFactor":1.025004,"tobaccoFactorByAge":{"21":1.025004,"22":1.025004,"23":1.025004,"24":1.025004,"25":1.025,"26":1.024999,"27":1.024995,"28":1.025002,"29":1.024992,"30":1.025009,"31":1.025005,"32":1.025001,"33":1.02501,"34":1.024999,"35":1.025007,"36":1.025001,"37":1.024995,"38":1.02499,"39":1.025005,"40":1.075008,"41":1.074998,"42":1.075009,"43":1.074996,"44":1.075004,"45":1.100001,"46":1.100003,"47":1.1,"48":1.099998,"49":1.099998,"50":1.149994,"51":1.149994,"52":1.149999,"53":1.15,"54":1.149998,"55":1.200003,"56":1.199999,"57":1.2,"58":1.2,"59":1.199999,"60":1.250003,"61":1.249999,"62":1.249997,"63":1.249999,"64+":1.250004}}},"ded":{"ind":3300,"fam":6600,"embedded":false},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":75,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":800}},"outpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["Emergency room: $400 copay per visit, waived if you are admitted as an inpatient.","Lab tests: 10% coinsurance at independent and facility-owned labs.","Mental health: office visits $50 copay per visit (used here); other outpatient mental health services 10% coinsurance.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $10 copay per prescription (used here), non-preferred generics $20 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $25 copay per prescription, non-preferred generic $50 copay per prescription; preferred brand $125 copay per prescription; non-preferred brand $250 copay per prescription.","Specialty drugs: 50% coinsurance, at most $800 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","High-deductible plan: the deductible applies to all services, including prescriptions, before any copay or coinsurance (SBC page 1). The family deductible is an aggregate: it must be met by the family as a whole, not per person.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $70 copay per visit; specialist $95 copay per visit; imaging 30% coinsurance; outpatient surgery facility 30% coinsurance; outpatient surgeon 30% coinsurance; hospital stay facility 30% coinsurance; hospital stay physician 30% coinsurance; prenatal visits $95 copay per visit; delivery professional 30% coinsurance; delivery facility 30% coinsurance; rehabilitation $95 copay per visit; lab tests 30% coinsurance.","This plan is sold only off Pennie. Capital's SBC prints no plan ID; its title is the plan name of the filing."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Silver-Advance-PPO-3300_10_50-HSA.pdf","prev":{"planYear":2026,"rates":{"7":{"base21":536.83,"tobaccoFactor":1.025017,"tobaccoFactorByAge":{"21":1.025017,"22":1.025017,"23":1.025017,"24":1.025017,"25":1.02501,"26":1.024995,"27":1.025009,"28":1.025003,"29":1.025003,"30":1.024995,"31":1.025008,"32":1.024989,"33":1.025003,"34":1.024995,"35":1.025,"36":1.024988,"37":1.025008,"38":1.024996,"39":1.024989,"40":1.075007,"41":1.074997,"42":1.074988,"43":1.075005,"44":1.074991,"45":1.100001,"46":1.100006,"47":1.100004,"48":1.100009,"49":1.099996,"50":1.149991,"51":1.15,"52":1.150005,"53":1.149999,"54":1.149999,"55":1.200002,"56":1.200003,"57":1.199997,"58":1.200007,"59":1.200003,"60":1.249998,"61":1.250003,"62":1.249998,"63":1.249997,"64+":1.250011}}}}},{"market":"off","id":"45127PA0020061-00","standardId":"45127PA0020061-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Silver Capital Advantage PPO 4450/20/35","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Cumberland","Dauphin","Perry"],"rates":{"9":{"base21":528.72,"tobaccoFactor":1.024985,"tobaccoFactorByAge":{"21":1.024985,"22":1.024985,"23":1.024985,"24":1.024985,"25":1.024999,"26":1.025009,"27":1.025014,"28":1.025004,"29":1.024999,"30":1.024996,"31":1.025001,"32":1.025005,"33":1.025008,"34":1.025005,"35":1.024997,"36":1.025003,"37":1.024994,"38":1.025001,"39":1.024999,"40":1.075004,"41":1.075001,"42":1.074998,"43":1.075,"44":1.074991,"45":1.100005,"46":1.100004,"47":1.100002,"48":1.099994,"49":1.100001,"50":1.149996,"51":1.150003,"52":1.150002,"53":1.150003,"54":1.149999,"55":1.200003,"56":1.200002,"57":1.199995,"58":1.199997,"59":1.199993,"60":1.250005,"61":1.249998,"62":1.25,"63":1.249998,"64+":1.249995}}},"ded":{"ind":4450,"fam":8900,"embedded":true},"drugDed":null,"oop":{"ind":10000,"fam":20000},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":800}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Emergency room: $400 copay per visit, waived if you are admitted as an inpatient.","Lab tests: 20% coinsurance at independent and facility-owned labs.","Mental health: office visits $35 copay per visit (used here); other outpatient mental health services 20% coinsurance.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $10 copay per prescription (used here), non-preferred generics $20 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $25 copay per prescription, non-preferred generic $50 copay per prescription; preferred brand $125 copay per prescription; non-preferred brand $250 copay per prescription.","Specialty drugs: 50% coinsurance, at most $800 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","Non-preferred in-network outpatient surgery: no charge at an acute care hospital (the SBC says the deductible does not apply there) and 20% coinsurance at an ambulatory surgical center (not marked).","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $60 copay per visit; specialist $85 copay per visit; prenatal visits $85 copay per visit; rehabilitation $85 copay per visit.","This plan is sold only off Pennie. Capital's SBC prints no plan ID; its title is the plan name of the filing."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Silver-Capital-Advantage-PPO-4450_20_35.pdf","prev":{"planYear":2026,"rates":{"9":{"base21":446.83,"tobaccoFactor":1.024998,"tobaccoFactorByAge":{"21":1.024998,"22":1.024998,"23":1.024998,"24":1.024998,"25":1.024988,"26":1.025003,"27":1.024985,"28":1.025015,"29":1.025,"30":1.025002,"31":1.024986,"32":1.024991,"33":1.024995,"34":1.024998,"35":1.024999,"36":1.025,"37":1.024983,"38":1.025002,"39":1.025004,"40":1.075002,"41":1.075012,"42":1.074994,"43":1.07499,"44":1.075006,"45":1.099997,"46":1.100009,"47":1.100001,"48":1.09999,"49":1.100001,"50":1.149992,"51":1.149999,"52":1.149998,"53":1.150001,"54":1.150003,"55":1.200004,"56":1.2,"57":1.200006,"58":1.200005,"59":1.2,"60":1.249996,"61":1.250002,"62":1.250004,"63":1.25,"64+":1.250007}}}}},{"market":"off","id":"45127PA0020066-00","standardId":"45127PA0020066-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Silver Convenience PPO 4450/20/35","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Adams","Franklin","Lebanon","Lehigh","Northampton","York"],"rates":{"6":{"base21":496.45,"tobaccoFactor":1.024997,"tobaccoFactorByAge":{"21":1.024997,"22":1.024997,"23":1.024997,"24":1.024997,"25":1.024998,"26":1.025002,"27":1.024987,"28":1.024998,"29":1.024985,"30":1.025006,"31":1.02501,"32":1.024996,"33":1.024985,"34":1.025005,"35":1.025006,"36":1.025007,"37":1.025008,"38":1.025009,"39":1.024995,"40":1.075009,"41":1.074987,"42":1.075009,"43":1.075006,"44":1.074992,"45":1.100004,"46":1.100004,"47":1.099994,"48":1.100001,"49":1.099995,"50":1.150001,"51":1.149998,"52":1.149999,"53":1.150007,"54":1.149992,"55":1.200004,"56":1.200007,"57":1.200002,"58":1.2,"59":1.200008,"60":1.25,"61":1.249996,"62":1.249996,"63":1.249993,"64+":1.250003}},"7":{"base21":553.63,"tobaccoFactor":1.024999,"tobaccoFactorByAge":{"21":1.024999,"22":1.024999,"23":1.024999,"24":1.024999,"25":1.025007,"26":1.024995,"27":1.025009,"28":1.025009,"29":1.025004,"30":1.025001,"31":1.025014,"32":1.02501,"33":1.024998,"34":1.025011,"35":1.02501,"36":1.025009,"37":1.025008,"38":1.025007,"39":1.025004,"40":1.074992,"41":1.075012,"42":1.07499,"43":1.075006,"44":1.074992,"45":1.099995,"46":1.100007,"47":1.099998,"48":1.100002,"49":1.100001,"50":1.150003,"51":1.149992,"52":1.149998,"53":1.15,"54":1.15,"55":1.200002,"56":1.200006,"57":1.200001,"58":1.200001,"59":1.200001,"60":1.249995,"61":1.250005,"62":1.250005,"63":1.250002,"64+":1.250006}},"9":{"base21":552.56,"tobaccoFactor":1.024993,"tobaccoFactorByAge":{"21":1.024993,"22":1.024993,"23":1.024993,"24":1.024993,"25":1.025001,"26":1.025008,"27":1.025005,"28":1.025007,"29":1.025004,"30":1.025002,"31":1.024999,"32":1.024997,"33":1.025001,"34":1.025,"35":1.024999,"36":1.024998,"37":1.024997,"38":1.024997,"39":1.024995,"40":1.074996,"41":1.075004,"42":1.074999,"43":1.075005,"44":1.074994,"45":1.1,"46":1.099995,"47":1.100006,"48":1.100008,"49":1.099993,"50":1.149999,"51":1.150002,"52":1.15,"53":1.149997,"54":1.150003,"55":1.199998,"56":1.199997,"57":1.199994,"58":1.200004,"59":1.199999,"60":1.249998,"61":1.249998,"62":1.250003,"63":1.250002,"64+":1.250008}}},"ded":{"ind":4450,"fam":8900,"embedded":true},"drugDed":null,"oop":{"ind":10000,"fam":20000},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":800}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Emergency room: $400 copay per visit, waived if you are admitted as an inpatient.","Lab tests: 20% coinsurance at independent and facility-owned labs.","Mental health: office visits $35 copay per visit (used here); other outpatient mental health services 20% coinsurance.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $10 copay per prescription (used here), non-preferred generics $20 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $25 copay per prescription, non-preferred generic $50 copay per prescription; preferred brand $125 copay per prescription; non-preferred brand $250 copay per prescription.","Specialty drugs: 50% coinsurance, at most $800 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $60 copay per visit; specialist $85 copay per visit; prenatal visits $85 copay per visit; rehabilitation $85 copay per visit.","This plan is sold only off Pennie. Capital's SBC prints no plan ID; its title is the plan name of the filing."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Silver-Convenience-PPO-4450_20_35.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":432.61,"tobaccoFactor":1.024988,"tobaccoFactorByAge":{"21":1.024988,"22":1.024988,"23":1.024988,"24":1.024988,"25":1.02498,"26":1.024989,"27":1.024991,"28":1.025009,"29":1.024995,"30":1.024989,"31":1.024991,"32":1.025011,"33":1.025007,"34":1.025001,"35":1.025008,"36":1.025014,"37":1.024983,"38":1.024989,"39":1.025002,"40":1.074991,"41":1.075011,"42":1.075,"43":1.074985,"44":1.075006,"45":1.100003,"46":1.099998,"47":1.100006,"48":1.099999,"49":1.100011,"50":1.150007,"51":1.149998,"52":1.149991,"53":1.150004,"54":1.149998,"55":1.199998,"56":1.199996,"57":1.199998,"58":1.199995,"59":1.200005,"60":1.249998,"61":1.250004,"62":1.250002,"63":1.249998,"64+":1.249996}},"7":{"base21":482.35,"tobaccoFactor":1.025003,"tobaccoFactorByAge":{"21":1.025003,"22":1.025003,"23":1.025003,"24":1.025003,"25":1.025006,"26":1.025004,"27":1.025004,"28":1.025004,"29":1.025012,"30":1.025006,"31":1.025007,"32":1.02499,"33":1.025006,"34":1.025001,"35":1.02499,"36":1.024996,"37":1.024985,"38":1.025008,"39":1.025003,"40":1.074994,"41":1.074996,"42":1.074994,"43":1.074997,"44":1.075002,"45":1.099997,"46":1.10001,"47":1.099997,"48":1.099994,"49":1.1,"50":1.149996,"51":1.150002,"52":1.149996,"53":1.15,"54":1.149996,"55":1.2,"56":1.200004,"57":1.2,"58":1.200002,"59":1.199997,"60":1.250002,"61":1.249996,"62":1.249998,"63":1.250002,"64+":1.250012}},"9":{"base21":467.21,"tobaccoFactor":1.024999,"tobaccoFactorByAge":{"21":1.024999,"22":1.024999,"23":1.024999,"24":1.024999,"25":1.025006,"26":1.024998,"27":1.024998,"28":1.025007,"29":1.025,"30":1.024986,"31":1.025005,"32":1.025004,"33":1.024995,"34":1.025,"35":1.025012,"36":1.025006,"37":1.025,"38":1.024994,"39":1.024999,"40":1.074996,"41":1.075011,"42":1.075001,"43":1.074999,"44":1.074996,"45":1.099991,"46":1.099997,"47":1.100007,"48":1.100001,"49":1.099991,"50":1.150005,"51":1.150009,"52":1.15,"53":1.149992,"54":1.150005,"55":1.199992,"56":1.199998,"57":1.2,"58":1.199998,"59":1.199998,"60":1.249996,"61":1.250002,"62":1.250004,"63":1.250005,"64+":1.250009}}}}},{"market":"off","id":"45127PA0020068-00","standardId":"45127PA0020068-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Gold PPO 0/10/40","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Lehigh","Mifflin","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Union","York"],"rates":{"6":{"base21":664.42,"tobaccoFactor":1.024999,"tobaccoFactorByAge":{"21":1.024999,"22":1.024999,"23":1.024999,"24":1.024999,"25":1.025004,"26":1.025001,"27":1.025003,"28":1.024992,"29":1.02499,"30":1.024996,"31":1.025011,"32":1.025,"33":1.025001,"34":1.024993,"35":1.025002,"36":1.024999,"37":1.025008,"38":1.025004,"39":1.024997,"40":1.074994,"41":1.074999,"42":1.074992,"43":1.074998,"44":1.074995,"45":1.100008,"46":1.099997,"47":1.100001,"48":1.099997,"49":1.1,"50":1.149992,"51":1.150007,"52":1.149998,"53":1.149998,"54":1.149999,"55":1.199999,"56":1.200001,"57":1.200001,"58":1.200001,"59":1.199995,"60":1.25,"61":1.250003,"62":1.25,"63":1.249999,"64+":1.250009}},"7":{"base21":740.95,"tobaccoFactor":1.024995,"tobaccoFactorByAge":{"21":1.024995,"22":1.024995,"23":1.024995,"24":1.024995,"25":1.025003,"26":1.025002,"27":1.025009,"28":1.024993,"29":1.025002,"30":1.024995,"31":1.025001,"32":1.024996,"33":1.02501,"34":1.025003,"35":1.024993,"36":1.024995,"37":1.024998,"38":1.024999,"39":1.024993,"40":1.075,"41":1.075007,"42":1.074998,"43":1.075,"44":1.075007,"45":1.099997,"46":1.099998,"47":1.1,"48":1.099996,"49":1.099995,"50":1.15,"51":1.15,"52":1.15,"53":1.15,"54":1.150001,"55":1.199999,"56":1.200002,"57":1.200001,"58":1.200002,"59":1.199996,"60":1.249999,"61":1.250002,"62":1.250002,"63":1.25,"64+":1.25}},"9":{"base21":739.52,"tobaccoFactor":1.024989,"tobaccoFactorByAge":{"21":1.024989,"22":1.024989,"23":1.024989,"24":1.024989,"25":1.025011,"26":1.024998,"27":1.025006,"28":1.025005,"29":1.025002,"30":1.025007,"31":1.025003,"32":1.024999,"33":1.025002,"34":1.025006,"35":1.024998,"36":1.025,"37":1.025002,"38":1.024993,"39":1.024998,"40":1.075008,"41":1.074996,"42":1.075001,"43":1.075006,"44":1.075007,"45":1.100004,"46":1.099993,"47":1.100003,"48":1.099999,"49":1.099998,"50":1.149995,"51":1.15,"52":1.149999,"53":1.150006,"54":1.15,"55":1.200004,"56":1.200001,"57":1.2,"58":1.200001,"59":1.199999,"60":1.249999,"61":1.25,"62":1.250001,"63":1.250003,"64+":1.250001}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":9000,"fam":18000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":800}},"outpatientFacility":{"base":{"kind":"copay","amount":2000,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":4000,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"prenatal":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":4000,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}}},"notes":["Emergency room: $500 copay per visit, waived if you are admitted as an inpatient.","Outpatient surgery facility: $2,000 copay per admission at an acute care hospital or an ambulatory surgical center (one charge per surgery here).","Hospital stay: $4,000 copay per admission; the stay's remaining days cost nothing more.","Delivery facility: $4,000 copay per admission; the stay's remaining days cost nothing more.","Lab tests: $40 copay per visit at an independent lab (used here); $150 copay per visit at a facility-owned lab (hospital or outpatient facility).","X-rays: $80 copay (the SBC's outpatient radiology value, used here); other diagnostic tests 10% coinsurance.","Mental health: office visits $40 copay per visit (used here); other outpatient mental health services 10% coinsurance.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $10 copay per prescription (used here), non-preferred generics $20 copay per prescription, for a 30-day retail supply.","Generic drugs: this SBC prints each generic cost followed by a comma and nothing else; the plan has no deductible for them, so it makes no difference.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $25 copay per prescription, non-preferred generic $50 copay per prescription; preferred brand $225 copay per prescription; non-preferred brand $313 copay per prescription.","Specialty drugs: 50% coinsurance, at most $800 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","This plan is sold only off Pennie. Capital's SBC prints no plan ID; its title is the plan name of the filing."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Gold-PPO-0_10_40.pdf"},{"market":"off","id":"45127PA0020070-00","standardId":"45127PA0020070-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Gold Capital Advantage PPO 2000/0/10 + HSA","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Cumberland","Dauphin","Perry"],"rates":{"9":{"base21":628.32,"tobaccoFactor":1.025003,"tobaccoFactorByAge":{"21":1.025003,"22":1.025003,"23":1.025003,"24":1.025003,"25":1.024999,"26":1.025008,"27":1.024997,"28":1.025008,"29":1.025004,"30":1.025002,"31":1.025006,"32":1.02501,"33":1.025002,"34":1.025001,"35":1.024993,"36":1.024999,"37":1.025004,"38":1.024997,"39":1.024996,"40":1.075007,"41":1.075006,"42":1.075001,"43":1.075003,"44":1.075009,"45":1.100001,"46":1.100002,"47":1.100004,"48":1.1,"49":1.100008,"50":1.150003,"51":1.149997,"52":1.149998,"53":1.150004,"54":1.150001,"55":1.200007,"56":1.200004,"57":1.199997,"58":1.199999,"59":1.199998,"60":1.250003,"61":1.250003,"62":1.250006,"63":1.25,"64+":1.250007}}},"ded":{"ind":2000,"fam":4000,"embedded":false},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":175,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":10,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":800}},"outpatientFacility":{"base":{"kind":"copay","amount":175,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":20,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $175 copay per visit, waived if you are admitted as an inpatient.","Lab tests: no charge at independent and facility-owned labs.","Mental health: office visits $10 copay per visit (used here); other outpatient mental health services no charge.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $10 copay per prescription (used here), non-preferred generics $20 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $25 copay per prescription, non-preferred generic $50 copay per prescription; preferred brand $113 copay per prescription; non-preferred brand $188 copay per prescription.","Specialty drugs: 50% coinsurance, at most $800 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","High-deductible plan: the deductible applies to all services, including prescriptions, before any copay or coinsurance (SBC page 1). The family deductible is an aggregate: it must be met by the family as a whole, not per person.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $20 copay per visit; specialist $40 copay per visit; imaging 30% coinsurance; outpatient surgery facility $350 copay; outpatient surgeon 30% coinsurance; hospital stay facility 30% coinsurance; hospital stay physician 30% coinsurance; prenatal visits $40 copay per visit; delivery professional 30% coinsurance; delivery facility 30% coinsurance; rehabilitation $40 copay per visit; lab tests 30% coinsurance.","This plan is sold only off Pennie. Capital's SBC prints no plan ID; its title is the plan name of the filing."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Gold-Capital-Advantage-PPO-2000_0_10-HSA.pdf"},{"market":"off","id":"45127PA0020072-00","standardId":"45127PA0020072-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Gold Convenience PPO 2000/0/10 + HSA","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Adams","Franklin","Lebanon","Lehigh","Northampton","York"],"rates":{"6":{"base21":590.31,"tobaccoFactor":1.024987,"tobaccoFactorByAge":{"21":1.024987,"22":1.024987,"23":1.024987,"24":1.024987,"25":1.024989,"26":1.024997,"27":1.025006,"28":1.024998,"29":1.025009,"30":1.025,"31":1.025009,"32":1.025003,"33":1.025,"34":1.025006,"35":1.025009,"36":1.024997,"37":1.025,"38":1.025003,"39":1.024994,"40":1.074999,"41":1.074995,"42":1.075011,"43":1.075002,"44":1.075001,"45":1.1,"46":1.099993,"47":1.099995,"48":1.099995,"49":1.100004,"50":1.149997,"51":1.150002,"52":1.149998,"53":1.150006,"54":1.150004,"55":1.200003,"56":1.200003,"57":1.200004,"58":1.2,"59":1.200005,"60":1.249998,"61":1.25,"62":1.249996,"63":1.250003,"64+":1.249994}},"7":{"base21":658.3,"tobaccoFactor":1.024989,"tobaccoFactorByAge":{"21":1.024989,"22":1.024989,"23":1.024989,"24":1.024989,"25":1.024995,"26":1.025011,"27":1.025004,"28":1.025001,"29":1.025006,"30":1.025001,"31":1.025008,"32":1.025001,"33":1.024992,"34":1.025001,"35":1.024999,"36":1.025009,"37":1.024995,"38":1.024993,"39":1.025001,"40":1.075003,"41":1.074997,"42":1.075002,"43":1.074991,"44":1.074997,"45":1.100002,"46":1.100006,"47":1.099998,"48":1.099999,"49":1.100004,"50":1.149993,"51":1.150002,"52":1.150001,"53":1.150001,"54":1.150001,"55":1.2,"56":1.2,"57":1.199998,"58":1.199995,"59":1.200001,"60":1.250004,"61":1.249999,"62":1.25,"63":1.249999,"64+":1.249999}},"9":{"base21":657.02,"tobaccoFactor":1.025007,"tobaccoFactorByAge":{"21":1.025007,"22":1.025007,"23":1.025007,"24":1.025007,"25":1.024998,"26":1.025,"27":1.025009,"28":1.024993,"29":1.025,"30":1.025009,"31":1.025004,"32":1.024998,"33":1.02499,"34":1.024999,"35":1.02501,"36":1.024996,"37":1.024994,"38":1.025005,"39":1.025001,"40":1.074993,"41":1.07499,"42":1.074998,"43":1.075002,"44":1.075001,"45":1.100006,"46":1.099996,"47":1.099997,"48":1.100007,"49":1.100002,"50":1.149994,"51":1.149998,"52":1.150003,"53":1.15,"54":1.149998,"55":1.200005,"56":1.200001,"57":1.199998,"58":1.2,"59":1.200002,"60":1.25,"61":1.25,"62":1.250001,"63":1.249997,"64+":1.250008}}},"ded":{"ind":2000,"fam":4000,"embedded":false},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":175,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":10,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":800}},"outpatientFacility":{"base":{"kind":"copay","amount":175,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":20,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $175 copay per visit, waived if you are admitted as an inpatient.","Lab tests: no charge at independent and facility-owned labs.","Mental health: office visits $10 copay per visit (used here); other outpatient mental health services no charge.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $10 copay per prescription (used here), non-preferred generics $20 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $25 copay per prescription, non-preferred generic $50 copay per prescription; preferred brand $113 copay per prescription; non-preferred brand $188 copay per prescription.","Specialty drugs: 50% coinsurance, at most $800 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","High-deductible plan: the deductible applies to all services, including prescriptions, before any copay or coinsurance (SBC page 1). The family deductible is an aggregate: it must be met by the family as a whole, not per person.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $20 copay per visit; specialist $40 copay per visit; imaging 30% coinsurance; outpatient surgery facility $350 copay; outpatient surgeon 30% coinsurance; hospital stay facility 30% coinsurance; hospital stay physician 30% coinsurance; prenatal visits $40 copay per visit; delivery professional 30% coinsurance; delivery facility 30% coinsurance; rehabilitation $40 copay per visit; lab tests 30% coinsurance.","This plan is sold only off Pennie. Capital's SBC prints no plan ID; its title is the plan name of the filing."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Gold-Convenience-PPO-2000_0_10-HSA.pdf"},{"market":"off","id":"52899PA0030132-00","standardId":"52899PA0030132-00","variant":"standard","issuer":"UPMC Health Plan","name":"Silver $3,500/$50 - Standard Network","metal":"Silver","network":"HMO","hsaEligible":false,"counties":["Clearfield","Crawford"],"rates":{"1":{"base21":514.35,"tobaccoFactor":1.025002},"5":{"base21":554.73,"tobaccoFactor":1.025003}},"ded":{"ind":3500,"fam":7000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":50,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Off-Pennie plan. UPMC publishes no SBC for this plan; its cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134925869, \"2027 IND HMO Standard.xlsx\", variant 00 in-network column), checked against the Department's rate decision (upmchp-rate-change-decision-indv-mkt.pdf, rate pages: metal, deductible, out-of-pocket maximum, coinsurance, primary care and specialist copays) and the filing's plan overview. UPMC's matrices agree with its published 2027 SBCs of the Pennie plans they hold.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as UPMC's SBCs of the same designs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $50 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $60 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: 30% coinsurance after the deductible (its other imaging row, used here). Other diagnostic testing: 30% coinsurance after the deductible.","Mental health: office visits, psychotherapy and counseling $50 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) 30% coinsurance after the deductible.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134925869/2027 IND HMO Standard.xlsx","prev":{"planYear":2026,"rates":{"1":{"base21":454.22,"tobaccoFactor":1.02501},"5":{"base21":489.88,"tobaccoFactor":1.025006}}}},{"market":"off","id":"52899PA0030134-00","standardId":"52899PA0030134-00","variant":"standard","issuer":"UPMC Health Plan","name":"UPMC Advantage Silver HSA $4,000/30% - Standard Network","metal":"Silver","network":"HMO","hsaEligible":true,"counties":["Clearfield","Crawford"],"rates":{"1":{"base21":472.87,"tobaccoFactor":1.024996},"5":{"base21":510,"tobaccoFactor":1.025}},"ded":{"ind":4000,"fam":8000,"embedded":true},"drugDed":null,"oop":{"ind":7100,"fam":14200},"rules":{"pcp":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Off-Pennie plan. UPMC publishes no SBC for this plan; its cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134925916, \"2027 IND HMO HSA.xlsx\", variant 00 in-network column), checked against the Department's rate decision (upmchp-rate-change-decision-indv-mkt.pdf, rate pages: metal, deductible, out-of-pocket maximum, coinsurance, primary care and specialist copays) and the filing's plan overview. UPMC's matrices agree with its published 2027 SBCs of the Pennie plans they hold.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as UPMC's SBCs of the same designs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at 30% coinsurance after the deductible; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: 30% coinsurance after the deductible (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: 30% coinsurance after the deductible (its other imaging row, used here). Other diagnostic testing: 30% coinsurance after the deductible.","Mental health: office visits, psychotherapy and counseling 30% coinsurance after the deductible (used here); other outpatient services (intensive outpatient, partial hospitalization) 30% coinsurance after the deductible.","Specialty drugs: 50% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Prescription drugs: the medical deductible applies (no separate drug deductible).","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134925916/2027 IND HMO HSA.xlsx","prev":{"planYear":2026,"rates":{"1":{"base21":417.92,"tobaccoFactor":1.025005},"5":{"base21":450.73,"tobaccoFactor":1.025004}}}},{"market":"off","id":"53789PA0100008-00","standardId":"53789PA0100008-00","variant":"standard","issuer":"Keystone Health Plan Central","name":"Bronze HMO 7450/0/60 + HSA","metal":"Bronze","network":"HMO","hsaEligible":true,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Lehigh","Mifflin","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Union","York"],"rates":{"6":{"base21":482.37,"tobaccoFactor":1.025002,"tobaccoFactorByAge":{"21":1.025002,"22":1.025002,"23":1.025002,"24":1.025002,"25":1.025005,"26":1.025003,"27":1.025003,"28":1.025003,"29":1.024992,"30":1.025005,"31":1.025006,"32":1.024989,"33":1.025005,"34":1.025,"35":1.025006,"36":1.024995,"37":1.025001,"38":1.02499,"39":1.024985,"40":1.075008,"41":1.074994,"42":1.07499,"43":1.07501,"44":1.074999,"45":1.099993,"46":1.100006,"47":1.100007,"48":1.100003,"49":1.099996,"50":1.150002,"51":1.149995,"52":1.150002,"53":1.150004,"54":1.15,"55":1.200002,"56":1.199995,"57":1.199991,"58":1.200002,"59":1.199997,"60":1.25,"61":1.250002,"62":1.250004,"63":1.249998,"64+":1.250009}},"7":{"base21":537.93,"tobaccoFactor":1.025003,"tobaccoFactorByAge":{"21":1.025003,"22":1.025003,"23":1.025003,"24":1.025003,"25":1.025015,"26":1.024998,"27":1.025011,"28":1.025003,"29":1.025002,"30":1.02501,"31":1.025006,"32":1.025001,"33":1.024998,"34":1.025006,"35":1.02501,"36":1.024998,"37":1.025002,"38":1.025005,"39":1.024997,"40":1.074999,"41":1.075001,"42":1.075004,"43":1.075003,"44":1.074998,"45":1.100004,"46":1.1,"47":1.100001,"48":1.099998,"49":1.099999,"50":1.149997,"51":1.150004,"52":1.150004,"53":1.150003,"54":1.149997,"55":1.200002,"56":1.2,"57":1.200002,"58":1.2,"59":1.200001,"60":1.250002,"61":1.250002,"62":1.25,"63":1.249997,"64+":1.250008}},"9":{"base21":536.89,"tobaccoFactor":1.025014,"tobaccoFactorByAge":{"21":1.025014,"22":1.025014,"23":1.025014,"24":1.025014,"25":1.025007,"26":1.024992,"27":1.024988,"28":1.025,"29":1.025001,"30":1.025009,"31":1.025006,"32":1.024986,"33":1.025,"34":1.024993,"35":1.025012,"36":1.025001,"37":1.025005,"38":1.024994,"39":1.025001,"40":1.074998,"41":1.074989,"42":1.075009,"43":1.074996,"44":1.074996,"45":1.09999,"46":1.100007,"47":1.099992,"48":1.099998,"49":1.100007,"50":1.150007,"51":1.149994,"52":1.149997,"53":1.150001,"54":1.15,"55":1.200005,"56":1.200005,"57":1.199998,"58":1.199999,"59":1.199994,"60":1.249998,"61":1.250002,"62":1.249997,"63":1.250002,"64+":1.250008}}},"ded":{"ind":7450,"fam":14900,"embedded":true},"drugDed":null,"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":85,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":800}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $400 copay per visit, waived if you are admitted as an inpatient.","Lab tests: $25 copay per visit at an independent lab (used here); $75 copay per visit at a facility-owned lab (hospital or outpatient facility).","Mental health: office visits $60 copay per visit (used here); other outpatient mental health services no charge.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $10 copay per prescription (used here), non-preferred generics $30 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $25 copay per prescription, non-preferred generic $75 copay per prescription; preferred brand no charge; non-preferred brand no charge.","Specialty drugs: 50% coinsurance, at most $800 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This plan is sold only off Pennie. Capital's SBC prints no plan ID; its title is the plan name of the filing.","The SBC title, Table 10, the rate exhibits and the plan design (Keystone Health Plan Central 2027 decision pp. 46-71) say Bronze HMO 7450/0/60 + HSA; only the decision's plan list (p. 72) says 7450/0/50. This SBC is followed."],"sbcUrl":"https://www.capbluecross.com/pdf/benefits-summary/ia/2027/2027-Bronze-HMO-7450_0_60-HSA.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":363.65,"tobaccoFactor":1.024997,"tobaccoFactorByAge":{"21":1.024997,"22":1.024997,"23":1.024997,"24":1.024997,"25":1.024979,"26":1.025001,"27":1.02498,"28":1.024994,"29":1.024992,"30":1.025004,"31":1.025008,"32":1.024988,"33":1.02502,"34":1.025007,"35":1.025001,"36":1.024995,"37":1.025011,"38":1.025005,"39":1.024993,"40":1.074987,"41":1.074999,"42":1.075004,"43":1.074998,"44":1.074997,"45":1.099998,"46":1.099985,"47":1.100002,"48":1.100005,"49":1.100002,"50":1.149997,"51":1.149998,"52":1.149989,"53":1.150003,"54":1.15,"55":1.200002,"56":1.2,"57":1.199995,"58":1.200004,"59":1.200004,"60":1.250003,"61":1.250005,"62":1.249998,"63":1.249995,"64+":1.250014}},"7":{"base21":405.47,"tobaccoFactor":1.025008,"tobaccoFactorByAge":{"21":1.025008,"22":1.025008,"23":1.025008,"24":1.025008,"25":1.025007,"26":1.025,"27":1.025016,"28":1.025003,"29":1.025015,"30":1.02501,"31":1.025003,"32":1.024996,"33":1.025013,"34":1.025008,"35":1.024985,"36":1.025004,"37":1.025001,"38":1.024999,"39":1.025015,"40":1.075011,"41":1.075011,"42":1.074993,"43":1.075006,"44":1.075012,"45":1.1,"46":1.099998,"47":1.100008,"48":1.099992,"49":1.10001,"50":1.150006,"51":1.15,"52":1.149997,"53":1.150007,"54":1.149998,"55":1.2,"56":1.200008,"57":1.200004,"58":1.200002,"59":1.200002,"60":1.249998,"61":1.250007,"62":1.25,"63":1.250002,"64+":1.250016}},"9":{"base21":392.74,"tobaccoFactor":1.025004,"tobaccoFactorByAge":{"21":1.025004,"22":1.025004,"23":1.025004,"24":1.025004,"25":1.025006,"26":1.024989,"27":1.025,"28":1.025017,"29":1.025007,"30":1.025013,"31":1.025001,"32":1.024988,"33":1.024994,"34":1.025001,"35":1.025004,"36":1.025007,"37":1.024989,"38":1.024992,"39":1.024998,"40":1.074991,"41":1.074998,"42":1.074982,"43":1.074998,"44":1.075001,"45":1.099996,"46":1.099997,"47":1.09999,"48":1.099994,"49":1.099997,"50":1.150006,"51":1.149999,"52":1.149992,"53":1.15,"54":1.149992,"55":1.199995,"56":1.200007,"57":1.199996,"58":1.199998,"59":1.199998,"60":1.249993,"61":1.249998,"62":1.250002,"63":1.249996,"64+":1.250013}}}}},{"market":"off","id":"75729PA0012630-00","standardId":"75729PA0012630-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger Marketplace All-Access PPO 30/50/5500","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Centre","Clinton","Columbia","Juniata","Lackawanna","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northumberland","Pike","Schuylkill","Snyder","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming"],"rates":{"3":{"base21":496.49,"tobaccoFactor":1.100002},"6":{"base21":522.62,"tobaccoFactor":1.099996},"9":{"base21":627.14,"tobaccoFactor":1.10001}},"ded":{"ind":5500,"fam":11000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794597, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"PPO 30 50 5500 Off Exchng Only\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 75729PA0012631, 75729PA0012635, 75729PA0012640 (they differ only in service area).","This plan is sold only off Pennie.","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family; it applies to preferred brand drugs, non-preferred brand drugs, specialty drugs (the filed summary says \"after deductible\" there).","Costs and limits here are for in-network (preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794597/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"3":{"base21":452.15,"tobaccoFactor":1.099989},"6":{"base21":475.95,"tobaccoFactor":1.099989},"9":{"base21":571.13,"tobaccoFactor":1.100012}}}},{"market":"off","id":"75729PA0012631-00","standardId":"75729PA0012631-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger Marketplace All-Access PPO 30/50/5500","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bedford","Blair","Cambria","Cameron","Clearfield","Elk","Huntingdon","Jefferson","Potter","Somerset"],"rates":{"2":{"base21":522.62,"tobaccoFactor":1.099996},"5":{"base21":496.49,"tobaccoFactor":1.100002}},"ded":{"ind":5500,"fam":11000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794597, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"PPO 30 50 5500 Off Exchng Only\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 75729PA0012630, 75729PA0012635, 75729PA0012640 (they differ only in service area).","This plan is sold only off Pennie.","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family; it applies to preferred brand drugs, non-preferred brand drugs, specialty drugs (the filed summary says \"after deductible\" there).","Costs and limits here are for in-network (preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794597/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"2":{"base21":475.95,"tobaccoFactor":1.099989},"5":{"base21":452.15,"tobaccoFactor":1.099989}}}},{"market":"off","id":"75729PA0012635-00","standardId":"75729PA0012635-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger Marketplace All-Access PPO 30/50/5500","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Cumberland","Dauphin","Franklin","Fulton","Lancaster","Lebanon","Perry","York"],"rates":{"7":{"base21":653.27,"tobaccoFactor":1.100005},"9":{"base21":627.14,"tobaccoFactor":1.10001}},"ded":{"ind":5500,"fam":11000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794597, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"PPO 30 50 5500 Off Exchng Only\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 75729PA0012631, 75729PA0012630, 75729PA0012640 (they differ only in service area).","This plan is sold only off Pennie.","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family; it applies to preferred brand drugs, non-preferred brand drugs, specialty drugs (the filed summary says \"after deductible\" there).","Costs and limits here are for in-network (preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794597/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"7":{"base21":594.93,"tobaccoFactor":1.099995},"9":{"base21":571.13,"tobaccoFactor":1.100012}}}},{"market":"off","id":"75729PA0012640-00","standardId":"75729PA0012640-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger Marketplace All-Access PPO 30/50/5500","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Lehigh","Northampton"],"rates":{"6":{"base21":522.62,"tobaccoFactor":1.099996}},"ded":{"ind":5500,"fam":11000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Geisinger has not published its 2027 SBCs yet, and its filings hold no SBC of this plan. This plan's cost sharing comes from the 2027 benefit summary Geisinger filed with the PA Insurance Department (SERFF form filing GSHP-134794597, \"PY2027_Individual_6.3.2026.xlsx\", sheet \"PPO 30 50 5500 Off Exchng Only\", in-network column; each rule's page is the sheet row), checked against the rate decision's rate pages (deductible, drug deductible, coinsurance, primary care and specialist copays, out-of-pocket maximum).","The filed summary writes \"after deductible\" on every cost the deductible applies to; costs without it are charged from the first dollar (each of the six sample SBCs in Geisinger's filings prints \"Deductible does not apply.\" on exactly those costs).","The summary lists this plan in one design with 75729PA0012631, 75729PA0012630, 75729PA0012635 (they differ only in service area).","This plan is sold only off Pennie.","Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill; a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family; it applies to preferred brand drugs, non-preferred brand drugs, specialty drugs (the filed summary says \"after deductible\" there).","Costs and limits here are for in-network (preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#GSHP-134794597/PY2027_Individual_6.3.2026.xlsx","prev":{"planYear":2026,"rates":{"6":{"base21":475.95,"tobaccoFactor":1.099989}}}},{"market":"off","id":"79962PA0270004-00","standardId":"79962PA0270004-00","variant":"standard","issuer":"Highmark Benefits Group","name":"my Priority Blue Flex PPO Silver 0","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":567.55,"tobaccoFactor":1.025002,"tobaccoFactorByAge":{"21":1.025002,"22":1.025002,"23":1.025002,"24":1.025002,"25":1.025008,"26":1.025001,"27":1.025,"28":1.024995,"29":1.025004,"30":1.024993,"31":1.024993,"32":1.025007,"33":1.025003,"34":1.025007,"35":1.025002,"36":1.024997,"37":1.025006,"38":1.025001,"39":1.025005,"40":1.099996,"41":1.105,"42":1.111995,"43":1.120999,"44":1.132001,"45":1.144996,"46":1.159997,"47":1.176996,"48":1.196004,"49":1.217002,"50":1.225001,"51":1.225002,"52":1.225001,"53":1.225004,"54":1.225002,"55":1.225001,"56":1.225,"57":1.224999,"58":1.225002,"59":1.225001,"60":1.224997,"61":1.224997,"62":1.225001,"63":1.225002,"64+":1.225002}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":10700,"fam":21400},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":1250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":800,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":2500,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":2500,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: pcp $70 copay; specialist $70 copay; lab and x-ray $80 copay (blood work/lab) $225 copay (x-ray); imaging $1,000 copay; outpatient surgery facility fee $1,250 copay; outpatient surgeon fees $1,250 copay; hospital facility fee $3,000 copay; prenatal office visits 50% coinsurance; delivery facility fee $3,000 copay; rehabilitation $70 copay. Deductible and out-of-pocket limits are the same in both and are shared.","Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $1,000 per 31-day retail prescription (60-day: $500 min / $2,000 max; 90-day: $750 min / $3,000 max; mail order: $500 min / $2,000 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 1 $5/$10/$15, mail order $10; Tier 2 $30/$60/$90, mail order $60; Tier 3 $250/$500/$750, mail order $500.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (30% coinsurance) is for the other prenatal visits.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,500 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/NEPA/Individual/I_79962PA0270004-00_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":455,"tobaccoFactor":1.025011,"tobaccoFactorByAge":{"21":1.025011,"22":1.025011,"23":1.025011,"24":1.025011,"25":1.024999,"26":1.025004,"27":1.024998,"28":1.02499,"29":1.025002,"30":1.024999,"31":1.024993,"32":1.025006,"33":1.025005,"34":1.025001,"35":1.025,"36":1.024998,"37":1.024996,"38":1.024994,"39":1.025008,"40":1.100002,"41":1.104995,"42":1.111996,"43":1.121,"44":1.131993,"45":1.145003,"46":1.16,"47":1.177004,"48":1.196,"49":1.216998,"50":1.224998,"51":1.224999,"52":1.225005,"53":1.225005,"54":1.224998,"55":1.225004,"56":1.224998,"57":1.225001,"58":1.224999,"59":1.224997,"60":1.225003,"61":1.224997,"62":1.224997,"63":1.224999,"64+":1.225004}}}}},{"market":"off","id":"79962PA0280002-00","standardId":"79962PA0280002-00","variant":"standard","issuer":"Highmark Benefits Group","name":"my Priority Blue Flex PPO Silver 0 + Adult Dental and Vision","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":584.22,"tobaccoFactor":1.025008,"tobaccoFactorByAge":{"21":1.025008,"22":1.025008,"23":1.025008,"24":1.025008,"25":1.024993,"26":1.025007,"27":1.025006,"28":1.025006,"29":1.024995,"30":1.025004,"31":1.025003,"32":1.025003,"33":1.025004,"34":1.024999,"35":1.025003,"36":1.024993,"37":1.024998,"38":1.025002,"39":1.024997,"40":1.099996,"41":1.105002,"42":1.112002,"43":1.121003,"44":1.131996,"45":1.144996,"46":1.159997,"47":1.177005,"48":1.196001,"49":1.217,"50":1.225,"51":1.224997,"52":1.225,"53":1.225002,"54":1.224996,"55":1.224998,"56":1.224998,"57":1.224999,"58":1.224998,"59":1.224999,"60":1.224998,"61":1.224998,"62":1.224998,"63":1.225,"64+":1.225001}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":10700,"fam":21400},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":1250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":800,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":2500,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":2500,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: pcp $70 copay; specialist $70 copay; lab and x-ray $80 copay (blood work/lab) $225 copay (x-ray); imaging $1,000 copay; outpatient surgery facility fee $1,250 copay; outpatient surgeon fees $1,250 copay; hospital facility fee $3,000 copay; prenatal office visits 50% coinsurance; delivery facility fee $3,000 copay; rehabilitation $70 copay. Deductible and out-of-pocket limits are the same in both and are shared.","Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $1,000 per 31-day retail prescription (60-day: $500 min / $2,000 max; 90-day: $750 min / $3,000 max; mail order: $500 min / $2,000 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 1 $5/$10/$15, mail order $10; Tier 2 $30/$60/$90, mail order $60; Tier 3 $250/$500/$750, mail order $500.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (30% coinsurance) is for the other prenatal visits.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,500 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/NEPA/Individual/I_79962PA0280002-00_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":471.41,"tobaccoFactor":1.02501,"tobaccoFactorByAge":{"21":1.02501,"22":1.02501,"23":1.02501,"24":1.02501,"25":1.024995,"26":1.025004,"27":1.024998,"28":1.024999,"29":1.025004,"30":1.025007,"31":1.025002,"32":1.024996,"33":1.025002,"34":1.025005,"35":1.024997,"36":1.025007,"37":1.025,"38":1.024992,"39":1.024995,"40":1.100007,"41":1.105005,"42":1.112004,"43":1.120994,"44":1.132,"45":1.144994,"46":1.160001,"47":1.177006,"48":1.196001,"49":1.217003,"50":1.225004,"51":1.225005,"52":1.224997,"53":1.225002,"54":1.224997,"55":1.225001,"56":1.225005,"57":1.225003,"58":1.225001,"59":1.224998,"60":1.225002,"61":1.225001,"62":1.224999,"63":1.225,"64+":1.224999}}}}},{"market":"off","id":"79962PA0330006-00","standardId":"79962PA0330006-00","variant":"standard","issuer":"Highmark Benefits Group","name":"my Blue Access PPO Silver 0","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":596.52,"tobaccoFactor":1.024995,"tobaccoFactorByAge":{"21":1.024995,"22":1.024995,"23":1.024995,"24":1.024995,"25":1.024995,"26":1.024998,"27":1.025002,"28":1.024999,"29":1.025003,"30":1.025006,"31":1.024994,"32":1.024997,"33":1.025006,"34":1.024994,"35":1.024995,"36":1.024996,"37":1.024997,"38":1.024998,"39":1.025,"40":1.100007,"41":1.105,"42":1.111995,"43":1.121004,"44":1.131999,"45":1.145002,"46":1.159995,"47":1.177002,"48":1.195999,"49":1.216998,"50":1.225,"51":1.224996,"52":1.224998,"53":1.224998,"54":1.224997,"55":1.224997,"56":1.225001,"57":1.225002,"58":1.224997,"59":1.225002,"60":1.225002,"61":1.225,"62":1.225003,"63":1.225,"64+":1.224999}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":10700,"fam":21400},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":1250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":800,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":2500,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":2500,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $1,000 per 31-day retail prescription (60-day: $500 min / $2,000 max; 90-day: $750 min / $3,000 max; mail order: $500 min / $2,000 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 1 $5/$10/$15, mail order $10; Tier 2 $30/$60/$90, mail order $60; Tier 3 $250/$500/$750, mail order $500.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (30% coinsurance) is for the other prenatal visits.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,500 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/SEPA/Individual/I_79962PA0330006-00_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":449.47,"tobaccoFactor":1.025007,"tobaccoFactorByAge":{"21":1.025007,"22":1.025007,"23":1.025007,"24":1.025007,"25":1.024996,"26":1.025008,"27":1.025008,"28":1.024991,"29":1.024992,"30":1.024993,"31":1.024993,"32":1.024994,"33":1.024997,"34":1.024997,"35":1.024998,"36":1.024998,"37":1.024998,"38":1.024998,"39":1.024999,"40":1.099997,"41":1.105005,"42":1.111997,"43":1.120997,"44":1.131993,"45":1.145001,"46":1.159995,"47":1.177006,"48":1.196005,"49":1.217006,"50":1.225002,"51":1.225002,"52":1.225002,"53":1.225003,"54":1.224995,"55":1.224998,"56":1.225003,"57":1.225004,"58":1.224999,"59":1.224997,"60":1.225001,"61":1.225002,"62":1.225001,"63":1.225001,"64+":1.224998}}}}},{"market":"off","id":"79962PA0330009-00","standardId":"79962PA0330009-00","variant":"standard","issuer":"Highmark Benefits Group","name":"my Blue Access PPO Platinum 0","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":806.08,"tobaccoFactor":1.024998,"tobaccoFactorByAge":{"21":1.024998,"22":1.024998,"23":1.024998,"24":1.024998,"25":1.024997,"26":1.025005,"27":1.025001,"28":1.025005,"29":1.025,"30":1.024997,"31":1.025004,"32":1.025,"33":1.024998,"34":1.024995,"35":1.025004,"36":1.025003,"37":1.025002,"38":1.025,"39":1.024998,"40":1.100003,"41":1.105,"42":1.111997,"43":1.121004,"44":1.131997,"45":1.145002,"46":1.160001,"47":1.176998,"48":1.196003,"49":1.216999,"50":1.224998,"51":1.224999,"52":1.225,"53":1.225,"54":1.225,"55":1.224999,"56":1.225,"57":1.224998,"58":1.225002,"59":1.224999,"60":1.224999,"61":1.224999,"62":1.225,"63":1.225001,"64+":1.224998}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":5400,"fam":10800},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":325,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":325,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $1,000 per 31-day retail prescription (60-day: $500 min / $2,000 max; 90-day: $750 min / $3,000 max; mail order: $500 min / $2,000 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 2 $10/$20/$30, mail order $20; Tier 3 $50/$100/$150, mail order $100.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (10% coinsurance) is for the other prenatal visits.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $325 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/SEPA/Individual/I_79962PA0330009-00_20270101_SBC.pdf"},{"market":"off","id":"79962PA0340003-00","standardId":"79962PA0340003-00","variant":"standard","issuer":"Highmark Benefits Group","name":"my Blue Access PPO Silver 0 + Adult Dental and Vision","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":614.58,"tobaccoFactor":1.024993,"tobaccoFactorByAge":{"21":1.024993,"22":1.024993,"23":1.024993,"24":1.024993,"25":1.025006,"26":1.024995,"27":1.024997,"28":1.024998,"29":1.024996,"30":1.025002,"31":1.025004,"32":1.025005,"33":1.025004,"34":1.024997,"35":1.025006,"36":1.025002,"37":1.024998,"38":1.024994,"39":1.025,"40":1.099996,"41":1.105001,"42":1.111995,"43":1.120997,"44":1.131999,"45":1.145,"46":1.160001,"47":1.176995,"48":1.196001,"49":1.217002,"50":1.225001,"51":1.224998,"52":1.224997,"53":1.224999,"54":1.225001,"55":1.224997,"56":1.225,"57":1.225001,"58":1.225001,"59":1.224998,"60":1.224998,"61":1.225001,"62":1.225,"63":1.224998,"64+":1.224999}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":10700,"fam":21400},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":1250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":800,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":1000,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":2500,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":2500,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $1,000 per 31-day retail prescription (60-day: $500 min / $2,000 max; 90-day: $750 min / $3,000 max; mail order: $500 min / $2,000 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 1 $5/$10/$15, mail order $10; Tier 2 $30/$60/$90, mail order $60; Tier 3 $250/$500/$750, mail order $500.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (30% coinsurance) is for the other prenatal visits.","The emergency room copay is waived if you are admitted as an inpatient.","Hospital stay: the SBC lists a $2,500 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/SEPA/Individual/I_79962PA0340003-00_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":465.87,"tobaccoFactor":1.025007,"tobaccoFactorByAge":{"21":1.025007,"22":1.025007,"23":1.025007,"24":1.025007,"25":1.024993,"26":1.025008,"27":1.025009,"28":1.025,"29":1.024995,"30":1.025002,"31":1.025003,"32":1.025004,"33":1.024995,"34":1.025001,"35":1.024996,"36":1.025008,"37":1.025002,"38":1.024997,"39":1.025003,"40":1.100003,"41":1.105002,"42":1.112008,"43":1.120992,"44":1.132003,"45":1.144993,"46":1.160001,"47":1.176996,"48":1.195996,"49":1.217006,"50":1.225001,"51":1.224999,"52":1.224999,"53":1.224997,"54":1.224998,"55":1.225,"56":1.225004,"57":1.225001,"58":1.224997,"59":1.225001,"60":1.224997,"61":1.225004,"62":1.225001,"63":1.224999,"64+":1.224998}}}}},{"market":"off","id":"79962PA0340007-00","standardId":"79962PA0340007-00","variant":"standard","issuer":"Highmark Benefits Group","name":"my Blue Access PPO Platinum 0 + Adult Dental and Vision","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Bucks","Chester","Delaware","Montgomery","Philadelphia"],"rates":{"8":{"base21":824.13,"tobaccoFactor":1.024996,"tobaccoFactorByAge":{"21":1.024996,"22":1.024996,"23":1.024996,"24":1.024996,"25":1.025005,"26":1.025003,"27":1.024997,"28":1.025005,"29":1.025005,"30":1.024995,"31":1.025001,"32":1.024996,"33":1.024997,"34":1.024998,"35":1.025003,"36":1.024998,"37":1.025003,"38":1.024998,"39":1.024999,"40":1.099996,"41":1.105003,"42":1.111999,"43":1.121001,"44":1.131997,"45":1.145004,"46":1.159998,"47":1.177002,"48":1.196,"49":1.217003,"50":1.225002,"51":1.225003,"52":1.225002,"53":1.225002,"54":1.224999,"55":1.225001,"56":1.225001,"57":1.225,"58":1.224999,"59":1.224999,"60":1.225002,"61":1.225001,"62":1.225,"63":1.225001,"64+":1.225001}}},"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":5400,"fam":10800},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":325,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":325,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Tier 4 (specialty) drugs: 50% coinsurance with a minimum of $250 and a maximum of $1,000 per 31-day retail prescription (60-day: $500 min / $2,000 max; 90-day: $750 min / $3,000 max; mail order: $500 min / $2,000 max). The 31-day retail minimum and maximum are modelled here.","Prescription copays used are the 31-day retail supply (the first amount); the SBC lists 31/60/90-day retail amounts and a 90-day mail-order copay: Tier 2 $10/$20/$30, mail order $20; Tier 3 $50/$100/$150, mail order $100.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The limit and copay do not apply to therapy for a mental health or substance abuse diagnosis.","Prenatal office visits: the first visit to confirm the pregnancy is covered at no charge; the amount used here (10% coinsurance) is for the other prenatal visits.","Hospital stay: the SBC lists a $325 copay per visit, treated here as one copay per admission (charged on the first hospital day of each stay, so a second admission is charged again). The delivery facility copay is likewise charged once per birth."],"sbcUrl":"https://shop.highmark.com/content/sbcs/2027/SEPA/Individual/I_79962PA0340007-00_20270101_SBC.pdf"},{"market":"off","id":"93909PA0010022-00","standardId":"93909PA0010022-00","variant":"standard","issuer":"Jefferson Health Plans (Health Partners Plans)","name":"Jefferson Health Plans + Direct + Bronze + HMO","metal":"Bronze","network":"HMO","hsaEligible":false,"counties":["Bucks","Carbon","Delaware","Lehigh","Monroe","Montgomery","Northampton","Philadelphia","Schuylkill"],"rates":{"3":{"base21":348.87,"tobaccoFactor":1.100009},"6":{"base21":371.71,"tobaccoFactor":1.099997},"8":{"base21":289.46,"tobaccoFactor":1.100014}},"ded":{"ind":6500,"fam":13000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":95,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":750,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":850,"ded":"after_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":850,"ded":"after_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 visits per benefit period combined; visits above the limit are priced in full here.","The SBC has no separate drug deductible, so drug tiers marked as subject to the Rx deductible are charged after the plan deductible: preferred brand drugs, non-preferred brand drugs, specialty drugs.","These prices are for In-Network Tier 1 (Enhanced) providers, the \"you pay the least\" column and the one the CMS data uses. In-Network Tier 2 (Standard) providers have a $9,500 individual / $19,000 family deductible and higher prices, for example primary care visit $95 copay; specialist visit $150 copay; emergency room 50% coinsurance after the deductible; hospital stay $1000 copay after the deductible (up to 5 days). Out-of-network care is not covered.","Lab work: $50 copay. X-rays: $200 copay.","Mental health: the outpatient services price (an office visit) is used.","Hospital stay and delivery facility fees are a copay per day for up to 5 days per admission.","Visits with Jefferson designated telemedicine providers are covered in full (the prices above are for in-person visits).","Page 1 of the SBC lists emergency room care and imaging among the services covered before you meet your deductible, but the chart cell says the deductible applies. The chart cell is followed here (the higher cost); the SBC contradicts itself on this point.","Imaging: the SBC cell says \"Subject to Rx deductible and $400/Scan\" although this plan has no separate drug deductible; it is read as after the plan deductible (the higher cost)."],"sbcUrl":"https://www.jeffersonhealthplans.com/content/dam/jeffersonhealthplans/documents/sbc/2027/jefferson-health-plans-direct-bronze-hmo-off-exchange-pa.pdf"},{"market":"off","id":"93909PA0010023-00","standardId":"93909PA0010023-00","variant":"standard","issuer":"Jefferson Health Plans (Health Partners Plans)","name":"Jefferson Health Plans + Direct + Silver + HMO","metal":"Silver","network":"HMO","hsaEligible":false,"counties":["Bucks","Carbon","Delaware","Lehigh","Monroe","Montgomery","Northampton","Philadelphia","Schuylkill"],"rates":{"3":{"base21":376.29,"tobaccoFactor":1.100003},"6":{"base21":400.92,"tobaccoFactor":1.099995},"8":{"base21":312.21,"tobaccoFactor":1.099997}},"ded":{"ind":4500,"fam":9000,"embedded":true},"drugDed":{"ind":225,"fam":450,"embedded":true},"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":950,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 visits per benefit period combined; visits above the limit are priced in full here.","Separate prescription drug deductible: $225 individual / $450 family. It applies to preferred brand drugs, non-preferred brand drugs, specialty drugs; the other drug tiers are charged their copay from the first fill.","These prices are for In-Network Tier 1 (Enhanced) providers, the \"you pay the least\" column and the one the CMS data uses. In-Network Tier 2 (Standard) providers have a $8,000 individual / $16,000 family deductible and higher prices, for example primary care visit $75 copay; specialist visit $125 copay; emergency room $950 copay; hospital stay $800 copay after the deductible (up to 5 days). Out-of-network care is not covered.","Lab work: $25 copay. X-rays: $100 copay after the deductible.","Mental health: the outpatient services price (an office visit) is used.","Hospital stay and delivery facility fees are a copay per day for up to 5 days per admission.","Visits with Jefferson designated telemedicine providers are covered in full (the prices above are for in-person visits).","Page 1 of the SBC lists x-rays and imaging among the services covered before you meet your deductible, but the chart cell says the deductible applies. The chart cell is followed here (the higher cost); the SBC contradicts itself on this point.","Lab work and x-rays: the SBC cell reads \"Subject to deductible and $100/Visit for x-ray, $25/Visit for lab work, Deductible does not apply.\"; the opening \"Subject to deductible\" is read as the x-ray's and the closing \"Deductible does not apply\" as the lab work's.","The SBC's \"having a baby\" coverage example shows $6,500 of deductible paid, more than this plan's $4,500 deductible (the same figures as the Direct Bronze plan); the example is not used here."],"sbcUrl":"https://www.jeffersonhealthplans.com/content/dam/jeffersonhealthplans/documents/sbc/2027/jefferson-health-plans-direct-silver-hmo-off-exchange-pa.pdf"},{"market":"off","id":"93909PA0010024-00","standardId":"93909PA0010024-00","variant":"standard","issuer":"Jefferson Health Plans (Health Partners Plans)","name":"Jefferson Health Plans + Direct + Gold + HMO","metal":"Gold","network":"HMO","hsaEligible":false,"counties":["Bucks","Carbon","Delaware","Lehigh","Monroe","Montgomery","Northampton","Philadelphia","Schuylkill"],"rates":{"3":{"base21":465.54,"tobaccoFactor":1.099991},"6":{"base21":496.01,"tobaccoFactor":1.099998},"8":{"base21":386.26,"tobaccoFactor":1.10001}},"ded":{"ind":500,"fam":1000,"embedded":true},"drugDed":{"ind":250,"fam":500,"embedded":true},"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":0,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":75,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":0,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"after_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":350,"ded":"after_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 visits per benefit period combined; visits above the limit are priced in full here.","Separate prescription drug deductible: $250 individual / $500 family. It applies to non-preferred brand drugs, specialty drugs; the other drug tiers are charged their copay from the first fill.","These prices are for In-Network Tier 1 (Enhanced) providers, the \"you pay the least\" column and the one the CMS data uses. In-Network Tier 2 (Standard) providers have a $2,000 individual / $4,000 family deductible and higher prices, for example primary care visit $60 copay; specialist visit $100 copay; emergency room $400 copay; hospital stay $500 copay after the deductible (up to 5 days). Out-of-network care is not covered.","Lab work: $0 copay. X-rays: $60 copay.","Mental health: the outpatient services price (an office visit) is used.","Hospital stay and delivery facility fees are a copay per day for up to 5 days per admission.","Visits with Jefferson designated telemedicine providers are covered in full (the prices above are for in-person visits)."],"sbcUrl":"https://www.jeffersonhealthplans.com/content/dam/jeffersonhealthplans/documents/sbc/2027/jefferson-health-plans-direct-gold-hmo-off-exchange-pa.pdf"},{"market":"group","id":"16481PA0100147-00","standardId":"16481PA0100147-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Small Business Advantage Platinum PPO $0 $20/$40 - Premium Network","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":546.04,"tobaccoFactor":1},"2":{"base21":649.66,"tobaccoFactor":1},"4":{"base21":529.28,"tobaccoFactor":1},"5":{"base21":580.16,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":560.64,"tobaccoFactor":1},"2":{"base21":667.03,"tobaccoFactor":1},"4":{"base21":543.43,"tobaccoFactor":1},"5":{"base21":595.66,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":575.62,"tobaccoFactor":1},"2":{"base21":684.85,"tobaccoFactor":1},"4":{"base21":557.95,"tobaccoFactor":1},"5":{"base21":611.58,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":591,"tobaccoFactor":1},"2":{"base21":703.15,"tobaccoFactor":1},"4":{"base21":572.86,"tobaccoFactor":1},"5":{"base21":627.92,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":5000,"fam":10000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":20,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929393, \"SG 2027 PPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 48, 75, 102, 129: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $20 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $40 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $40 copay (its other imaging row, used here). Other diagnostic testing: $40 copay.","Mental health: office visits, psychotherapy and counseling $20 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929393/SG 2027 PPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0100148-00","standardId":"16481PA0100148-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Small Business Advantage Platinum PPO $250 $20/$40 - Premium Network","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":548.49,"tobaccoFactor":1},"2":{"base21":652.58,"tobaccoFactor":1},"4":{"base21":531.66,"tobaccoFactor":1},"5":{"base21":582.76,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":563.15,"tobaccoFactor":1},"2":{"base21":670.02,"tobaccoFactor":1},"4":{"base21":545.87,"tobaccoFactor":1},"5":{"base21":598.34,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":578.2,"tobaccoFactor":1},"2":{"base21":687.93,"tobaccoFactor":1},"4":{"base21":560.46,"tobaccoFactor":1},"5":{"base21":614.33,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":593.66,"tobaccoFactor":1},"2":{"base21":706.31,"tobaccoFactor":1},"4":{"base21":575.43,"tobaccoFactor":1},"5":{"base21":630.74,"tobaccoFactor":1}}}],"ded":{"ind":250,"fam":500,"embedded":true},"drugDed":null,"oop":{"ind":4500,"fam":9000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":20,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929393, \"SG 2027 PPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 48, 49, 75, 76, 102, 103, 129, 130: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $20 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $20 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $20 copay (its other imaging row, used here). Other diagnostic testing: $40 copay.","Mental health: office visits, psychotherapy and counseling $20 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929393/SG 2027 PPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0100149-00","standardId":"16481PA0100149-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Small Business Advantage Gold PPO $500 $40/$50 - Premium Network","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":515.74,"tobaccoFactor":1},"2":{"base21":613.61,"tobaccoFactor":1},"4":{"base21":499.91,"tobaccoFactor":1},"5":{"base21":547.96,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":529.52,"tobaccoFactor":1},"2":{"base21":630.01,"tobaccoFactor":1},"4":{"base21":513.27,"tobaccoFactor":1},"5":{"base21":562.61,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":543.68,"tobaccoFactor":1},"2":{"base21":646.85,"tobaccoFactor":1},"4":{"base21":526.99,"tobaccoFactor":1},"5":{"base21":577.64,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":558.21,"tobaccoFactor":1},"2":{"base21":664.14,"tobaccoFactor":1},"4":{"base21":541.07,"tobaccoFactor":1},"5":{"base21":593.08,"tobaccoFactor":1}}}],"ded":{"ind":500,"fam":1000,"embedded":true},"drugDed":null,"oop":{"ind":8500,"fam":17000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":40,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929393, \"SG 2027 PPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 49, 76, 103, 130: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $40 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $50 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay (its other imaging row, used here). Other diagnostic testing: $50 copay.","Mental health: office visits, psychotherapy and counseling $40 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929393/SG 2027 PPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0100150-00","standardId":"16481PA0100150-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Small Business Advantage Gold PPO $1,000 $40/$50 - Premium Network","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":505.1,"tobaccoFactor":1},"2":{"base21":600.95,"tobaccoFactor":1},"4":{"base21":489.59,"tobaccoFactor":1},"5":{"base21":536.65,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":518.59,"tobaccoFactor":1},"2":{"base21":617.01,"tobaccoFactor":1},"4":{"base21":502.68,"tobaccoFactor":1},"5":{"base21":550.99,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":532.45,"tobaccoFactor":1},"2":{"base21":633.5,"tobaccoFactor":1},"4":{"base21":516.11,"tobaccoFactor":1},"5":{"base21":565.72,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":546.68,"tobaccoFactor":1},"2":{"base21":650.43,"tobaccoFactor":1},"4":{"base21":529.9,"tobaccoFactor":1},"5":{"base21":580.84,"tobaccoFactor":1}}}],"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":40,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929393, \"SG 2027 PPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 41, 68, 95, 122: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $40 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $50 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay (its other imaging row, used here). Other diagnostic testing: $50 copay.","Mental health: office visits, psychotherapy and counseling $40 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929393/SG 2027 PPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0100151-00","standardId":"16481PA0100151-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Small Business Advantage Gold PPO $1,500 $40/$50 - Premium Network","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":495.67,"tobaccoFactor":1},"2":{"base21":589.74,"tobaccoFactor":1},"4":{"base21":480.46,"tobaccoFactor":1},"5":{"base21":526.64,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":508.92,"tobaccoFactor":1},"2":{"base21":605.5,"tobaccoFactor":1},"4":{"base21":493.3,"tobaccoFactor":1},"5":{"base21":540.72,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":522.52,"tobaccoFactor":1},"2":{"base21":621.68,"tobaccoFactor":1},"4":{"base21":506.48,"tobaccoFactor":1},"5":{"base21":555.17,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":536.49,"tobaccoFactor":1},"2":{"base21":638.29,"tobaccoFactor":1},"4":{"base21":520.02,"tobaccoFactor":1},"5":{"base21":570,"tobaccoFactor":1}}}],"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":40,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929393, \"SG 2027 PPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 41, 68, 95, 122: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $40 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $50 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay (its other imaging row, used here). Other diagnostic testing: $50 copay.","Mental health: office visits, psychotherapy and counseling $40 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929393/SG 2027 PPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0100152-00","standardId":"16481PA0100152-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Small Business Advantage Gold PPO $2,000 $35/$50 - Premium Network","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":490.34,"tobaccoFactor":1},"2":{"base21":583.4,"tobaccoFactor":1},"4":{"base21":475.29,"tobaccoFactor":1},"5":{"base21":520.98,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":503.45,"tobaccoFactor":1},"2":{"base21":598.99,"tobaccoFactor":1},"4":{"base21":488,"tobaccoFactor":1},"5":{"base21":534.9,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":516.9,"tobaccoFactor":1},"2":{"base21":615,"tobaccoFactor":1},"4":{"base21":501.04,"tobaccoFactor":1},"5":{"base21":549.2,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":530.72,"tobaccoFactor":1},"2":{"base21":631.43,"tobaccoFactor":1},"4":{"base21":514.43,"tobaccoFactor":1},"5":{"base21":563.87,"tobaccoFactor":1}}}],"ded":{"ind":2000,"fam":4000,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":35,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929393, \"SG 2027 PPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 41, 42, 68, 69, 95, 96, 122, 123: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $35 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $40 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay (its other imaging row, used here). Other diagnostic testing: $50 copay.","Mental health: office visits, psychotherapy and counseling $35 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929393/SG 2027 PPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0100153-00","standardId":"16481PA0100153-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Small Business Advantage Gold PPO $3,100 $30/$40 - Premium Network","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":478.93,"tobaccoFactor":1},"2":{"base21":569.82,"tobaccoFactor":1},"4":{"base21":464.23,"tobaccoFactor":1},"5":{"base21":508.85,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":491.73,"tobaccoFactor":1},"2":{"base21":585.05,"tobaccoFactor":1},"4":{"base21":476.64,"tobaccoFactor":1},"5":{"base21":522.45,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":504.87,"tobaccoFactor":1},"2":{"base21":600.68,"tobaccoFactor":1},"4":{"base21":489.38,"tobaccoFactor":1},"5":{"base21":536.42,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":518.37,"tobaccoFactor":1},"2":{"base21":616.74,"tobaccoFactor":1},"4":{"base21":502.45,"tobaccoFactor":1},"5":{"base21":550.75,"tobaccoFactor":1}}}],"ded":{"ind":3100,"fam":6200,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":30,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929393, \"SG 2027 PPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 42, 69, 96, 123: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $30 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $40 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay (its other imaging row, used here). Other diagnostic testing: $40 copay.","Mental health: office visits, psychotherapy and counseling $30 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929393/SG 2027 PPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0100154-00","standardId":"16481PA0100154-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Small Business Advantage Silver PPO $4,400 $60/$80 - Premium Network","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":417.06,"tobaccoFactor":1},"2":{"base21":496.2,"tobaccoFactor":1},"4":{"base21":404.26,"tobaccoFactor":1},"5":{"base21":443.12,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":428.21,"tobaccoFactor":1},"2":{"base21":509.47,"tobaccoFactor":1},"4":{"base21":415.06,"tobaccoFactor":1},"5":{"base21":454.96,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":439.65,"tobaccoFactor":1},"2":{"base21":523.08,"tobaccoFactor":1},"4":{"base21":426.15,"tobaccoFactor":1},"5":{"base21":467.12,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":451.4,"tobaccoFactor":1},"2":{"base21":537.06,"tobaccoFactor":1},"4":{"base21":437.54,"tobaccoFactor":1},"5":{"base21":479.6,"tobaccoFactor":1}}}],"ded":{"ind":4400,"fam":8800,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":750,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":750,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":60,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":750,"ded":"after_ded"}}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929393, \"SG 2027 PPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 42, 43, 69, 70, 96, 97, 123, 124: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $60 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $60 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay after the deductible (its other imaging row, used here). Other diagnostic testing: $80 copay.","Mental health: office visits, psychotherapy and counseling $60 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge after the deductible.","Hospital stay: $750 copay after the deductible once per admission.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929393/SG 2027 PPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0100155-00","standardId":"16481PA0100155-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC First Care Silver PPO $7,500 $80/$100 - Premium Network","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":397.81,"tobaccoFactor":1},"2":{"base21":473.3,"tobaccoFactor":1},"4":{"base21":385.6,"tobaccoFactor":1},"5":{"base21":422.66,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":408.44,"tobaccoFactor":1},"2":{"base21":485.95,"tobaccoFactor":1},"4":{"base21":395.91,"tobaccoFactor":1},"5":{"base21":433.96,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":419.36,"tobaccoFactor":1},"2":{"base21":498.94,"tobaccoFactor":1},"4":{"base21":406.49,"tobaccoFactor":1},"5":{"base21":445.56,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":430.57,"tobaccoFactor":1},"2":{"base21":512.27,"tobaccoFactor":1},"4":{"base21":417.35,"tobaccoFactor":1},"5":{"base21":457.46,"tobaccoFactor":1}}}],"ded":{"ind":7500,"fam":15000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"no_ded"}}},"specialist":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"no_ded"}}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":550,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":350,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":80,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":350,"ded":"after_ded"}}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929393, \"SG 2027 PPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 44, 45, 71, 72, 98, 99, 125, 126: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Primary care visits: the first visit is free; later visits are $80 copay.","Specialist visits: the first visit is free; later visits are $100 copay.","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $80 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $80 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $200 copay after the deductible (its other imaging row, used here). Other diagnostic testing: $100 copay.","Mental health: office visits, psychotherapy and counseling no charge (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge after the deductible.","Hospital stay: $350 copay after the deductible once per admission.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929393/SG 2027 PPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0100156-00","standardId":"16481PA0100156-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC First Care Silver PPO $5,000 $80/$100 - Premium Network","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":416.61,"tobaccoFactor":1},"2":{"base21":495.67,"tobaccoFactor":1},"4":{"base21":403.82,"tobaccoFactor":1},"5":{"base21":442.64,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":427.74,"tobaccoFactor":1},"2":{"base21":508.92,"tobaccoFactor":1},"4":{"base21":414.62,"tobaccoFactor":1},"5":{"base21":454.47,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":439.18,"tobaccoFactor":1},"2":{"base21":522.52,"tobaccoFactor":1},"4":{"base21":425.7,"tobaccoFactor":1},"5":{"base21":466.61,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":450.91,"tobaccoFactor":1},"2":{"base21":536.48,"tobaccoFactor":1},"4":{"base21":437.07,"tobaccoFactor":1},"5":{"base21":479.08,"tobaccoFactor":1}}}],"ded":{"ind":5000,"fam":10000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"no_ded"}}},"specialist":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"no_ded"}}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":750,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":80,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929393, \"SG 2027 PPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 64, 91, 118, 145: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Primary care visits: the first visit is free; later visits are $80 copay.","Specialist visits: the first visit is free; later visits are $100 copay.","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $80 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $80 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $500 copay after the deductible (its other imaging row, used here). Other diagnostic testing: $100 copay.","Mental health: office visits, psychotherapy and counseling no charge (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge after the deductible.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929393/SG 2027 PPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0100157-00","standardId":"16481PA0100157-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Small Business Advantage Silver PPO $6,000 $50/$70 - Premium Network","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":413.92,"tobaccoFactor":1},"2":{"base21":492.47,"tobaccoFactor":1},"4":{"base21":401.22,"tobaccoFactor":1},"5":{"base21":439.78,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":424.98,"tobaccoFactor":1},"2":{"base21":505.63,"tobaccoFactor":1},"4":{"base21":411.94,"tobaccoFactor":1},"5":{"base21":451.53,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":436.34,"tobaccoFactor":1},"2":{"base21":519.15,"tobaccoFactor":1},"4":{"base21":422.95,"tobaccoFactor":1},"5":{"base21":463.6,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":448,"tobaccoFactor":1},"2":{"base21":533.02,"tobaccoFactor":1},"4":{"base21":434.25,"tobaccoFactor":1},"5":{"base21":475.99,"tobaccoFactor":1}}}],"ded":{"ind":6000,"fam":12000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":50,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929393, \"SG 2027 PPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 64, 65, 91, 92, 118, 119, 145, 146: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $50 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $50 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay after the deductible (its other imaging row, used here). Other diagnostic testing: $70 copay.","Mental health: office visits, psychotherapy and counseling $50 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge after the deductible.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929393/SG 2027 PPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0100158-00","standardId":"16481PA0100158-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Small Business Advantage Bronze PPO $9,100 - Premium Network","metal":"Bronze","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":328.62,"tobaccoFactor":1},"2":{"base21":390.99,"tobaccoFactor":1},"4":{"base21":318.54,"tobaccoFactor":1},"5":{"base21":349.16,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":337.41,"tobaccoFactor":1},"2":{"base21":401.44,"tobaccoFactor":1},"4":{"base21":327.05,"tobaccoFactor":1},"5":{"base21":358.49,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":346.42,"tobaccoFactor":1},"2":{"base21":412.16,"tobaccoFactor":1},"4":{"base21":335.79,"tobaccoFactor":1},"5":{"base21":368.07,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":355.68,"tobaccoFactor":1},"2":{"base21":423.18,"tobaccoFactor":1},"4":{"base21":344.76,"tobaccoFactor":1},"5":{"base21":377.9,"tobaccoFactor":1}}}],"ded":{"ind":9100,"fam":18200,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"copay","amount":95,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929393, \"SG 2027 PPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 43, 70, 97, 124: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced as free (the primary care visit costs nothing on this plan; UPMC's SBCs print \"No cost\" for prenatal visits, read as before the deductible as for UPMC's individual plans); later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: no charge after the deductible (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: no charge after the deductible (its other imaging row, used here). Other diagnostic testing: no charge after the deductible.","Mental health: office visits, psychotherapy and counseling no charge after the deductible (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge after the deductible.","Prescription drugs: retail (not mail-order) cost shares are used.","Prescription drugs: the medical deductible applies (no separate drug deductible).","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929393/SG 2027 PPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0100159-00","standardId":"16481PA0100159-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Small Business Advantage Gold HSA PPO $1,850/10% - Premium Network","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":438.6,"tobaccoFactor":1},"2":{"base21":521.83,"tobaccoFactor":1},"4":{"base21":425.14,"tobaccoFactor":1},"5":{"base21":466,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":450.32,"tobaccoFactor":1},"2":{"base21":535.78,"tobaccoFactor":1},"4":{"base21":436.5,"tobaccoFactor":1},"5":{"base21":478.45,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":462.35,"tobaccoFactor":1},"2":{"base21":550.09,"tobaccoFactor":1},"4":{"base21":448.16,"tobaccoFactor":1},"5":{"base21":491.24,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":474.71,"tobaccoFactor":1},"2":{"base21":564.8,"tobaccoFactor":1},"4":{"base21":460.14,"tobaccoFactor":1},"5":{"base21":504.37,"tobaccoFactor":1}}}],"ded":{"ind":1850,"fam":3700,"embedded":false},"drugDed":null,"oop":{"ind":8500,"fam":12000,"famPerPerson":12000},"rules":{"pcp":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134931169, \"SG 2027 PPO HSA Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 43, 44, 70, 71, 97, 98, 124, 125: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at 10% coinsurance after the deductible; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: 10% coinsurance after the deductible (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: 10% coinsurance after the deductible (its other imaging row, used here). Other diagnostic testing: 10% coinsurance after the deductible.","Mental health: office visits, psychotherapy and counseling 10% coinsurance after the deductible (used here); other outpatient services (intensive outpatient, partial hospitalization) 10% coinsurance after the deductible.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Prescription drugs: the medical deductible applies (no separate drug deductible).","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered.","The deductible is aggregate (the matrix's accumulation type): the whole family deductible must be met before the plan pays for anyone in the family, and the estimate uses it."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134931169/SG 2027 PPO HSA Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0100160-00","standardId":"16481PA0100160-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Small Business Advantage Gold HSA PPO $3,300 - Premium Network","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":415.49,"tobaccoFactor":1},"2":{"base21":494.34,"tobaccoFactor":1},"4":{"base21":402.74,"tobaccoFactor":1},"5":{"base21":441.45,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":426.59,"tobaccoFactor":1},"2":{"base21":507.55,"tobaccoFactor":1},"4":{"base21":413.5,"tobaccoFactor":1},"5":{"base21":453.25,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":437.99,"tobaccoFactor":1},"2":{"base21":521.11,"tobaccoFactor":1},"4":{"base21":424.55,"tobaccoFactor":1},"5":{"base21":465.36,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":449.7,"tobaccoFactor":1},"2":{"base21":535.04,"tobaccoFactor":1},"4":{"base21":435.9,"tobaccoFactor":1},"5":{"base21":477.79,"tobaccoFactor":1}}}],"ded":{"ind":3300,"fam":6600,"embedded":false},"drugDed":null,"oop":{"ind":7500,"fam":12000,"famPerPerson":12000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134931169, \"SG 2027 PPO HSA Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 49, 50, 76, 77, 103, 104, 130, 131: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced as free (the primary care visit costs nothing on this plan; UPMC's SBCs print \"No cost\" for prenatal visits, read as before the deductible as for UPMC's individual plans); later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: no charge after the deductible (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: no charge after the deductible (its other imaging row, used here). Other diagnostic testing: no charge after the deductible.","Mental health: office visits, psychotherapy and counseling no charge after the deductible (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge after the deductible.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Prescription drugs: the medical deductible applies (no separate drug deductible).","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered.","The deductible is aggregate (the matrix's accumulation type): the whole family deductible must be met before the plan pays for anyone in the family, and the estimate uses it."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134931169/SG 2027 PPO HSA Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0100161-00","standardId":"16481PA0100161-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Small Business Advantage Silver HSA PPO $5,200 - Premium Network","metal":"Silver","network":"PPO","hsaEligible":true,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":379.62,"tobaccoFactor":1},"2":{"base21":451.65,"tobaccoFactor":1},"4":{"base21":367.96,"tobaccoFactor":1},"5":{"base21":403.33,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":389.76,"tobaccoFactor":1},"2":{"base21":463.72,"tobaccoFactor":1},"4":{"base21":377.8,"tobaccoFactor":1},"5":{"base21":414.11,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":400.18,"tobaccoFactor":1},"2":{"base21":476.12,"tobaccoFactor":1},"4":{"base21":387.89,"tobaccoFactor":1},"5":{"base21":425.18,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":410.87,"tobaccoFactor":1},"2":{"base21":488.84,"tobaccoFactor":1},"4":{"base21":398.26,"tobaccoFactor":1},"5":{"base21":436.54,"tobaccoFactor":1}}}],"ded":{"ind":5200,"fam":10400,"embedded":true},"drugDed":null,"oop":{"ind":8500,"fam":17000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134931169, \"SG 2027 PPO HSA Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 44, 71, 98, 125: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced as free (the primary care visit costs nothing on this plan; UPMC's SBCs print \"No cost\" for prenatal visits, read as before the deductible as for UPMC's individual plans); later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: no charge after the deductible (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: no charge after the deductible (its other imaging row, used here). Other diagnostic testing: no charge after the deductible.","Mental health: office visits, psychotherapy and counseling no charge after the deductible (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge after the deductible.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Prescription drugs: the medical deductible applies (no separate drug deductible).","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134931169/SG 2027 PPO HSA Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0100162-00","standardId":"16481PA0100162-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC MyCare Advantage Gold PPO $1,000/10% $30/$50 - Premium Network","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Allegheny","Beaver","Bedford","Blair","Butler","Erie","Fayette","Greene","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Washington","Westmoreland"],"rates":{"1":{"base21":466.5,"tobaccoFactor":1},"2":{"base21":555.02,"tobaccoFactor":1},"4":{"base21":452.18,"tobaccoFactor":1},"5":{"base21":495.64,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":478.96,"tobaccoFactor":1},"2":{"base21":569.86,"tobaccoFactor":1},"4":{"base21":464.26,"tobaccoFactor":1},"5":{"base21":508.89,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":491.76,"tobaccoFactor":1},"2":{"base21":585.08,"tobaccoFactor":1},"4":{"base21":476.67,"tobaccoFactor":1},"5":{"base21":522.49,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":504.91,"tobaccoFactor":1},"2":{"base21":600.72,"tobaccoFactor":1},"4":{"base21":489.41,"tobaccoFactor":1},"5":{"base21":536.45,"tobaccoFactor":1}}}],"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":500,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":30,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":500,"ded":"after_ded"}}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929393, \"SG 2027 PPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 47, 48, 74, 75, 101, 102, 128, 129: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $30 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $50 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay (its other imaging row, used here). Other diagnostic testing: $50 copay.","Mental health: office visits, psychotherapy and counseling $30 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge.","Hospital stay: $500 copay after the deductible once per admission.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered.","This plan has two in-network tiers. The rules use Tier 1, whose deductible ($1,000 individual / $2,000 family) the rate filing lists. Tier 2 providers have a $2,000 individual / $4,000 family deductible and higher cost sharing; both tiers share the out-of-pocket limit (each rule's text gives both tiers).","Primary care: Tier 1 $30 copay (used here); Tier 2 $50 copay.","Specialist: Tier 1 $50 copay (used here); Tier 2 $100 copay.","Emergency room: Tier 1 $200 copay (used here); Tier 2 $200 copay.","Outpatient surgery facility fee: Tier 1 10% coinsurance after the deductible (used here); Tier 2 35% coinsurance after the deductible.","Hospital stay facility fee: Tier 1 $500 copay after the deductible once per admission (used here); Tier 2 $500 copay after the deductible once per admission."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929393/SG 2027 PPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0100163-00","standardId":"16481PA0100163-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC MyCare Advantage Gold PPO $1,250 $35/$50 - Premium Network","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Allegheny","Beaver","Bedford","Blair","Butler","Erie","Fayette","Greene","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Washington","Westmoreland"],"rates":{"1":{"base21":472.61,"tobaccoFactor":1},"2":{"base21":562.29,"tobaccoFactor":1},"4":{"base21":458.1,"tobaccoFactor":1},"5":{"base21":502.13,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":485.24,"tobaccoFactor":1},"2":{"base21":577.32,"tobaccoFactor":1},"4":{"base21":470.34,"tobaccoFactor":1},"5":{"base21":515.55,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":498.21,"tobaccoFactor":1},"2":{"base21":592.75,"tobaccoFactor":1},"4":{"base21":482.91,"tobaccoFactor":1},"5":{"base21":529.33,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":511.52,"tobaccoFactor":1},"2":{"base21":608.59,"tobaccoFactor":1},"4":{"base21":495.82,"tobaccoFactor":1},"5":{"base21":543.48,"tobaccoFactor":1}}}],"ded":{"ind":1250,"fam":2500,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":35,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929393, \"SG 2027 PPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 45, 72, 99, 126: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $35 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $50 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay (its other imaging row, used here). Other diagnostic testing: $50 copay.","Mental health: office visits, psychotherapy and counseling $35 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered.","This plan has two in-network tiers. The rules use Tier 1, whose deductible ($1,250 individual / $2,500 family) the rate filing lists. Tier 2 providers have a $2,500 individual / $5,000 family deductible and higher cost sharing; both tiers share the out-of-pocket limit (each rule's text gives both tiers).","Primary care: Tier 1 $35 copay (used here); Tier 2 $70 copay.","Specialist: Tier 1 $50 copay (used here); Tier 2 $100 copay.","Emergency room: Tier 1 $200 copay (used here); Tier 2 $200 copay.","Outpatient surgery facility fee: Tier 1 no charge after the deductible (used here); Tier 2 35% coinsurance after the deductible.","Hospital stay facility fee: Tier 1 no charge after the deductible (used here); Tier 2 35% coinsurance after the deductible."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929393/SG 2027 PPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0100164-00","standardId":"16481PA0100164-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC MyCare Advantage Gold PPO $2,000 $35/$50 - Premium Network","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Allegheny","Beaver","Bedford","Blair","Butler","Erie","Fayette","Greene","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Washington","Westmoreland"],"rates":{"1":{"base21":452.42,"tobaccoFactor":1},"2":{"base21":538.27,"tobaccoFactor":1},"4":{"base21":438.53,"tobaccoFactor":1},"5":{"base21":480.68,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":464.51,"tobaccoFactor":1},"2":{"base21":552.66,"tobaccoFactor":1},"4":{"base21":450.25,"tobaccoFactor":1},"5":{"base21":493.53,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":476.92,"tobaccoFactor":1},"2":{"base21":567.43,"tobaccoFactor":1},"4":{"base21":462.28,"tobaccoFactor":1},"5":{"base21":506.72,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":489.67,"tobaccoFactor":1},"2":{"base21":582.59,"tobaccoFactor":1},"4":{"base21":474.64,"tobaccoFactor":1},"5":{"base21":520.26,"tobaccoFactor":1}}}],"ded":{"ind":2000,"fam":4000,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":175,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":35,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929393, \"SG 2027 PPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 45, 46, 72, 73, 99, 100, 126, 127: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $35 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $50 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay (its other imaging row, used here). Other diagnostic testing: $50 copay.","Mental health: office visits, psychotherapy and counseling $35 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered.","This plan has two in-network tiers. The rules use Tier 1, whose deductible ($2,000 individual / $4,000 family) the rate filing lists. Tier 2 providers have a $4,000 individual / $8,000 family deductible and higher cost sharing; both tiers share the out-of-pocket limit (each rule's text gives both tiers).","Primary care: Tier 1 $35 copay (used here); Tier 2 $70 copay.","Specialist: Tier 1 $50 copay (used here); Tier 2 $100 copay.","Emergency room: Tier 1 $175 copay after the deductible (used here); Tier 2 $175 copay after the deductible.","Outpatient surgery facility fee: Tier 1 no charge after the deductible (used here); Tier 2 35% coinsurance after the deductible.","Hospital stay facility fee: Tier 1 no charge after the deductible (used here); Tier 2 35% coinsurance after the deductible."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929393/SG 2027 PPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0100165-00","standardId":"16481PA0100165-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC MyCare Advantage Gold PPO $2,500/10% $30/$50 - Premium Network","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Allegheny","Beaver","Bedford","Blair","Butler","Erie","Fayette","Greene","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Washington","Westmoreland"],"rates":{"1":{"base21":445.94,"tobaccoFactor":1},"2":{"base21":530.56,"tobaccoFactor":1},"4":{"base21":432.25,"tobaccoFactor":1},"5":{"base21":473.8,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":457.86,"tobaccoFactor":1},"2":{"base21":544.74,"tobaccoFactor":1},"4":{"base21":443.8,"tobaccoFactor":1},"5":{"base21":486.46,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":470.09,"tobaccoFactor":1},"2":{"base21":559.3,"tobaccoFactor":1},"4":{"base21":455.66,"tobaccoFactor":1},"5":{"base21":499.46,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":482.65,"tobaccoFactor":1},"2":{"base21":574.25,"tobaccoFactor":1},"4":{"base21":467.84,"tobaccoFactor":1},"5":{"base21":512.81,"tobaccoFactor":1}}}],"ded":{"ind":2500,"fam":5000,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":30,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":30,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929393, \"SG 2027 PPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 46, 73, 100, 127: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $30 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $50 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay (its other imaging row, used here). Other diagnostic testing: $50 copay.","Mental health: office visits, psychotherapy and counseling $30 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered.","This plan has two in-network tiers. The rules use Tier 1, whose deductible ($2,500 individual / $5,000 family) the rate filing lists. Tier 2 providers have a $5,000 individual / $10,000 family deductible and higher cost sharing; both tiers share the out-of-pocket limit (each rule's text gives both tiers).","Primary care: Tier 1 $30 copay (used here); Tier 2 $60 copay.","Specialist: Tier 1 $50 copay (used here); Tier 2 $100 copay.","Emergency room: Tier 1 $200 copay (used here); Tier 2 $200 copay.","Outpatient surgery facility fee: Tier 1 10% coinsurance after the deductible (used here); Tier 2 35% coinsurance after the deductible.","Hospital stay facility fee: Tier 1 10% coinsurance after the deductible (used here); Tier 2 35% coinsurance after the deductible."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929393/SG 2027 PPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0100166-00","standardId":"16481PA0100166-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC MyCare Advantage Silver PPO $4,400/20% $50/$80 - Premium Network","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Allegheny","Beaver","Bedford","Blair","Butler","Erie","Fayette","Greene","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Washington","Westmoreland"],"rates":{"1":{"base21":380.43,"tobaccoFactor":1},"2":{"base21":452.63,"tobaccoFactor":1},"4":{"base21":368.76,"tobaccoFactor":1},"5":{"base21":404.2,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":390.6,"tobaccoFactor":1},"2":{"base21":464.72,"tobaccoFactor":1},"4":{"base21":378.61,"tobaccoFactor":1},"5":{"base21":415,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":401.04,"tobaccoFactor":1},"2":{"base21":477.14,"tobaccoFactor":1},"4":{"base21":388.73,"tobaccoFactor":1},"5":{"base21":426.09,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":411.76,"tobaccoFactor":1},"2":{"base21":489.9,"tobaccoFactor":1},"4":{"base21":399.12,"tobaccoFactor":1},"5":{"base21":437.48,"tobaccoFactor":1}}}],"ded":{"ind":4400,"fam":8800,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":50,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929393, \"SG 2027 PPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 48, 75, 102, 129: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $50 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $60 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay (its other imaging row, used here). Other diagnostic testing: $80 copay.","Mental health: office visits, psychotherapy and counseling $50 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge after the deductible.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered.","This plan has two in-network tiers. The rules use Tier 1, whose deductible ($4,400 individual / $8,800 family) the rate filing lists. Tier 2 providers have a $8,800 individual / $17,600 family deductible and higher cost sharing; both tiers share the out-of-pocket limit (each rule's text gives both tiers).","Primary care: Tier 1 $50 copay (used here); Tier 2 $70 copay.","Specialist: Tier 1 $80 copay (used here); Tier 2 $140 copay.","Emergency room: Tier 1 $300 copay after the deductible (used here); Tier 2 $300 copay after the deductible.","Outpatient surgery facility fee: Tier 1 20% coinsurance after the deductible (used here); Tier 2 35% coinsurance after the deductible.","Hospital stay facility fee: Tier 1 20% coinsurance after the deductible (used here); Tier 2 35% coinsurance after the deductible."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929393/SG 2027 PPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0100167-00","standardId":"16481PA0100167-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC MyCare Advantage Silver PPO $5,000/20% $50/$70 - Premium Network","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Allegheny","Beaver","Bedford","Blair","Butler","Erie","Fayette","Greene","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Washington","Westmoreland"],"rates":{"1":{"base21":377.81,"tobaccoFactor":1},"2":{"base21":449.5,"tobaccoFactor":1},"4":{"base21":366.21,"tobaccoFactor":1},"5":{"base21":401.41,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":387.91,"tobaccoFactor":1},"2":{"base21":461.52,"tobaccoFactor":1},"4":{"base21":376,"tobaccoFactor":1},"5":{"base21":412.14,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":398.27,"tobaccoFactor":1},"2":{"base21":473.85,"tobaccoFactor":1},"4":{"base21":386.05,"tobaccoFactor":1},"5":{"base21":423.15,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":408.92,"tobaccoFactor":1},"2":{"base21":486.51,"tobaccoFactor":1},"4":{"base21":396.36,"tobaccoFactor":1},"5":{"base21":434.46,"tobaccoFactor":1}}}],"ded":{"ind":5000,"fam":10000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":70,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":50,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929393, \"SG 2027 PPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 47, 74, 101, 128: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $50 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $70 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay (its other imaging row, used here). Other diagnostic testing: $70 copay.","Mental health: office visits, psychotherapy and counseling $50 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) 20% coinsurance after the deductible.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered.","This plan has two in-network tiers. The rules use Tier 1, whose deductible ($5,000 individual / $10,000 family) the rate filing lists. Tier 2 providers have a $8,000 individual / $16,000 family deductible and higher cost sharing; both tiers share the out-of-pocket limit (each rule's text gives both tiers).","Primary care: Tier 1 $50 copay (used here); Tier 2 $100 copay.","Specialist: Tier 1 $70 copay (used here); Tier 2 $140 copay.","Emergency room: Tier 1 20% coinsurance after the deductible (used here); Tier 2 20% coinsurance after the deductible.","Outpatient surgery facility fee: Tier 1 20% coinsurance after the deductible (used here); Tier 2 35% coinsurance after the deductible.","Hospital stay facility fee: Tier 1 20% coinsurance after the deductible (used here); Tier 2 35% coinsurance after the deductible."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929393/SG 2027 PPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0100168-00","standardId":"16481PA0100168-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC MyCare Advantage Silver PPO HSA $3,800/20% - Premium Network","metal":"Silver","network":"PPO","hsaEligible":true,"counties":["Allegheny","Beaver","Bedford","Blair","Butler","Erie","Fayette","Greene","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Washington","Westmoreland"],"rates":{"1":{"base21":356.94,"tobaccoFactor":1},"2":{"base21":424.68,"tobaccoFactor":1},"4":{"base21":345.99,"tobaccoFactor":1},"5":{"base21":379.24,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":366.48,"tobaccoFactor":1},"2":{"base21":436.03,"tobaccoFactor":1},"4":{"base21":355.23,"tobaccoFactor":1},"5":{"base21":389.38,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":376.28,"tobaccoFactor":1},"2":{"base21":447.68,"tobaccoFactor":1},"4":{"base21":364.73,"tobaccoFactor":1},"5":{"base21":399.78,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":386.33,"tobaccoFactor":1},"2":{"base21":459.64,"tobaccoFactor":1},"4":{"base21":374.47,"tobaccoFactor":1},"5":{"base21":410.47,"tobaccoFactor":1}}}],"ded":{"ind":3800,"fam":7600,"embedded":true},"drugDed":null,"oop":{"ind":8500,"fam":17000},"rules":{"pcp":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134931169, \"SG 2027 PPO HSA Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 46, 47, 73, 74, 100, 101, 127, 128: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","The benefit matrix names this plan with $3,800/10%; its own coinsurance cells, the plan overview's name ($3,800/20%) and the rate decision agree on $3,800/20%, which is used.","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at 20% coinsurance after the deductible; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: 20% coinsurance after the deductible (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: 20% coinsurance after the deductible (its other imaging row, used here). Other diagnostic testing: 20% coinsurance after the deductible.","Mental health: office visits, psychotherapy and counseling 20% coinsurance after the deductible (used here); other outpatient services (intensive outpatient, partial hospitalization) 20% coinsurance after the deductible.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Prescription drugs: the medical deductible applies (no separate drug deductible).","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered.","This plan has two in-network tiers. The rules use Tier 1, whose deductible ($3,800 individual / $7,600 family) the rate filing lists. Tier 2 providers have a $7,000 individual / $14,000 family deductible and higher cost sharing; both tiers share the out-of-pocket limit (each rule's text gives both tiers).","Primary care: Tier 1 20% coinsurance after the deductible (used here); Tier 2 35% coinsurance after the deductible.","Specialist: Tier 1 20% coinsurance after the deductible (used here); Tier 2 35% coinsurance after the deductible.","Emergency room: Tier 1 20% coinsurance after the deductible (used here); Tier 2 20% coinsurance after the deductible.","Outpatient surgery facility fee: Tier 1 20% coinsurance after the deductible (used here); Tier 2 35% coinsurance after the deductible.","Hospital stay facility fee: Tier 1 20% coinsurance after the deductible (used here); Tier 2 35% coinsurance after the deductible."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134931169/SG 2027 PPO HSA Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0100169-00","standardId":"16481PA0100169-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Small Business Advantage Gold HSA PPO $2,200/10% - Premium Network","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":428.23,"tobaccoFactor":1},"2":{"base21":509.49,"tobaccoFactor":1},"4":{"base21":415.08,"tobaccoFactor":1},"5":{"base21":454.98,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":439.67,"tobaccoFactor":1},"2":{"base21":523.11,"tobaccoFactor":1},"4":{"base21":426.17,"tobaccoFactor":1},"5":{"base21":467.14,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":451.42,"tobaccoFactor":1},"2":{"base21":537.09,"tobaccoFactor":1},"4":{"base21":437.56,"tobaccoFactor":1},"5":{"base21":479.62,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":463.48,"tobaccoFactor":1},"2":{"base21":551.44,"tobaccoFactor":1},"4":{"base21":449.26,"tobaccoFactor":1},"5":{"base21":492.44,"tobaccoFactor":1}}}],"ded":{"ind":2200,"fam":4400,"embedded":false},"drugDed":null,"oop":{"ind":7500,"fam":12000,"famPerPerson":12000},"rules":{"pcp":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134931169, \"SG 2027 PPO HSA Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 44, 71, 98, 125: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at 10% coinsurance after the deductible; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: 10% coinsurance after the deductible (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: 10% coinsurance after the deductible (its other imaging row, used here). Other diagnostic testing: 10% coinsurance after the deductible.","Mental health: office visits, psychotherapy and counseling 10% coinsurance after the deductible (used here); other outpatient services (intensive outpatient, partial hospitalization) 10% coinsurance after the deductible.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Prescription drugs: the medical deductible applies (no separate drug deductible).","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered.","The deductible is aggregate (the matrix's accumulation type): the whole family deductible must be met before the plan pays for anyone in the family, and the estimate uses it."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134931169/SG 2027 PPO HSA Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0110021-00","standardId":"16481PA0110021-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Small Business Advantage Platinum EPO $0 $20/$40 - Premium Network","metal":"Platinum","network":"EPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":523.77,"tobaccoFactor":1},"2":{"base21":623.16,"tobaccoFactor":1},"4":{"base21":507.69,"tobaccoFactor":1},"5":{"base21":556.49,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":537.76,"tobaccoFactor":1},"2":{"base21":639.81,"tobaccoFactor":1},"4":{"base21":521.26,"tobaccoFactor":1},"5":{"base21":571.36,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":552.14,"tobaccoFactor":1},"2":{"base21":656.91,"tobaccoFactor":1},"4":{"base21":535.19,"tobaccoFactor":1},"5":{"base21":586.63,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":566.89,"tobaccoFactor":1},"2":{"base21":674.47,"tobaccoFactor":1},"4":{"base21":549.49,"tobaccoFactor":1},"5":{"base21":602.31,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":5000,"fam":10000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":20,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929314, \"SG 2027 EPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 57, 58, 84, 85, 111, 112, 138, 139: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $20 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $40 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $40 copay (its other imaging row, used here). Other diagnostic testing: $40 copay.","Mental health: office visits, psychotherapy and counseling $20 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929314/SG 2027 EPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0110022-00","standardId":"16481PA0110022-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Small Business Advantage Platinum EPO $0 $20/$40 - Partner Network","metal":"Platinum","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Erie","Greene","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Washington"],"rates":{"1":{"base21":428.79,"tobaccoFactor":1},"2":{"base21":510.16,"tobaccoFactor":1},"4":{"base21":415.63,"tobaccoFactor":1},"5":{"base21":455.58,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":440.25,"tobaccoFactor":1},"2":{"base21":523.8,"tobaccoFactor":1},"4":{"base21":426.74,"tobaccoFactor":1},"5":{"base21":467.76,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":452.02,"tobaccoFactor":1},"2":{"base21":537.8,"tobaccoFactor":1},"4":{"base21":438.14,"tobaccoFactor":1},"5":{"base21":480.26,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":464.1,"tobaccoFactor":1},"2":{"base21":552.17,"tobaccoFactor":1},"4":{"base21":449.85,"tobaccoFactor":1},"5":{"base21":493.09,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":5000,"fam":10000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":20,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929314, \"SG 2027 EPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 62, 63, 89, 90, 116, 117, 143, 144: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $20 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $40 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $40 copay (its other imaging row, used here). Other diagnostic testing: $40 copay.","Mental health: office visits, psychotherapy and counseling $20 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929314/SG 2027 EPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0110023-00","standardId":"16481PA0110023-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Small Business Advantage Platinum EPO $250 $20/$40 - Premium Network","metal":"Platinum","network":"EPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":526.9,"tobaccoFactor":1},"2":{"base21":626.89,"tobaccoFactor":1},"4":{"base21":510.73,"tobaccoFactor":1},"5":{"base21":559.82,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":540.99,"tobaccoFactor":1},"2":{"base21":643.65,"tobaccoFactor":1},"4":{"base21":524.38,"tobaccoFactor":1},"5":{"base21":574.78,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":555.44,"tobaccoFactor":1},"2":{"base21":660.85,"tobaccoFactor":1},"4":{"base21":538.39,"tobaccoFactor":1},"5":{"base21":590.14,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":570.29,"tobaccoFactor":1},"2":{"base21":678.51,"tobaccoFactor":1},"4":{"base21":552.78,"tobaccoFactor":1},"5":{"base21":605.92,"tobaccoFactor":1}}}],"ded":{"ind":250,"fam":500,"embedded":true},"drugDed":null,"oop":{"ind":4500,"fam":9000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":20,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929314, \"SG 2027 EPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 58, 85, 112, 139: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $20 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $20 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $20 copay (its other imaging row, used here). Other diagnostic testing: $40 copay.","Mental health: office visits, psychotherapy and counseling $20 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929314/SG 2027 EPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0110024-00","standardId":"16481PA0110024-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Small Business Advantage Platinum EPO $250 $20/$40 - Partner Network","metal":"Platinum","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Erie","Greene","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Washington"],"rates":{"1":{"base21":431.36,"tobaccoFactor":1},"2":{"base21":513.22,"tobaccoFactor":1},"4":{"base21":418.12,"tobaccoFactor":1},"5":{"base21":458.31,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":442.89,"tobaccoFactor":1},"2":{"base21":526.94,"tobaccoFactor":1},"4":{"base21":429.29,"tobaccoFactor":1},"5":{"base21":470.56,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":454.73,"tobaccoFactor":1},"2":{"base21":541.02,"tobaccoFactor":1},"4":{"base21":440.77,"tobaccoFactor":1},"5":{"base21":483.13,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":466.88,"tobaccoFactor":1},"2":{"base21":555.48,"tobaccoFactor":1},"4":{"base21":452.55,"tobaccoFactor":1},"5":{"base21":496.05,"tobaccoFactor":1}}}],"ded":{"ind":250,"fam":500,"embedded":true},"drugDed":null,"oop":{"ind":4500,"fam":9000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":20,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929314, \"SG 2027 EPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 63, 90, 117, 144: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $20 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $20 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $20 copay (its other imaging row, used here). Other diagnostic testing: $40 copay.","Mental health: office visits, psychotherapy and counseling $20 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929314/SG 2027 EPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0110025-00","standardId":"16481PA0110025-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Small Business Advantage Gold EPO $500 $40/$50 - Premium Network","metal":"Gold","network":"EPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":494.74,"tobaccoFactor":1},"2":{"base21":588.63,"tobaccoFactor":1},"4":{"base21":479.56,"tobaccoFactor":1},"5":{"base21":525.65,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":507.96,"tobaccoFactor":1},"2":{"base21":604.36,"tobaccoFactor":1},"4":{"base21":492.37,"tobaccoFactor":1},"5":{"base21":539.7,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":521.54,"tobaccoFactor":1},"2":{"base21":620.51,"tobaccoFactor":1},"4":{"base21":505.53,"tobaccoFactor":1},"5":{"base21":554.12,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":535.48,"tobaccoFactor":1},"2":{"base21":637.09,"tobaccoFactor":1},"4":{"base21":519.04,"tobaccoFactor":1},"5":{"base21":568.93,"tobaccoFactor":1}}}],"ded":{"ind":500,"fam":1000,"embedded":true},"drugDed":null,"oop":{"ind":8500,"fam":17000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":40,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929314, \"SG 2027 EPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 58, 59, 85, 86, 112, 113, 139, 140: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $40 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $50 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay (its other imaging row, used here). Other diagnostic testing: $50 copay.","Mental health: office visits, psychotherapy and counseling $40 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929314/SG 2027 EPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0110026-00","standardId":"16481PA0110026-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Small Business Advantage Gold EPO $500 $40/$50 - Partner Network","metal":"Gold","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Erie","Greene","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Washington"],"rates":{"1":{"base21":422.22,"tobaccoFactor":1},"2":{"base21":502.35,"tobaccoFactor":1},"4":{"base21":409.26,"tobaccoFactor":1},"5":{"base21":448.6,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":433.51,"tobaccoFactor":1},"2":{"base21":515.77,"tobaccoFactor":1},"4":{"base21":420.2,"tobaccoFactor":1},"5":{"base21":460.59,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":445.09,"tobaccoFactor":1},"2":{"base21":529.56,"tobaccoFactor":1},"4":{"base21":431.43,"tobaccoFactor":1},"5":{"base21":472.9,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":456.99,"tobaccoFactor":1},"2":{"base21":543.71,"tobaccoFactor":1},"4":{"base21":442.96,"tobaccoFactor":1},"5":{"base21":485.54,"tobaccoFactor":1}}}],"ded":{"ind":500,"fam":1000,"embedded":true},"drugDed":null,"oop":{"ind":8500,"fam":17000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":40,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929314, \"SG 2027 EPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 63, 64, 90, 91, 117, 118, 144, 145: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $40 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $50 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay (its other imaging row, used here). Other diagnostic testing: $50 copay.","Mental health: office visits, psychotherapy and counseling $40 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929314/SG 2027 EPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0110027-00","standardId":"16481PA0110027-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Small Business Advantage Gold EPO $1,000 $40/$50 - Premium Network","metal":"Gold","network":"EPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":485.6,"tobaccoFactor":1},"2":{"base21":577.75,"tobaccoFactor":1},"4":{"base21":470.69,"tobaccoFactor":1},"5":{"base21":515.93,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":498.57,"tobaccoFactor":1},"2":{"base21":593.19,"tobaccoFactor":1},"4":{"base21":483.27,"tobaccoFactor":1},"5":{"base21":529.72,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":511.9,"tobaccoFactor":1},"2":{"base21":609.04,"tobaccoFactor":1},"4":{"base21":496.19,"tobaccoFactor":1},"5":{"base21":543.88,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":525.58,"tobaccoFactor":1},"2":{"base21":625.32,"tobaccoFactor":1},"4":{"base21":509.45,"tobaccoFactor":1},"5":{"base21":558.41,"tobaccoFactor":1}}}],"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":40,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929314, \"SG 2027 EPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 50, 77, 104, 131: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $40 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $50 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay (its other imaging row, used here). Other diagnostic testing: $50 copay.","Mental health: office visits, psychotherapy and counseling $40 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929314/SG 2027 EPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0110028-00","standardId":"16481PA0110028-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Small Business Advantage Gold EPO $1,000 $40/$50 - Partner Network","metal":"Gold","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Erie","Greene","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Washington"],"rates":{"1":{"base21":397.54,"tobaccoFactor":1},"2":{"base21":472.99,"tobaccoFactor":1},"4":{"base21":385.34,"tobaccoFactor":1},"5":{"base21":422.38,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":408.17,"tobaccoFactor":1},"2":{"base21":485.63,"tobaccoFactor":1},"4":{"base21":395.64,"tobaccoFactor":1},"5":{"base21":433.67,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":419.08,"tobaccoFactor":1},"2":{"base21":498.6,"tobaccoFactor":1},"4":{"base21":406.21,"tobaccoFactor":1},"5":{"base21":445.26,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":430.28,"tobaccoFactor":1},"2":{"base21":511.93,"tobaccoFactor":1},"4":{"base21":417.07,"tobaccoFactor":1},"5":{"base21":457.16,"tobaccoFactor":1}}}],"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":40,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929314, \"SG 2027 EPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 59, 60, 86, 87, 113, 114, 140, 141: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $40 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $50 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay (its other imaging row, used here). Other diagnostic testing: $50 copay.","Mental health: office visits, psychotherapy and counseling $40 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929314/SG 2027 EPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0110029-00","standardId":"16481PA0110029-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Small Business Advantage Gold EPO $1,500 $40/$50 - Premium Network","metal":"Gold","network":"EPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":477.31,"tobaccoFactor":1},"2":{"base21":567.89,"tobaccoFactor":1},"4":{"base21":462.66,"tobaccoFactor":1},"5":{"base21":507.13,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":490.07,"tobaccoFactor":1},"2":{"base21":583.07,"tobaccoFactor":1},"4":{"base21":475.02,"tobaccoFactor":1},"5":{"base21":520.68,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":503.16,"tobaccoFactor":1},"2":{"base21":598.65,"tobaccoFactor":1},"4":{"base21":487.72,"tobaccoFactor":1},"5":{"base21":534.6,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":516.61,"tobaccoFactor":1},"2":{"base21":614.65,"tobaccoFactor":1},"4":{"base21":500.75,"tobaccoFactor":1},"5":{"base21":548.89,"tobaccoFactor":1}}}],"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":40,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929314, \"SG 2027 EPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 50, 51, 77, 78, 104, 105, 131, 132: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $40 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $50 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay (its other imaging row, used here). Other diagnostic testing: $50 copay.","Mental health: office visits, psychotherapy and counseling $40 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929314/SG 2027 EPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0110030-00","standardId":"16481PA0110030-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Small Business Advantage Gold EPO $1,500 $40/$50 - Partner Network","metal":"Gold","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Erie","Greene","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Washington"],"rates":{"1":{"base21":390.76,"tobaccoFactor":1},"2":{"base21":464.91,"tobaccoFactor":1},"4":{"base21":378.77,"tobaccoFactor":1},"5":{"base21":415.17,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":401.2,"tobaccoFactor":1},"2":{"base21":477.34,"tobaccoFactor":1},"4":{"base21":388.89,"tobaccoFactor":1},"5":{"base21":426.27,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":411.93,"tobaccoFactor":1},"2":{"base21":490.1,"tobaccoFactor":1},"4":{"base21":399.28,"tobaccoFactor":1},"5":{"base21":437.66,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":422.93,"tobaccoFactor":1},"2":{"base21":503.19,"tobaccoFactor":1},"4":{"base21":409.95,"tobaccoFactor":1},"5":{"base21":449.36,"tobaccoFactor":1}}}],"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":40,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929314, \"SG 2027 EPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 60, 87, 114, 141: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $40 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $50 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay (its other imaging row, used here). Other diagnostic testing: $50 copay.","Mental health: office visits, psychotherapy and counseling $40 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929314/SG 2027 EPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0110031-00","standardId":"16481PA0110031-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Small Business Advantage Gold EPO $2,000 $35/$50 - Premium Network","metal":"Gold","network":"EPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":472.77,"tobaccoFactor":1},"2":{"base21":562.48,"tobaccoFactor":1},"4":{"base21":458.26,"tobaccoFactor":1},"5":{"base21":502.3,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":485.4,"tobaccoFactor":1},"2":{"base21":577.52,"tobaccoFactor":1},"4":{"base21":470.5,"tobaccoFactor":1},"5":{"base21":515.73,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":498.38,"tobaccoFactor":1},"2":{"base21":592.95,"tobaccoFactor":1},"4":{"base21":483.08,"tobaccoFactor":1},"5":{"base21":529.51,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":511.69,"tobaccoFactor":1},"2":{"base21":608.8,"tobaccoFactor":1},"4":{"base21":495.99,"tobaccoFactor":1},"5":{"base21":543.66,"tobaccoFactor":1}}}],"ded":{"ind":2000,"fam":4000,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":35,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929314, \"SG 2027 EPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 51, 78, 105, 132: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $35 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $40 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay (its other imaging row, used here). Other diagnostic testing: $50 copay.","Mental health: office visits, psychotherapy and counseling $35 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929314/SG 2027 EPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0110032-00","standardId":"16481PA0110032-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Small Business Advantage Gold EPO $3,100 $30/$40 - Premium Network","metal":"Gold","network":"EPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":462.67,"tobaccoFactor":1},"2":{"base21":550.47,"tobaccoFactor":1},"4":{"base21":448.47,"tobaccoFactor":1},"5":{"base21":491.58,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":475.04,"tobaccoFactor":1},"2":{"base21":565.19,"tobaccoFactor":1},"4":{"base21":460.46,"tobaccoFactor":1},"5":{"base21":504.72,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":487.73,"tobaccoFactor":1},"2":{"base21":580.29,"tobaccoFactor":1},"4":{"base21":472.76,"tobaccoFactor":1},"5":{"base21":518.2,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":500.77,"tobaccoFactor":1},"2":{"base21":595.8,"tobaccoFactor":1},"4":{"base21":485.4,"tobaccoFactor":1},"5":{"base21":532.05,"tobaccoFactor":1}}}],"ded":{"ind":3100,"fam":6200,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":30,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929314, \"SG 2027 EPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 51, 52, 78, 79, 105, 106, 132, 133: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $30 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $40 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay (its other imaging row, used here). Other diagnostic testing: $40 copay.","Mental health: office visits, psychotherapy and counseling $30 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929314/SG 2027 EPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0110033-00","standardId":"16481PA0110033-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Small Business Advantage Silver EPO $4,400 $60/$80 - Premium Network","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":404.2,"tobaccoFactor":1},"2":{"base21":480.9,"tobaccoFactor":1},"4":{"base21":391.79,"tobaccoFactor":1},"5":{"base21":429.45,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":415,"tobaccoFactor":1},"2":{"base21":493.75,"tobaccoFactor":1},"4":{"base21":402.26,"tobaccoFactor":1},"5":{"base21":440.92,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":426.09,"tobaccoFactor":1},"2":{"base21":506.95,"tobaccoFactor":1},"4":{"base21":413.01,"tobaccoFactor":1},"5":{"base21":452.71,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":437.48,"tobaccoFactor":1},"2":{"base21":520.49,"tobaccoFactor":1},"4":{"base21":424.05,"tobaccoFactor":1},"5":{"base21":464.81,"tobaccoFactor":1}}}],"ded":{"ind":4400,"fam":8800,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":750,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":750,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":60,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":750,"ded":"after_ded"}}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929314, \"SG 2027 EPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 52, 79, 106, 133: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $60 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $60 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay after the deductible (its other imaging row, used here). Other diagnostic testing: $80 copay.","Mental health: office visits, psychotherapy and counseling $60 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge after the deductible.","Hospital stay: $750 copay after the deductible once per admission.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929314/SG 2027 EPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0110034-00","standardId":"16481PA0110034-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Small Business Advantage Silver EPO $4,400 $60/$80 - Partner Network","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Erie","Greene","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Washington"],"rates":{"1":{"base21":330.9,"tobaccoFactor":1},"2":{"base21":393.7,"tobaccoFactor":1},"4":{"base21":320.75,"tobaccoFactor":1},"5":{"base21":351.58,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":339.75,"tobaccoFactor":1},"2":{"base21":404.22,"tobaccoFactor":1},"4":{"base21":329.32,"tobaccoFactor":1},"5":{"base21":360.97,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":348.83,"tobaccoFactor":1},"2":{"base21":415.02,"tobaccoFactor":1},"4":{"base21":338.12,"tobaccoFactor":1},"5":{"base21":370.62,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":358.15,"tobaccoFactor":1},"2":{"base21":426.11,"tobaccoFactor":1},"4":{"base21":347.16,"tobaccoFactor":1},"5":{"base21":380.52,"tobaccoFactor":1}}}],"ded":{"ind":4400,"fam":8800,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":750,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":750,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":60,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":750,"ded":"after_ded"}}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929314, \"SG 2027 EPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 60, 87, 114, 141: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $60 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $60 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay after the deductible (its other imaging row, used here). Other diagnostic testing: $80 copay.","Mental health: office visits, psychotherapy and counseling $60 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge after the deductible.","Hospital stay: $750 copay after the deductible once per admission.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929314/SG 2027 EPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0110035-00","standardId":"16481PA0110035-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC First Care Silver EPO $7,500 $80/$100 - Premium Network","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":385.71,"tobaccoFactor":1},"2":{"base21":458.91,"tobaccoFactor":1},"4":{"base21":373.87,"tobaccoFactor":1},"5":{"base21":409.81,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":396.02,"tobaccoFactor":1},"2":{"base21":471.17,"tobaccoFactor":1},"4":{"base21":383.87,"tobaccoFactor":1},"5":{"base21":420.76,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":406.61,"tobaccoFactor":1},"2":{"base21":483.77,"tobaccoFactor":1},"4":{"base21":394.12,"tobaccoFactor":1},"5":{"base21":432.01,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":417.47,"tobaccoFactor":1},"2":{"base21":496.69,"tobaccoFactor":1},"4":{"base21":404.66,"tobaccoFactor":1},"5":{"base21":443.55,"tobaccoFactor":1}}}],"ded":{"ind":7500,"fam":15000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"no_ded"}}},"specialist":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"no_ded"}}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":550,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":350,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":80,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":350,"ded":"after_ded"}}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929314, \"SG 2027 EPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 52, 53, 79, 80, 106, 107, 133, 134: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Primary care visits: the first visit is free; later visits are $80 copay.","Specialist visits: the first visit is free; later visits are $100 copay.","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $80 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $80 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $200 copay after the deductible (its other imaging row, used here). Other diagnostic testing: $100 copay.","Mental health: office visits, psychotherapy and counseling no charge (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge after the deductible.","Hospital stay: $350 copay after the deductible once per admission.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929314/SG 2027 EPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0110036-00","standardId":"16481PA0110036-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC First Care Silver EPO $7,500 $80/$100 - Partner Network","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Erie","Greene","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Washington"],"rates":{"1":{"base21":315.77,"tobaccoFactor":1},"2":{"base21":375.7,"tobaccoFactor":1},"4":{"base21":306.08,"tobaccoFactor":1},"5":{"base21":335.5,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":324.21,"tobaccoFactor":1},"2":{"base21":385.74,"tobaccoFactor":1},"4":{"base21":314.26,"tobaccoFactor":1},"5":{"base21":344.47,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":332.88,"tobaccoFactor":1},"2":{"base21":396.04,"tobaccoFactor":1},"4":{"base21":322.66,"tobaccoFactor":1},"5":{"base21":353.67,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":341.77,"tobaccoFactor":1},"2":{"base21":406.63,"tobaccoFactor":1},"4":{"base21":331.28,"tobaccoFactor":1},"5":{"base21":363.12,"tobaccoFactor":1}}}],"ded":{"ind":7500,"fam":15000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"no_ded"}}},"specialist":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"no_ded"}}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":550,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":350,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":80,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":350,"ded":"after_ded"}}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929314, \"SG 2027 EPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 62, 89, 116, 143: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Primary care visits: the first visit is free; later visits are $80 copay.","Specialist visits: the first visit is free; later visits are $100 copay.","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $80 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $80 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $200 copay after the deductible (its other imaging row, used here). Other diagnostic testing: $100 copay.","Mental health: office visits, psychotherapy and counseling no charge (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge after the deductible.","Hospital stay: $350 copay after the deductible once per admission.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929314/SG 2027 EPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0110037-00","standardId":"16481PA0110037-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC First Care Silver EPO $5,000 $80/$100 - Premium Network","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":403.97,"tobaccoFactor":1},"2":{"base21":480.63,"tobaccoFactor":1},"4":{"base21":391.57,"tobaccoFactor":1},"5":{"base21":429.21,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":414.77,"tobaccoFactor":1},"2":{"base21":493.48,"tobaccoFactor":1},"4":{"base21":402.04,"tobaccoFactor":1},"5":{"base21":440.68,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":425.85,"tobaccoFactor":1},"2":{"base21":506.67,"tobaccoFactor":1},"4":{"base21":412.78,"tobaccoFactor":1},"5":{"base21":452.46,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":437.23,"tobaccoFactor":1},"2":{"base21":520.21,"tobaccoFactor":1},"4":{"base21":423.81,"tobaccoFactor":1},"5":{"base21":464.55,"tobaccoFactor":1}}}],"ded":{"ind":5000,"fam":10000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"no_ded"}}},"specialist":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"no_ded"}}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":750,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":80,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929314, \"SG 2027 EPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 65, 92, 119, 146: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Primary care visits: the first visit is free; later visits are $80 copay.","Specialist visits: the first visit is free; later visits are $100 copay.","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $80 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $80 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $500 copay after the deductible (its other imaging row, used here). Other diagnostic testing: $100 copay.","Mental health: office visits, psychotherapy and counseling no charge (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge after the deductible.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929314/SG 2027 EPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0110038-00","standardId":"16481PA0110038-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC First Care Silver EPO $5,000 $80/$100 - Partner Network","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Erie","Greene","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Washington"],"rates":{"1":{"base21":330.72,"tobaccoFactor":1},"2":{"base21":393.48,"tobaccoFactor":1},"4":{"base21":320.57,"tobaccoFactor":1},"5":{"base21":351.38,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":339.56,"tobaccoFactor":1},"2":{"base21":404,"tobaccoFactor":1},"4":{"base21":329.14,"tobaccoFactor":1},"5":{"base21":360.77,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":348.63,"tobaccoFactor":1},"2":{"base21":414.79,"tobaccoFactor":1},"4":{"base21":337.93,"tobaccoFactor":1},"5":{"base21":370.41,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":357.95,"tobaccoFactor":1},"2":{"base21":425.88,"tobaccoFactor":1},"4":{"base21":346.96,"tobaccoFactor":1},"5":{"base21":380.31,"tobaccoFactor":1}}}],"ded":{"ind":5000,"fam":10000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"no_ded"}}},"specialist":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"no_ded"}}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":750,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":80,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929314, \"SG 2027 EPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 65, 66, 92, 93, 119, 120, 146, 147: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Primary care visits: the first visit is free; later visits are $80 copay.","Specialist visits: the first visit is free; later visits are $100 copay.","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $80 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $80 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $500 copay after the deductible (its other imaging row, used here). Other diagnostic testing: $100 copay.","Mental health: office visits, psychotherapy and counseling no charge (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge after the deductible.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929314/SG 2027 EPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0110039-00","standardId":"16481PA0110039-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Small Business Advantage Silver EPO $6,000 $50/$70 - Premium Network","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":401.56,"tobaccoFactor":1},"2":{"base21":477.76,"tobaccoFactor":1},"4":{"base21":389.24,"tobaccoFactor":1},"5":{"base21":426.65,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":412.29,"tobaccoFactor":1},"2":{"base21":490.53,"tobaccoFactor":1},"4":{"base21":399.64,"tobaccoFactor":1},"5":{"base21":438.05,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":423.31,"tobaccoFactor":1},"2":{"base21":503.64,"tobaccoFactor":1},"4":{"base21":410.32,"tobaccoFactor":1},"5":{"base21":449.76,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":434.62,"tobaccoFactor":1},"2":{"base21":517.1,"tobaccoFactor":1},"4":{"base21":421.28,"tobaccoFactor":1},"5":{"base21":461.78,"tobaccoFactor":1}}}],"ded":{"ind":6000,"fam":12000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":50,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929314, \"SG 2027 EPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 66, 93, 120, 147: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $50 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $50 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay after the deductible (its other imaging row, used here). Other diagnostic testing: $70 copay.","Mental health: office visits, psychotherapy and counseling $50 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge after the deductible.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929314/SG 2027 EPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0110040-00","standardId":"16481PA0110040-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Small Business Advantage Silver EPO $6,000 $50/$70 - Partner Network","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Erie","Greene","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Washington"],"rates":{"1":{"base21":328.75,"tobaccoFactor":1},"2":{"base21":391.13,"tobaccoFactor":1},"4":{"base21":318.66,"tobaccoFactor":1},"5":{"base21":349.28,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":337.53,"tobaccoFactor":1},"2":{"base21":401.58,"tobaccoFactor":1},"4":{"base21":327.17,"tobaccoFactor":1},"5":{"base21":358.62,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":346.55,"tobaccoFactor":1},"2":{"base21":412.32,"tobaccoFactor":1},"4":{"base21":335.92,"tobaccoFactor":1},"5":{"base21":368.2,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":355.81,"tobaccoFactor":1},"2":{"base21":423.34,"tobaccoFactor":1},"4":{"base21":344.89,"tobaccoFactor":1},"5":{"base21":378.04,"tobaccoFactor":1}}}],"ded":{"ind":6000,"fam":12000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":50,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929314, \"SG 2027 EPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 66, 67, 93, 94, 120, 121, 147, 148: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $50 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $50 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay after the deductible (its other imaging row, used here). Other diagnostic testing: $70 copay.","Mental health: office visits, psychotherapy and counseling $50 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge after the deductible.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929314/SG 2027 EPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0110041-00","standardId":"16481PA0110041-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Small Business Advantage Bronze EPO $9,100 - Premium Network","metal":"Bronze","network":"EPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":318.02,"tobaccoFactor":1},"2":{"base21":378.38,"tobaccoFactor":1},"4":{"base21":308.26,"tobaccoFactor":1},"5":{"base21":337.89,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":326.52,"tobaccoFactor":1},"2":{"base21":388.49,"tobaccoFactor":1},"4":{"base21":316.5,"tobaccoFactor":1},"5":{"base21":346.92,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":335.25,"tobaccoFactor":1},"2":{"base21":398.87,"tobaccoFactor":1},"4":{"base21":324.96,"tobaccoFactor":1},"5":{"base21":356.19,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":344.21,"tobaccoFactor":1},"2":{"base21":409.53,"tobaccoFactor":1},"4":{"base21":333.64,"tobaccoFactor":1},"5":{"base21":365.71,"tobaccoFactor":1}}}],"ded":{"ind":9100,"fam":18200,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"copay","amount":95,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929314, \"SG 2027 EPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 52, 79, 106, 133: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced as free (the primary care visit costs nothing on this plan; UPMC's SBCs print \"No cost\" for prenatal visits, read as before the deductible as for UPMC's individual plans); later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: no charge after the deductible (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: no charge after the deductible (its other imaging row, used here). Other diagnostic testing: no charge after the deductible.","Mental health: office visits, psychotherapy and counseling no charge after the deductible (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge after the deductible.","Prescription drugs: retail (not mail-order) cost shares are used.","Prescription drugs: the medical deductible applies (no separate drug deductible).","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929314/SG 2027 EPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0110042-00","standardId":"16481PA0110042-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Small Business Advantage Bronze EPO $9,100 - Partner Network","metal":"Bronze","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Erie","Greene","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Washington"],"rates":{"1":{"base21":260.36,"tobaccoFactor":1},"2":{"base21":309.76,"tobaccoFactor":1},"4":{"base21":252.37,"tobaccoFactor":1},"5":{"base21":276.62,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":267.32,"tobaccoFactor":1},"2":{"base21":318.04,"tobaccoFactor":1},"4":{"base21":259.11,"tobaccoFactor":1},"5":{"base21":284.02,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":274.46,"tobaccoFactor":1},"2":{"base21":326.54,"tobaccoFactor":1},"4":{"base21":266.03,"tobaccoFactor":1},"5":{"base21":291.61,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":281.79,"tobaccoFactor":1},"2":{"base21":335.27,"tobaccoFactor":1},"4":{"base21":273.14,"tobaccoFactor":1},"5":{"base21":299.4,"tobaccoFactor":1}}}],"ded":{"ind":9100,"fam":18200,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"copay","amount":95,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929314, \"SG 2027 EPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 60, 61, 87, 88, 114, 115, 141, 142: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced as free (the primary care visit costs nothing on this plan; UPMC's SBCs print \"No cost\" for prenatal visits, read as before the deductible as for UPMC's individual plans); later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: no charge after the deductible (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: no charge after the deductible (its other imaging row, used here). Other diagnostic testing: no charge after the deductible.","Mental health: office visits, psychotherapy and counseling no charge after the deductible (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge after the deductible.","Prescription drugs: retail (not mail-order) cost shares are used.","Prescription drugs: the medical deductible applies (no separate drug deductible).","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929314/SG 2027 EPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0110043-00","standardId":"16481PA0110043-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Small Business Advantage Gold HSA EPO $1,850/10% - Premium Network","metal":"Gold","network":"EPO","hsaEligible":true,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":422.89,"tobaccoFactor":1},"2":{"base21":503.14,"tobaccoFactor":1},"4":{"base21":409.91,"tobaccoFactor":1},"5":{"base21":449.31,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":434.19,"tobaccoFactor":1},"2":{"base21":516.59,"tobaccoFactor":1},"4":{"base21":420.86,"tobaccoFactor":1},"5":{"base21":461.32,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":445.8,"tobaccoFactor":1},"2":{"base21":530.39,"tobaccoFactor":1},"4":{"base21":432.11,"tobaccoFactor":1},"5":{"base21":473.65,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":457.71,"tobaccoFactor":1},"2":{"base21":544.57,"tobaccoFactor":1},"4":{"base21":443.66,"tobaccoFactor":1},"5":{"base21":486.3,"tobaccoFactor":1}}}],"ded":{"ind":1850,"fam":3700,"embedded":false},"drugDed":null,"oop":{"ind":8500,"fam":12000,"famPerPerson":12000},"rules":{"pcp":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929403, \"SG 2027 EPO HSA Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 56, 83, 110, 137: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at 10% coinsurance after the deductible; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: 10% coinsurance after the deductible (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: 10% coinsurance after the deductible (its other imaging row, used here). Other diagnostic testing: 10% coinsurance after the deductible.","Mental health: office visits, psychotherapy and counseling 10% coinsurance after the deductible (used here); other outpatient services (intensive outpatient, partial hospitalization) 10% coinsurance after the deductible.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Prescription drugs: the medical deductible applies (no separate drug deductible).","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered.","The deductible is aggregate (the matrix's accumulation type): the whole family deductible must be met before the plan pays for anyone in the family, and the estimate uses it."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929403/SG 2027 EPO HSA Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0110044-00","standardId":"16481PA0110044-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Small Business Advantage Gold HSA EPO $2,200/10% - Premium Network","metal":"Gold","network":"EPO","hsaEligible":true,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":413.35,"tobaccoFactor":1},"2":{"base21":491.79,"tobaccoFactor":1},"4":{"base21":400.66,"tobaccoFactor":1},"5":{"base21":439.17,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":424.4,"tobaccoFactor":1},"2":{"base21":504.93,"tobaccoFactor":1},"4":{"base21":411.37,"tobaccoFactor":1},"5":{"base21":450.91,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":435.74,"tobaccoFactor":1},"2":{"base21":518.43,"tobaccoFactor":1},"4":{"base21":422.36,"tobaccoFactor":1},"5":{"base21":462.96,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":447.38,"tobaccoFactor":1},"2":{"base21":532.28,"tobaccoFactor":1},"4":{"base21":433.65,"tobaccoFactor":1},"5":{"base21":475.33,"tobaccoFactor":1}}}],"ded":{"ind":2200,"fam":4400,"embedded":false},"drugDed":null,"oop":{"ind":7500,"fam":12000,"famPerPerson":12000},"rules":{"pcp":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929403, \"SG 2027 EPO HSA Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 56, 57, 83, 84, 110, 111, 137, 138: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at 10% coinsurance after the deductible; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: 10% coinsurance after the deductible (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: 10% coinsurance after the deductible (its other imaging row, used here). Other diagnostic testing: 10% coinsurance after the deductible.","Mental health: office visits, psychotherapy and counseling 10% coinsurance after the deductible (used here); other outpatient services (intensive outpatient, partial hospitalization) 10% coinsurance after the deductible.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Prescription drugs: the medical deductible applies (no separate drug deductible).","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered.","The deductible is aggregate (the matrix's accumulation type): the whole family deductible must be met before the plan pays for anyone in the family, and the estimate uses it."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929403/SG 2027 EPO HSA Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0110045-00","standardId":"16481PA0110045-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Small Business Advantage Gold HSA EPO $3,300 - Premium Network","metal":"Gold","network":"EPO","hsaEligible":true,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":401.75,"tobaccoFactor":1},"2":{"base21":477.99,"tobaccoFactor":1},"4":{"base21":389.42,"tobaccoFactor":1},"5":{"base21":426.85,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":412.48,"tobaccoFactor":1},"2":{"base21":490.76,"tobaccoFactor":1},"4":{"base21":399.82,"tobaccoFactor":1},"5":{"base21":438.25,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":423.51,"tobaccoFactor":1},"2":{"base21":503.88,"tobaccoFactor":1},"4":{"base21":410.51,"tobaccoFactor":1},"5":{"base21":449.97,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":434.83,"tobaccoFactor":1},"2":{"base21":517.34,"tobaccoFactor":1},"4":{"base21":421.48,"tobaccoFactor":1},"5":{"base21":461.99,"tobaccoFactor":1}}}],"ded":{"ind":3300,"fam":6600,"embedded":false},"drugDed":null,"oop":{"ind":7500,"fam":12000,"famPerPerson":12000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929403, \"SG 2027 EPO HSA Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 59, 86, 113, 140: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced as free (the primary care visit costs nothing on this plan; UPMC's SBCs print \"No cost\" for prenatal visits, read as before the deductible as for UPMC's individual plans); later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: no charge after the deductible (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: no charge after the deductible (its other imaging row, used here). Other diagnostic testing: no charge after the deductible.","Mental health: office visits, psychotherapy and counseling no charge after the deductible (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge after the deductible.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Prescription drugs: the medical deductible applies (no separate drug deductible).","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered.","The deductible is aggregate (the matrix's accumulation type): the whole family deductible must be met before the plan pays for anyone in the family, and the estimate uses it."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929403/SG 2027 EPO HSA Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0110046-00","standardId":"16481PA0110046-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC Small Business Advantage Silver HSA EPO $5,200 - Premium Network","metal":"Silver","network":"EPO","hsaEligible":true,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":367.26,"tobaccoFactor":1},"2":{"base21":436.95,"tobaccoFactor":1},"4":{"base21":355.99,"tobaccoFactor":1},"5":{"base21":390.2,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":377.08,"tobaccoFactor":1},"2":{"base21":448.63,"tobaccoFactor":1},"4":{"base21":365.5,"tobaccoFactor":1},"5":{"base21":400.63,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":387.15,"tobaccoFactor":1},"2":{"base21":460.62,"tobaccoFactor":1},"4":{"base21":375.27,"tobaccoFactor":1},"5":{"base21":411.34,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":397.5,"tobaccoFactor":1},"2":{"base21":472.93,"tobaccoFactor":1},"4":{"base21":385.3,"tobaccoFactor":1},"5":{"base21":422.33,"tobaccoFactor":1}}}],"ded":{"ind":5200,"fam":10400,"embedded":true},"drugDed":null,"oop":{"ind":8500,"fam":17000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929403, \"SG 2027 EPO HSA Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 57, 84, 111, 138: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced as free (the primary care visit costs nothing on this plan; UPMC's SBCs print \"No cost\" for prenatal visits, read as before the deductible as for UPMC's individual plans); later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: no charge after the deductible (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: no charge after the deductible (its other imaging row, used here). Other diagnostic testing: no charge after the deductible.","Mental health: office visits, psychotherapy and counseling no charge after the deductible (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge after the deductible.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Prescription drugs: the medical deductible applies (no separate drug deductible).","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929403/SG 2027 EPO HSA Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0110047-00","standardId":"16481PA0110047-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC MyCare Advantage Gold EPO $1,000/10% $30/$50 - Premium Network","metal":"Gold","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Bedford","Blair","Butler","Erie","Fayette","Greene","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Washington","Westmoreland"],"rates":{"1":{"base21":449.89,"tobaccoFactor":1},"2":{"base21":535.26,"tobaccoFactor":1},"4":{"base21":436.08,"tobaccoFactor":1},"5":{"base21":478,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":461.91,"tobaccoFactor":1},"2":{"base21":549.57,"tobaccoFactor":1},"4":{"base21":447.73,"tobaccoFactor":1},"5":{"base21":490.77,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":474.26,"tobaccoFactor":1},"2":{"base21":564.26,"tobaccoFactor":1},"4":{"base21":459.7,"tobaccoFactor":1},"5":{"base21":503.89,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":486.93,"tobaccoFactor":1},"2":{"base21":579.34,"tobaccoFactor":1},"4":{"base21":471.99,"tobaccoFactor":1},"5":{"base21":517.35,"tobaccoFactor":1}}}],"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":500,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":30,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":500,"ded":"after_ded"}}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929314, \"SG 2027 EPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 55, 56, 82, 83, 109, 110, 136, 137: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $30 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $50 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay (its other imaging row, used here). Other diagnostic testing: $50 copay.","Mental health: office visits, psychotherapy and counseling $30 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge.","Hospital stay: $500 copay after the deductible once per admission.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered.","This plan has two in-network tiers. The rules use Tier 1, whose deductible ($1,000 individual / $2,000 family) the rate filing lists. Tier 2 providers have a $2,000 individual / $4,000 family deductible and higher cost sharing; both tiers share the out-of-pocket limit (each rule's text gives both tiers).","Primary care: Tier 1 $30 copay (used here); Tier 2 $50 copay.","Specialist: Tier 1 $50 copay (used here); Tier 2 $100 copay.","Emergency room: Tier 1 $200 copay (used here); Tier 2 $200 copay.","Outpatient surgery facility fee: Tier 1 10% coinsurance after the deductible (used here); Tier 2 35% coinsurance after the deductible.","Hospital stay facility fee: Tier 1 $500 copay after the deductible once per admission (used here); Tier 2 $500 copay after the deductible once per admission."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929314/SG 2027 EPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0110048-00","standardId":"16481PA0110048-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC MyCare Advantage Gold EPO $1,250 $35/$50 - Premium Network","metal":"Gold","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Bedford","Blair","Butler","Erie","Fayette","Greene","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Washington","Westmoreland"],"rates":{"1":{"base21":456.33,"tobaccoFactor":1},"2":{"base21":542.93,"tobaccoFactor":1},"4":{"base21":442.33,"tobaccoFactor":1},"5":{"base21":484.84,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":468.53,"tobaccoFactor":1},"2":{"base21":557.44,"tobaccoFactor":1},"4":{"base21":454.15,"tobaccoFactor":1},"5":{"base21":497.8,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":481.05,"tobaccoFactor":1},"2":{"base21":572.34,"tobaccoFactor":1},"4":{"base21":466.28,"tobaccoFactor":1},"5":{"base21":511.1,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":493.91,"tobaccoFactor":1},"2":{"base21":587.63,"tobaccoFactor":1},"4":{"base21":478.75,"tobaccoFactor":1},"5":{"base21":524.76,"tobaccoFactor":1}}}],"ded":{"ind":1250,"fam":2500,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":35,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929314, \"SG 2027 EPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 53, 80, 107, 134: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $35 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $50 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay (its other imaging row, used here). Other diagnostic testing: $50 copay.","Mental health: office visits, psychotherapy and counseling $35 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered.","This plan has two in-network tiers. The rules use Tier 1, whose deductible ($1,250 individual / $2,500 family) the rate filing lists. Tier 2 providers have a $2,500 individual / $5,000 family deductible and higher cost sharing; both tiers share the out-of-pocket limit (each rule's text gives both tiers).","Primary care: Tier 1 $35 copay (used here); Tier 2 $70 copay.","Specialist: Tier 1 $50 copay (used here); Tier 2 $100 copay.","Emergency room: Tier 1 $200 copay (used here); Tier 2 $200 copay.","Outpatient surgery facility fee: Tier 1 no charge after the deductible (used here); Tier 2 35% coinsurance after the deductible.","Hospital stay facility fee: Tier 1 no charge after the deductible (used here); Tier 2 35% coinsurance after the deductible."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929314/SG 2027 EPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0110049-00","standardId":"16481PA0110049-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC MyCare Advantage Gold EPO $2,000 $35/$50 - Premium Network","metal":"Gold","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Bedford","Blair","Butler","Erie","Fayette","Greene","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Washington","Westmoreland"],"rates":{"1":{"base21":438.57,"tobaccoFactor":1},"2":{"base21":521.8,"tobaccoFactor":1},"4":{"base21":425.11,"tobaccoFactor":1},"5":{"base21":465.97,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":450.29,"tobaccoFactor":1},"2":{"base21":535.74,"tobaccoFactor":1},"4":{"base21":436.47,"tobaccoFactor":1},"5":{"base21":478.42,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":462.33,"tobaccoFactor":1},"2":{"base21":550.06,"tobaccoFactor":1},"4":{"base21":448.13,"tobaccoFactor":1},"5":{"base21":491.21,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":474.68,"tobaccoFactor":1},"2":{"base21":564.76,"tobaccoFactor":1},"4":{"base21":460.11,"tobaccoFactor":1},"5":{"base21":504.34,"tobaccoFactor":1}}}],"ded":{"ind":2000,"fam":4000,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":175,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":35,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929314, \"SG 2027 EPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 53, 54, 80, 81, 107, 108, 134, 135: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $35 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $50 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay (its other imaging row, used here). Other diagnostic testing: $50 copay.","Mental health: office visits, psychotherapy and counseling $35 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered.","This plan has two in-network tiers. The rules use Tier 1, whose deductible ($2,000 individual / $4,000 family) the rate filing lists. Tier 2 providers have a $4,000 individual / $8,000 family deductible and higher cost sharing; both tiers share the out-of-pocket limit (each rule's text gives both tiers).","Primary care: Tier 1 $35 copay (used here); Tier 2 $70 copay.","Specialist: Tier 1 $50 copay (used here); Tier 2 $100 copay.","Emergency room: Tier 1 $175 copay after the deductible (used here); Tier 2 $175 copay after the deductible.","Outpatient surgery facility fee: Tier 1 no charge after the deductible (used here); Tier 2 35% coinsurance after the deductible.","Hospital stay facility fee: Tier 1 no charge after the deductible (used here); Tier 2 35% coinsurance after the deductible."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929314/SG 2027 EPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0110050-00","standardId":"16481PA0110050-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC MyCare Advantage Gold EPO $2,500/10% $30/$50 - Premium Network","metal":"Gold","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Bedford","Blair","Butler","Erie","Fayette","Greene","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Washington","Westmoreland"],"rates":{"1":{"base21":431.72,"tobaccoFactor":1},"2":{"base21":513.64,"tobaccoFactor":1},"4":{"base21":418.47,"tobaccoFactor":1},"5":{"base21":458.69,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":443.26,"tobaccoFactor":1},"2":{"base21":527.37,"tobaccoFactor":1},"4":{"base21":429.65,"tobaccoFactor":1},"5":{"base21":470.95,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":455.1,"tobaccoFactor":1},"2":{"base21":541.47,"tobaccoFactor":1},"4":{"base21":441.13,"tobaccoFactor":1},"5":{"base21":483.53,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":467.26,"tobaccoFactor":1},"2":{"base21":555.94,"tobaccoFactor":1},"4":{"base21":452.92,"tobaccoFactor":1},"5":{"base21":496.46,"tobaccoFactor":1}}}],"ded":{"ind":2500,"fam":5000,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":30,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":30,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929314, \"SG 2027 EPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 54, 81, 108, 135: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $30 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $50 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay (its other imaging row, used here). Other diagnostic testing: $50 copay.","Mental health: office visits, psychotherapy and counseling $30 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered.","This plan has two in-network tiers. The rules use Tier 1, whose deductible ($2,500 individual / $5,000 family) the rate filing lists. Tier 2 providers have a $5,000 individual / $10,000 family deductible and higher cost sharing; both tiers share the out-of-pocket limit (each rule's text gives both tiers).","Primary care: Tier 1 $30 copay (used here); Tier 2 $60 copay.","Specialist: Tier 1 $50 copay (used here); Tier 2 $100 copay.","Emergency room: Tier 1 $200 copay (used here); Tier 2 $200 copay.","Outpatient surgery facility fee: Tier 1 10% coinsurance after the deductible (used here); Tier 2 35% coinsurance after the deductible.","Hospital stay facility fee: Tier 1 10% coinsurance after the deductible (used here); Tier 2 35% coinsurance after the deductible."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929314/SG 2027 EPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0110051-00","standardId":"16481PA0110051-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC MyCare Advantage Silver EPO $4,400/20% $50/$80 - Premium Network","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Bedford","Blair","Butler","Erie","Fayette","Greene","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Washington","Westmoreland"],"rates":{"1":{"base21":369.05,"tobaccoFactor":1},"2":{"base21":439.09,"tobaccoFactor":1},"4":{"base21":357.73,"tobaccoFactor":1},"5":{"base21":392.11,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":378.92,"tobaccoFactor":1},"2":{"base21":450.82,"tobaccoFactor":1},"4":{"base21":367.29,"tobaccoFactor":1},"5":{"base21":402.59,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":389.04,"tobaccoFactor":1},"2":{"base21":462.87,"tobaccoFactor":1},"4":{"base21":377.1,"tobaccoFactor":1},"5":{"base21":413.35,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":399.44,"tobaccoFactor":1},"2":{"base21":475.24,"tobaccoFactor":1},"4":{"base21":387.18,"tobaccoFactor":1},"5":{"base21":424.4,"tobaccoFactor":1}}}],"ded":{"ind":4400,"fam":8800,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":50,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929314, \"SG 2027 EPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 56, 83, 110, 137: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $50 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $60 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay (its other imaging row, used here). Other diagnostic testing: $80 copay.","Mental health: office visits, psychotherapy and counseling $50 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge after the deductible.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered.","This plan has two in-network tiers. The rules use Tier 1, whose deductible ($4,400 individual / $8,800 family) the rate filing lists. Tier 2 providers have a $8,800 individual / $17,600 family deductible and higher cost sharing; both tiers share the out-of-pocket limit (each rule's text gives both tiers).","Primary care: Tier 1 $50 copay (used here); Tier 2 $70 copay.","Specialist: Tier 1 $80 copay (used here); Tier 2 $140 copay.","Emergency room: Tier 1 $300 copay after the deductible (used here); Tier 2 $300 copay after the deductible.","Outpatient surgery facility fee: Tier 1 20% coinsurance after the deductible (used here); Tier 2 35% coinsurance after the deductible.","Hospital stay facility fee: Tier 1 20% coinsurance after the deductible (used here); Tier 2 35% coinsurance after the deductible."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929314/SG 2027 EPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0110052-00","standardId":"16481PA0110052-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC MyCare Advantage Silver EPO $5,000/20% $50/$70 - Premium Network","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Bedford","Blair","Butler","Erie","Fayette","Greene","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Washington","Westmoreland"],"rates":{"1":{"base21":366.87,"tobaccoFactor":1},"2":{"base21":436.48,"tobaccoFactor":1},"4":{"base21":355.6,"tobaccoFactor":1},"5":{"base21":389.78,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":376.67,"tobaccoFactor":1},"2":{"base21":448.15,"tobaccoFactor":1},"4":{"base21":365.11,"tobaccoFactor":1},"5":{"base21":400.2,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":386.74,"tobaccoFactor":1},"2":{"base21":460.13,"tobaccoFactor":1},"4":{"base21":374.86,"tobaccoFactor":1},"5":{"base21":410.9,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":397.07,"tobaccoFactor":1},"2":{"base21":472.42,"tobaccoFactor":1},"4":{"base21":384.88,"tobaccoFactor":1},"5":{"base21":421.88,"tobaccoFactor":1}}}],"ded":{"ind":5000,"fam":10000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":70,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":50,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929314, \"SG 2027 EPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 55, 82, 109, 136: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $50 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $70 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay (its other imaging row, used here). Other diagnostic testing: $70 copay.","Mental health: office visits, psychotherapy and counseling $50 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) 20% coinsurance after the deductible.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered.","This plan has two in-network tiers. The rules use Tier 1, whose deductible ($5,000 individual / $10,000 family) the rate filing lists. Tier 2 providers have a $8,000 individual / $16,000 family deductible and higher cost sharing; both tiers share the out-of-pocket limit (each rule's text gives both tiers).","Primary care: Tier 1 $50 copay (used here); Tier 2 $100 copay.","Specialist: Tier 1 $70 copay (used here); Tier 2 $140 copay.","Emergency room: Tier 1 20% coinsurance after the deductible (used here); Tier 2 20% coinsurance after the deductible.","Outpatient surgery facility fee: Tier 1 20% coinsurance after the deductible (used here); Tier 2 35% coinsurance after the deductible.","Hospital stay facility fee: Tier 1 20% coinsurance after the deductible (used here); Tier 2 35% coinsurance after the deductible."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929314/SG 2027 EPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0110053-00","standardId":"16481PA0110053-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC MyCare Advantage Silver EPO HSA $3,800/20% - Premium Network","metal":"Silver","network":"EPO","hsaEligible":true,"counties":["Allegheny","Beaver","Bedford","Blair","Butler","Erie","Fayette","Greene","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Washington","Westmoreland"],"rates":{"1":{"base21":345.42,"tobaccoFactor":1},"2":{"base21":410.97,"tobaccoFactor":1},"4":{"base21":334.82,"tobaccoFactor":1},"5":{"base21":367,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":354.65,"tobaccoFactor":1},"2":{"base21":421.95,"tobaccoFactor":1},"4":{"base21":343.77,"tobaccoFactor":1},"5":{"base21":376.81,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":364.13,"tobaccoFactor":1},"2":{"base21":433.23,"tobaccoFactor":1},"4":{"base21":352.95,"tobaccoFactor":1},"5":{"base21":386.88,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":373.86,"tobaccoFactor":1},"2":{"base21":444.81,"tobaccoFactor":1},"4":{"base21":362.39,"tobaccoFactor":1},"5":{"base21":397.22,"tobaccoFactor":1}}}],"ded":{"ind":3800,"fam":7600,"embedded":true},"drugDed":null,"oop":{"ind":8500,"fam":17000},"rules":{"pcp":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929403, \"SG 2027 EPO HSA Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 54, 55, 81, 82, 108, 109, 135, 136: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","The benefit matrix names this plan with $3,800/10%; its own coinsurance cells, the plan overview's name ($3,800/20%) and the rate decision agree on $3,800/20%, which is used.","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at 20% coinsurance after the deductible; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: 20% coinsurance after the deductible (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: 20% coinsurance after the deductible (its other imaging row, used here). Other diagnostic testing: 20% coinsurance after the deductible.","Mental health: office visits, psychotherapy and counseling 20% coinsurance after the deductible (used here); other outpatient services (intensive outpatient, partial hospitalization) 20% coinsurance after the deductible.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Prescription drugs: the medical deductible applies (no separate drug deductible).","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered.","This plan has two in-network tiers. The rules use Tier 1, whose deductible ($3,800 individual / $7,600 family) the rate filing lists. Tier 2 providers have a $7,000 individual / $14,000 family deductible and higher cost sharing; both tiers share the out-of-pocket limit (each rule's text gives both tiers).","Primary care: Tier 1 20% coinsurance after the deductible (used here); Tier 2 35% coinsurance after the deductible.","Specialist: Tier 1 20% coinsurance after the deductible (used here); Tier 2 35% coinsurance after the deductible.","Emergency room: Tier 1 20% coinsurance after the deductible (used here); Tier 2 20% coinsurance after the deductible.","Outpatient surgery facility fee: Tier 1 20% coinsurance after the deductible (used here); Tier 2 35% coinsurance after the deductible.","Hospital stay facility fee: Tier 1 20% coinsurance after the deductible (used here); Tier 2 35% coinsurance after the deductible."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929403/SG 2027 EPO HSA Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0110054-00","standardId":"16481PA0110054-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC VirtualCare Gold EPO $1,500 $40/$50 - Partner Network","metal":"Gold","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Erie","Greene","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Washington"],"rates":{"1":{"base21":392.55,"tobaccoFactor":1},"2":{"base21":467.04,"tobaccoFactor":1},"4":{"base21":380.5,"tobaccoFactor":1},"5":{"base21":417.07,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":403.04,"tobaccoFactor":1},"2":{"base21":479.52,"tobaccoFactor":1},"4":{"base21":390.66,"tobaccoFactor":1},"5":{"base21":428.22,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":413.81,"tobaccoFactor":1},"2":{"base21":492.33,"tobaccoFactor":1},"4":{"base21":401.11,"tobaccoFactor":1},"5":{"base21":439.66,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":424.87,"tobaccoFactor":1},"2":{"base21":505.49,"tobaccoFactor":1},"4":{"base21":411.82,"tobaccoFactor":1},"5":{"base21":451.41,"tobaccoFactor":1}}}],"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":40,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929314, \"SG 2027 EPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 61, 88, 115, 142: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $40 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $50 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay (its other imaging row, used here). Other diagnostic testing: $50 copay.","Mental health: office visits, psychotherapy and counseling $40 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929314/SG 2027 EPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0110055-00","standardId":"16481PA0110055-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC VirtualCare Gold EPO $1,000 $40/$50 - Partner Network","metal":"Gold","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Erie","Greene","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Washington"],"rates":{"1":{"base21":399.37,"tobaccoFactor":1},"2":{"base21":475.15,"tobaccoFactor":1},"4":{"base21":387.11,"tobaccoFactor":1},"5":{"base21":424.32,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":410.04,"tobaccoFactor":1},"2":{"base21":487.85,"tobaccoFactor":1},"4":{"base21":397.45,"tobaccoFactor":1},"5":{"base21":435.66,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":421,"tobaccoFactor":1},"2":{"base21":500.89,"tobaccoFactor":1},"4":{"base21":408.08,"tobaccoFactor":1},"5":{"base21":447.3,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":432.25,"tobaccoFactor":1},"2":{"base21":514.28,"tobaccoFactor":1},"4":{"base21":418.98,"tobaccoFactor":1},"5":{"base21":459.25,"tobaccoFactor":1}}}],"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":40,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929314, \"SG 2027 EPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 64, 91, 118, 145: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $40 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $50 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay (its other imaging row, used here). Other diagnostic testing: $50 copay.","Mental health: office visits, psychotherapy and counseling $40 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929314/SG 2027 EPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"16481PA0110056-00","standardId":"16481PA0110056-00","variant":"standard","issuer":"UPMC Health Network","name":"UPMC VirtualCare Silver EPO $4,400 $60/$80 - Partner Network","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Bedford","Blair","Butler","Erie","Greene","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Washington"],"rates":{"1":{"base21":333.17,"tobaccoFactor":1},"2":{"base21":396.4,"tobaccoFactor":1},"4":{"base21":322.95,"tobaccoFactor":1},"5":{"base21":353.99,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":342.08,"tobaccoFactor":1},"2":{"base21":406.99,"tobaccoFactor":1},"4":{"base21":331.58,"tobaccoFactor":1},"5":{"base21":363.45,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":351.22,"tobaccoFactor":1},"2":{"base21":417.87,"tobaccoFactor":1},"4":{"base21":340.44,"tobaccoFactor":1},"5":{"base21":373.16,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":360.6,"tobaccoFactor":1},"2":{"base21":429.04,"tobaccoFactor":1},"4":{"base21":349.54,"tobaccoFactor":1},"5":{"base21":383.13,"tobaccoFactor":1}}}],"ded":{"ind":4400,"fam":8800,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":750,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":750,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":60,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":750,"ded":"after_ded"}}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134929314, \"SG 2027 EPO Health Network Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hn-rate-change-decision-sm-grp-mkt.pdf, rate pages 61, 62, 88, 89, 115, 116, 142, 143: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $60 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $60 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay after the deductible (its other imaging row, used here). Other diagnostic testing: $80 copay.","Mental health: office visits, psychotherapy and counseling $60 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge after the deductible.","Hospital stay: $750 copay after the deductible once per admission.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134929314/SG 2027 EPO Health Network Benefit Matrix.xlsx"},{"market":"group","id":"22444PA0060062-00","standardId":"22444PA0060062-00","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Small Group ACA All-Access HMO 20/40/3200","metal":"Gold","network":"HMO","hsaEligible":false,"counties":["Adams","Bedford","Berks","Blair","Bradford","Cambria","Cameron","Carbon","Centre","Clearfield","Clinton","Columbia","Cumberland","Dauphin","Elk","Franklin","Fulton","Huntingdon","Jefferson","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northampton","Northumberland","Perry","Pike","Potter","Schuylkill","Snyder","Somerset","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"2":{"base21":588.71,"tobaccoFactor":1},"3":{"base21":559.27,"tobaccoFactor":1},"5":{"base21":559.27,"tobaccoFactor":1},"6":{"base21":588.71,"tobaccoFactor":1},"7":{"base21":735.88,"tobaccoFactor":1},"9":{"base21":706.45,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"2":{"base21":599.55,"tobaccoFactor":1},"3":{"base21":569.57,"tobaccoFactor":1},"5":{"base21":569.57,"tobaccoFactor":1},"6":{"base21":599.55,"tobaccoFactor":1},"7":{"base21":749.43,"tobaccoFactor":1},"9":{"base21":719.46,"tobaccoFactor":1}}},{"from":7,"rates":{"2":{"base21":610.59,"tobaccoFactor":1},"3":{"base21":580.06,"tobaccoFactor":1},"5":{"base21":580.06,"tobaccoFactor":1},"6":{"base21":610.59,"tobaccoFactor":1},"7":{"base21":763.23,"tobaccoFactor":1},"9":{"base21":732.71,"tobaccoFactor":1}}},{"from":10,"rates":{"2":{"base21":621.83,"tobaccoFactor":1},"3":{"base21":590.74,"tobaccoFactor":1},"5":{"base21":590.74,"tobaccoFactor":1},"6":{"base21":621.83,"tobaccoFactor":1},"7":{"base21":777.29,"tobaccoFactor":1},"9":{"base21":746.2,"tobaccoFactor":1}}}],"ded":{"ind":3200,"fam":6400,"embedded":true},"drugDed":{"ind":150,"fam":300,"embedded":true},"oop":{"ind":8550,"fam":17100},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":60,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded","max":200}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $15 copay.","Specialty drugs: 40% coinsurance up to $200 per fill (the cap is modelled here).","Separate prescription drug deductible: $150 individual / $300 family. Drug rows that say \"Deductible does not apply\" (generic drugs) are charged from the first fill; the others (preferred brand drugs, non-preferred brand drugs, specialty drugs) do not say, so they are read as after the drug deductible.","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, imaging, outpatient surgery facility fees, outpatient surgeon fees, hospital stay facility fees, hospital stay physician fees, delivery facility fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/22444PA0060062-00.pdf","prev":{"planYear":2026,"rates":{"2":{"base21":550.45,"tobaccoFactor":1},"3":{"base21":522.92,"tobaccoFactor":1},"5":{"base21":522.92,"tobaccoFactor":1},"6":{"base21":550.45,"tobaccoFactor":1},"7":{"base21":688.06,"tobaccoFactor":1},"9":{"base21":660.54,"tobaccoFactor":1}}}},{"market":"group","id":"22444PA0060063-00","standardId":"22444PA0060063-00","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Small Group ACA All-Access HMO 30/60/5800","metal":"Silver","network":"HMO","hsaEligible":false,"counties":["Adams","Bedford","Berks","Blair","Bradford","Cambria","Cameron","Carbon","Centre","Clearfield","Clinton","Columbia","Cumberland","Dauphin","Elk","Franklin","Fulton","Huntingdon","Jefferson","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northampton","Northumberland","Perry","Pike","Potter","Schuylkill","Snyder","Somerset","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"2":{"base21":493.21,"tobaccoFactor":1},"3":{"base21":468.55,"tobaccoFactor":1},"5":{"base21":468.55,"tobaccoFactor":1},"6":{"base21":493.21,"tobaccoFactor":1},"7":{"base21":616.52,"tobaccoFactor":1},"9":{"base21":591.86,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"2":{"base21":502.3,"tobaccoFactor":1},"3":{"base21":477.18,"tobaccoFactor":1},"5":{"base21":477.18,"tobaccoFactor":1},"6":{"base21":502.3,"tobaccoFactor":1},"7":{"base21":627.87,"tobaccoFactor":1},"9":{"base21":602.75,"tobaccoFactor":1}}},{"from":7,"rates":{"2":{"base21":511.55,"tobaccoFactor":1},"3":{"base21":485.97,"tobaccoFactor":1},"5":{"base21":485.97,"tobaccoFactor":1},"6":{"base21":511.55,"tobaccoFactor":1},"7":{"base21":639.43,"tobaccoFactor":1},"9":{"base21":613.85,"tobaccoFactor":1}}},{"from":10,"rates":{"2":{"base21":520.97,"tobaccoFactor":1},"3":{"base21":494.92,"tobaccoFactor":1},"5":{"base21":494.92,"tobaccoFactor":1},"6":{"base21":520.97,"tobaccoFactor":1},"7":{"base21":651.21,"tobaccoFactor":1},"9":{"base21":625.16,"tobaccoFactor":1}}}],"ded":{"ind":5800,"fam":11600,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Outpatient surgery facility fees: $100 copay per day of service, charged once per service here.","Separate prescription drug deductible: $500 individual / $1,000 family. Drug rows that say \"Deductible does not apply\" (generic drugs) are charged from the first fill; the others (preferred brand drugs, non-preferred brand drugs, specialty drugs) do not say, so they are read as after the drug deductible.","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, imaging, outpatient surgeon fees, hospital stay facility fees, hospital stay physician fees, delivery facility fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/22444PA0060063-00.pdf","prev":{"planYear":2026,"rates":{"2":{"base21":449.62,"tobaccoFactor":1},"3":{"base21":427.14,"tobaccoFactor":1},"5":{"base21":427.14,"tobaccoFactor":1},"6":{"base21":449.62,"tobaccoFactor":1},"7":{"base21":562.02,"tobaccoFactor":1},"9":{"base21":539.54,"tobaccoFactor":1}}}},{"market":"group","id":"22444PA0060114-00","standardId":"22444PA0060114-00","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Small Group ACA All-Access HMO 25/50/0","metal":"Platinum","network":"HMO","hsaEligible":false,"counties":["Adams","Bedford","Berks","Blair","Bradford","Cambria","Cameron","Carbon","Centre","Clearfield","Clinton","Columbia","Cumberland","Dauphin","Elk","Franklin","Fulton","Huntingdon","Jefferson","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northampton","Northumberland","Perry","Pike","Potter","Schuylkill","Snyder","Somerset","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"2":{"base21":702.73,"tobaccoFactor":1},"3":{"base21":667.6,"tobaccoFactor":1},"5":{"base21":667.6,"tobaccoFactor":1},"6":{"base21":702.73,"tobaccoFactor":1},"7":{"base21":878.42,"tobaccoFactor":1},"9":{"base21":843.28,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"2":{"base21":715.68,"tobaccoFactor":1},"3":{"base21":679.89,"tobaccoFactor":1},"5":{"base21":679.89,"tobaccoFactor":1},"6":{"base21":715.68,"tobaccoFactor":1},"7":{"base21":894.59,"tobaccoFactor":1},"9":{"base21":858.81,"tobaccoFactor":1}}},{"from":7,"rates":{"2":{"base21":728.86,"tobaccoFactor":1},"3":{"base21":692.41,"tobaccoFactor":1},"5":{"base21":692.41,"tobaccoFactor":1},"6":{"base21":728.86,"tobaccoFactor":1},"7":{"base21":911.07,"tobaccoFactor":1},"9":{"base21":874.63,"tobaccoFactor":1}}},{"from":10,"rates":{"2":{"base21":742.28,"tobaccoFactor":1},"3":{"base21":705.16,"tobaccoFactor":1},"5":{"base21":705.16,"tobaccoFactor":1},"6":{"base21":742.28,"tobaccoFactor":1},"7":{"base21":927.85,"tobaccoFactor":1},"9":{"base21":890.73,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":7000,"fam":14000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":300,"ded":"no_ded"},"perDay":{"maxDays":1}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $5 copay.","Imaging: $250 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $300 copay per day of service, charged once per service here.","Hospital stay: $300 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $300 copay per admission.","Specialty drugs: 40% coinsurance up to $150 per fill (the cap is modelled here).","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/22444PA0060114-00.pdf","prev":{"planYear":2026,"rates":{"2":{"base21":670.25,"tobaccoFactor":1},"3":{"base21":636.74,"tobaccoFactor":1},"5":{"base21":636.74,"tobaccoFactor":1},"6":{"base21":670.25,"tobaccoFactor":1},"7":{"base21":837.81,"tobaccoFactor":1},"9":{"base21":804.3,"tobaccoFactor":1}}}},{"market":"group","id":"22444PA0060116-00","standardId":"22444PA0060116-00","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Small Group ACA All-Access HMO Gold 25/50/500","metal":"Gold","network":"HMO","hsaEligible":false,"counties":["Adams","Bedford","Berks","Blair","Bradford","Cambria","Cameron","Carbon","Centre","Clearfield","Clinton","Columbia","Cumberland","Dauphin","Elk","Franklin","Fulton","Huntingdon","Jefferson","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northampton","Northumberland","Perry","Pike","Potter","Schuylkill","Snyder","Somerset","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"2":{"base21":577.13,"tobaccoFactor":1},"3":{"base21":548.27,"tobaccoFactor":1},"5":{"base21":548.27,"tobaccoFactor":1},"6":{"base21":577.13,"tobaccoFactor":1},"7":{"base21":721.41,"tobaccoFactor":1},"9":{"base21":692.55,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"2":{"base21":587.76,"tobaccoFactor":1},"3":{"base21":558.37,"tobaccoFactor":1},"5":{"base21":558.37,"tobaccoFactor":1},"6":{"base21":587.76,"tobaccoFactor":1},"7":{"base21":734.7,"tobaccoFactor":1},"9":{"base21":705.31,"tobaccoFactor":1}}},{"from":7,"rates":{"2":{"base21":598.58,"tobaccoFactor":1},"3":{"base21":568.65,"tobaccoFactor":1},"5":{"base21":568.65,"tobaccoFactor":1},"6":{"base21":598.58,"tobaccoFactor":1},"7":{"base21":748.22,"tobaccoFactor":1},"9":{"base21":718.3,"tobaccoFactor":1}}},{"from":10,"rates":{"2":{"base21":609.6,"tobaccoFactor":1},"3":{"base21":579.12,"tobaccoFactor":1},"5":{"base21":579.12,"tobaccoFactor":1},"6":{"base21":609.6,"tobaccoFactor":1},"7":{"base21":762,"tobaccoFactor":1},"9":{"base21":731.52,"tobaccoFactor":1}}}],"ded":{"ind":500,"fam":1000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":275,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":500,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $15 copay.","Imaging: $275 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $500 copay per day of service, charged once per service here.","Hospital stay: $500 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $500 copay per admission.","Specialty drugs: 40% coinsurance up to $150 per fill (the cap is modelled here).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, outpatient surgeon fees, hospital stay physician fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/22444PA0060116-00.pdf","prev":{"planYear":2026,"rates":{"2":{"base21":582.14,"tobaccoFactor":1},"3":{"base21":553.03,"tobaccoFactor":1},"5":{"base21":553.03,"tobaccoFactor":1},"6":{"base21":582.14,"tobaccoFactor":1},"7":{"base21":727.67,"tobaccoFactor":1},"9":{"base21":698.57,"tobaccoFactor":1}}}},{"market":"group","id":"22444PA0060118-00","standardId":"22444PA0060118-00","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Small Group ACA All-Access HMO 20/40/1500","metal":"Gold","network":"HMO","hsaEligible":false,"counties":["Adams","Bedford","Berks","Blair","Bradford","Cambria","Cameron","Carbon","Centre","Clearfield","Clinton","Columbia","Cumberland","Dauphin","Elk","Franklin","Fulton","Huntingdon","Jefferson","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northampton","Northumberland","Perry","Pike","Potter","Schuylkill","Snyder","Somerset","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"2":{"base21":615.89,"tobaccoFactor":1},"3":{"base21":585.1,"tobaccoFactor":1},"5":{"base21":585.1,"tobaccoFactor":1},"6":{"base21":615.89,"tobaccoFactor":1},"7":{"base21":769.87,"tobaccoFactor":1},"9":{"base21":739.07,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"2":{"base21":627.24,"tobaccoFactor":1},"3":{"base21":595.88,"tobaccoFactor":1},"5":{"base21":595.88,"tobaccoFactor":1},"6":{"base21":627.24,"tobaccoFactor":1},"7":{"base21":784.04,"tobaccoFactor":1},"9":{"base21":752.68,"tobaccoFactor":1}}},{"from":7,"rates":{"2":{"base21":638.79,"tobaccoFactor":1},"3":{"base21":606.85,"tobaccoFactor":1},"5":{"base21":606.85,"tobaccoFactor":1},"6":{"base21":638.79,"tobaccoFactor":1},"7":{"base21":798.48,"tobaccoFactor":1},"9":{"base21":766.54,"tobaccoFactor":1}}},{"from":10,"rates":{"2":{"base21":650.55,"tobaccoFactor":1},"3":{"base21":618.02,"tobaccoFactor":1},"5":{"base21":618.02,"tobaccoFactor":1},"6":{"base21":650.55,"tobaccoFactor":1},"7":{"base21":813.19,"tobaccoFactor":1},"9":{"base21":780.66,"tobaccoFactor":1}}}],"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":250}},"outpatientFacility":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":500,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Imaging: $200 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $400 copay per day of service, charged once per service here.","Hospital stay: $500 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $500 copay per admission.","Specialty drugs: 40% coinsurance up to $250 per fill (the cap is modelled here).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, outpatient surgeon fees, hospital stay physician fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/22444PA0060118-00.pdf","prev":{"planYear":2026,"rates":{"2":{"base21":593.82,"tobaccoFactor":1},"3":{"base21":564.13,"tobaccoFactor":1},"5":{"base21":564.13,"tobaccoFactor":1},"6":{"base21":593.82,"tobaccoFactor":1},"7":{"base21":742.28,"tobaccoFactor":1},"9":{"base21":712.59,"tobaccoFactor":1}}}},{"market":"group","id":"22444PA0060120-00","standardId":"22444PA0060120-00","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Small Group ACA All-Access HMO Platinum 25/50/500","metal":"Platinum","network":"HMO","hsaEligible":false,"counties":["Adams","Bedford","Berks","Blair","Bradford","Cambria","Cameron","Carbon","Centre","Clearfield","Clinton","Columbia","Cumberland","Dauphin","Elk","Franklin","Fulton","Huntingdon","Jefferson","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northampton","Northumberland","Perry","Pike","Potter","Schuylkill","Snyder","Somerset","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"2":{"base21":668.06,"tobaccoFactor":1},"3":{"base21":634.66,"tobaccoFactor":1},"5":{"base21":634.66,"tobaccoFactor":1},"6":{"base21":668.06,"tobaccoFactor":1},"7":{"base21":835.07,"tobaccoFactor":1},"9":{"base21":801.67,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"2":{"base21":680.36,"tobaccoFactor":1},"3":{"base21":646.34,"tobaccoFactor":1},"5":{"base21":646.34,"tobaccoFactor":1},"6":{"base21":680.36,"tobaccoFactor":1},"7":{"base21":850.45,"tobaccoFactor":1},"9":{"base21":816.43,"tobaccoFactor":1}}},{"from":7,"rates":{"2":{"base21":692.89,"tobaccoFactor":1},"3":{"base21":658.25,"tobaccoFactor":1},"5":{"base21":658.25,"tobaccoFactor":1},"6":{"base21":692.89,"tobaccoFactor":1},"7":{"base21":866.11,"tobaccoFactor":1},"9":{"base21":831.47,"tobaccoFactor":1}}},{"from":10,"rates":{"2":{"base21":705.65,"tobaccoFactor":1},"3":{"base21":670.37,"tobaccoFactor":1},"5":{"base21":670.37,"tobaccoFactor":1},"6":{"base21":705.65,"tobaccoFactor":1},"7":{"base21":882.06,"tobaccoFactor":1},"9":{"base21":846.78,"tobaccoFactor":1}}}],"ded":{"ind":500,"fam":1000,"embedded":true},"drugDed":null,"oop":{"ind":3500,"fam":7000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":250,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $5 copay.","Imaging: $200 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $250 copay per day of service, charged once per service here.","Hospital stay: $250 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $250 copay per admission.","Specialty drugs: 40% coinsurance up to $150 per fill (the cap is modelled here).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (outpatient surgeon fees, hospital stay physician fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/22444PA0060120-00.pdf","prev":{"planYear":2026,"rates":{"2":{"base21":654.69,"tobaccoFactor":1},"3":{"base21":621.95,"tobaccoFactor":1},"5":{"base21":621.95,"tobaccoFactor":1},"6":{"base21":654.69,"tobaccoFactor":1},"7":{"base21":818.36,"tobaccoFactor":1},"9":{"base21":785.63,"tobaccoFactor":1}}}},{"market":"group","id":"22444PA0060121-00","standardId":"22444PA0060121-00","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Premier HMO 25/50/0","metal":"Platinum","network":"HMO","hsaEligible":false,"counties":["Centre","Columbia","Mifflin","Montour","Northumberland","Snyder","Union"],"rates":{"6":{"base21":660.57,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":672.74,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":685.12,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":697.74,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":7000,"fam":14000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":300,"ded":"no_ded"},"perDay":{"maxDays":1}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $5 copay.","Imaging: $250 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $300 copay per day of service, charged once per service here.","Hospital stay: $300 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $300 copay per admission.","Specialty drugs: 40% coinsurance up to $150 per fill (the cap is modelled here).","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/22444PA0060121-00.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":630.04,"tobaccoFactor":1}}}},{"market":"group","id":"22444PA0060122-00","standardId":"22444PA0060122-00","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Premier HMO 20/40/1500","metal":"Gold","network":"HMO","hsaEligible":false,"counties":["Centre","Columbia","Mifflin","Montour","Northumberland","Snyder","Union"],"rates":{"6":{"base21":578.94,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":589.6,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":600.46,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":611.52,"tobaccoFactor":1}}}],"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":250}},"outpatientFacility":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":500,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Imaging: $200 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $400 copay per day of service, charged once per service here.","Hospital stay: $500 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $500 copay per admission.","Specialty drugs: 40% coinsurance up to $250 per fill (the cap is modelled here).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, outpatient surgeon fees, hospital stay physician fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/22444PA0060122-00.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":574.57,"tobaccoFactor":1}}}},{"market":"group","id":"22444PA0060123-00","standardId":"22444PA0060123-00","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Premier HMO 35/70/4300","metal":"Silver","network":"HMO","hsaEligible":false,"counties":["Centre","Columbia","Mifflin","Montour","Northumberland","Snyder","Union"],"rates":{"6":{"base21":482.43,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":491.31,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":500.36,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":509.57,"tobaccoFactor":1}}}],"ded":{"ind":4300,"fam":8600,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":200,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Imaging: $250 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $250 copay per day of service, charged once per service here.","Hospital stay: $200 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $200 copay per admission.","Separate prescription drug deductible: $500 individual / $1,000 family. Drug rows that say \"Deductible does not apply\" (generic drugs) are charged from the first fill; the others (preferred brand drugs, non-preferred brand drugs, specialty drugs) do not say, so they are read as after the drug deductible.","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, outpatient surgeon fees, hospital stay physician fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/22444PA0060123-00.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":443.79,"tobaccoFactor":1}}}},{"market":"group","id":"22444PA0060124-00","standardId":"22444PA0060124-00","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Premier HMO 25/50/3300","metal":"Gold","network":"HMO","hsaEligible":false,"counties":["Centre","Columbia","Mifflin","Montour","Northumberland","Snyder","Union"],"rates":{"6":{"base21":544.46,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":554.49,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":564.7,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":575.1,"tobaccoFactor":1}}}],"ded":{"ind":3300,"fam":6600,"embedded":true},"drugDed":null,"oop":{"ind":8550,"fam":17100},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":250}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Specialty drugs: 40% coinsurance up to $250 per fill (the cap is modelled here).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, imaging, outpatient surgery facility fees, outpatient surgeon fees, hospital stay facility fees, hospital stay physician fees, delivery facility fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/22444PA0060124-00.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":521.17,"tobaccoFactor":1}}}},{"market":"group","id":"22444PA0060125-00","standardId":"22444PA0060125-00","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Premier HMO 25/50/3000","metal":"Gold","network":"HMO","hsaEligible":false,"counties":["Centre","Columbia","Mifflin","Montour","Northumberland","Snyder","Union"],"rates":{"6":{"base21":556.39,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":566.64,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":577.07,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":587.7,"tobaccoFactor":1}}}],"ded":{"ind":3000,"fam":6000,"embedded":true},"drugDed":null,"oop":{"ind":9500,"fam":19000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":250}},"outpatientFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":150,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Imaging: $100 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $150 copay per day of service, charged once per service here.","Hospital stay: $150 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $150 copay per admission.","Specialty drugs: 40% coinsurance up to $250 per fill (the cap is modelled here).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, outpatient surgeon fees, hospital stay physician fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/22444PA0060125-00.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":543.27,"tobaccoFactor":1}}}},{"market":"group","id":"22444PA0060126-00","standardId":"22444PA0060126-00","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Premier HMO 25/50/0","metal":"Platinum","network":"HMO","hsaEligible":false,"counties":["Carbon","Lehigh","Monroe","Northampton","Schuylkill"],"rates":{"3":{"base21":627.54,"tobaccoFactor":1},"6":{"base21":660.57,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":639.1,"tobaccoFactor":1},"6":{"base21":672.74,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":650.87,"tobaccoFactor":1},"6":{"base21":685.12,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":662.85,"tobaccoFactor":1},"6":{"base21":697.74,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":7000,"fam":14000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":300,"ded":"no_ded"},"perDay":{"maxDays":1}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $5 copay.","Imaging: $250 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $300 copay per day of service, charged once per service here.","Hospital stay: $300 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $300 copay per admission.","Specialty drugs: 40% coinsurance up to $150 per fill (the cap is modelled here).","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/22444PA0060126-00.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":598.54,"tobaccoFactor":1},"6":{"base21":630.04,"tobaccoFactor":1}}}},{"market":"group","id":"22444PA0060127-00","standardId":"22444PA0060127-00","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Premier HMO 20/40/1500","metal":"Gold","network":"HMO","hsaEligible":false,"counties":["Carbon","Lehigh","Monroe","Northampton","Schuylkill"],"rates":{"3":{"base21":550,"tobaccoFactor":1},"6":{"base21":578.94,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":560.12,"tobaccoFactor":1},"6":{"base21":589.6,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":570.44,"tobaccoFactor":1},"6":{"base21":600.46,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":580.94,"tobaccoFactor":1},"6":{"base21":611.52,"tobaccoFactor":1}}}],"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":250}},"outpatientFacility":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":500,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Imaging: $200 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $400 copay per day of service, charged once per service here.","Hospital stay: $500 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $500 copay per admission.","Specialty drugs: 40% coinsurance up to $250 per fill (the cap is modelled here).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, outpatient surgeon fees, hospital stay physician fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/22444PA0060127-00.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":545.84,"tobaccoFactor":1},"6":{"base21":574.57,"tobaccoFactor":1}}}},{"market":"group","id":"22444PA0060128-00","standardId":"22444PA0060128-00","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Premier HMO 35/70/4300","metal":"Silver","network":"HMO","hsaEligible":false,"counties":["Carbon","Lehigh","Monroe","Northampton","Schuylkill"],"rates":{"3":{"base21":458.3,"tobaccoFactor":1},"6":{"base21":482.43,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":466.74,"tobaccoFactor":1},"6":{"base21":491.31,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":475.34,"tobaccoFactor":1},"6":{"base21":500.36,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":484.09,"tobaccoFactor":1},"6":{"base21":509.57,"tobaccoFactor":1}}}],"ded":{"ind":4300,"fam":8600,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":200,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Imaging: $250 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $250 copay per day of service, charged once per service here.","Hospital stay: $200 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $200 copay per admission.","Separate prescription drug deductible: $500 individual / $1,000 family. Drug rows that say \"Deductible does not apply\" (generic drugs) are charged from the first fill; the others (preferred brand drugs, non-preferred brand drugs, specialty drugs) do not say, so they are read as after the drug deductible.","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, outpatient surgeon fees, hospital stay physician fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/22444PA0060128-00.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":421.6,"tobaccoFactor":1},"6":{"base21":443.79,"tobaccoFactor":1}}}},{"market":"group","id":"22444PA0060129-00","standardId":"22444PA0060129-00","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Premier HMO 25/50/3300","metal":"Gold","network":"HMO","hsaEligible":false,"counties":["Carbon","Lehigh","Monroe","Northampton","Schuylkill"],"rates":{"3":{"base21":517.24,"tobaccoFactor":1},"6":{"base21":544.46,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":526.77,"tobaccoFactor":1},"6":{"base21":554.49,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":536.47,"tobaccoFactor":1},"6":{"base21":564.7,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":546.35,"tobaccoFactor":1},"6":{"base21":575.1,"tobaccoFactor":1}}}],"ded":{"ind":3300,"fam":6600,"embedded":true},"drugDed":null,"oop":{"ind":8550,"fam":17100},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":250}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Specialty drugs: 40% coinsurance up to $250 per fill (the cap is modelled here).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, imaging, outpatient surgery facility fees, outpatient surgeon fees, hospital stay facility fees, hospital stay physician fees, delivery facility fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/22444PA0060129-00.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":495.11,"tobaccoFactor":1},"6":{"base21":521.17,"tobaccoFactor":1}}}},{"market":"group","id":"22444PA0060130-00","standardId":"22444PA0060130-00","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Premier HMO 25/50/3000","metal":"Gold","network":"HMO","hsaEligible":false,"counties":["Carbon","Lehigh","Monroe","Northampton","Schuylkill"],"rates":{"3":{"base21":528.57,"tobaccoFactor":1},"6":{"base21":556.39,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":538.31,"tobaccoFactor":1},"6":{"base21":566.64,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":548.22,"tobaccoFactor":1},"6":{"base21":577.07,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":558.31,"tobaccoFactor":1},"6":{"base21":587.7,"tobaccoFactor":1}}}],"ded":{"ind":3000,"fam":6000,"embedded":true},"drugDed":null,"oop":{"ind":9500,"fam":19000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":250}},"outpatientFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":150,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Imaging: $100 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $150 copay per day of service, charged once per service here.","Hospital stay: $150 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $150 copay per admission.","Specialty drugs: 40% coinsurance up to $250 per fill (the cap is modelled here).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, outpatient surgeon fees, hospital stay physician fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/22444PA0060130-00.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":516.11,"tobaccoFactor":1},"6":{"base21":543.27,"tobaccoFactor":1}}}},{"market":"group","id":"22444PA0060131-00","standardId":"22444PA0060131-00","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Premier HMO 25/50/0","metal":"Platinum","network":"HMO","hsaEligible":false,"counties":["Lackawanna","Luzerne","Wayne"],"rates":{"3":{"base21":627.54,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":639.1,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":650.87,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":662.85,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":7000,"fam":14000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":300,"ded":"no_ded"},"perDay":{"maxDays":1}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $5 copay.","Imaging: $250 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $300 copay per day of service, charged once per service here.","Hospital stay: $300 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $300 copay per admission.","Specialty drugs: 40% coinsurance up to $150 per fill (the cap is modelled here).","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/22444PA0060131-00.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":598.54,"tobaccoFactor":1}}}},{"market":"group","id":"22444PA0060132-00","standardId":"22444PA0060132-00","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Premier HMO 20/40/1500","metal":"Gold","network":"HMO","hsaEligible":false,"counties":["Lackawanna","Luzerne","Wayne"],"rates":{"3":{"base21":550,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":560.12,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":570.44,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":580.94,"tobaccoFactor":1}}}],"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":250}},"outpatientFacility":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":500,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Imaging: $200 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $400 copay per day of service, charged once per service here.","Hospital stay: $500 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $500 copay per admission.","Specialty drugs: 40% coinsurance up to $250 per fill (the cap is modelled here).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, outpatient surgeon fees, hospital stay physician fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/22444PA0060132-00.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":545.84,"tobaccoFactor":1}}}},{"market":"group","id":"22444PA0060133-00","standardId":"22444PA0060133-00","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Premier HMO 35/70/4300","metal":"Silver","network":"HMO","hsaEligible":false,"counties":["Lackawanna","Luzerne","Wayne"],"rates":{"3":{"base21":458.3,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":466.74,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":475.34,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":484.09,"tobaccoFactor":1}}}],"ded":{"ind":4300,"fam":8600,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":200,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Imaging: $250 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $250 copay per day of service, charged once per service here.","Hospital stay: $200 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $200 copay per admission.","Separate prescription drug deductible: $500 individual / $1,000 family. Drug rows that say \"Deductible does not apply\" (generic drugs) are charged from the first fill; the others (preferred brand drugs, non-preferred brand drugs, specialty drugs) do not say, so they are read as after the drug deductible.","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, outpatient surgeon fees, hospital stay physician fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/22444PA0060133-00.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":421.6,"tobaccoFactor":1}}}},{"market":"group","id":"22444PA0060134-00","standardId":"22444PA0060134-00","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Premier HMO 25/50/3300","metal":"Gold","network":"HMO","hsaEligible":false,"counties":["Lackawanna","Luzerne","Wayne"],"rates":{"3":{"base21":517.24,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":526.77,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":536.47,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":546.35,"tobaccoFactor":1}}}],"ded":{"ind":3300,"fam":6600,"embedded":true},"drugDed":null,"oop":{"ind":8550,"fam":17100},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":250}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Specialty drugs: 40% coinsurance up to $250 per fill (the cap is modelled here).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, imaging, outpatient surgery facility fees, outpatient surgeon fees, hospital stay facility fees, hospital stay physician fees, delivery facility fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/22444PA0060134-00.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":495.11,"tobaccoFactor":1}}}},{"market":"group","id":"22444PA0060135-00","standardId":"22444PA0060135-00","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Premier HMO 25/50/3000","metal":"Gold","network":"HMO","hsaEligible":false,"counties":["Lackawanna","Luzerne","Wayne"],"rates":{"3":{"base21":528.57,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":538.31,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":548.22,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":558.31,"tobaccoFactor":1}}}],"ded":{"ind":3000,"fam":6000,"embedded":true},"drugDed":null,"oop":{"ind":9500,"fam":19000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":250}},"outpatientFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":150,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Imaging: $100 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $150 copay per day of service, charged once per service here.","Hospital stay: $150 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $150 copay per admission.","Specialty drugs: 40% coinsurance up to $250 per fill (the cap is modelled here).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, outpatient surgeon fees, hospital stay physician fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/22444PA0060135-00.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":516.11,"tobaccoFactor":1}}}},{"market":"group","id":"22444PA0060138-00","standardId":"22444PA0060138-00","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Small Group ACA All-Access HMO 45/75/6000","metal":"Silver","network":"HMO","hsaEligible":false,"counties":["Adams","Bedford","Berks","Blair","Bradford","Cambria","Cameron","Carbon","Centre","Clearfield","Clinton","Columbia","Cumberland","Dauphin","Elk","Franklin","Fulton","Huntingdon","Jefferson","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northampton","Northumberland","Perry","Pike","Potter","Schuylkill","Snyder","Somerset","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"2":{"base21":516.94,"tobaccoFactor":1},"3":{"base21":491.09,"tobaccoFactor":1},"5":{"base21":491.09,"tobaccoFactor":1},"6":{"base21":516.94,"tobaccoFactor":1},"7":{"base21":646.17,"tobaccoFactor":1},"9":{"base21":620.33,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"2":{"base21":526.46,"tobaccoFactor":1},"3":{"base21":500.14,"tobaccoFactor":1},"5":{"base21":500.14,"tobaccoFactor":1},"6":{"base21":526.46,"tobaccoFactor":1},"7":{"base21":658.07,"tobaccoFactor":1},"9":{"base21":631.75,"tobaccoFactor":1}}},{"from":7,"rates":{"2":{"base21":536.15,"tobaccoFactor":1},"3":{"base21":509.35,"tobaccoFactor":1},"5":{"base21":509.35,"tobaccoFactor":1},"6":{"base21":536.15,"tobaccoFactor":1},"7":{"base21":670.19,"tobaccoFactor":1},"9":{"base21":643.38,"tobaccoFactor":1}}},{"from":10,"rates":{"2":{"base21":546.03,"tobaccoFactor":1},"3":{"base21":518.73,"tobaccoFactor":1},"5":{"base21":518.73,"tobaccoFactor":1},"6":{"base21":546.03,"tobaccoFactor":1},"7":{"base21":682.53,"tobaccoFactor":1},"9":{"base21":655.23,"tobaccoFactor":1}}}],"ded":{"ind":6000,"fam":12000,"embedded":true},"drugDed":null,"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":450,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":250}},"outpatientFacility":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":400,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Imaging: $300 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $400 copay per day of service, charged once per service here.","Hospital stay: $400 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $400 copay per admission.","Specialty drugs: 40% coinsurance up to $250 per fill (the cap is modelled here).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, outpatient surgeon fees, hospital stay physician fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/22444PA0060138-00.pdf","prev":{"planYear":2026,"rates":{"2":{"base21":512.1,"tobaccoFactor":1},"3":{"base21":486.49,"tobaccoFactor":1},"5":{"base21":486.49,"tobaccoFactor":1},"6":{"base21":512.1,"tobaccoFactor":1},"7":{"base21":640.12,"tobaccoFactor":1},"9":{"base21":614.51,"tobaccoFactor":1}}}},{"market":"group","id":"22444PA0060141-00","standardId":"22444PA0060141-00","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Small Group ACA All-Access HMO 25/50/3000","metal":"Gold","network":"HMO","hsaEligible":false,"counties":["Adams","Bedford","Berks","Blair","Bradford","Cambria","Cameron","Carbon","Centre","Clearfield","Clinton","Columbia","Cumberland","Dauphin","Elk","Franklin","Fulton","Huntingdon","Jefferson","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northampton","Northumberland","Perry","Pike","Potter","Schuylkill","Snyder","Somerset","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"2":{"base21":591.9,"tobaccoFactor":1},"3":{"base21":562.31,"tobaccoFactor":1},"5":{"base21":562.31,"tobaccoFactor":1},"6":{"base21":591.9,"tobaccoFactor":1},"7":{"base21":739.88,"tobaccoFactor":1},"9":{"base21":710.28,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"2":{"base21":602.8,"tobaccoFactor":1},"3":{"base21":572.66,"tobaccoFactor":1},"5":{"base21":572.66,"tobaccoFactor":1},"6":{"base21":602.8,"tobaccoFactor":1},"7":{"base21":753.5,"tobaccoFactor":1},"9":{"base21":723.36,"tobaccoFactor":1}}},{"from":7,"rates":{"2":{"base21":613.91,"tobaccoFactor":1},"3":{"base21":583.21,"tobaccoFactor":1},"5":{"base21":583.21,"tobaccoFactor":1},"6":{"base21":613.91,"tobaccoFactor":1},"7":{"base21":767.38,"tobaccoFactor":1},"9":{"base21":736.69,"tobaccoFactor":1}}},{"from":10,"rates":{"2":{"base21":625.21,"tobaccoFactor":1},"3":{"base21":593.95,"tobaccoFactor":1},"5":{"base21":593.95,"tobaccoFactor":1},"6":{"base21":625.21,"tobaccoFactor":1},"7":{"base21":781.51,"tobaccoFactor":1},"9":{"base21":750.25,"tobaccoFactor":1}}}],"ded":{"ind":3000,"fam":6000,"embedded":true},"drugDed":null,"oop":{"ind":9500,"fam":19000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":250}},"outpatientFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":150,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Imaging: $100 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $150 copay per day of service, charged once per service here.","Hospital stay: $150 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $150 copay per admission.","Specialty drugs: 40% coinsurance up to $250 per fill (the cap is modelled here).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, outpatient surgeon fees, hospital stay physician fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/22444PA0060141-00.pdf","prev":{"planYear":2026,"rates":{"2":{"base21":577.95,"tobaccoFactor":1},"3":{"base21":549.05,"tobaccoFactor":1},"5":{"base21":549.05,"tobaccoFactor":1},"6":{"base21":577.95,"tobaccoFactor":1},"7":{"base21":722.44,"tobaccoFactor":1},"9":{"base21":693.54,"tobaccoFactor":1}}}},{"market":"group","id":"22444PA0060142-00","standardId":"22444PA0060142-00","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Small Group ACA All-Access QHDHP HMO 3500","metal":"Gold","network":"HMO","hsaEligible":true,"counties":["Adams","Bedford","Berks","Blair","Bradford","Cambria","Cameron","Carbon","Centre","Clearfield","Clinton","Columbia","Cumberland","Dauphin","Elk","Franklin","Fulton","Huntingdon","Jefferson","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northampton","Northumberland","Perry","Pike","Potter","Schuylkill","Snyder","Somerset","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"2":{"base21":578.17,"tobaccoFactor":1},"3":{"base21":549.26,"tobaccoFactor":1},"5":{"base21":549.26,"tobaccoFactor":1},"6":{"base21":578.17,"tobaccoFactor":1},"7":{"base21":722.71,"tobaccoFactor":1},"9":{"base21":693.81,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"2":{"base21":588.82,"tobaccoFactor":1},"3":{"base21":559.38,"tobaccoFactor":1},"5":{"base21":559.38,"tobaccoFactor":1},"6":{"base21":588.82,"tobaccoFactor":1},"7":{"base21":736.02,"tobaccoFactor":1},"9":{"base21":706.58,"tobaccoFactor":1}}},{"from":7,"rates":{"2":{"base21":599.66,"tobaccoFactor":1},"3":{"base21":569.68,"tobaccoFactor":1},"5":{"base21":569.68,"tobaccoFactor":1},"6":{"base21":599.66,"tobaccoFactor":1},"7":{"base21":749.58,"tobaccoFactor":1},"9":{"base21":719.59,"tobaccoFactor":1}}},{"from":10,"rates":{"2":{"base21":610.71,"tobaccoFactor":1},"3":{"base21":580.17,"tobaccoFactor":1},"5":{"base21":580.17,"tobaccoFactor":1},"6":{"base21":610.71,"tobaccoFactor":1},"7":{"base21":763.38,"tobaccoFactor":1},"9":{"base21":732.85,"tobaccoFactor":1}}}],"ded":{"ind":3500,"fam":7000,"embedded":true},"drugDed":null,"oop":{"ind":3500,"fam":7000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"}},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are no charge after the deductible.","Prescription drugs share the medical deductible (the SBC says the drug deductible is combined with medical).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (primary care visits, specialist visits, urgent care, emergency room care, lab tests, x-rays, imaging, rehabilitation therapy, outpatient mental health visits, generic drugs, preferred brand drugs, non-preferred brand drugs, specialty drugs, outpatient surgery facility fees, outpatient surgeon fees, hospital stay facility fees, hospital stay physician fees, delivery facility fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/22444PA0060142-00.pdf","prev":{"planYear":2026,"rates":{"2":{"base21":555.44,"tobaccoFactor":1},"3":{"base21":527.67,"tobaccoFactor":1},"5":{"base21":527.67,"tobaccoFactor":1},"6":{"base21":555.44,"tobaccoFactor":1},"7":{"base21":694.3,"tobaccoFactor":1},"9":{"base21":666.53,"tobaccoFactor":1}}}},{"market":"group","id":"22444PA0060143-00","standardId":"22444PA0060143-00","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Small Group ACA All-Access QHDHP HMO 5750","metal":"Silver","network":"HMO","hsaEligible":true,"counties":["Adams","Bedford","Berks","Blair","Bradford","Cambria","Cameron","Carbon","Centre","Clearfield","Clinton","Columbia","Cumberland","Dauphin","Elk","Franklin","Fulton","Huntingdon","Jefferson","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northampton","Northumberland","Perry","Pike","Potter","Schuylkill","Snyder","Somerset","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"2":{"base21":512.29,"tobaccoFactor":1},"3":{"base21":486.68,"tobaccoFactor":1},"5":{"base21":486.68,"tobaccoFactor":1},"6":{"base21":512.29,"tobaccoFactor":1},"7":{"base21":640.36,"tobaccoFactor":1},"9":{"base21":614.75,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"2":{"base21":521.73,"tobaccoFactor":1},"3":{"base21":495.64,"tobaccoFactor":1},"5":{"base21":495.64,"tobaccoFactor":1},"6":{"base21":521.73,"tobaccoFactor":1},"7":{"base21":652.16,"tobaccoFactor":1},"9":{"base21":626.07,"tobaccoFactor":1}}},{"from":7,"rates":{"2":{"base21":531.33,"tobaccoFactor":1},"3":{"base21":504.77,"tobaccoFactor":1},"5":{"base21":504.77,"tobaccoFactor":1},"6":{"base21":531.33,"tobaccoFactor":1},"7":{"base21":664.17,"tobaccoFactor":1},"9":{"base21":637.6,"tobaccoFactor":1}}},{"from":10,"rates":{"2":{"base21":541.12,"tobaccoFactor":1},"3":{"base21":514.06,"tobaccoFactor":1},"5":{"base21":514.06,"tobaccoFactor":1},"6":{"base21":541.12,"tobaccoFactor":1},"7":{"base21":676.4,"tobaccoFactor":1},"9":{"base21":649.34,"tobaccoFactor":1}}}],"ded":{"ind":5750,"fam":11500,"embedded":true},"drugDed":null,"oop":{"ind":5750,"fam":11500},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"}},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are no charge after the deductible.","Prescription drugs share the medical deductible (the SBC says the drug deductible is combined with medical).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (primary care visits, specialist visits, urgent care, emergency room care, lab tests, x-rays, imaging, rehabilitation therapy, outpatient mental health visits, generic drugs, preferred brand drugs, non-preferred brand drugs, specialty drugs, outpatient surgery facility fees, outpatient surgeon fees, hospital stay facility fees, hospital stay physician fees, delivery facility fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/22444PA0060143-00.pdf","prev":{"planYear":2026,"rates":{"2":{"base21":501.12,"tobaccoFactor":1},"3":{"base21":476.06,"tobaccoFactor":1},"5":{"base21":476.06,"tobaccoFactor":1},"6":{"base21":501.12,"tobaccoFactor":1},"7":{"base21":626.4,"tobaccoFactor":1},"9":{"base21":601.34,"tobaccoFactor":1}}}},{"market":"group","id":"22444PA0060144-00","standardId":"22444PA0060144-00","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Small Group ACA All-Access QHDHP HMO 8000","metal":"Bronze","network":"HMO","hsaEligible":true,"counties":["Adams","Bedford","Berks","Blair","Bradford","Cambria","Cameron","Carbon","Centre","Clearfield","Clinton","Columbia","Cumberland","Dauphin","Elk","Franklin","Fulton","Huntingdon","Jefferson","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northampton","Northumberland","Perry","Pike","Potter","Schuylkill","Snyder","Somerset","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"2":{"base21":441.58,"tobaccoFactor":1},"3":{"base21":419.5,"tobaccoFactor":1},"5":{"base21":419.5,"tobaccoFactor":1},"6":{"base21":441.58,"tobaccoFactor":1},"7":{"base21":551.97,"tobaccoFactor":1},"9":{"base21":529.9,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"2":{"base21":449.71,"tobaccoFactor":1},"3":{"base21":427.23,"tobaccoFactor":1},"5":{"base21":427.23,"tobaccoFactor":1},"6":{"base21":449.71,"tobaccoFactor":1},"7":{"base21":562.14,"tobaccoFactor":1},"9":{"base21":539.65,"tobaccoFactor":1}}},{"from":7,"rates":{"2":{"base21":457.99,"tobaccoFactor":1},"3":{"base21":435.09,"tobaccoFactor":1},"5":{"base21":435.09,"tobaccoFactor":1},"6":{"base21":457.99,"tobaccoFactor":1},"7":{"base21":572.49,"tobaccoFactor":1},"9":{"base21":549.59,"tobaccoFactor":1}}},{"from":10,"rates":{"2":{"base21":466.43,"tobaccoFactor":1},"3":{"base21":443.11,"tobaccoFactor":1},"5":{"base21":443.11,"tobaccoFactor":1},"6":{"base21":466.43,"tobaccoFactor":1},"7":{"base21":583.03,"tobaccoFactor":1},"9":{"base21":559.71,"tobaccoFactor":1}}}],"ded":{"ind":8000,"fam":16000,"embedded":true},"drugDed":null,"oop":{"ind":8000,"fam":16000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"}},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are no charge after the deductible.","Prescription drugs share the medical deductible (the SBC says the drug deductible is combined with medical).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (primary care visits, specialist visits, urgent care, emergency room care, lab tests, x-rays, imaging, rehabilitation therapy, outpatient mental health visits, generic drugs, preferred brand drugs, non-preferred brand drugs, specialty drugs, outpatient surgery facility fees, outpatient surgeon fees, hospital stay facility fees, hospital stay physician fees, delivery facility fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/22444PA0060144-00.pdf","prev":{"planYear":2026,"rates":{"2":{"base21":431.26,"tobaccoFactor":1},"3":{"base21":409.7,"tobaccoFactor":1},"5":{"base21":409.7,"tobaccoFactor":1},"6":{"base21":431.26,"tobaccoFactor":1},"7":{"base21":539.08,"tobaccoFactor":1},"9":{"base21":517.52,"tobaccoFactor":1}}}},{"market":"group","id":"22444PA0060146-00","standardId":"22444PA0060146-00","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Small Group ACA All-Access HMO $0 PCP/11000","metal":"Bronze","network":"HMO","hsaEligible":false,"counties":["Adams","Bedford","Berks","Blair","Bradford","Cambria","Cameron","Carbon","Centre","Clearfield","Clinton","Columbia","Cumberland","Dauphin","Elk","Franklin","Fulton","Huntingdon","Jefferson","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northampton","Northumberland","Perry","Pike","Potter","Schuylkill","Snyder","Somerset","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"2":{"base21":427.33,"tobaccoFactor":1},"3":{"base21":405.97,"tobaccoFactor":1},"5":{"base21":405.97,"tobaccoFactor":1},"6":{"base21":427.33,"tobaccoFactor":1},"7":{"base21":534.16,"tobaccoFactor":1},"9":{"base21":512.8,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"2":{"base21":435.2,"tobaccoFactor":1},"3":{"base21":413.44,"tobaccoFactor":1},"5":{"base21":413.44,"tobaccoFactor":1},"6":{"base21":435.2,"tobaccoFactor":1},"7":{"base21":544,"tobaccoFactor":1},"9":{"base21":522.24,"tobaccoFactor":1}}},{"from":7,"rates":{"2":{"base21":443.22,"tobaccoFactor":1},"3":{"base21":421.06,"tobaccoFactor":1},"5":{"base21":421.06,"tobaccoFactor":1},"6":{"base21":443.22,"tobaccoFactor":1},"7":{"base21":554.02,"tobaccoFactor":1},"9":{"base21":531.86,"tobaccoFactor":1}}},{"from":10,"rates":{"2":{"base21":451.38,"tobaccoFactor":1},"3":{"base21":428.81,"tobaccoFactor":1},"5":{"base21":428.81,"tobaccoFactor":1},"6":{"base21":451.38,"tobaccoFactor":1},"7":{"base21":564.22,"tobaccoFactor":1},"9":{"base21":541.65,"tobaccoFactor":1}}}],"ded":{"ind":11000,"fam":22000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"no_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"}},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family. Drug rows that say \"Deductible does not apply\" (generic drugs) are charged from the first fill; the others (preferred brand drugs, non-preferred brand drugs, specialty drugs) do not say, so they are read as after the drug deductible.","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (specialist visits, emergency room care, lab tests, x-rays, imaging, rehabilitation therapy, outpatient surgery facility fees, outpatient surgeon fees, hospital stay facility fees, hospital stay physician fees, delivery facility fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/22444PA0060146-00.pdf","prev":{"planYear":2026,"rates":{"2":{"base21":373.99,"tobaccoFactor":1},"3":{"base21":355.29,"tobaccoFactor":1},"5":{"base21":355.29,"tobaccoFactor":1},"6":{"base21":373.99,"tobaccoFactor":1},"7":{"base21":467.49,"tobaccoFactor":1},"9":{"base21":448.79,"tobaccoFactor":1}}}},{"market":"group","id":"22444PA0080066-00","standardId":"22444PA0080066-00","variant":"standard","issuer":"Geisinger Health Plan","name":"Geisinger Small Group ACA All-Access QHDHP POS 8000","metal":"Bronze","network":"POS","hsaEligible":true,"counties":["Adams","Bedford","Berks","Blair","Bradford","Cambria","Cameron","Carbon","Centre","Clearfield","Clinton","Columbia","Cumberland","Dauphin","Elk","Franklin","Fulton","Huntingdon","Jefferson","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northampton","Northumberland","Perry","Pike","Potter","Schuylkill","Snyder","Somerset","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"2":{"base21":452.14,"tobaccoFactor":1},"3":{"base21":429.53,"tobaccoFactor":1},"5":{"base21":429.53,"tobaccoFactor":1},"6":{"base21":452.14,"tobaccoFactor":1},"7":{"base21":565.17,"tobaccoFactor":1},"9":{"base21":542.57,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"2":{"base21":460.46,"tobaccoFactor":1},"3":{"base21":437.44,"tobaccoFactor":1},"5":{"base21":437.44,"tobaccoFactor":1},"6":{"base21":460.46,"tobaccoFactor":1},"7":{"base21":575.58,"tobaccoFactor":1},"9":{"base21":552.56,"tobaccoFactor":1}}},{"from":7,"rates":{"2":{"base21":468.94,"tobaccoFactor":1},"3":{"base21":445.5,"tobaccoFactor":1},"5":{"base21":445.5,"tobaccoFactor":1},"6":{"base21":468.94,"tobaccoFactor":1},"7":{"base21":586.18,"tobaccoFactor":1},"9":{"base21":562.73,"tobaccoFactor":1}}},{"from":10,"rates":{"2":{"base21":477.58,"tobaccoFactor":1},"3":{"base21":453.7,"tobaccoFactor":1},"5":{"base21":453.7,"tobaccoFactor":1},"6":{"base21":477.58,"tobaccoFactor":1},"7":{"base21":596.97,"tobaccoFactor":1},"9":{"base21":573.1,"tobaccoFactor":1}}}],"ded":{"ind":8000,"fam":16000,"embedded":true},"drugDed":null,"oop":{"ind":8000,"fam":16000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"}},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are no charge after the deductible.","Prescription drugs share the medical deductible (the SBC says the drug deductible is combined with medical).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (primary care visits, specialist visits, urgent care, emergency room care, lab tests, x-rays, imaging, rehabilitation therapy, outpatient mental health visits, generic drugs, preferred brand drugs, non-preferred brand drugs, specialty drugs, outpatient surgery facility fees, outpatient surgeon fees, hospital stay facility fees, hospital stay physician fees, delivery facility fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/22444PA0080066-00.pdf","prev":{"planYear":2026,"rates":{"2":{"base21":436.77,"tobaccoFactor":1},"3":{"base21":414.94,"tobaccoFactor":1},"5":{"base21":414.94,"tobaccoFactor":1},"6":{"base21":436.77,"tobaccoFactor":1},"7":{"base21":545.97,"tobaccoFactor":1},"9":{"base21":524.13,"tobaccoFactor":1}}}},{"market":"group","id":"23489PA0130005-00","standardId":"23489PA0130005-00","variant":"standard","issuer":"UnitedHealthcare Insurance Company","name":"UHC Choice HSA Gold 2000-1","metal":"Gold","network":"EPO","hsaEligible":true,"counties":["Adams","Berks","Bradford","Bucks","Carbon","Chester","Clinton","Columbia","Cumberland","Dauphin","Delaware","Franklin","Fulton","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montgomery","Montour","Northampton","Northumberland","Perry","Philadelphia","Pike","Schuylkill","Snyder","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"3":{"base21":757.88,"tobaccoFactor":1},"6":{"base21":735.13,"tobaccoFactor":1},"7":{"base21":747.58,"tobaccoFactor":1},"8":{"base21":720.31,"tobaccoFactor":1},"9":{"base21":751.04,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":779.86,"tobaccoFactor":1},"6":{"base21":756.45,"tobaccoFactor":1},"7":{"base21":769.26,"tobaccoFactor":1},"8":{"base21":741.2,"tobaccoFactor":1},"9":{"base21":772.82,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":802.6,"tobaccoFactor":1},"6":{"base21":778.51,"tobaccoFactor":1},"7":{"base21":791.69,"tobaccoFactor":1},"8":{"base21":762.8,"tobaccoFactor":1},"9":{"base21":795.35,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":826.09,"tobaccoFactor":1},"6":{"base21":801.29,"tobaccoFactor":1},"7":{"base21":814.86,"tobaccoFactor":1},"8":{"base21":785.13,"tobaccoFactor":1},"9":{"base21":818.63,"tobaccoFactor":1}}}],"ded":{"ind":2000,"fam":4000,"embedded":false},"drugDed":null,"oop":{"ind":4750,"fam":9500,"famPerPerson":9500},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":60,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":15,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":750,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":750,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}}},"notes":["Small-business plan. Source: UnitedHealthcare's Summary of Benefits and Coverage filed with the PA Insurance Department (SERFF filing UHLC-134903606, attachment 2027 PA SB Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDIF_2027_K95S_SB.pdf).","Hospital stay: $750 copay per admission (the first night of each admission is charged, later nights are not).","Prenatal office visits are listed as no charge, but the SBC adds that a copayment, deductible or coinsurance may apply depending on the type of service; the no-charge reading is used here.","Physical and occupational therapy: 30 visits per year combined; visits above the limit are priced in full outside the out-of-pocket maximum (our model). There are no limits when prescribed for a mental health or substance use condition.","Drugs: Tier 1, 2 and 3 retail amounts are used for generic, preferred brand and non-preferred brand drugs; specialty drugs use Tier 4's amount at a preferred specialty pharmacy (50% coinsurance with a $1,000 maximum per fill; a non-preferred specialty pharmacy costs more).","Copays apply after the deductible: page 1 says only preventive care is covered before it, and the cells do not say otherwise."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#tracking=UHLC-134903606&attachment=2027%20PA%20SB%20Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDIF_2027_K95S_SB.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":599.2,"tobaccoFactor":1},"6":{"base21":566.44,"tobaccoFactor":1},"7":{"base21":579.94,"tobaccoFactor":1},"8":{"base21":557.19,"tobaccoFactor":1},"9":{"base21":579.76,"tobaccoFactor":1}}}},{"market":"group","id":"23489PA0130006-00","standardId":"23489PA0130006-00","variant":"standard","issuer":"UnitedHealthcare Insurance Company","name":"UHC Choice Platinum 500-3","metal":"Platinum","network":"EPO","hsaEligible":false,"counties":["Adams","Allegheny","Armstrong","Beaver","Bedford","Berks","Blair","Bradford","Bucks","Butler","Cambria","Cameron","Carbon","Centre","Chester","Clarion","Clearfield","Clinton","Columbia","Crawford","Cumberland","Dauphin","Delaware","Elk","Erie","Fayette","Forest","Franklin","Fulton","Greene","Huntingdon","Indiana","Jefferson","Juniata","Lackawanna","Lancaster","Lawrence","Lebanon","Lehigh","Luzerne","Lycoming","McKean","Mercer","Mifflin","Monroe","Montgomery","Montour","Northampton","Northumberland","Perry","Philadelphia","Pike","Potter","Schuylkill","Snyder","Somerset","Sullivan","Susquehanna","Tioga","Union","Venango","Warren","Washington","Wayne","Westmoreland","Wyoming","York"],"rates":{"1":{"base21":702.01,"tobaccoFactor":1},"2":{"base21":752.04,"tobaccoFactor":1},"3":{"base21":861.55,"tobaccoFactor":1},"4":{"base21":839.44,"tobaccoFactor":1},"5":{"base21":756.72,"tobaccoFactor":1},"6":{"base21":835.69,"tobaccoFactor":1},"7":{"base21":849.84,"tobaccoFactor":1},"8":{"base21":818.83,"tobaccoFactor":1},"9":{"base21":853.77,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":722.37,"tobaccoFactor":1},"2":{"base21":773.85,"tobaccoFactor":1},"3":{"base21":886.53,"tobaccoFactor":1},"4":{"base21":863.78,"tobaccoFactor":1},"5":{"base21":778.67,"tobaccoFactor":1},"6":{"base21":859.92,"tobaccoFactor":1},"7":{"base21":874.48,"tobaccoFactor":1},"8":{"base21":842.58,"tobaccoFactor":1},"9":{"base21":878.53,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":743.43,"tobaccoFactor":1},"2":{"base21":796.41,"tobaccoFactor":1},"3":{"base21":912.38,"tobaccoFactor":1},"4":{"base21":888.97,"tobaccoFactor":1},"5":{"base21":801.37,"tobaccoFactor":1},"6":{"base21":884.99,"tobaccoFactor":1},"7":{"base21":899.98,"tobaccoFactor":1},"8":{"base21":867.15,"tobaccoFactor":1},"9":{"base21":904.15,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":765.19,"tobaccoFactor":1},"2":{"base21":819.72,"tobaccoFactor":1},"3":{"base21":939.09,"tobaccoFactor":1},"4":{"base21":914.99,"tobaccoFactor":1},"5":{"base21":824.83,"tobaccoFactor":1},"6":{"base21":910.9,"tobaccoFactor":1},"7":{"base21":926.33,"tobaccoFactor":1},"8":{"base21":892.53,"tobaccoFactor":1},"9":{"base21":930.61,"tobaccoFactor":1}}}],"ded":{"ind":500,"fam":1000,"embedded":true},"drugDed":null,"oop":{"ind":5000,"fam":10000},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":250}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":1000}},"outpatientFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":500,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}}},"notes":["Small-business plan. Source: UnitedHealthcare's Summary of Benefits and Coverage filed with the PA Insurance Department (SERFF filing UHLC-134903606, attachment 2027 PA SB Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDIC_2027_K94_SB.pdf).","Hospital stay: $500 copay per admission (the first night of each admission is charged, later nights are not).","Prenatal office visits are listed as no charge, but the SBC adds that a copayment, deductible or coinsurance may apply depending on the type of service; the no-charge reading is used here.","Physical and occupational therapy: 30 visits per year combined; visits above the limit are priced in full outside the out-of-pocket maximum (our model). There are no limits when prescribed for a mental health or substance use condition.","Drugs: Tier 1, 2 and 3 retail amounts are used for generic, preferred brand and non-preferred brand drugs; specialty drugs use Tier 4's retail amount (50% coinsurance with a $1,000 maximum).","Primary care, lab and x-ray, outpatient mental health and rehabilitation visits are listed as \"No Charge\" and read as free before the deductible (the SBC's default reading); UHC's 2026 filed plan-level differentials marked lab, x-ray, outpatient mental health and rehabilitation of this plan not subject to the deductible, its filed 2026-to-2027 changes are its out-of-pocket limit and actuarial value only, and the SBC's diabetes example (a $200 deductible) is consistent with primary care visits outside it."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#tracking=UHLC-134903606&attachment=2027%20PA%20SB%20Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDIC_2027_K94_SB.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":536.24,"tobaccoFactor":1},"2":{"base21":576.87,"tobaccoFactor":1},"3":{"base21":675.97,"tobaccoFactor":1},"4":{"base21":623.55,"tobaccoFactor":1},"5":{"base21":586.37,"tobaccoFactor":1},"6":{"base21":639.01,"tobaccoFactor":1},"7":{"base21":654.25,"tobaccoFactor":1},"8":{"base21":628.58,"tobaccoFactor":1},"9":{"base21":654.04,"tobaccoFactor":1}}}},{"market":"group","id":"23489PA0130012-00","standardId":"23489PA0130012-00","variant":"standard","issuer":"UnitedHealthcare Insurance Company","name":"UHC Choice Gold 1500","metal":"Gold","network":"EPO","hsaEligible":false,"counties":["Adams","Berks","Bradford","Bucks","Carbon","Chester","Clinton","Columbia","Cumberland","Dauphin","Delaware","Franklin","Fulton","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montgomery","Montour","Northampton","Northumberland","Perry","Philadelphia","Pike","Schuylkill","Snyder","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"3":{"base21":737.11,"tobaccoFactor":1},"6":{"base21":714.98,"tobaccoFactor":1},"7":{"base21":727.09,"tobaccoFactor":1},"8":{"base21":700.56,"tobaccoFactor":1},"9":{"base21":730.46,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":758.49,"tobaccoFactor":1},"6":{"base21":735.72,"tobaccoFactor":1},"7":{"base21":748.18,"tobaccoFactor":1},"8":{"base21":720.88,"tobaccoFactor":1},"9":{"base21":751.64,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":780.6,"tobaccoFactor":1},"6":{"base21":757.17,"tobaccoFactor":1},"7":{"base21":769.99,"tobaccoFactor":1},"8":{"base21":741.9,"tobaccoFactor":1},"9":{"base21":773.55,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":803.45,"tobaccoFactor":1},"6":{"base21":779.33,"tobaccoFactor":1},"7":{"base21":792.53,"tobaccoFactor":1},"8":{"base21":763.62,"tobaccoFactor":1},"9":{"base21":796.2,"tobaccoFactor":1}}}],"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":null,"oop":{"ind":6500,"fam":13000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":25,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":1000}},"outpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["Small-business plan. Source: UnitedHealthcare's Summary of Benefits and Coverage filed with the PA Insurance Department (SERFF filing UHLC-134903606, attachment 2027 PA SB Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDIW_2027_K95S_SB.pdf).","Imaging (CT/PET scans, MRIs): 10% coinsurance at a freestanding center or office (used here); 30% coinsurance at a hospital.","Outpatient surgery facility fee: 10% coinsurance at an ambulatory surgery center (used here); 30% coinsurance at a hospital.","Prenatal office visits are listed as no charge, but the SBC adds that a copayment, deductible or coinsurance may apply depending on the type of service; the no-charge reading is used here.","Physical and occupational therapy: 30 visits per year combined; visits above the limit are priced in full outside the out-of-pocket maximum (our model). There are no limits when prescribed for a mental health or substance use condition.","Drugs: Tier 1, 2 and 3 retail amounts are used for generic, preferred brand and non-preferred brand drugs; specialty drugs use Tier 4's amount at a preferred specialty pharmacy (50% coinsurance with a $1,000 maximum per fill; a non-preferred specialty pharmacy costs more)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#tracking=UHLC-134903606&attachment=2027%20PA%20SB%20Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDIW_2027_K95S_SB.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":571.96,"tobaccoFactor":1},"6":{"base21":540.69,"tobaccoFactor":1},"7":{"base21":553.58,"tobaccoFactor":1},"8":{"base21":531.86,"tobaccoFactor":1},"9":{"base21":553.4,"tobaccoFactor":1}}}},{"market":"group","id":"23489PA0130014-00","standardId":"23489PA0130014-00","variant":"standard","issuer":"UnitedHealthcare Insurance Company","name":"UHC Choice Platinum 0","metal":"Platinum","network":"EPO","hsaEligible":false,"counties":["Adams","Allegheny","Armstrong","Beaver","Bedford","Berks","Blair","Bradford","Bucks","Butler","Cambria","Cameron","Carbon","Centre","Chester","Clarion","Clearfield","Clinton","Columbia","Crawford","Cumberland","Dauphin","Delaware","Elk","Erie","Fayette","Forest","Franklin","Fulton","Greene","Huntingdon","Indiana","Jefferson","Juniata","Lackawanna","Lancaster","Lawrence","Lebanon","Lehigh","Luzerne","Lycoming","McKean","Mercer","Mifflin","Monroe","Montgomery","Montour","Northampton","Northumberland","Perry","Philadelphia","Pike","Potter","Schuylkill","Snyder","Somerset","Sullivan","Susquehanna","Tioga","Union","Venango","Warren","Washington","Wayne","Westmoreland","Wyoming","York"],"rates":{"1":{"base21":707.6,"tobaccoFactor":1},"2":{"base21":758.03,"tobaccoFactor":1},"3":{"base21":868.41,"tobaccoFactor":1},"4":{"base21":846.13,"tobaccoFactor":1},"5":{"base21":762.75,"tobaccoFactor":1},"6":{"base21":842.34,"tobaccoFactor":1},"7":{"base21":856.61,"tobaccoFactor":1},"8":{"base21":825.35,"tobaccoFactor":1},"9":{"base21":860.57,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":728.12,"tobaccoFactor":1},"2":{"base21":780.01,"tobaccoFactor":1},"3":{"base21":893.59,"tobaccoFactor":1},"4":{"base21":870.66,"tobaccoFactor":1},"5":{"base21":784.87,"tobaccoFactor":1},"6":{"base21":866.77,"tobaccoFactor":1},"7":{"base21":881.45,"tobaccoFactor":1},"8":{"base21":849.29,"tobaccoFactor":1},"9":{"base21":885.53,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":749.35,"tobaccoFactor":1},"2":{"base21":802.75,"tobaccoFactor":1},"3":{"base21":919.65,"tobaccoFactor":1},"4":{"base21":896.05,"tobaccoFactor":1},"5":{"base21":807.75,"tobaccoFactor":1},"6":{"base21":892.04,"tobaccoFactor":1},"7":{"base21":907.15,"tobaccoFactor":1},"8":{"base21":874.05,"tobaccoFactor":1},"9":{"base21":911.34,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":771.29,"tobaccoFactor":1},"2":{"base21":826.25,"tobaccoFactor":1},"3":{"base21":946.57,"tobaccoFactor":1},"4":{"base21":922.28,"tobaccoFactor":1},"5":{"base21":831.4,"tobaccoFactor":1},"6":{"base21":918.15,"tobaccoFactor":1},"7":{"base21":933.7,"tobaccoFactor":1},"8":{"base21":899.64,"tobaccoFactor":1},"9":{"base21":938.02,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":2500,"fam":5000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"no_ded"},"perDay":{"maxDays":4}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":500,"ded":"no_ded"},"perDay":{"maxDays":4}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Small-business plan. Source: UnitedHealthcare's Summary of Benefits and Coverage filed with the PA Insurance Department (SERFF filing UHLC-134903606, attachment 2027 PA SB Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDIU_2027_K95S_SB.pdf).","Imaging (CT/PET scans, MRIs): $250 copay per service at a freestanding center or office (used here); $500 copay per service at a hospital.","Outpatient surgery facility fee: $250 copay per visit at an ambulatory surgery center (used here); $500 copay per visit at a hospital.","Hospital stay: $500 copay per day up to a maximum of $2,000 (4 days).","Childbirth facility: $500 copay per day up to a maximum of $2,000 (4 days).","Prenatal office visits are listed as no charge, but the SBC adds that a copayment, deductible or coinsurance may apply depending on the type of service; the no-charge reading is used here.","Physical and occupational therapy: 30 visits per year combined; visits above the limit are priced in full outside the out-of-pocket maximum (our model). There are no limits when prescribed for a mental health or substance use condition.","Drugs: Tier 1, 2 and 3 retail amounts are used for generic, preferred brand and non-preferred brand drugs; specialty drugs use Tier 4's amount at a preferred specialty pharmacy (50% coinsurance with a $1,000 maximum per fill; a non-preferred specialty pharmacy costs more)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#tracking=UHLC-134903606&attachment=2027%20PA%20SB%20Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDIU_2027_K95S_SB.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":552.35,"tobaccoFactor":1},"2":{"base21":594.2,"tobaccoFactor":1},"3":{"base21":696.27,"tobaccoFactor":1},"4":{"base21":642.27,"tobaccoFactor":1},"5":{"base21":603.98,"tobaccoFactor":1},"6":{"base21":658.2,"tobaccoFactor":1},"7":{"base21":673.9,"tobaccoFactor":1},"8":{"base21":647.46,"tobaccoFactor":1},"9":{"base21":673.68,"tobaccoFactor":1}}}},{"market":"group","id":"23489PA0130015-00","standardId":"23489PA0130015-00","variant":"standard","issuer":"UnitedHealthcare Insurance Company","name":"UHC Choice Platinum 500-2","metal":"Platinum","network":"EPO","hsaEligible":false,"counties":["Adams","Allegheny","Armstrong","Beaver","Bedford","Berks","Blair","Bradford","Bucks","Butler","Cambria","Cameron","Carbon","Centre","Chester","Clarion","Clearfield","Clinton","Columbia","Crawford","Cumberland","Dauphin","Delaware","Elk","Erie","Fayette","Forest","Franklin","Fulton","Greene","Huntingdon","Indiana","Jefferson","Juniata","Lackawanna","Lancaster","Lawrence","Lebanon","Lehigh","Luzerne","Lycoming","McKean","Mercer","Mifflin","Monroe","Montgomery","Montour","Northampton","Northumberland","Perry","Philadelphia","Pike","Potter","Schuylkill","Snyder","Somerset","Sullivan","Susquehanna","Tioga","Union","Venango","Warren","Washington","Wayne","Westmoreland","Wyoming","York"],"rates":{"1":{"base21":721.81,"tobaccoFactor":1},"2":{"base21":773.25,"tobaccoFactor":1},"3":{"base21":885.85,"tobaccoFactor":1},"4":{"base21":863.11,"tobaccoFactor":1},"5":{"base21":778.07,"tobaccoFactor":1},"6":{"base21":859.26,"tobaccoFactor":1},"7":{"base21":873.81,"tobaccoFactor":1},"8":{"base21":841.93,"tobaccoFactor":1},"9":{"base21":877.85,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":742.74,"tobaccoFactor":1},"2":{"base21":795.67,"tobaccoFactor":1},"3":{"base21":911.54,"tobaccoFactor":1},"4":{"base21":888.15,"tobaccoFactor":1},"5":{"base21":800.63,"tobaccoFactor":1},"6":{"base21":884.18,"tobaccoFactor":1},"7":{"base21":899.15,"tobaccoFactor":1},"8":{"base21":866.34,"tobaccoFactor":1},"9":{"base21":903.31,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":764.4,"tobaccoFactor":1},"2":{"base21":818.87,"tobaccoFactor":1},"3":{"base21":938.11,"tobaccoFactor":1},"4":{"base21":914.04,"tobaccoFactor":1},"5":{"base21":823.97,"tobaccoFactor":1},"6":{"base21":909.95,"tobaccoFactor":1},"7":{"base21":925.36,"tobaccoFactor":1},"8":{"base21":891.6,"tobaccoFactor":1},"9":{"base21":929.64,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":786.77,"tobaccoFactor":1},"2":{"base21":842.84,"tobaccoFactor":1},"3":{"base21":965.57,"tobaccoFactor":1},"4":{"base21":940.8,"tobaccoFactor":1},"5":{"base21":848.09,"tobaccoFactor":1},"6":{"base21":936.59,"tobaccoFactor":1},"7":{"base21":952.45,"tobaccoFactor":1},"8":{"base21":917.7,"tobaccoFactor":1},"9":{"base21":956.86,"tobaccoFactor":1}}}],"ded":{"ind":500,"fam":1000,"embedded":true},"drugDed":null,"oop":{"ind":3000,"fam":6000},"rules":{"pcp":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":5,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"no_ded"},"perDay":{"maxDays":3}},"inpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":250,"ded":"no_ded"},"perDay":{"maxDays":3}},"deliveryProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}}},"notes":["Small-business plan. Source: UnitedHealthcare's Summary of Benefits and Coverage filed with the PA Insurance Department (SERFF filing UHLC-134903606, attachment 2027 PA SB Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDIS_2027_K95S_SB.pdf).","Imaging (CT/PET scans, MRIs): $75 copay per service at a freestanding center or office (used here); $150 copay per service at a hospital.","Outpatient surgery facility fee: $75 copay per visit at an ambulatory surgery center (used here); $150 copay per visit at a hospital.","Hospital stay: $250 copay per day up to a maximum of $750 (3 days).","Childbirth facility: $250 copay per day up to a maximum of $750 (3 days).","Prenatal office visits are listed as no charge, but the SBC adds that a copayment, deductible or coinsurance may apply depending on the type of service; the no-charge reading is used here.","Physical and occupational therapy: 30 visits per year combined; visits above the limit are priced in full outside the out-of-pocket maximum (our model). There are no limits when prescribed for a mental health or substance use condition.","Drugs: Tier 1, 2 and 3 retail amounts are used for generic, preferred brand and non-preferred brand drugs; specialty drugs use Tier 4's amount at a preferred specialty pharmacy (50% coinsurance with a $1,000 maximum per fill; a non-preferred specialty pharmacy costs more).","The emergency room copay is charged after the deductible: the chart says its costs are after the deductible unless a cell says otherwise; UHC's 2026 filed plan-level differentials marked this plan's emergency room subject to the deductible, and its filed 2026-to-2027 changes do not change that (page 1 says that categories with a copay are covered before it)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#tracking=UHLC-134903606&attachment=2027%20PA%20SB%20Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDIS_2027_K95S_SB.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":547.72,"tobaccoFactor":1},"2":{"base21":589.22,"tobaccoFactor":1},"3":{"base21":690.44,"tobaccoFactor":1},"4":{"base21":636.89,"tobaccoFactor":1},"5":{"base21":598.92,"tobaccoFactor":1},"6":{"base21":652.69,"tobaccoFactor":1},"7":{"base21":668.25,"tobaccoFactor":1},"8":{"base21":642.04,"tobaccoFactor":1},"9":{"base21":668.04,"tobaccoFactor":1}}}},{"market":"group","id":"23489PA0130019-00","standardId":"23489PA0130019-00","variant":"standard","issuer":"UnitedHealthcare Insurance Company","name":"UHC Choice HSA Silver 4000","metal":"Silver","network":"EPO","hsaEligible":true,"counties":["Adams","Berks","Bradford","Bucks","Carbon","Chester","Clinton","Columbia","Cumberland","Dauphin","Delaware","Franklin","Fulton","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montgomery","Montour","Northampton","Northumberland","Perry","Philadelphia","Pike","Schuylkill","Snyder","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"3":{"base21":638.78,"tobaccoFactor":1},"6":{"base21":619.6,"tobaccoFactor":1},"7":{"base21":630.1,"tobaccoFactor":1},"8":{"base21":607.11,"tobaccoFactor":1},"9":{"base21":633.01,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":657.3,"tobaccoFactor":1},"6":{"base21":637.57,"tobaccoFactor":1},"7":{"base21":648.37,"tobaccoFactor":1},"8":{"base21":624.71,"tobaccoFactor":1},"9":{"base21":651.37,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":676.47,"tobaccoFactor":1},"6":{"base21":656.16,"tobaccoFactor":1},"7":{"base21":667.27,"tobaccoFactor":1},"8":{"base21":642.93,"tobaccoFactor":1},"9":{"base21":670.36,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":696.27,"tobaccoFactor":1},"6":{"base21":675.37,"tobaccoFactor":1},"7":{"base21":686.8,"tobaccoFactor":1},"8":{"base21":661.75,"tobaccoFactor":1},"9":{"base21":689.98,"tobaccoFactor":1}}}],"ded":{"ind":4000,"fam":8000,"embedded":false},"drugDed":null,"oop":{"ind":8000,"fam":16000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":35,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":60,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":10,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":750,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":750,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}}},"notes":["Small-business plan. Source: UnitedHealthcare's Summary of Benefits and Coverage filed with the PA Insurance Department (SERFF filing UHLC-134903606, attachment 2027 PA SB Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDIQ_2027-01-01_T.pdf).","Specialist visits: $35 copay per visit with a UnitedHealthcare Designated Network provider (used here); $70 copay per visit with other network providers.","Imaging (CT/PET scans, MRIs): $250 copay per service at a freestanding center or office (used here); $500 copay per service at a hospital.","Outpatient surgery facility fee: $500 copay per visit at an ambulatory surgery center (used here); $750 copay per visit at a hospital.","Hospital stay: $750 copay per admission (the first night of each admission is charged, later nights are not).","Prenatal office visits are listed as no charge, but the SBC adds that a copayment, deductible or coinsurance may apply depending on the type of service; the no-charge reading is used here.","Physical and occupational therapy: 30 visits per year combined; visits above the limit are priced in full outside the out-of-pocket maximum (our model). There are no limits when prescribed for a mental health or substance use condition.","Drugs: Tier 1, 2 and 3 retail amounts are used for generic, preferred brand and non-preferred brand drugs; specialty drugs use Tier 4's amount at a preferred specialty pharmacy (50% coinsurance with a $1,000 maximum per fill; a non-preferred specialty pharmacy costs more).","Copays apply after the deductible: page 1 says only preventive care is covered before it, and the cells do not say otherwise."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#tracking=UHLC-134903606&attachment=2027%20PA%20SB%20Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDIQ_2027-01-01_T.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":527.07,"tobaccoFactor":1},"6":{"base21":498.26,"tobaccoFactor":1},"7":{"base21":510.14,"tobaccoFactor":1},"8":{"base21":490.13,"tobaccoFactor":1},"9":{"base21":509.97,"tobaccoFactor":1}}}},{"market":"group","id":"23489PA0130023-00","standardId":"23489PA0130023-00","variant":"standard","issuer":"UnitedHealthcare Insurance Company","name":"UHC Choice HSA Bronze 8700","metal":"Bronze","network":"EPO","hsaEligible":true,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Bradford","Butler","Cambria","Cameron","Carbon","Centre","Clarion","Clearfield","Clinton","Crawford","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lackawanna","Lawrence","Luzerne","Lycoming","McKean","Mercer","Monroe","Pike","Potter","Somerset","Sullivan","Susquehanna","Tioga","Venango","Warren","Washington","Wayne","Westmoreland","Wyoming"],"rates":{"1":{"base21":468.86,"tobaccoFactor":1},"2":{"base21":502.28,"tobaccoFactor":1},"3":{"base21":575.41,"tobaccoFactor":1},"4":{"base21":560.65,"tobaccoFactor":1},"5":{"base21":505.4,"tobaccoFactor":1},"6":{"base21":558.14,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":482.46,"tobaccoFactor":1},"2":{"base21":516.84,"tobaccoFactor":1},"3":{"base21":592.1,"tobaccoFactor":1},"4":{"base21":576.91,"tobaccoFactor":1},"5":{"base21":520.06,"tobaccoFactor":1},"6":{"base21":574.33,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":496.52,"tobaccoFactor":1},"2":{"base21":531.91,"tobaccoFactor":1},"3":{"base21":609.36,"tobaccoFactor":1},"4":{"base21":593.73,"tobaccoFactor":1},"5":{"base21":535.22,"tobaccoFactor":1},"6":{"base21":591.07,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":511.06,"tobaccoFactor":1},"2":{"base21":547.48,"tobaccoFactor":1},"3":{"base21":627.2,"tobaccoFactor":1},"4":{"base21":611.11,"tobaccoFactor":1},"5":{"base21":550.89,"tobaccoFactor":1},"6":{"base21":608.38,"tobaccoFactor":1}}}],"ded":{"ind":8700,"fam":17400,"embedded":true},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":0,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":0,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":0,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"copay","amount":0,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}}},"notes":["Small-business plan. Source: UnitedHealthcare's Summary of Benefits and Coverage filed with the PA Insurance Department (SERFF filing UHLC-134903606, attachment 2027 PA SB Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDID_2027_E83_SB.pdf).","Prenatal office visits are listed as no charge, but the SBC adds that a copayment, deductible or coinsurance may apply depending on the type of service; the no-charge reading is used here.","Physical and occupational therapy: 30 visits per year combined; visits above the limit are priced in full outside the out-of-pocket maximum (our model). There are no limits when prescribed for a mental health or substance use condition.","Drugs: Tier 1, 2 and 3 retail amounts are used for generic, preferred brand and non-preferred brand drugs; specialty drugs use Tier 4's retail amount ($0 copay).","Copays apply after the deductible: page 1 says only preventive care is covered before it, and the cells do not say otherwise."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#tracking=UHLC-134903606&attachment=2027%20PA%20SB%20Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDID_2027_E83_SB.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":377.13,"tobaccoFactor":1},"2":{"base21":405.71,"tobaccoFactor":1},"3":{"base21":475.4,"tobaccoFactor":1},"4":{"base21":438.53,"tobaccoFactor":1},"5":{"base21":412.39,"tobaccoFactor":1},"6":{"base21":449.41,"tobaccoFactor":1}}}},{"market":"group","id":"23489PA0130024-00","standardId":"23489PA0130024-00","variant":"standard","issuer":"UnitedHealthcare Insurance Company","name":"UHC Choice Silver 4000","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Adams","Berks","Bradford","Bucks","Carbon","Chester","Clinton","Columbia","Cumberland","Dauphin","Delaware","Franklin","Fulton","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montgomery","Montour","Northampton","Northumberland","Perry","Philadelphia","Pike","Schuylkill","Snyder","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"3":{"base21":653.93,"tobaccoFactor":1},"6":{"base21":634.3,"tobaccoFactor":1},"7":{"base21":645.04,"tobaccoFactor":1},"8":{"base21":621.51,"tobaccoFactor":1},"9":{"base21":648.03,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":672.89,"tobaccoFactor":1},"6":{"base21":652.69,"tobaccoFactor":1},"7":{"base21":663.75,"tobaccoFactor":1},"8":{"base21":639.53,"tobaccoFactor":1},"9":{"base21":666.82,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":692.51,"tobaccoFactor":1},"6":{"base21":671.72,"tobaccoFactor":1},"7":{"base21":683.1,"tobaccoFactor":1},"8":{"base21":658.18,"tobaccoFactor":1},"9":{"base21":686.26,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":712.78,"tobaccoFactor":1},"6":{"base21":691.39,"tobaccoFactor":1},"7":{"base21":703.09,"tobaccoFactor":1},"8":{"base21":677.44,"tobaccoFactor":1},"9":{"base21":706.35,"tobaccoFactor":1}}}],"ded":{"ind":4000,"fam":8000,"embedded":true},"drugDed":null,"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":700,"ded":"after_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":700,"ded":"after_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}}},"notes":["Small-business plan. Source: UnitedHealthcare's Summary of Benefits and Coverage filed with the PA Insurance Department (SERFF filing UHLC-134903606, attachment 2027 PA SB Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDIO_2027-01-01_T.pdf).","Specialist visits: $75 copay per visit with a UnitedHealthcare Designated Network provider (used here); $100 copay per visit with other network providers.","Imaging (CT/PET scans, MRIs): $500 copay per service at a freestanding center or office (used here); $750 copay per service at a hospital.","Outpatient surgery facility fee: $500 copay per visit at an ambulatory surgery center (used here); $750 copay per visit at a hospital.","Hospital stay: $700 copay per day up to a maximum of $3,500 (5 days).","Childbirth facility: $700 copay per day up to a maximum of $3,500 (5 days).","Prenatal office visits are listed as no charge, but the SBC adds that a copayment, deductible or coinsurance may apply depending on the type of service; the no-charge reading is used here.","Physical and occupational therapy: 30 visits per year combined; visits above the limit are priced in full outside the out-of-pocket maximum (our model). There are no limits when prescribed for a mental health or substance use condition.","Drugs: Tier 1, 2 and 3 retail amounts are used for generic, preferred brand and non-preferred brand drugs; specialty drugs use Tier 4's amount at a preferred specialty pharmacy (50% coinsurance with a $1,000 maximum per fill; a non-preferred specialty pharmacy costs more).","Outpatient surgery and hospital stay copays are charged after the deductible: the chart says its costs are after the deductible unless a cell says otherwise; UHC's 2026 filed plan-level differentials marked this plan's outpatient surgery and inpatient stays subject to the deductible, and its filed 2026-to-2027 changes do not change that (page 1 says that categories with a copay are covered before it)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#tracking=UHLC-134903606&attachment=2027%20PA%20SB%20Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDIO_2027-01-01_T.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":521.54,"tobaccoFactor":1},"6":{"base21":493.02,"tobaccoFactor":1},"7":{"base21":504.78,"tobaccoFactor":1},"8":{"base21":484.98,"tobaccoFactor":1},"9":{"base21":504.62,"tobaccoFactor":1}}}},{"market":"group","id":"23489PA0140003-00","standardId":"23489PA0140003-00","variant":"standard","issuer":"UnitedHealthcare Insurance Company","name":"UHC Choice Plus HSA Gold 2000-1","metal":"Gold","network":"POS","hsaEligible":true,"counties":["Adams","Berks","Bradford","Bucks","Carbon","Chester","Clinton","Columbia","Cumberland","Dauphin","Delaware","Franklin","Fulton","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montgomery","Montour","Northampton","Northumberland","Perry","Philadelphia","Pike","Schuylkill","Snyder","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"3":{"base21":772.75,"tobaccoFactor":1},"6":{"base21":749.55,"tobaccoFactor":1},"7":{"base21":762.24,"tobaccoFactor":1},"8":{"base21":734.43,"tobaccoFactor":1},"9":{"base21":765.77,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":795.15,"tobaccoFactor":1},"6":{"base21":771.29,"tobaccoFactor":1},"7":{"base21":784.35,"tobaccoFactor":1},"8":{"base21":755.73,"tobaccoFactor":1},"9":{"base21":787.98,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":818.34,"tobaccoFactor":1},"6":{"base21":793.77,"tobaccoFactor":1},"7":{"base21":807.21,"tobaccoFactor":1},"8":{"base21":777.77,"tobaccoFactor":1},"9":{"base21":810.95,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":842.29,"tobaccoFactor":1},"6":{"base21":817.01,"tobaccoFactor":1},"7":{"base21":830.84,"tobaccoFactor":1},"8":{"base21":800.53,"tobaccoFactor":1},"9":{"base21":834.69,"tobaccoFactor":1}}}],"ded":{"ind":2000,"fam":4000,"embedded":false},"drugDed":null,"oop":{"ind":4750,"fam":9500,"famPerPerson":9500},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":60,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":15,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":750,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":750,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}}},"notes":["Small-business plan. Source: UnitedHealthcare's Summary of Benefits and Coverage filed with the PA Insurance Department (SERFF filing UHLC-134903709, attachment 2027 PA SB Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDIG_2027_K95S_SB.pdf).","Hospital stay: $750 copay per admission (the first night of each admission is charged, later nights are not).","Prenatal office visits are listed as no charge, but the SBC adds that a copayment, deductible or coinsurance may apply depending on the type of service; the no-charge reading is used here.","Physical and occupational therapy: 30 visits per year combined; visits above the limit are priced in full outside the out-of-pocket maximum (our model). There are no limits when prescribed for a mental health or substance use condition.","Drugs: Tier 1, 2 and 3 retail amounts are used for generic, preferred brand and non-preferred brand drugs; specialty drugs use Tier 4's amount at a preferred specialty pharmacy (50% coinsurance with a $1,000 maximum per fill; a non-preferred specialty pharmacy costs more).","Copays apply after the deductible: page 1 says only preventive care is covered before it, and the cells do not say otherwise."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#tracking=UHLC-134903709&attachment=2027%20PA%20SB%20Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDIG_2027_K95S_SB.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":610.57,"tobaccoFactor":1},"6":{"base21":577.18,"tobaccoFactor":1},"7":{"base21":590.95,"tobaccoFactor":1},"8":{"base21":567.76,"tobaccoFactor":1},"9":{"base21":590.76,"tobaccoFactor":1}}}},{"market":"group","id":"23489PA0140007-00","standardId":"23489PA0140007-00","variant":"standard","issuer":"UnitedHealthcare Insurance Company","name":"UHC Choice Plus Gold 1500","metal":"Gold","network":"POS","hsaEligible":false,"counties":["Adams","Berks","Bradford","Bucks","Carbon","Chester","Clinton","Columbia","Cumberland","Dauphin","Delaware","Franklin","Fulton","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montgomery","Montour","Northampton","Northumberland","Perry","Philadelphia","Pike","Schuylkill","Snyder","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"3":{"base21":752.83,"tobaccoFactor":1},"6":{"base21":730.23,"tobaccoFactor":1},"7":{"base21":742.6,"tobaccoFactor":1},"8":{"base21":715.51,"tobaccoFactor":1},"9":{"base21":746.04,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":774.66,"tobaccoFactor":1},"6":{"base21":751.41,"tobaccoFactor":1},"7":{"base21":764.13,"tobaccoFactor":1},"8":{"base21":736.26,"tobaccoFactor":1},"9":{"base21":767.67,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":797.25,"tobaccoFactor":1},"6":{"base21":773.32,"tobaccoFactor":1},"7":{"base21":786.41,"tobaccoFactor":1},"8":{"base21":757.72,"tobaccoFactor":1},"9":{"base21":790.05,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":820.59,"tobaccoFactor":1},"6":{"base21":795.96,"tobaccoFactor":1},"7":{"base21":809.43,"tobaccoFactor":1},"8":{"base21":779.9,"tobaccoFactor":1},"9":{"base21":813.18,"tobaccoFactor":1}}}],"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":null,"oop":{"ind":6500,"fam":13000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":25,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":1000}},"outpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["Small-business plan. Source: UnitedHealthcare's Summary of Benefits and Coverage filed with the PA Insurance Department (SERFF filing UHLC-134903709, attachment 2027 PA SB Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDIV_2027_K95S_SB.pdf).","Imaging (CT/PET scans, MRIs): 10% coinsurance at a freestanding center or office (used here); 30% coinsurance at a hospital.","Outpatient surgery facility fee: 10% coinsurance at an ambulatory surgery center (used here); 30% coinsurance at a hospital.","Prenatal office visits are listed as no charge, but the SBC adds that a copayment, deductible or coinsurance may apply depending on the type of service; the no-charge reading is used here.","Physical and occupational therapy: 30 visits per year combined; visits above the limit are priced in full outside the out-of-pocket maximum (our model). There are no limits when prescribed for a mental health or substance use condition.","Drugs: Tier 1, 2 and 3 retail amounts are used for generic, preferred brand and non-preferred brand drugs; specialty drugs use Tier 4's amount at a preferred specialty pharmacy (50% coinsurance with a $1,000 maximum per fill; a non-preferred specialty pharmacy costs more)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#tracking=UHLC-134903709&attachment=2027%20PA%20SB%20Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDIV_2027_K95S_SB.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":583.92,"tobaccoFactor":1},"6":{"base21":551.99,"tobaccoFactor":1},"7":{"base21":565.15,"tobaccoFactor":1},"8":{"base21":542.98,"tobaccoFactor":1},"9":{"base21":564.97,"tobaccoFactor":1}}}},{"market":"group","id":"23489PA0140010-00","standardId":"23489PA0140010-00","variant":"standard","issuer":"UnitedHealthcare Insurance Company","name":"UHC Choice Plus Platinum 0","metal":"Platinum","network":"POS","hsaEligible":false,"counties":["Adams","Allegheny","Armstrong","Beaver","Bedford","Berks","Blair","Bradford","Bucks","Butler","Cambria","Cameron","Carbon","Centre","Chester","Clarion","Clearfield","Clinton","Columbia","Crawford","Cumberland","Dauphin","Delaware","Elk","Erie","Fayette","Forest","Franklin","Fulton","Greene","Huntingdon","Indiana","Jefferson","Juniata","Lackawanna","Lancaster","Lawrence","Lebanon","Lehigh","Luzerne","Lycoming","McKean","Mercer","Mifflin","Monroe","Montgomery","Montour","Northampton","Northumberland","Perry","Philadelphia","Pike","Potter","Schuylkill","Snyder","Somerset","Sullivan","Susquehanna","Tioga","Union","Venango","Warren","Washington","Wayne","Westmoreland","Wyoming","York"],"rates":{"1":{"base21":724.92,"tobaccoFactor":1},"2":{"base21":776.58,"tobaccoFactor":1},"3":{"base21":889.66,"tobaccoFactor":1},"4":{"base21":866.83,"tobaccoFactor":1},"5":{"base21":781.41,"tobaccoFactor":1},"6":{"base21":862.95,"tobaccoFactor":1},"7":{"base21":877.57,"tobaccoFactor":1},"8":{"base21":845.55,"tobaccoFactor":1},"9":{"base21":881.63,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":745.94,"tobaccoFactor":1},"2":{"base21":799.1,"tobaccoFactor":1},"3":{"base21":915.46,"tobaccoFactor":1},"4":{"base21":891.97,"tobaccoFactor":1},"5":{"base21":804.07,"tobaccoFactor":1},"6":{"base21":887.98,"tobaccoFactor":1},"7":{"base21":903.02,"tobaccoFactor":1},"8":{"base21":870.07,"tobaccoFactor":1},"9":{"base21":907.19,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":767.69,"tobaccoFactor":1},"2":{"base21":822.4,"tobaccoFactor":1},"3":{"base21":942.15,"tobaccoFactor":1},"4":{"base21":917.97,"tobaccoFactor":1},"5":{"base21":827.52,"tobaccoFactor":1},"6":{"base21":913.87,"tobaccoFactor":1},"7":{"base21":929.34,"tobaccoFactor":1},"8":{"base21":895.44,"tobaccoFactor":1},"9":{"base21":933.64,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":790.16,"tobaccoFactor":1},"2":{"base21":846.47,"tobaccoFactor":1},"3":{"base21":969.73,"tobaccoFactor":1},"4":{"base21":944.84,"tobaccoFactor":1},"5":{"base21":851.74,"tobaccoFactor":1},"6":{"base21":940.62,"tobaccoFactor":1},"7":{"base21":956.55,"tobaccoFactor":1},"8":{"base21":921.65,"tobaccoFactor":1},"9":{"base21":960.97,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":2500,"fam":5000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"no_ded"},"perDay":{"maxDays":4}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":500,"ded":"no_ded"},"perDay":{"maxDays":4}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Small-business plan. Source: UnitedHealthcare's Summary of Benefits and Coverage filed with the PA Insurance Department (SERFF filing UHLC-134903709, attachment 2027 PA SB Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDIT_2027_K95S_SB.pdf).","Imaging (CT/PET scans, MRIs): $250 copay per service at a freestanding center or office (used here); $500 copay per service at a hospital.","Outpatient surgery facility fee: $250 copay per visit at an ambulatory surgery center (used here); $500 copay per visit at a hospital.","Hospital stay: $500 copay per day up to a maximum of $2,000 (4 days).","Childbirth facility: $500 copay per day up to a maximum of $2,000 (4 days).","Prenatal office visits are listed as no charge, but the SBC adds that a copayment, deductible or coinsurance may apply depending on the type of service; the no-charge reading is used here.","Physical and occupational therapy: 30 visits per year combined; visits above the limit are priced in full outside the out-of-pocket maximum (our model). There are no limits when prescribed for a mental health or substance use condition.","Drugs: Tier 1, 2 and 3 retail amounts are used for generic, preferred brand and non-preferred brand drugs; specialty drugs use Tier 4's amount at a preferred specialty pharmacy (50% coinsurance with a $1,000 maximum per fill; a non-preferred specialty pharmacy costs more)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#tracking=UHLC-134903709&attachment=2027%20PA%20SB%20Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDIT_2027_K95S_SB.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":565.52,"tobaccoFactor":1},"2":{"base21":608.37,"tobaccoFactor":1},"3":{"base21":712.88,"tobaccoFactor":1},"4":{"base21":657.59,"tobaccoFactor":1},"5":{"base21":618.39,"tobaccoFactor":1},"6":{"base21":673.9,"tobaccoFactor":1},"7":{"base21":689.97,"tobaccoFactor":1},"8":{"base21":662.9,"tobaccoFactor":1},"9":{"base21":689.75,"tobaccoFactor":1}}}},{"market":"group","id":"23489PA0140011-00","standardId":"23489PA0140011-00","variant":"standard","issuer":"UnitedHealthcare Insurance Company","name":"UHC Choice Plus Platinum 500","metal":"Platinum","network":"POS","hsaEligible":false,"counties":["Adams","Allegheny","Armstrong","Beaver","Bedford","Berks","Blair","Bradford","Bucks","Butler","Cambria","Cameron","Carbon","Centre","Chester","Clarion","Clearfield","Clinton","Columbia","Crawford","Cumberland","Dauphin","Delaware","Elk","Erie","Fayette","Forest","Franklin","Fulton","Greene","Huntingdon","Indiana","Jefferson","Juniata","Lackawanna","Lancaster","Lawrence","Lebanon","Lehigh","Luzerne","Lycoming","McKean","Mercer","Mifflin","Monroe","Montgomery","Montour","Northampton","Northumberland","Perry","Philadelphia","Pike","Potter","Schuylkill","Snyder","Somerset","Sullivan","Susquehanna","Tioga","Union","Venango","Warren","Washington","Wayne","Westmoreland","Wyoming","York"],"rates":{"1":{"base21":737.73,"tobaccoFactor":1},"2":{"base21":790.3,"tobaccoFactor":1},"3":{"base21":905.38,"tobaccoFactor":1},"4":{"base21":882.15,"tobaccoFactor":1},"5":{"base21":795.22,"tobaccoFactor":1},"6":{"base21":878.2,"tobaccoFactor":1},"7":{"base21":893.07,"tobaccoFactor":1},"8":{"base21":860.49,"tobaccoFactor":1},"9":{"base21":897.21,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":759.12,"tobaccoFactor":1},"2":{"base21":813.22,"tobaccoFactor":1},"3":{"base21":931.64,"tobaccoFactor":1},"4":{"base21":907.73,"tobaccoFactor":1},"5":{"base21":818.28,"tobaccoFactor":1},"6":{"base21":903.67,"tobaccoFactor":1},"7":{"base21":918.97,"tobaccoFactor":1},"8":{"base21":885.45,"tobaccoFactor":1},"9":{"base21":923.23,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":781.25,"tobaccoFactor":1},"2":{"base21":836.93,"tobaccoFactor":1},"3":{"base21":958.8,"tobaccoFactor":1},"4":{"base21":934.19,"tobaccoFactor":1},"5":{"base21":842.14,"tobaccoFactor":1},"6":{"base21":930.02,"tobaccoFactor":1},"7":{"base21":945.77,"tobaccoFactor":1},"8":{"base21":911.26,"tobaccoFactor":1},"9":{"base21":950.14,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":804.12,"tobaccoFactor":1},"2":{"base21":861.43,"tobaccoFactor":1},"3":{"base21":986.86,"tobaccoFactor":1},"4":{"base21":961.54,"tobaccoFactor":1},"5":{"base21":866.79,"tobaccoFactor":1},"6":{"base21":957.24,"tobaccoFactor":1},"7":{"base21":973.45,"tobaccoFactor":1},"8":{"base21":937.94,"tobaccoFactor":1},"9":{"base21":977.96,"tobaccoFactor":1}}}],"ded":{"ind":500,"fam":1000,"embedded":true},"drugDed":null,"oop":{"ind":3000,"fam":6000},"rules":{"pcp":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":5,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"no_ded"},"perDay":{"maxDays":3}},"inpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":250,"ded":"no_ded"},"perDay":{"maxDays":3}},"deliveryProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}}},"notes":["Small-business plan. Source: UnitedHealthcare's Summary of Benefits and Coverage filed with the PA Insurance Department (SERFF filing UHLC-134903709, attachment 2027 PA SB Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDIR_2027_K95S_SB.pdf).","Imaging (CT/PET scans, MRIs): $75 copay per service at a freestanding center or office (used here); $150 copay per service at a hospital.","Outpatient surgery facility fee: $75 copay per visit at an ambulatory surgery center (used here); $150 copay per visit at a hospital.","Hospital stay: $250 copay per day up to a maximum of $750 (3 days).","Childbirth facility: $250 copay per day up to a maximum of $750 (3 days).","Prenatal office visits are listed as no charge, but the SBC adds that a copayment, deductible or coinsurance may apply depending on the type of service; the no-charge reading is used here.","Physical and occupational therapy: 30 visits per year combined; visits above the limit are priced in full outside the out-of-pocket maximum (our model). There are no limits when prescribed for a mental health or substance use condition.","Drugs: Tier 1, 2 and 3 retail amounts are used for generic, preferred brand and non-preferred brand drugs; specialty drugs use Tier 4's amount at a preferred specialty pharmacy (50% coinsurance with a $1,000 maximum per fill; a non-preferred specialty pharmacy costs more).","The emergency room copay is charged after the deductible: the chart says its costs are after the deductible unless a cell says otherwise; UHC's 2026 filed plan-level differentials marked this plan's emergency room subject to the deductible, and its filed 2026-to-2027 changes do not change that (page 1 says that categories with a copay are covered before it)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#tracking=UHLC-134903709&attachment=2027%20PA%20SB%20Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDIR_2027_K95S_SB.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":559.37,"tobaccoFactor":1},"2":{"base21":601.76,"tobaccoFactor":1},"3":{"base21":705.13,"tobaccoFactor":1},"4":{"base21":650.44,"tobaccoFactor":1},"5":{"base21":611.66,"tobaccoFactor":1},"6":{"base21":666.58,"tobaccoFactor":1},"7":{"base21":682.47,"tobaccoFactor":1},"8":{"base21":655.7,"tobaccoFactor":1},"9":{"base21":682.25,"tobaccoFactor":1}}}},{"market":"group","id":"23489PA0140015-00","standardId":"23489PA0140015-00","variant":"standard","issuer":"UnitedHealthcare Insurance Company","name":"UHC Choice Plus HSA Silver 4000-2","metal":"Silver","network":"POS","hsaEligible":true,"counties":["Adams","Berks","Bradford","Bucks","Carbon","Chester","Clinton","Columbia","Cumberland","Dauphin","Delaware","Franklin","Fulton","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montgomery","Montour","Northampton","Northumberland","Perry","Philadelphia","Pike","Schuylkill","Snyder","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"3":{"base21":648.97,"tobaccoFactor":1},"6":{"base21":629.49,"tobaccoFactor":1},"7":{"base21":640.15,"tobaccoFactor":1},"8":{"base21":616.8,"tobaccoFactor":1},"9":{"base21":643.12,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":667.79,"tobaccoFactor":1},"6":{"base21":647.75,"tobaccoFactor":1},"7":{"base21":658.72,"tobaccoFactor":1},"8":{"base21":634.68,"tobaccoFactor":1},"9":{"base21":661.77,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":687.26,"tobaccoFactor":1},"6":{"base21":666.63,"tobaccoFactor":1},"7":{"base21":677.92,"tobaccoFactor":1},"8":{"base21":653.19,"tobaccoFactor":1},"9":{"base21":681.06,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":707.38,"tobaccoFactor":1},"6":{"base21":686.15,"tobaccoFactor":1},"7":{"base21":697.77,"tobaccoFactor":1},"8":{"base21":672.31,"tobaccoFactor":1},"9":{"base21":701,"tobaccoFactor":1}}}],"ded":{"ind":4000,"fam":8000,"embedded":false},"drugDed":null,"oop":{"ind":8000,"fam":16000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":35,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":60,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":10,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":750,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":750,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}}},"notes":["Small-business plan. Source: UnitedHealthcare's Summary of Benefits and Coverage filed with the PA Insurance Department (SERFF filing UHLC-134903709, attachment 2027 PA SB Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDIP_2027_K95S_SB.pdf).","Specialist visits: $35 copay per visit with a UnitedHealthcare Designated Network provider (used here); $70 copay per visit with other network providers.","Imaging (CT/PET scans, MRIs): $250 copay per service at a freestanding center or office (used here); $500 copay per service at a hospital.","Outpatient surgery facility fee: $500 copay per visit at an ambulatory surgery center (used here); $750 copay per visit at a hospital.","Hospital stay: $750 copay per admission (the first night of each admission is charged, later nights are not).","Prenatal office visits are listed as no charge, but the SBC adds that a copayment, deductible or coinsurance may apply depending on the type of service; the no-charge reading is used here.","Physical and occupational therapy: 30 visits per year combined; visits above the limit are priced in full outside the out-of-pocket maximum (our model). There are no limits when prescribed for a mental health or substance use condition.","Drugs: Tier 1, 2 and 3 retail amounts are used for generic, preferred brand and non-preferred brand drugs; specialty drugs use Tier 4's amount at a preferred specialty pharmacy (50% coinsurance with a $1,000 maximum per fill; a non-preferred specialty pharmacy costs more).","Copays apply after the deductible: page 1 says only preventive care is covered before it, and the cells do not say otherwise."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#tracking=UHLC-134903709&attachment=2027%20PA%20SB%20Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDIP_2027_K95S_SB.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":537.26,"tobaccoFactor":1},"6":{"base21":507.89,"tobaccoFactor":1},"7":{"base21":520,"tobaccoFactor":1},"8":{"base21":499.6,"tobaccoFactor":1},"9":{"base21":519.83,"tobaccoFactor":1}}}},{"market":"group","id":"23489PA0140018-00","standardId":"23489PA0140018-00","variant":"standard","issuer":"UnitedHealthcare Insurance Company","name":"UHC Choice Plus Silver 4000","metal":"Silver","network":"POS","hsaEligible":false,"counties":["Adams","Berks","Bradford","Bucks","Carbon","Chester","Clinton","Columbia","Cumberland","Dauphin","Delaware","Franklin","Fulton","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montgomery","Montour","Northampton","Northumberland","Perry","Philadelphia","Pike","Schuylkill","Snyder","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"3":{"base21":664.5,"tobaccoFactor":1},"6":{"base21":644.56,"tobaccoFactor":1},"7":{"base21":655.47,"tobaccoFactor":1},"8":{"base21":631.56,"tobaccoFactor":1},"9":{"base21":658.51,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":683.77,"tobaccoFactor":1},"6":{"base21":663.25,"tobaccoFactor":1},"7":{"base21":674.48,"tobaccoFactor":1},"8":{"base21":649.87,"tobaccoFactor":1},"9":{"base21":677.6,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":703.71,"tobaccoFactor":1},"6":{"base21":682.59,"tobaccoFactor":1},"7":{"base21":694.15,"tobaccoFactor":1},"8":{"base21":668.82,"tobaccoFactor":1},"9":{"base21":697.36,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":724.31,"tobaccoFactor":1},"6":{"base21":702.57,"tobaccoFactor":1},"7":{"base21":714.46,"tobaccoFactor":1},"8":{"base21":688.4,"tobaccoFactor":1},"9":{"base21":717.77,"tobaccoFactor":1}}}],"ded":{"ind":4000,"fam":8000,"embedded":true},"drugDed":null,"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":700,"ded":"after_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":700,"ded":"after_ded"},"perDay":{"maxDays":5}},"deliveryProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}}},"notes":["Small-business plan. Source: UnitedHealthcare's Summary of Benefits and Coverage filed with the PA Insurance Department (SERFF filing UHLC-134903709, attachment 2027 PA SB Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDIN_2027_K95S_SB.pdf).","Specialist visits: $75 copay per visit with a UnitedHealthcare Designated Network provider (used here); $100 copay per visit with other network providers.","Imaging (CT/PET scans, MRIs): $500 copay per service at a freestanding center or office (used here); $750 copay per service at a hospital.","Outpatient surgery facility fee: $500 copay per visit at an ambulatory surgery center (used here); $750 copay per visit at a hospital.","Hospital stay: $700 copay per day up to a maximum of $3,500 (5 days).","Childbirth facility: $700 copay per day up to a maximum of $3,500 (5 days).","Prenatal office visits are listed as no charge, but the SBC adds that a copayment, deductible or coinsurance may apply depending on the type of service; the no-charge reading is used here.","Physical and occupational therapy: 30 visits per year combined; visits above the limit are priced in full outside the out-of-pocket maximum (our model). There are no limits when prescribed for a mental health or substance use condition.","Drugs: Tier 1, 2 and 3 retail amounts are used for generic, preferred brand and non-preferred brand drugs; specialty drugs use Tier 4's amount at a preferred specialty pharmacy (50% coinsurance with a $1,000 maximum per fill; a non-preferred specialty pharmacy costs more).","Outpatient surgery and hospital stay copays are charged after the deductible: the chart says its costs are after the deductible unless a cell says otherwise; UHC's 2026 filed plan-level differentials marked this plan's outpatient surgery and inpatient stays subject to the deductible, and its filed 2026-to-2027 changes do not change that (page 1 says that categories with a copay are covered before it)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#tracking=UHLC-134903709&attachment=2027%20PA%20SB%20Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDIN_2027_K95S_SB.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":531.21,"tobaccoFactor":1},"6":{"base21":502.17,"tobaccoFactor":1},"7":{"base21":514.14,"tobaccoFactor":1},"8":{"base21":493.97,"tobaccoFactor":1},"9":{"base21":513.97,"tobaccoFactor":1}}}},{"market":"group","id":"23489PA0140023-00","standardId":"23489PA0140023-00","variant":"standard","issuer":"UnitedHealthcare Insurance Company","name":"UHC Choice Plus HSA Bronze 8700","metal":"Bronze","network":"POS","hsaEligible":true,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Bradford","Butler","Cambria","Cameron","Carbon","Centre","Clarion","Clearfield","Clinton","Columbia","Crawford","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lackawanna","Lawrence","Lehigh","Luzerne","Lycoming","McKean","Mercer","Mifflin","Monroe","Montour","Northampton","Northumberland","Pike","Potter","Schuylkill","Snyder","Somerset","Sullivan","Susquehanna","Tioga","Union","Venango","Warren","Washington","Wayne","Westmoreland","Wyoming"],"rates":{"1":{"base21":477.09,"tobaccoFactor":1},"2":{"base21":511.09,"tobaccoFactor":1},"3":{"base21":585.51,"tobaccoFactor":1},"4":{"base21":570.49,"tobaccoFactor":1},"5":{"base21":514.28,"tobaccoFactor":1},"6":{"base21":567.94,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":490.93,"tobaccoFactor":1},"2":{"base21":525.91,"tobaccoFactor":1},"3":{"base21":602.49,"tobaccoFactor":1},"4":{"base21":587.03,"tobaccoFactor":1},"5":{"base21":529.19,"tobaccoFactor":1},"6":{"base21":584.41,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":505.24,"tobaccoFactor":1},"2":{"base21":541.25,"tobaccoFactor":1},"3":{"base21":620.06,"tobaccoFactor":1},"4":{"base21":604.15,"tobaccoFactor":1},"5":{"base21":544.62,"tobaccoFactor":1},"6":{"base21":601.45,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":520.03,"tobaccoFactor":1},"2":{"base21":557.09,"tobaccoFactor":1},"3":{"base21":638.21,"tobaccoFactor":1},"4":{"base21":621.83,"tobaccoFactor":1},"5":{"base21":560.56,"tobaccoFactor":1},"6":{"base21":619.05,"tobaccoFactor":1}}}],"ded":{"ind":8700,"fam":17400,"embedded":true},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":0,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":0,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":0,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"copay","amount":0,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}}},"notes":["Small-business plan. Source: UnitedHealthcare's Summary of Benefits and Coverage filed with the PA Insurance Department (SERFF filing UHLC-134903709, attachment 2027 PA SB Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDIE_2027_E83_SB.pdf).","Prenatal office visits are listed as no charge, but the SBC adds that a copayment, deductible or coinsurance may apply depending on the type of service; the no-charge reading is used here.","Physical and occupational therapy: 30 visits per year combined; visits above the limit are priced in full outside the out-of-pocket maximum (our model). There are no limits when prescribed for a mental health or substance use condition.","Drugs: Tier 1, 2 and 3 retail amounts are used for generic, preferred brand and non-preferred brand drugs; specialty drugs use Tier 4's retail amount ($0 copay).","Copays apply after the deductible: page 1 says only preventive care is covered before it, and the cells do not say otherwise."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#tracking=UHLC-134903709&attachment=2027%20PA%20SB%20Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDIE_2027_E83_SB.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":383.52,"tobaccoFactor":1},"2":{"base21":412.57,"tobaccoFactor":1},"3":{"base21":483.45,"tobaccoFactor":1},"4":{"base21":445.95,"tobaccoFactor":1},"5":{"base21":419.37,"tobaccoFactor":1},"6":{"base21":457.02,"tobaccoFactor":1}}}},{"market":"group","id":"23489PA0140025-00","standardId":"23489PA0140025-00","variant":"standard","issuer":"UnitedHealthcare Insurance Company","name":"UHC Choice Plus HSA Gold 1800","metal":"Gold","network":"POS","hsaEligible":true,"counties":["Adams","Berks","Bradford","Bucks","Carbon","Centre","Chester","Clinton","Columbia","Cumberland","Dauphin","Delaware","Franklin","Fulton","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montgomery","Montour","Northampton","Northumberland","Perry","Philadelphia","Pike","Schuylkill","Snyder","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"3":{"base21":784.85,"tobaccoFactor":1},"6":{"base21":761.29,"tobaccoFactor":1},"7":{"base21":774.18,"tobaccoFactor":1},"8":{"base21":745.93,"tobaccoFactor":1},"9":{"base21":777.76,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":807.61,"tobaccoFactor":1},"6":{"base21":783.37,"tobaccoFactor":1},"7":{"base21":796.63,"tobaccoFactor":1},"8":{"base21":767.57,"tobaccoFactor":1},"9":{"base21":800.32,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":831.15,"tobaccoFactor":1},"6":{"base21":806.2,"tobaccoFactor":1},"7":{"base21":819.86,"tobaccoFactor":1},"8":{"base21":789.94,"tobaccoFactor":1},"9":{"base21":823.65,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":855.48,"tobaccoFactor":1},"6":{"base21":829.8,"tobaccoFactor":1},"7":{"base21":843.86,"tobaccoFactor":1},"8":{"base21":813.07,"tobaccoFactor":1},"9":{"base21":847.76,"tobaccoFactor":1}}}],"ded":{"ind":1800,"fam":3600,"embedded":false},"drugDed":null,"oop":{"ind":5500,"fam":8900,"famPerPerson":8900},"rules":{"pcp":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":800,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":1500,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":1500,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}}},"notes":["Small-business plan. Source: UnitedHealthcare's Summary of Benefits and Coverage filed with the PA Insurance Department (SERFF filing UHLC-134903709, attachment 2027 PA SB Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDIH_2027_K95S_SB.pdf).","Hospital stay: $1,500 copay per admission (the first night of each admission is charged, later nights are not).","Prenatal office visits are listed as no charge, but the SBC adds that a copayment, deductible or coinsurance may apply depending on the type of service; the no-charge reading is used here.","Physical and occupational therapy: 30 visits per year combined; visits above the limit are priced in full outside the out-of-pocket maximum (our model). There are no limits when prescribed for a mental health or substance use condition.","Drugs: Tier 1, 2 and 3 retail amounts are used for generic, preferred brand and non-preferred brand drugs; specialty drugs use Tier 4's amount at a preferred specialty pharmacy (50% coinsurance with a $1,000 maximum per fill; a non-preferred specialty pharmacy costs more).","Copays apply after the deductible: page 1 says only preventive care is covered before it, and the cells do not say otherwise."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#tracking=UHLC-134903709&attachment=2027%20PA%20SB%20Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDIH_2027_K95S_SB.pdf"},{"market":"group","id":"23489PA0140026-00","standardId":"23489PA0140026-00","variant":"standard","issuer":"UnitedHealthcare Insurance Company","name":"UHC Choice Plus HSA Gold 2500","metal":"Gold","network":"POS","hsaEligible":true,"counties":["Adams","Berks","Bradford","Bucks","Carbon","Centre","Chester","Clinton","Columbia","Cumberland","Dauphin","Delaware","Franklin","Fulton","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montgomery","Montour","Northampton","Northumberland","Perry","Philadelphia","Pike","Schuylkill","Snyder","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"3":{"base21":743.87,"tobaccoFactor":1},"6":{"base21":721.55,"tobaccoFactor":1},"7":{"base21":733.76,"tobaccoFactor":1},"8":{"base21":706.99,"tobaccoFactor":1},"9":{"base21":737.16,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":765.45,"tobaccoFactor":1},"6":{"base21":742.47,"tobaccoFactor":1},"7":{"base21":755.04,"tobaccoFactor":1},"8":{"base21":727.5,"tobaccoFactor":1},"9":{"base21":758.54,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":787.76,"tobaccoFactor":1},"6":{"base21":764.12,"tobaccoFactor":1},"7":{"base21":777.06,"tobaccoFactor":1},"8":{"base21":748.71,"tobaccoFactor":1},"9":{"base21":780.65,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":810.82,"tobaccoFactor":1},"6":{"base21":786.49,"tobaccoFactor":1},"7":{"base21":799.8,"tobaccoFactor":1},"8":{"base21":770.62,"tobaccoFactor":1},"9":{"base21":803.5,"tobaccoFactor":1}}}],"ded":{"ind":2500,"fam":5000,"embedded":false},"drugDed":null,"oop":{"ind":5500,"fam":8900,"famPerPerson":8900},"rules":{"pcp":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":800,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":1500,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":1500,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}}},"notes":["Small-business plan. Source: UnitedHealthcare's Summary of Benefits and Coverage filed with the PA Insurance Department (SERFF filing UHLC-134903709, attachment 2027 PA SB Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDII_2027_K95S_SB.pdf).","Hospital stay: $1,500 copay per admission (the first night of each admission is charged, later nights are not).","Prenatal office visits are listed as no charge, but the SBC adds that a copayment, deductible or coinsurance may apply depending on the type of service; the no-charge reading is used here.","Physical and occupational therapy: 30 visits per year combined; visits above the limit are priced in full outside the out-of-pocket maximum (our model). There are no limits when prescribed for a mental health or substance use condition.","Drugs: Tier 1, 2 and 3 retail amounts are used for generic, preferred brand and non-preferred brand drugs; specialty drugs use Tier 4's amount at a preferred specialty pharmacy (50% coinsurance with a $1,000 maximum per fill; a non-preferred specialty pharmacy costs more).","Copays apply after the deductible: page 1 says only preventive care is covered before it, and the cells do not say otherwise."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#tracking=UHLC-134903709&attachment=2027%20PA%20SB%20Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDII_2027_K95S_SB.pdf"},{"market":"group","id":"23489PA0140027-00","standardId":"23489PA0140027-00","variant":"standard","issuer":"UnitedHealthcare Insurance Company","name":"UHC Choice Plus HSA Silver 4000-3","metal":"Silver","network":"POS","hsaEligible":true,"counties":["Adams","Berks","Bradford","Bucks","Carbon","Centre","Chester","Clinton","Columbia","Cumberland","Dauphin","Delaware","Franklin","Fulton","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montgomery","Montour","Northampton","Northumberland","Perry","Philadelphia","Pike","Schuylkill","Snyder","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"3":{"base21":687.47,"tobaccoFactor":1},"6":{"base21":666.83,"tobaccoFactor":1},"7":{"base21":678.12,"tobaccoFactor":1},"8":{"base21":653.38,"tobaccoFactor":1},"9":{"base21":681.26,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":707.4,"tobaccoFactor":1},"6":{"base21":686.17,"tobaccoFactor":1},"7":{"base21":697.79,"tobaccoFactor":1},"8":{"base21":672.33,"tobaccoFactor":1},"9":{"base21":701.02,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":728.03,"tobaccoFactor":1},"6":{"base21":706.18,"tobaccoFactor":1},"7":{"base21":718.13,"tobaccoFactor":1},"8":{"base21":691.93,"tobaccoFactor":1},"9":{"base21":721.46,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":749.34,"tobaccoFactor":1},"6":{"base21":726.85,"tobaccoFactor":1},"7":{"base21":739.15,"tobaccoFactor":1},"8":{"base21":712.19,"tobaccoFactor":1},"9":{"base21":742.58,"tobaccoFactor":1}}}],"ded":{"ind":4000,"fam":8000,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":800,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":1500,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":1500,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}}},"notes":["Small-business plan. Source: UnitedHealthcare's Summary of Benefits and Coverage filed with the PA Insurance Department (SERFF filing UHLC-134903709, attachment 2027 PA SB Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDIJ_2027_K95S_SB.pdf).","Hospital stay: $1,500 copay per admission (the first night of each admission is charged, later nights are not).","Prenatal office visits are listed as no charge, but the SBC adds that a copayment, deductible or coinsurance may apply depending on the type of service; the no-charge reading is used here.","Physical and occupational therapy: 30 visits per year combined; visits above the limit are priced in full outside the out-of-pocket maximum (our model). There are no limits when prescribed for a mental health or substance use condition.","Drugs: Tier 1, 2 and 3 retail amounts are used for generic, preferred brand and non-preferred brand drugs; specialty drugs use Tier 4's amount at a preferred specialty pharmacy (50% coinsurance with a $1,000 maximum per fill; a non-preferred specialty pharmacy costs more).","Copays apply after the deductible: page 1 says only preventive care is covered before it, and the cells do not say otherwise."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#tracking=UHLC-134903709&attachment=2027%20PA%20SB%20Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDIJ_2027_K95S_SB.pdf"},{"market":"group","id":"23489PA0140028-00","standardId":"23489PA0140028-00","variant":"standard","issuer":"UnitedHealthcare Insurance Company","name":"UHC Choice Plus HSA Silver 5000","metal":"Silver","network":"POS","hsaEligible":true,"counties":["Adams","Berks","Bradford","Bucks","Carbon","Centre","Chester","Clinton","Columbia","Cumberland","Dauphin","Delaware","Franklin","Fulton","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montgomery","Montour","Northampton","Northumberland","Perry","Philadelphia","Pike","Schuylkill","Snyder","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"3":{"base21":655.83,"tobaccoFactor":1},"6":{"base21":636.15,"tobaccoFactor":1},"7":{"base21":646.92,"tobaccoFactor":1},"8":{"base21":623.32,"tobaccoFactor":1},"9":{"base21":649.91,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":674.85,"tobaccoFactor":1},"6":{"base21":654.6,"tobaccoFactor":1},"7":{"base21":665.68,"tobaccoFactor":1},"8":{"base21":641.39,"tobaccoFactor":1},"9":{"base21":668.76,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":694.53,"tobaccoFactor":1},"6":{"base21":673.68,"tobaccoFactor":1},"7":{"base21":685.09,"tobaccoFactor":1},"8":{"base21":660.09,"tobaccoFactor":1},"9":{"base21":688.26,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":714.86,"tobaccoFactor":1},"6":{"base21":693.4,"tobaccoFactor":1},"7":{"base21":705.14,"tobaccoFactor":1},"8":{"base21":679.42,"tobaccoFactor":1},"9":{"base21":708.41,"tobaccoFactor":1}}}],"ded":{"ind":5000,"fam":10000,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":800,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":1500,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":1500,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}}},"notes":["Small-business plan. Source: UnitedHealthcare's Summary of Benefits and Coverage filed with the PA Insurance Department (SERFF filing UHLC-134903709, attachment 2027 PA SB Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDIK_2027_K95S_SB.pdf).","Hospital stay: $1,500 copay per admission (the first night of each admission is charged, later nights are not).","Prenatal office visits are listed as no charge, but the SBC adds that a copayment, deductible or coinsurance may apply depending on the type of service; the no-charge reading is used here.","Physical and occupational therapy: 30 visits per year combined; visits above the limit are priced in full outside the out-of-pocket maximum (our model). There are no limits when prescribed for a mental health or substance use condition.","Drugs: Tier 1, 2 and 3 retail amounts are used for generic, preferred brand and non-preferred brand drugs; specialty drugs use Tier 4's amount at a preferred specialty pharmacy (50% coinsurance with a $1,000 maximum per fill; a non-preferred specialty pharmacy costs more).","Copays apply after the deductible: page 1 says only preventive care is covered before it, and the cells do not say otherwise."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#tracking=UHLC-134903709&attachment=2027%20PA%20SB%20Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDIK_2027_K95S_SB.pdf"},{"market":"group","id":"23489PA0140034-00","standardId":"23489PA0140034-00","variant":"standard","issuer":"UnitedHealthcare Insurance Company","name":"UHC Navigate Plus HSA Bronze 8000","metal":"Bronze","network":"POS","hsaEligible":true,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Bradford","Butler","Cambria","Cameron","Carbon","Centre","Clarion","Clearfield","Clinton","Columbia","Crawford","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lackawanna","Lawrence","Lehigh","Luzerne","Lycoming","McKean","Mercer","Mifflin","Monroe","Montour","Northampton","Northumberland","Pike","Potter","Schuylkill","Snyder","Somerset","Sullivan","Susquehanna","Tioga","Union","Venango","Warren","Washington","Wayne","Westmoreland","Wyoming"],"rates":{"1":{"base21":491.45,"tobaccoFactor":1},"2":{"base21":526.48,"tobaccoFactor":1},"3":{"base21":603.14,"tobaccoFactor":1},"4":{"base21":587.66,"tobaccoFactor":1},"5":{"base21":529.76,"tobaccoFactor":1},"6":{"base21":585.04,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":505.71,"tobaccoFactor":1},"2":{"base21":541.75,"tobaccoFactor":1},"3":{"base21":620.63,"tobaccoFactor":1},"4":{"base21":604.71,"tobaccoFactor":1},"5":{"base21":545.12,"tobaccoFactor":1},"6":{"base21":602,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":520.45,"tobaccoFactor":1},"2":{"base21":557.54,"tobaccoFactor":1},"3":{"base21":638.73,"tobaccoFactor":1},"4":{"base21":622.34,"tobaccoFactor":1},"5":{"base21":561.01,"tobaccoFactor":1},"6":{"base21":619.55,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":535.69,"tobaccoFactor":1},"2":{"base21":573.86,"tobaccoFactor":1},"3":{"base21":657.42,"tobaccoFactor":1},"4":{"base21":640.55,"tobaccoFactor":1},"5":{"base21":577.44,"tobaccoFactor":1},"6":{"base21":637.69,"tobaccoFactor":1}}}],"ded":{"ind":8000,"fam":16000,"embedded":true},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":0,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":0,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":0,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"copay","amount":0,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}}},"notes":["Small-business plan. Source: UnitedHealthcare's Summary of Benefits and Coverage filed with the PA Insurance Department (SERFF filing UHLC-134903709, attachment 2027 PA SB Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDIM_2027_E83_SB.pdf).","Prenatal office visits are listed as no charge, but the SBC adds that a copayment, deductible or coinsurance may apply depending on the type of service; the no-charge reading is used here.","Physical and occupational therapy: 30 visits per year combined; visits above the limit are priced in full outside the out-of-pocket maximum (our model). There are no limits when prescribed for a mental health or substance use condition.","Drugs: Tier 1, 2 and 3 retail amounts are used for generic, preferred brand and non-preferred brand drugs; specialty drugs use Tier 4's retail amount ($0 copay).","Navigate Plus: the amounts are for network care with a referral from your primary care provider; without a referral, network care costs more (primary care visits 20% coinsurance; specialist visits 20% coinsurance; outpatient surgery facility fee 20% coinsurance; outpatient surgeon fees 20% coinsurance; hospital stay 20% coinsurance; hospital physician fees 20% coinsurance).","Copays apply after the deductible: page 1 says only preventive care is covered before it, and the cells do not say otherwise."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#tracking=UHLC-134903709&attachment=2027%20PA%20SB%20Filing.zip/Cirrus_SBC_1556082_2045199348_PA_FDIM_2027_E83_SB.pdf"},{"market":"group","id":"24872PA0030001-00","standardId":"24872PA0030001-00","variant":"standard","issuer":"UnitedHealthcare of Pennsylvania","name":"UHC Navigate HSA Bronze 7200","metal":"Bronze","network":"HMO","hsaEligible":true,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Bradford","Butler","Cambria","Cameron","Carbon","Centre","Clarion","Clearfield","Clinton","Crawford","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lackawanna","Lawrence","Luzerne","Lycoming","McKean","Mercer","Monroe","Pike","Potter","Somerset","Sullivan","Susquehanna","Tioga","Venango","Warren","Washington","Wayne","Westmoreland","Wyoming"],"rates":{"1":{"base21":435.51,"tobaccoFactor":1},"2":{"base21":466.54,"tobaccoFactor":1},"3":{"base21":534.48,"tobaccoFactor":1},"4":{"base21":520.76,"tobaccoFactor":1},"5":{"base21":469.45,"tobaccoFactor":1},"6":{"base21":518.44,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":448.14,"tobaccoFactor":1},"2":{"base21":480.07,"tobaccoFactor":1},"3":{"base21":549.98,"tobaccoFactor":1},"4":{"base21":535.86,"tobaccoFactor":1},"5":{"base21":483.06,"tobaccoFactor":1},"6":{"base21":533.47,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":461.2,"tobaccoFactor":1},"2":{"base21":494.06,"tobaccoFactor":1},"3":{"base21":566.01,"tobaccoFactor":1},"4":{"base21":551.48,"tobaccoFactor":1},"5":{"base21":497.14,"tobaccoFactor":1},"6":{"base21":549.02,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":474.7,"tobaccoFactor":1},"2":{"base21":508.53,"tobaccoFactor":1},"3":{"base21":582.58,"tobaccoFactor":1},"4":{"base21":567.62,"tobaccoFactor":1},"5":{"base21":511.7,"tobaccoFactor":1},"6":{"base21":565.09,"tobaccoFactor":1}}}],"ded":{"ind":8000,"fam":16000,"embedded":true},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":0,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":0,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":0,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"copay","amount":0,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0,"ded":"after_ded"}}},"notes":["Small-business plan. Source: UnitedHealthcare's Summary of Benefits and Coverage filed with the PA Insurance Department (SERFF filing UHLC-134903707, attachment Cirrus_SBC_1556082_2045199348_PA_FDIL_2027_E83_SB.pdf).","Prenatal office visits are listed as no charge, but the SBC adds that a copayment, deductible or coinsurance may apply depending on the type of service; the no-charge reading is used here.","Physical and occupational therapy: 30 visits per year combined; visits above the limit are priced in full outside the out-of-pocket maximum (our model). There are no limits when prescribed for a mental health or substance use condition.","Drugs: Tier 1, 2 and 3 retail amounts are used for generic, preferred brand and non-preferred brand drugs; specialty drugs use Tier 4's retail amount ($0 copay).","Navigate HMO: the amounts are for network care with a referral from your primary care provider; the SBC lists most services as not covered without a referral.","Copays apply after the deductible: page 1 says only preventive care is covered before it, and the cells do not say otherwise."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#tracking=UHLC-134903707&attachment=Cirrus_SBC_1556082_2045199348_PA_FDIL_2027_E83_SB.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":359.67,"tobaccoFactor":1},"2":{"base21":386.92,"tobaccoFactor":1},"3":{"base21":453.38,"tobaccoFactor":1},"4":{"base21":418.22,"tobaccoFactor":1},"5":{"base21":393.28,"tobaccoFactor":1},"6":{"base21":428.59,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA0920001-00","standardId":"33709PA0920001-00","variant":"standard","issuer":"Highmark Inc.","name":"Health Savings Flex PPO Embedded $7100 a Community Blue Plan","metal":"Bronze","network":"PPO","hsaEligible":true,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Lehigh","Mifflin","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Union","York"],"rates":{"6":{"base21":479.73,"tobaccoFactor":1},"7":{"base21":476.11,"tobaccoFactor":1},"9":{"base21":465.64,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":489.41,"tobaccoFactor":1},"7":{"base21":485.71,"tobaccoFactor":1},"9":{"base21":475.03,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":499.3,"tobaccoFactor":1},"7":{"base21":495.53,"tobaccoFactor":1},"9":{"base21":484.63,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":509.4,"tobaccoFactor":1},"7":{"base21":505.55,"tobaccoFactor":1},"9":{"base21":494.43,"tobaccoFactor":1}}}],"ded":{"ind":7500,"fam":15000,"embedded":true},"drugDed":null,"oop":{"ind":8000,"fam":16000},"rules":{"pcp":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: primary care 50% coinsurance; specialist 50% coinsurance; lab and x-ray 50% coinsurance; imaging 50% coinsurance; outpatient surgery facility fee 50% coinsurance; outpatient surgeon fees 50% coinsurance; urgent care 50% coinsurance; hospital facility fee 50% coinsurance; hospital physician fees 50% coinsurance; prenatal office visits 50% coinsurance; delivery professional fees 50% coinsurance; delivery facility fee 50% coinsurance; rehabilitation 50% coinsurance.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","The SBC has no specialty drug row; every drug tier is priced the same, and specialty drugs are priced like them.","Low-cost generic drugs (used here): 40% coinsurance (retail and mail order).","Formulary brand drugs (used here): 40% coinsurance (retail and mail order).","Non-formulary brand drugs (used here): 40% coinsurance (retail and mail order).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exam, and pediatric dental exam. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Page 1 of this SBC lists \"prescription drug expenses\" among the costs that do not count toward the out-of-pocket limit. The filed certificate (CERT-HBS-HDHP-SM-2027) says \"all medical and drug services must be applied toward the out-of-pocket amount\", its statement of variability puts drugs under the medical deductible (\"Combined with Medical\") and its out-of-pocket limit \"Includes deductible, coinsurance and copayments\", and federal rules count covered drugs toward the limit; drug costs are counted toward it here.","This is a small-business (small-group) plan. Highmark does not list this plan in its small-group SBC search; its SBC is the one in its form filing with the Pennsylvania Insurance Department, SERFF HGHM-134875102 (submitted 5/15/2026, approved 9/23/2026; certificate CERT-HBS-HDHP-SM-2027, supporting document SBC-CERT-HBS-HDHP-SM-2027-V2.pdf)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#HGHM-134875102/SBC-CERT-HBS-HDHP-SM-2027-V2.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":445.61,"tobaccoFactor":1},"7":{"base21":460.76,"tobaccoFactor":1},"9":{"base21":450.55,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1190002-00","standardId":"33709PA1190002-00","variant":"standard","issuer":"Highmark Inc.","name":"Together Blue with AHN EPO $0","metal":"Gold","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Erie","Mercer","Washington","Westmoreland"],"rates":{"1":{"base21":386.84,"tobaccoFactor":1},"4":{"base21":446.53,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":394.65,"tobaccoFactor":1},"4":{"base21":455.54,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":402.62,"tobaccoFactor":1},"4":{"base21":464.75,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":410.77,"tobaccoFactor":1},"4":{"base21":474.15,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":9100,"fam":18200},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":405,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":360,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":75,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":250,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Hospital stay: $250 copay per admission, charged on the first day of each stay. The SBC prints \"$250 copay/visit\"; a hospital visit is read as one stay (Highmark's 2026 SBCs said \"per admission\").","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 (used here): no charge (retail and mail order).","Tier 2 (used here): $25 copay for a 31-day retail supply ($50 for 60 days, $75 for 90 days); $50 for a 90-day mail-order supply.","Tier 3 (used here): $80 copay for a 31-day retail supply ($160 for 60 days, $240 for 90 days); $160 for a 90-day mail-order supply.","Tier 4 (used here): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply.","No network deductible: copays and coinsurance apply from the first visit.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245907013/SE_2245907013_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":350.41,"tobaccoFactor":1},"4":{"base21":400.96,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1190003-00","standardId":"33709PA1190003-00","variant":"standard","issuer":"Highmark Inc.","name":"Together Blue with AHN EPO $500","metal":"Gold","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Erie","Mercer","Washington","Westmoreland"],"rates":{"1":{"base21":386.61,"tobaccoFactor":1},"4":{"base21":446.26,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":394.41,"tobaccoFactor":1},"4":{"base21":455.27,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":402.38,"tobaccoFactor":1},"4":{"base21":464.47,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":410.52,"tobaccoFactor":1},"4":{"base21":473.86,"tobaccoFactor":1}}}],"ded":{"ind":500,"fam":1000,"embedded":true},"drugDed":null,"oop":{"ind":7900,"fam":15800},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 (used here): no charge (retail and mail order).","Tier 2 (used here): $25 copay for a 31-day retail supply ($50 for 60 days, $75 for 90 days); $50 for a 90-day mail-order supply.","Tier 3 (used here): $80 copay for a 31-day retail supply ($160 for 60 days, $240 for 90 days); $160 for a 90-day mail-order supply.","Tier 4 (used here): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245905237/SE_2245905237_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":345.79,"tobaccoFactor":1},"4":{"base21":395.67,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1190004-00","standardId":"33709PA1190004-00","variant":"standard","issuer":"Highmark Inc.","name":"Together Blue with AHN EPO $1000","metal":"Gold","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Erie","Mercer","Washington","Westmoreland"],"rates":{"1":{"base21":374.46,"tobaccoFactor":1},"4":{"base21":432.23,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":382.01,"tobaccoFactor":1},"4":{"base21":440.96,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":389.73,"tobaccoFactor":1},"4":{"base21":449.86,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":397.61,"tobaccoFactor":1},"4":{"base21":458.96,"tobaccoFactor":1}}}],"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":9100,"fam":18200},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 (used here): no charge (retail and mail order).","Tier 2 (used here): $25 copay for a 31-day retail supply ($50 for 60 days, $75 for 90 days); $50 for a 90-day mail-order supply.","Tier 3 (used here): $80 copay for a 31-day retail supply ($160 for 60 days, $240 for 90 days); $160 for a 90-day mail-order supply.","Tier 4 (used here): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245909839/SE_2245909839_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":332.21,"tobaccoFactor":1},"4":{"base21":380.13,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1190005-00","standardId":"33709PA1190005-00","variant":"standard","issuer":"Highmark Inc.","name":"Together Blue with AHN EPO $1500","metal":"Gold","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Erie","Mercer","Washington","Westmoreland"],"rates":{"1":{"base21":363.72,"tobaccoFactor":1},"4":{"base21":419.83,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":371.05,"tobaccoFactor":1},"4":{"base21":428.31,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":378.55,"tobaccoFactor":1},"4":{"base21":436.96,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":386.21,"tobaccoFactor":1},"4":{"base21":445.8,"tobaccoFactor":1}}}],"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":null,"oop":{"ind":7900,"fam":15800},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 (used here): no charge (retail and mail order).","Tier 2 (used here): $25 copay for a 31-day retail supply ($50 for 60 days, $75 for 90 days); $50 for a 90-day mail-order supply.","Tier 3 (used here): $80 copay for a 31-day retail supply ($160 for 60 days, $240 for 90 days); $160 for a 90-day mail-order supply.","Tier 4 (used here): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245903928/SE_2245903928_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":320.93,"tobaccoFactor":1},"4":{"base21":367.22,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1190006-00","standardId":"33709PA1190006-00","variant":"standard","issuer":"Highmark Inc.","name":"Together Blue with AHN EPO $2500 1x","metal":"Gold","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Erie","Mercer","Washington","Westmoreland"],"rates":{"1":{"base21":355.33,"tobaccoFactor":1},"4":{"base21":410.16,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":362.5,"tobaccoFactor":1},"4":{"base21":418.43,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":369.82,"tobaccoFactor":1},"4":{"base21":426.89,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":377.31,"tobaccoFactor":1},"4":{"base21":435.52,"tobaccoFactor":1}}}],"ded":{"ind":2500,"fam":2500,"embedded":true},"drugDed":null,"oop":{"ind":7900,"fam":7900},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 (used here): no charge (retail and mail order).","Tier 2 (used here): $25 copay for a 31-day retail supply ($50 for 60 days, $75 for 90 days); $50 for a 90-day mail-order supply.","Tier 3 (used here): $80 copay for a 31-day retail supply ($160 for 60 days, $240 for 90 days); $160 for a 90-day mail-order supply.","Tier 4 (used here): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245982402/SE_2245982402_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":313.22,"tobaccoFactor":1},"4":{"base21":358.4,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1190007-00","standardId":"33709PA1190007-00","variant":"standard","issuer":"Highmark Inc.","name":"Together Blue with AHN EPO $5000 1x","metal":"Gold","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Erie","Mercer","Washington","Westmoreland"],"rates":{"1":{"base21":344.67,"tobaccoFactor":1},"4":{"base21":397.85,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":351.62,"tobaccoFactor":1},"4":{"base21":405.87,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":358.72,"tobaccoFactor":1},"4":{"base21":414.07,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":365.98,"tobaccoFactor":1},"4":{"base21":422.45,"tobaccoFactor":1}}}],"ded":{"ind":5000,"fam":5000,"embedded":true},"drugDed":null,"oop":{"ind":7900,"fam":7900},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":325,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":45,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 (used here): no charge (retail and mail order).","Tier 2 (used here): $25 copay for a 31-day retail supply ($50 for 60 days, $75 for 90 days); $50 for a 90-day mail-order supply.","Tier 3 (used here): $80 copay for a 31-day retail supply ($160 for 60 days, $240 for 90 days); $160 for a 90-day mail-order supply.","Tier 4 (used here): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245910958/SE_2245910958_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":297.45,"tobaccoFactor":1},"4":{"base21":340.36,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1190008-00","standardId":"33709PA1190008-00","variant":"standard","issuer":"Highmark Inc.","name":"Together Blue with AHN EPO $2000","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Erie","Mercer","Washington","Westmoreland"],"rates":{"1":{"base21":290.87,"tobaccoFactor":1},"4":{"base21":335.75,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":296.74,"tobaccoFactor":1},"4":{"base21":342.52,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":302.73,"tobaccoFactor":1},"4":{"base21":349.44,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":308.85,"tobaccoFactor":1},"4":{"base21":356.51,"tobaccoFactor":1}}}],"ded":{"ind":2000,"fam":4000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":565,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":550,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":85,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":155,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 (used here): no charge (retail and mail order).","Tier 2 (used here): $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $60 for a 90-day mail-order supply.","Tier 3 (used here): $155 copay for a 31-day retail supply ($310 for 60 days, $465 for 90 days); $310 for a 90-day mail-order supply.","Tier 4 (used here): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245908229/SE_2245908229_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":259.27,"tobaccoFactor":1},"4":{"base21":296.67,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1190009-00","standardId":"33709PA1190009-00","variant":"standard","issuer":"Highmark Inc.","name":"Together Blue with AHN EPO $250","metal":"Platinum","network":"EPO","hsaEligible":false,"counties":["Allegheny","Beaver","Butler","Erie","Mercer","Washington","Westmoreland"],"rates":{"1":{"base21":431.95,"tobaccoFactor":1},"4":{"base21":498.59,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":440.66,"tobaccoFactor":1},"4":{"base21":508.65,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":449.56,"tobaccoFactor":1},"4":{"base21":518.93,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":458.66,"tobaccoFactor":1},"4":{"base21":529.43,"tobaccoFactor":1}}}],"ded":{"ind":250,"fam":500,"embedded":true},"drugDed":null,"oop":{"ind":4000,"fam":8000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":35,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"no_ded","min":250,"max":750}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 (used here): no charge (retail and mail order).","Tier 2 (used here): $5 copay for a 31-day retail supply ($10 for 60 days, $15 for 90 days); $10 for a 90-day mail-order supply.","Tier 3 (used here): $20 copay for a 31-day retail supply ($40 for 60 days, $60 for 90 days); $40 for a 90-day mail-order supply.","Tier 4 (used here): 50% coinsurance per fill with a minimum of $250 and a maximum of $750 for a 31-day retail supply ($500 / $1,500 for 60 days, $750 / $2,250 for 90 days) and a minimum of $500 and a maximum of $1,500 for a 90-day mail-order supply.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245910574/SE_2245910574_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":389.04,"tobaccoFactor":1},"4":{"base21":445.16,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1200001-00","standardId":"33709PA1200001-00","variant":"standard","issuer":"Highmark Inc.","name":"Together Blue with AHN EPO Embedded Q$3800","metal":"Silver","network":"EPO","hsaEligible":true,"counties":["Allegheny","Beaver","Butler","Erie","Mercer","Washington","Westmoreland"],"rates":{"1":{"base21":308.59,"tobaccoFactor":1},"4":{"base21":356.21,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":314.82,"tobaccoFactor":1},"4":{"base21":363.4,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":321.18,"tobaccoFactor":1},"4":{"base21":370.74,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":327.68,"tobaccoFactor":1},"4":{"base21":378.24,"tobaccoFactor":1}}}],"ded":{"ind":3800,"fam":7600,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":155,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 (used here): no charge (retail and mail order).","Tier 2 (used here): $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $60 for a 90-day mail-order supply.","Tier 3 (used here): $155 copay for a 31-day retail supply ($310 for 60 days, $465 for 90 days); $310 for a 90-day mail-order supply.","Tier 4 (used here): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply.","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, emergency room care, lab tests, x-rays, imaging, therapy, outpatient mental health, generic drugs, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245909182/SE_2245909182_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":270.34,"tobaccoFactor":1},"4":{"base21":309.34,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1200002-00","standardId":"33709PA1200002-00","variant":"standard","issuer":"Highmark Inc.","name":"Together Blue with AHN EPO Embedded Q$6650","metal":"Bronze","network":"EPO","hsaEligible":true,"counties":["Allegheny","Beaver","Butler","Erie","Mercer","Washington","Westmoreland"],"rates":{"1":{"base21":256.69,"tobaccoFactor":1},"4":{"base21":296.29,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":261.86,"tobaccoFactor":1},"4":{"base21":302.27,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":267.15,"tobaccoFactor":1},"4":{"base21":308.38,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":272.56,"tobaccoFactor":1},"4":{"base21":314.61,"tobaccoFactor":1}}}],"ded":{"ind":6650,"fam":13300,"embedded":true},"drugDed":null,"oop":{"ind":8000,"fam":16000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":155,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded","min":250,"max":1000}},"outpatientFacility":{"base":{"kind":"copay","amount":20,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Drug tiers are numbered on the Highmark SBC, not named; Tier 1 is treated as generic, Tier 2 as preferred brand, Tier 3 as non-preferred brand and Tier 4 as specialty.","Tier 1 (used here): no charge (retail and mail order).","Tier 2 (used here): $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $60 for a 90-day mail-order supply.","Tier 3 (used here): $155 copay for a 31-day retail supply ($310 for 60 days, $465 for 90 days); $310 for a 90-day mail-order supply.","Tier 4 (used here): 50% coinsurance per fill with a minimum of $250 and a maximum of $1,000 for a 31-day retail supply ($500 / $2,000 for 60 days, $750 / $3,000 for 90 days) and a minimum of $500 and a maximum of $2,000 for a 90-day mail-order supply.","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, emergency room care, imaging, therapy, outpatient mental health, generic drugs, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245914661/SE_2245914661_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":226.68,"tobaccoFactor":1},"4":{"base21":259.38,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1280001-00","standardId":"33709PA1280001-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $0 100/80 Platinum","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Bedford","Blair","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Forest","Greene","Huntingdon","Jefferson","McKean","Mercer","Potter","Somerset","Venango","Warren"],"rates":{"1":{"base21":580.82,"tobaccoFactor":1},"2":{"base21":690.55,"tobaccoFactor":1},"4":{"base21":670.44,"tobaccoFactor":1},"5":{"base21":700.27,"tobaccoFactor":1},"6":{"base21":710.51,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":592.54,"tobaccoFactor":1},"2":{"base21":704.48,"tobaccoFactor":1},"4":{"base21":683.96,"tobaccoFactor":1},"5":{"base21":714.4,"tobaccoFactor":1},"6":{"base21":724.85,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":604.51,"tobaccoFactor":1},"2":{"base21":718.72,"tobaccoFactor":1},"4":{"base21":697.78,"tobaccoFactor":1},"5":{"base21":728.83,"tobaccoFactor":1},"6":{"base21":739.49,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":616.74,"tobaccoFactor":1},"2":{"base21":733.25,"tobaccoFactor":1},"4":{"base21":711.9,"tobaccoFactor":1},"5":{"base21":743.58,"tobaccoFactor":1},"6":{"base21":754.45,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":9500,"fam":19000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","No network deductible: copays and coinsurance apply from the first visit.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245886344/SE_2245886344_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":537.68,"tobaccoFactor":1},"2":{"base21":615.24,"tobaccoFactor":1},"4":{"base21":615.24,"tobaccoFactor":1},"5":{"base21":623.85,"tobaccoFactor":1},"6":{"base21":637.65,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1280002-00","standardId":"33709PA1280002-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $250 100/80 Platinum","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Bedford","Blair","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Forest","Greene","Huntingdon","Jefferson","McKean","Mercer","Potter","Somerset","Venango","Warren"],"rates":{"1":{"base21":570.59,"tobaccoFactor":1},"2":{"base21":678.38,"tobaccoFactor":1},"4":{"base21":658.62,"tobaccoFactor":1},"5":{"base21":687.93,"tobaccoFactor":1},"6":{"base21":697.99,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":582.1,"tobaccoFactor":1},"2":{"base21":692.07,"tobaccoFactor":1},"4":{"base21":671.91,"tobaccoFactor":1},"5":{"base21":701.81,"tobaccoFactor":1},"6":{"base21":712.08,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":593.86,"tobaccoFactor":1},"2":{"base21":706.05,"tobaccoFactor":1},"4":{"base21":685.49,"tobaccoFactor":1},"5":{"base21":715.99,"tobaccoFactor":1},"6":{"base21":726.46,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":605.87,"tobaccoFactor":1},"2":{"base21":720.34,"tobaccoFactor":1},"4":{"base21":699.35,"tobaccoFactor":1},"5":{"base21":730.48,"tobaccoFactor":1},"6":{"base21":741.16,"tobaccoFactor":1}}}],"ded":{"ind":250,"fam":500,"embedded":true},"drugDed":null,"oop":{"ind":6500,"fam":13000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245917253/SE_2245917253_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":524.62,"tobaccoFactor":1},"2":{"base21":600.3,"tobaccoFactor":1},"4":{"base21":600.3,"tobaccoFactor":1},"5":{"base21":608.71,"tobaccoFactor":1},"6":{"base21":622.17,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1280003-00","standardId":"33709PA1280003-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $250 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bedford","Blair","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Forest","Greene","Huntingdon","Jefferson","McKean","Mercer","Potter","Somerset","Venango","Warren"],"rates":{"1":{"base21":518.16,"tobaccoFactor":1},"2":{"base21":616.05,"tobaccoFactor":1},"4":{"base21":598.11,"tobaccoFactor":1},"5":{"base21":624.72,"tobaccoFactor":1},"6":{"base21":633.86,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":528.61,"tobaccoFactor":1},"2":{"base21":628.48,"tobaccoFactor":1},"4":{"base21":610.18,"tobaccoFactor":1},"5":{"base21":637.33,"tobaccoFactor":1},"6":{"base21":646.65,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":539.29,"tobaccoFactor":1},"2":{"base21":641.18,"tobaccoFactor":1},"4":{"base21":622.5,"tobaccoFactor":1},"5":{"base21":650.2,"tobaccoFactor":1},"6":{"base21":659.71,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":550.2,"tobaccoFactor":1},"2":{"base21":654.15,"tobaccoFactor":1},"4":{"base21":635.09,"tobaccoFactor":1},"5":{"base21":663.36,"tobaccoFactor":1},"6":{"base21":673.06,"tobaccoFactor":1}}}],"ded":{"ind":250,"fam":500,"embedded":true},"drugDed":null,"oop":{"ind":8900,"fam":17800},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $20 copay for a 31-day retail supply ($40 for 60 days, $60 for 90 days); $20 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245916945/SE_2245916945_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":479.47,"tobaccoFactor":1},"2":{"base21":548.64,"tobaccoFactor":1},"4":{"base21":548.64,"tobaccoFactor":1},"5":{"base21":556.32,"tobaccoFactor":1},"6":{"base21":568.62,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1280004-00","standardId":"33709PA1280004-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $500 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bedford","Blair","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Forest","Greene","Huntingdon","Jefferson","McKean","Mercer","Potter","Somerset","Venango","Warren"],"rates":{"1":{"base21":513.56,"tobaccoFactor":1},"2":{"base21":610.58,"tobaccoFactor":1},"4":{"base21":592.8,"tobaccoFactor":1},"5":{"base21":619.17,"tobaccoFactor":1},"6":{"base21":628.23,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":523.92,"tobaccoFactor":1},"2":{"base21":622.9,"tobaccoFactor":1},"4":{"base21":604.76,"tobaccoFactor":1},"5":{"base21":631.67,"tobaccoFactor":1},"6":{"base21":640.91,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":534.5,"tobaccoFactor":1},"2":{"base21":635.48,"tobaccoFactor":1},"4":{"base21":616.97,"tobaccoFactor":1},"5":{"base21":644.43,"tobaccoFactor":1},"6":{"base21":653.85,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":545.31,"tobaccoFactor":1},"2":{"base21":648.34,"tobaccoFactor":1},"4":{"base21":629.45,"tobaccoFactor":1},"5":{"base21":657.46,"tobaccoFactor":1},"6":{"base21":667.08,"tobaccoFactor":1}}}],"ded":{"ind":500,"fam":1000,"embedded":true},"drugDed":null,"oop":{"ind":10100,"fam":20200},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":275,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":55,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $20 copay for a 31-day retail supply ($40 for 60 days, $60 for 90 days); $20 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245916662/SE_2245916662_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":473.7,"tobaccoFactor":1},"2":{"base21":542.03,"tobaccoFactor":1},"4":{"base21":542.03,"tobaccoFactor":1},"5":{"base21":549.62,"tobaccoFactor":1},"6":{"base21":561.78,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1280005-00","standardId":"33709PA1280005-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $750 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bedford","Blair","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Forest","Greene","Huntingdon","Jefferson","McKean","Mercer","Potter","Somerset","Venango","Warren"],"rates":{"1":{"base21":510.44,"tobaccoFactor":1},"2":{"base21":606.87,"tobaccoFactor":1},"4":{"base21":589.2,"tobaccoFactor":1},"5":{"base21":615.41,"tobaccoFactor":1},"6":{"base21":624.41,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":520.74,"tobaccoFactor":1},"2":{"base21":619.12,"tobaccoFactor":1},"4":{"base21":601.08,"tobaccoFactor":1},"5":{"base21":627.83,"tobaccoFactor":1},"6":{"base21":637.01,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":531.26,"tobaccoFactor":1},"2":{"base21":631.62,"tobaccoFactor":1},"4":{"base21":613.23,"tobaccoFactor":1},"5":{"base21":640.52,"tobaccoFactor":1},"6":{"base21":649.88,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":542,"tobaccoFactor":1},"2":{"base21":644.4,"tobaccoFactor":1},"4":{"base21":625.63,"tobaccoFactor":1},"5":{"base21":653.47,"tobaccoFactor":1},"6":{"base21":663.03,"tobaccoFactor":1}}}],"ded":{"ind":750,"fam":1500,"embedded":true},"drugDed":null,"oop":{"ind":10100,"fam":20200},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":225,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":55,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245917320/SE_2245917320_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":469.76,"tobaccoFactor":1},"2":{"base21":537.52,"tobaccoFactor":1},"4":{"base21":537.52,"tobaccoFactor":1},"5":{"base21":545.05,"tobaccoFactor":1},"6":{"base21":557.1,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1280006-00","standardId":"33709PA1280006-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $1000 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bedford","Blair","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Forest","Greene","Huntingdon","Jefferson","McKean","Mercer","Potter","Somerset","Venango","Warren"],"rates":{"1":{"base21":502.22,"tobaccoFactor":1},"2":{"base21":597.1,"tobaccoFactor":1},"4":{"base21":579.71,"tobaccoFactor":1},"5":{"base21":605.51,"tobaccoFactor":1},"6":{"base21":614.36,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":512.35,"tobaccoFactor":1},"2":{"base21":609.15,"tobaccoFactor":1},"4":{"base21":591.41,"tobaccoFactor":1},"5":{"base21":617.72,"tobaccoFactor":1},"6":{"base21":626.76,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":522.7,"tobaccoFactor":1},"2":{"base21":621.45,"tobaccoFactor":1},"4":{"base21":603.35,"tobaccoFactor":1},"5":{"base21":630.2,"tobaccoFactor":1},"6":{"base21":639.42,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":533.28,"tobaccoFactor":1},"2":{"base21":634.03,"tobaccoFactor":1},"4":{"base21":615.56,"tobaccoFactor":1},"5":{"base21":642.95,"tobaccoFactor":1},"6":{"base21":652.35,"tobaccoFactor":1}}}],"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":9100,"fam":18200},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":225,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":55,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245892153/SE_2245892153_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":461.2,"tobaccoFactor":1},"2":{"base21":527.73,"tobaccoFactor":1},"4":{"base21":527.73,"tobaccoFactor":1},"5":{"base21":535.11,"tobaccoFactor":1},"6":{"base21":546.95,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1280007-00","standardId":"33709PA1280007-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $1250 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bedford","Blair","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Forest","Greene","Huntingdon","Jefferson","McKean","Mercer","Potter","Somerset","Venango","Warren"],"rates":{"1":{"base21":490.27,"tobaccoFactor":1},"2":{"base21":582.9,"tobaccoFactor":1},"4":{"base21":565.92,"tobaccoFactor":1},"5":{"base21":591.11,"tobaccoFactor":1},"6":{"base21":599.75,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":500.17,"tobaccoFactor":1},"2":{"base21":594.66,"tobaccoFactor":1},"4":{"base21":577.34,"tobaccoFactor":1},"5":{"base21":603.03,"tobaccoFactor":1},"6":{"base21":611.85,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":510.27,"tobaccoFactor":1},"2":{"base21":606.67,"tobaccoFactor":1},"4":{"base21":589,"tobaccoFactor":1},"5":{"base21":615.22,"tobaccoFactor":1},"6":{"base21":624.21,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":520.59,"tobaccoFactor":1},"2":{"base21":618.95,"tobaccoFactor":1},"4":{"base21":600.92,"tobaccoFactor":1},"5":{"base21":627.66,"tobaccoFactor":1},"6":{"base21":636.84,"tobaccoFactor":1}}}],"ded":{"ind":1250,"fam":2500,"embedded":true},"drugDed":null,"oop":{"ind":9100,"fam":18200},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":225,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":225,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":55,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245892919/SE_2245892919_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":449.82,"tobaccoFactor":1},"2":{"base21":514.71,"tobaccoFactor":1},"4":{"base21":514.71,"tobaccoFactor":1},"5":{"base21":521.92,"tobaccoFactor":1},"6":{"base21":533.46,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1280008-00","standardId":"33709PA1280008-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $1400 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bedford","Blair","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Forest","Greene","Huntingdon","Jefferson","McKean","Mercer","Potter","Somerset","Venango","Warren"],"rates":{"1":{"base21":474.88,"tobaccoFactor":1},"2":{"base21":564.59,"tobaccoFactor":1},"4":{"base21":548.15,"tobaccoFactor":1},"5":{"base21":572.54,"tobaccoFactor":1},"6":{"base21":580.91,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":484.46,"tobaccoFactor":1},"2":{"base21":575.98,"tobaccoFactor":1},"4":{"base21":559.21,"tobaccoFactor":1},"5":{"base21":584.09,"tobaccoFactor":1},"6":{"base21":592.63,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":494.24,"tobaccoFactor":1},"2":{"base21":587.62,"tobaccoFactor":1},"4":{"base21":570.5,"tobaccoFactor":1},"5":{"base21":595.89,"tobaccoFactor":1},"6":{"base21":604.61,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":504.24,"tobaccoFactor":1},"2":{"base21":599.51,"tobaccoFactor":1},"4":{"base21":582.04,"tobaccoFactor":1},"5":{"base21":607.94,"tobaccoFactor":1},"6":{"base21":616.84,"tobaccoFactor":1}}}],"ded":{"ind":1400,"fam":2800,"embedded":true},"drugDed":null,"oop":{"ind":9100,"fam":18200},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":70,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245912831/SE_2245912831_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":434.39,"tobaccoFactor":1},"2":{"base21":497.05,"tobaccoFactor":1},"4":{"base21":497.05,"tobaccoFactor":1},"5":{"base21":504.01,"tobaccoFactor":1},"6":{"base21":515.16,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1280009-00","standardId":"33709PA1280009-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $1500 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bedford","Blair","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Forest","Greene","Huntingdon","Jefferson","McKean","Mercer","Potter","Somerset","Venango","Warren"],"rates":{"1":{"base21":486.02,"tobaccoFactor":1},"2":{"base21":577.84,"tobaccoFactor":1},"4":{"base21":561.01,"tobaccoFactor":1},"5":{"base21":585.97,"tobaccoFactor":1},"6":{"base21":594.54,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":495.83,"tobaccoFactor":1},"2":{"base21":589.5,"tobaccoFactor":1},"4":{"base21":572.33,"tobaccoFactor":1},"5":{"base21":597.8,"tobaccoFactor":1},"6":{"base21":606.54,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":505.84,"tobaccoFactor":1},"2":{"base21":601.41,"tobaccoFactor":1},"4":{"base21":583.89,"tobaccoFactor":1},"5":{"base21":609.87,"tobaccoFactor":1},"6":{"base21":618.79,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":516.07,"tobaccoFactor":1},"2":{"base21":613.57,"tobaccoFactor":1},"4":{"base21":595.7,"tobaccoFactor":1},"5":{"base21":622.21,"tobaccoFactor":1},"6":{"base21":631.31,"tobaccoFactor":1}}}],"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":null,"oop":{"ind":9100,"fam":18200},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":225,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":225,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":55,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $20 copay for a 31-day retail supply ($40 for 60 days, $60 for 90 days); $20 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245913044/SE_2245913044_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":445.27,"tobaccoFactor":1},"2":{"base21":509.5,"tobaccoFactor":1},"4":{"base21":509.5,"tobaccoFactor":1},"5":{"base21":516.64,"tobaccoFactor":1},"6":{"base21":528.06,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1280010-00","standardId":"33709PA1280010-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $1550 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bedford","Blair","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Forest","Greene","Huntingdon","Jefferson","McKean","Mercer","Potter","Somerset","Venango","Warren"],"rates":{"1":{"base21":488.51,"tobaccoFactor":1},"2":{"base21":580.81,"tobaccoFactor":1},"4":{"base21":563.89,"tobaccoFactor":1},"5":{"base21":588.98,"tobaccoFactor":1},"6":{"base21":597.6,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":498.37,"tobaccoFactor":1},"2":{"base21":592.53,"tobaccoFactor":1},"4":{"base21":575.27,"tobaccoFactor":1},"5":{"base21":600.87,"tobaccoFactor":1},"6":{"base21":609.65,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":508.44,"tobaccoFactor":1},"2":{"base21":604.5,"tobaccoFactor":1},"4":{"base21":586.89,"tobaccoFactor":1},"5":{"base21":613.01,"tobaccoFactor":1},"6":{"base21":621.97,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":518.72,"tobaccoFactor":1},"2":{"base21":616.72,"tobaccoFactor":1},"4":{"base21":598.76,"tobaccoFactor":1},"5":{"base21":625.41,"tobaccoFactor":1},"6":{"base21":634.55,"tobaccoFactor":1}}}],"ded":{"ind":1550,"fam":3100,"embedded":true},"drugDed":null,"oop":{"ind":11100,"fam":22200},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":175,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":30,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":175,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":250,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $250 copay per admission, charged on the first day of each stay. The other days count toward the deductible until it is met, then cost nothing more. The SBC prints \"$250 copay/visit\"; a hospital visit is read as one stay (Highmark's 2026 SBCs said \"per admission\").","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Outpatient surgeon fees: the chart marks it \"Deductible does not apply\"; page 1 does not list it among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245913431/SE_2245913431_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":446.23,"tobaccoFactor":1},"2":{"base21":510.6,"tobaccoFactor":1},"4":{"base21":510.6,"tobaccoFactor":1},"5":{"base21":517.75,"tobaccoFactor":1},"6":{"base21":529.2,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1280011-00","standardId":"33709PA1280011-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $2000 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bedford","Blair","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Forest","Greene","Huntingdon","Jefferson","McKean","Mercer","Potter","Somerset","Venango","Warren"],"rates":{"1":{"base21":475.11,"tobaccoFactor":1},"2":{"base21":564.87,"tobaccoFactor":1},"4":{"base21":548.41,"tobaccoFactor":1},"5":{"base21":572.82,"tobaccoFactor":1},"6":{"base21":581.19,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":484.69,"tobaccoFactor":1},"2":{"base21":576.26,"tobaccoFactor":1},"4":{"base21":559.48,"tobaccoFactor":1},"5":{"base21":584.37,"tobaccoFactor":1},"6":{"base21":592.92,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":494.48,"tobaccoFactor":1},"2":{"base21":587.9,"tobaccoFactor":1},"4":{"base21":570.78,"tobaccoFactor":1},"5":{"base21":596.18,"tobaccoFactor":1},"6":{"base21":604.9,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":504.49,"tobaccoFactor":1},"2":{"base21":599.8,"tobaccoFactor":1},"4":{"base21":582.33,"tobaccoFactor":1},"5":{"base21":608.24,"tobaccoFactor":1},"6":{"base21":617.13,"tobaccoFactor":1}}}],"ded":{"ind":2000,"fam":4000,"embedded":true},"drugDed":null,"oop":{"ind":9100,"fam":18200},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":225,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":225,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":55,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $20 copay for a 31-day retail supply ($40 for 60 days, $60 for 90 days); $20 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245916386/SE_2245916386_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":433.66,"tobaccoFactor":1},"2":{"base21":496.22,"tobaccoFactor":1},"4":{"base21":496.22,"tobaccoFactor":1},"5":{"base21":503.16,"tobaccoFactor":1},"6":{"base21":514.29,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1280012-00","standardId":"33709PA1280012-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $2500 1x 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bedford","Blair","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Forest","Greene","Huntingdon","Jefferson","McKean","Mercer","Potter","Somerset","Venango","Warren"],"rates":{"1":{"base21":486.82,"tobaccoFactor":1},"2":{"base21":578.79,"tobaccoFactor":1},"4":{"base21":561.93,"tobaccoFactor":1},"5":{"base21":586.94,"tobaccoFactor":1},"6":{"base21":595.52,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":496.64,"tobaccoFactor":1},"2":{"base21":590.47,"tobaccoFactor":1},"4":{"base21":573.27,"tobaccoFactor":1},"5":{"base21":598.78,"tobaccoFactor":1},"6":{"base21":607.53,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":506.67,"tobaccoFactor":1},"2":{"base21":602.39,"tobaccoFactor":1},"4":{"base21":584.85,"tobaccoFactor":1},"5":{"base21":610.87,"tobaccoFactor":1},"6":{"base21":619.81,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":516.92,"tobaccoFactor":1},"2":{"base21":614.58,"tobaccoFactor":1},"4":{"base21":596.68,"tobaccoFactor":1},"5":{"base21":623.23,"tobaccoFactor":1},"6":{"base21":632.35,"tobaccoFactor":1}}}],"ded":{"ind":2500,"fam":2500,"embedded":true},"drugDed":null,"oop":{"ind":9100,"fam":9100},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":35,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":35,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":35,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":300,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $300 copay per admission, charged on the first day of each stay. The other days count toward the deductible until it is met, then cost nothing more. The SBC prints \"$300 copay/visit\"; a hospital visit is read as one stay (Highmark's 2026 SBCs said \"per admission\").","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $20 copay for a 31-day retail supply ($40 for 60 days, $60 for 90 days); $20 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245900588/SE_2245900588_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":443.87,"tobaccoFactor":1},"2":{"base21":507.9,"tobaccoFactor":1},"4":{"base21":507.9,"tobaccoFactor":1},"5":{"base21":515.01,"tobaccoFactor":1},"6":{"base21":526.4,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1280013-00","standardId":"33709PA1280013-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $5000 1x 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bedford","Blair","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Forest","Greene","Huntingdon","Jefferson","McKean","Mercer","Potter","Somerset","Venango","Warren"],"rates":{"1":{"base21":456.85,"tobaccoFactor":1},"2":{"base21":543.16,"tobaccoFactor":1},"4":{"base21":527.34,"tobaccoFactor":1},"5":{"base21":550.81,"tobaccoFactor":1},"6":{"base21":558.86,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":466.07,"tobaccoFactor":1},"2":{"base21":554.12,"tobaccoFactor":1},"4":{"base21":537.98,"tobaccoFactor":1},"5":{"base21":561.92,"tobaccoFactor":1},"6":{"base21":570.14,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":475.48,"tobaccoFactor":1},"2":{"base21":565.31,"tobaccoFactor":1},"4":{"base21":548.85,"tobaccoFactor":1},"5":{"base21":573.27,"tobaccoFactor":1},"6":{"base21":581.65,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":485.1,"tobaccoFactor":1},"2":{"base21":576.75,"tobaccoFactor":1},"4":{"base21":559.95,"tobaccoFactor":1},"5":{"base21":584.87,"tobaccoFactor":1},"6":{"base21":593.42,"tobaccoFactor":1}}}],"ded":{"ind":5000,"fam":5000,"embedded":true},"drugDed":null,"oop":{"ind":9100,"fam":9100},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":325,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":45,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $20 copay for a 31-day retail supply ($40 for 60 days, $60 for 90 days); $20 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245897777/SE_2245897777_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":415.36,"tobaccoFactor":1},"2":{"base21":475.28,"tobaccoFactor":1},"4":{"base21":475.28,"tobaccoFactor":1},"5":{"base21":481.93,"tobaccoFactor":1},"6":{"base21":492.59,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1280014-00","standardId":"33709PA1280014-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $0 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bedford","Blair","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Forest","Greene","Huntingdon","Jefferson","McKean","Mercer","Potter","Somerset","Venango","Warren"],"rates":{"1":{"base21":515.84,"tobaccoFactor":1},"2":{"base21":613.3,"tobaccoFactor":1},"4":{"base21":595.44,"tobaccoFactor":1},"5":{"base21":621.93,"tobaccoFactor":1},"6":{"base21":631.03,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":526.25,"tobaccoFactor":1},"2":{"base21":625.67,"tobaccoFactor":1},"4":{"base21":607.45,"tobaccoFactor":1},"5":{"base21":634.48,"tobaccoFactor":1},"6":{"base21":643.76,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":536.88,"tobaccoFactor":1},"2":{"base21":638.32,"tobaccoFactor":1},"4":{"base21":619.72,"tobaccoFactor":1},"5":{"base21":647.3,"tobaccoFactor":1},"6":{"base21":656.77,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":547.74,"tobaccoFactor":1},"2":{"base21":651.23,"tobaccoFactor":1},"4":{"base21":632.26,"tobaccoFactor":1},"5":{"base21":660.39,"tobaccoFactor":1},"6":{"base21":670.05,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":70,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":500,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $500 copay per admission, charged on the first day of each stay. The SBC prints \"$500 copay/visit\"; a hospital visit is read as one stay (Highmark's 2026 SBCs said \"per admission\").","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $20 copay for a 31-day retail supply ($40 for 60 days, $60 for 90 days); $20 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","No network deductible: copays and coinsurance apply from the first visit.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245883059/SE_2245883059_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":478.03,"tobaccoFactor":1},"2":{"base21":546.99,"tobaccoFactor":1},"4":{"base21":546.99,"tobaccoFactor":1},"5":{"base21":554.64,"tobaccoFactor":1},"6":{"base21":566.91,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1280016-00","standardId":"33709PA1280016-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $1000 90/70 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bedford","Blair","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Forest","Greene","Huntingdon","Jefferson","McKean","Mercer","Potter","Somerset","Venango","Warren"],"rates":{"1":{"base21":459.44,"tobaccoFactor":1},"2":{"base21":546.24,"tobaccoFactor":1},"4":{"base21":530.33,"tobaccoFactor":1},"5":{"base21":553.93,"tobaccoFactor":1},"6":{"base21":562.03,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":468.71,"tobaccoFactor":1},"2":{"base21":557.26,"tobaccoFactor":1},"4":{"base21":541.03,"tobaccoFactor":1},"5":{"base21":565.11,"tobaccoFactor":1},"6":{"base21":573.37,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":478.18,"tobaccoFactor":1},"2":{"base21":568.52,"tobaccoFactor":1},"4":{"base21":551.96,"tobaccoFactor":1},"5":{"base21":576.52,"tobaccoFactor":1},"6":{"base21":584.96,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":487.85,"tobaccoFactor":1},"2":{"base21":580.02,"tobaccoFactor":1},"4":{"base21":563.13,"tobaccoFactor":1},"5":{"base21":588.19,"tobaccoFactor":1},"6":{"base21":596.79,"tobaccoFactor":1}}}],"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":7900,"fam":15800},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":75,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245892673/SE_2245892673_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":423.08,"tobaccoFactor":1},"2":{"base21":484.11,"tobaccoFactor":1},"4":{"base21":484.11,"tobaccoFactor":1},"5":{"base21":490.89,"tobaccoFactor":1},"6":{"base21":501.75,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1280017-00","standardId":"33709PA1280017-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $1750 90/70 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bedford","Blair","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Forest","Greene","Huntingdon","Jefferson","McKean","Mercer","Potter","Somerset","Venango","Warren"],"rates":{"1":{"base21":457.38,"tobaccoFactor":1},"2":{"base21":543.79,"tobaccoFactor":1},"4":{"base21":527.95,"tobaccoFactor":1},"5":{"base21":551.45,"tobaccoFactor":1},"6":{"base21":559.51,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":466.61,"tobaccoFactor":1},"2":{"base21":554.76,"tobaccoFactor":1},"4":{"base21":538.61,"tobaccoFactor":1},"5":{"base21":562.57,"tobaccoFactor":1},"6":{"base21":570.8,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":476.04,"tobaccoFactor":1},"2":{"base21":565.97,"tobaccoFactor":1},"4":{"base21":549.49,"tobaccoFactor":1},"5":{"base21":573.94,"tobaccoFactor":1},"6":{"base21":582.33,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":485.67,"tobaccoFactor":1},"2":{"base21":577.42,"tobaccoFactor":1},"4":{"base21":560.6,"tobaccoFactor":1},"5":{"base21":585.55,"tobaccoFactor":1},"6":{"base21":594.11,"tobaccoFactor":1}}}],"ded":{"ind":1750,"fam":3500,"embedded":true},"drugDed":null,"oop":{"ind":7900,"fam":15800},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245916106/SE_2245916106_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":419.01,"tobaccoFactor":1},"2":{"base21":479.46,"tobaccoFactor":1},"4":{"base21":479.46,"tobaccoFactor":1},"5":{"base21":486.17,"tobaccoFactor":1},"6":{"base21":496.92,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1280018-00","standardId":"33709PA1280018-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $2000 90/70 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bedford","Blair","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Forest","Greene","Huntingdon","Jefferson","McKean","Mercer","Potter","Somerset","Venango","Warren"],"rates":{"1":{"base21":452.83,"tobaccoFactor":1},"2":{"base21":538.39,"tobaccoFactor":1},"4":{"base21":522.7,"tobaccoFactor":1},"5":{"base21":545.96,"tobaccoFactor":1},"6":{"base21":553.95,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":461.97,"tobaccoFactor":1},"2":{"base21":549.25,"tobaccoFactor":1},"4":{"base21":533.25,"tobaccoFactor":1},"5":{"base21":556.98,"tobaccoFactor":1},"6":{"base21":565.13,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":471.3,"tobaccoFactor":1},"2":{"base21":560.34,"tobaccoFactor":1},"4":{"base21":544.02,"tobaccoFactor":1},"5":{"base21":568.23,"tobaccoFactor":1},"6":{"base21":576.54,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":480.84,"tobaccoFactor":1},"2":{"base21":571.68,"tobaccoFactor":1},"4":{"base21":555.03,"tobaccoFactor":1},"5":{"base21":579.73,"tobaccoFactor":1},"6":{"base21":588.2,"tobaccoFactor":1}}}],"ded":{"ind":2000,"fam":4000,"embedded":true},"drugDed":null,"oop":{"ind":7900,"fam":15800},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245916728/SE_2245916728_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":414.24,"tobaccoFactor":1},"2":{"base21":473.99,"tobaccoFactor":1},"4":{"base21":473.99,"tobaccoFactor":1},"5":{"base21":480.62,"tobaccoFactor":1},"6":{"base21":491.25,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1280019-00","standardId":"33709PA1280019-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $600 50/40 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bedford","Blair","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Forest","Greene","Huntingdon","Jefferson","McKean","Mercer","Potter","Somerset","Venango","Warren"],"rates":{"1":{"base21":391.15,"tobaccoFactor":1},"2":{"base21":465.05,"tobaccoFactor":1},"4":{"base21":451.5,"tobaccoFactor":1},"5":{"base21":471.6,"tobaccoFactor":1},"6":{"base21":478.49,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":399.04,"tobaccoFactor":1},"2":{"base21":474.43,"tobaccoFactor":1},"4":{"base21":460.61,"tobaccoFactor":1},"5":{"base21":481.11,"tobaccoFactor":1},"6":{"base21":488.15,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":407.1,"tobaccoFactor":1},"2":{"base21":484.02,"tobaccoFactor":1},"4":{"base21":469.92,"tobaccoFactor":1},"5":{"base21":490.83,"tobaccoFactor":1},"6":{"base21":498.01,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":415.34,"tobaccoFactor":1},"2":{"base21":493.81,"tobaccoFactor":1},"4":{"base21":479.42,"tobaccoFactor":1},"5":{"base21":500.76,"tobaccoFactor":1},"6":{"base21":508.08,"tobaccoFactor":1}}}],"ded":{"ind":600,"fam":1200,"embedded":true},"drugDed":null,"oop":{"ind":11500,"fam":23000},"rules":{"pcp":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":95,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":195,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245917024/SE_2245917024_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":371.43,"tobaccoFactor":1},"2":{"base21":425.01,"tobaccoFactor":1},"4":{"base21":425.01,"tobaccoFactor":1},"5":{"base21":430.96,"tobaccoFactor":1},"6":{"base21":440.49,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1280020-00","standardId":"33709PA1280020-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $2600 70/50 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bedford","Blair","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Forest","Greene","Huntingdon","Jefferson","McKean","Mercer","Potter","Somerset","Venango","Warren"],"rates":{"1":{"base21":378.42,"tobaccoFactor":1},"2":{"base21":449.91,"tobaccoFactor":1},"4":{"base21":436.81,"tobaccoFactor":1},"5":{"base21":456.25,"tobaccoFactor":1},"6":{"base21":462.92,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":386.06,"tobaccoFactor":1},"2":{"base21":458.99,"tobaccoFactor":1},"4":{"base21":445.62,"tobaccoFactor":1},"5":{"base21":465.45,"tobaccoFactor":1},"6":{"base21":472.26,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":393.86,"tobaccoFactor":1},"2":{"base21":468.27,"tobaccoFactor":1},"4":{"base21":454.63,"tobaccoFactor":1},"5":{"base21":474.86,"tobaccoFactor":1},"6":{"base21":481.8,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":401.82,"tobaccoFactor":1},"2":{"base21":477.74,"tobaccoFactor":1},"4":{"base21":463.82,"tobaccoFactor":1},"5":{"base21":484.46,"tobaccoFactor":1},"6":{"base21":491.55,"tobaccoFactor":1}}}],"ded":{"ind":2600,"fam":5200,"embedded":true},"drugDed":null,"oop":{"ind":11500,"fam":23000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":90,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":90,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":85,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":140,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Primary care visits: the chart marks it \"Deductible does not apply\"; page 1 does not list it among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Preventive care services, urgent care, outpatient mental health, outpatient substance abuse, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245916525/SE_2245916525_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":350.59,"tobaccoFactor":1},"2":{"base21":401.16,"tobaccoFactor":1},"4":{"base21":401.16,"tobaccoFactor":1},"5":{"base21":406.78,"tobaccoFactor":1},"6":{"base21":415.77,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1280021-00","standardId":"33709PA1280021-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $5000 1x 70/50 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bedford","Blair","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Forest","Greene","Huntingdon","Jefferson","McKean","Mercer","Potter","Somerset","Venango","Warren"],"rates":{"1":{"base21":392.87,"tobaccoFactor":1},"2":{"base21":467.09,"tobaccoFactor":1},"4":{"base21":453.48,"tobaccoFactor":1},"5":{"base21":473.66,"tobaccoFactor":1},"6":{"base21":480.59,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":400.79,"tobaccoFactor":1},"2":{"base21":476.51,"tobaccoFactor":1},"4":{"base21":462.63,"tobaccoFactor":1},"5":{"base21":483.22,"tobaccoFactor":1},"6":{"base21":490.29,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":408.89,"tobaccoFactor":1},"2":{"base21":486.14,"tobaccoFactor":1},"4":{"base21":471.98,"tobaccoFactor":1},"5":{"base21":492.98,"tobaccoFactor":1},"6":{"base21":500.19,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":417.16,"tobaccoFactor":1},"2":{"base21":495.97,"tobaccoFactor":1},"4":{"base21":481.53,"tobaccoFactor":1},"5":{"base21":502.96,"tobaccoFactor":1},"6":{"base21":510.31,"tobaccoFactor":1}}}],"ded":{"ind":5000,"fam":5000,"embedded":true},"drugDed":null,"oop":{"ind":9200,"fam":9200},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":140,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Primary care visits: the chart marks it \"Deductible does not apply\"; page 1 does not list it among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Preventive care services, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245892362/SE_2245892362_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":360.57,"tobaccoFactor":1},"2":{"base21":412.58,"tobaccoFactor":1},"4":{"base21":412.58,"tobaccoFactor":1},"5":{"base21":418.36,"tobaccoFactor":1},"6":{"base21":427.61,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1280022-00","standardId":"33709PA1280022-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $4500 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bedford","Blair","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Forest","Greene","Huntingdon","Jefferson","McKean","Mercer","Potter","Somerset","Venango","Warren"],"rates":{"1":{"base21":411.35,"tobaccoFactor":1},"2":{"base21":489.07,"tobaccoFactor":1},"4":{"base21":474.82,"tobaccoFactor":1},"5":{"base21":495.95,"tobaccoFactor":1},"6":{"base21":503.21,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":419.65,"tobaccoFactor":1},"2":{"base21":498.94,"tobaccoFactor":1},"4":{"base21":484.4,"tobaccoFactor":1},"5":{"base21":505.96,"tobaccoFactor":1},"6":{"base21":513.36,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":428.13,"tobaccoFactor":1},"2":{"base21":509.02,"tobaccoFactor":1},"4":{"base21":494.19,"tobaccoFactor":1},"5":{"base21":516.18,"tobaccoFactor":1},"6":{"base21":523.73,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":436.79,"tobaccoFactor":1},"2":{"base21":519.31,"tobaccoFactor":1},"4":{"base21":504.19,"tobaccoFactor":1},"5":{"base21":526.62,"tobaccoFactor":1},"6":{"base21":534.32,"tobaccoFactor":1}}}],"ded":{"ind":4500,"fam":9000,"embedded":true},"drugDed":null,"oop":{"ind":7700,"fam":15400},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":100,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $100 copay per admission, charged on the first day of each stay. The other days count toward the deductible until it is met, then cost nothing more. The SBC prints \"$100 copay/visit\"; a hospital visit is read as one stay (Highmark's 2026 SBCs said \"per admission\").","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgery facility fees, outpatient surgeon fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245912902/SE_2245912902_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":393.87,"tobaccoFactor":1},"2":{"base21":450.68,"tobaccoFactor":1},"4":{"base21":450.68,"tobaccoFactor":1},"5":{"base21":456.99,"tobaccoFactor":1},"6":{"base21":467.1,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1290001-00","standardId":"33709PA1290001-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO Qualified $1800 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Bedford","Blair","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Forest","Greene","Huntingdon","Jefferson","McKean","Mercer","Potter","Somerset","Venango","Warren"],"rates":{"1":{"base21":471,"tobaccoFactor":1},"2":{"base21":559.99,"tobaccoFactor":1},"4":{"base21":543.68,"tobaccoFactor":1},"5":{"base21":567.87,"tobaccoFactor":1},"6":{"base21":576.17,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":480.51,"tobaccoFactor":1},"2":{"base21":571.29,"tobaccoFactor":1},"4":{"base21":554.65,"tobaccoFactor":1},"5":{"base21":579.33,"tobaccoFactor":1},"6":{"base21":587.8,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":490.21,"tobaccoFactor":1},"2":{"base21":582.83,"tobaccoFactor":1},"4":{"base21":565.85,"tobaccoFactor":1},"5":{"base21":591.03,"tobaccoFactor":1},"6":{"base21":599.67,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":500.13,"tobaccoFactor":1},"2":{"base21":594.62,"tobaccoFactor":1},"4":{"base21":577.3,"tobaccoFactor":1},"5":{"base21":602.99,"tobaccoFactor":1},"6":{"base21":611.8,"tobaccoFactor":1}}}],"ded":{"ind":1800,"fam":3600,"embedded":false},"drugDed":null,"oop":{"ind":6000,"fam":12000,"famPerPerson":12000},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":25,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":25,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":65,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","Family deductible: the SBC says the overall family deductible must be met before the plan begins to pay (an aggregate family deductible), and the estimate uses the aggregate family deductible.","Out-of-pocket limit: this SBC says $6,000 for one person; the Rate Pages of the approved rate filing say $7,000 (hmk-rate-change-decision-sm-grp-mkt.pdf, page 42). They agree on the deductible, coinsurance and primary care copay; the SBC, Highmark's January 2027 document, is followed.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245916246/SE_2245916246_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":437.26,"tobaccoFactor":1},"2":{"base21":500.34,"tobaccoFactor":1},"4":{"base21":500.34,"tobaccoFactor":1},"5":{"base21":507.34,"tobaccoFactor":1},"6":{"base21":518.56,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1290002-00","standardId":"33709PA1290002-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO Qualified Embedded $3500 100/80 Silver","metal":"Silver","network":"PPO","hsaEligible":true,"counties":["Bedford","Blair","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Forest","Greene","Huntingdon","Jefferson","McKean","Mercer","Potter","Somerset","Venango","Warren"],"rates":{"1":{"base21":406.8,"tobaccoFactor":1},"2":{"base21":483.66,"tobaccoFactor":1},"4":{"base21":469.57,"tobaccoFactor":1},"5":{"base21":490.47,"tobaccoFactor":1},"6":{"base21":497.64,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":415.01,"tobaccoFactor":1},"2":{"base21":493.42,"tobaccoFactor":1},"4":{"base21":479.05,"tobaccoFactor":1},"5":{"base21":500.36,"tobaccoFactor":1},"6":{"base21":507.68,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":423.4,"tobaccoFactor":1},"2":{"base21":503.39,"tobaccoFactor":1},"4":{"base21":488.72,"tobaccoFactor":1},"5":{"base21":510.47,"tobaccoFactor":1},"6":{"base21":517.94,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":431.96,"tobaccoFactor":1},"2":{"base21":513.57,"tobaccoFactor":1},"4":{"base21":498.61,"tobaccoFactor":1},"5":{"base21":520.8,"tobaccoFactor":1},"6":{"base21":528.41,"tobaccoFactor":1}}}],"ded":{"ind":3500,"fam":7000,"embedded":true},"drugDed":null,"oop":{"ind":8500,"fam":17000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":45,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":275,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":30,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":165,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245917500/SE_2245917500_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":377.97,"tobaccoFactor":1},"2":{"base21":432.49,"tobaccoFactor":1},"4":{"base21":432.49,"tobaccoFactor":1},"5":{"base21":438.55,"tobaccoFactor":1},"6":{"base21":448.25,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1290003-00","standardId":"33709PA1290003-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO Qualified Embedded $3700 100/100 Silver","metal":"Silver","network":"PPO","hsaEligible":true,"counties":["Bedford","Blair","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Forest","Greene","Huntingdon","Jefferson","McKean","Mercer","Potter","Somerset","Venango","Warren"],"rates":{"1":{"base21":420.12,"tobaccoFactor":1},"2":{"base21":499.49,"tobaccoFactor":1},"4":{"base21":484.95,"tobaccoFactor":1},"5":{"base21":506.52,"tobaccoFactor":1},"6":{"base21":513.93,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":428.6,"tobaccoFactor":1},"2":{"base21":509.57,"tobaccoFactor":1},"4":{"base21":494.73,"tobaccoFactor":1},"5":{"base21":516.75,"tobaccoFactor":1},"6":{"base21":524.3,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":437.26,"tobaccoFactor":1},"2":{"base21":519.87,"tobaccoFactor":1},"4":{"base21":504.72,"tobaccoFactor":1},"5":{"base21":527.18,"tobaccoFactor":1},"6":{"base21":534.89,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":446.1,"tobaccoFactor":1},"2":{"base21":530.38,"tobaccoFactor":1},"4":{"base21":514.93,"tobaccoFactor":1},"5":{"base21":537.85,"tobaccoFactor":1},"6":{"base21":545.71,"tobaccoFactor":1}}}],"ded":{"ind":3700,"fam":7400,"embedded":true},"drugDed":null,"oop":{"ind":7050,"fam":14100},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":70,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $70 copay for a 31-day retail supply ($140 for 60 days, $210 for 90 days); $140 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $100 copay for a 31-day retail supply ($200 for 60 days, $300 for 90 days); $200 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, emergency room care, lab tests, x-rays, imaging, therapy, outpatient mental health, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245913595/SE_2245913595_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":384.99,"tobaccoFactor":1},"2":{"base21":440.52,"tobaccoFactor":1},"4":{"base21":440.52,"tobaccoFactor":1},"5":{"base21":446.69,"tobaccoFactor":1},"6":{"base21":456.56,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1290006-00","standardId":"33709PA1290006-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO Qualified Embedded $7500 100/100 Bronze","metal":"Bronze","network":"PPO","hsaEligible":true,"counties":["Bedford","Blair","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Forest","Greene","Huntingdon","Jefferson","McKean","Mercer","Potter","Somerset","Venango","Warren"],"rates":{"1":{"base21":351.41,"tobaccoFactor":1},"2":{"base21":417.81,"tobaccoFactor":1},"4":{"base21":405.64,"tobaccoFactor":1},"5":{"base21":423.69,"tobaccoFactor":1},"6":{"base21":429.88,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":358.51,"tobaccoFactor":1},"2":{"base21":426.24,"tobaccoFactor":1},"4":{"base21":413.82,"tobaccoFactor":1},"5":{"base21":432.24,"tobaccoFactor":1},"6":{"base21":438.56,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":365.75,"tobaccoFactor":1},"2":{"base21":434.85,"tobaccoFactor":1},"4":{"base21":422.18,"tobaccoFactor":1},"5":{"base21":440.97,"tobaccoFactor":1},"6":{"base21":447.42,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":373.15,"tobaccoFactor":1},"2":{"base21":443.64,"tobaccoFactor":1},"4":{"base21":430.72,"tobaccoFactor":1},"5":{"base21":449.89,"tobaccoFactor":1},"6":{"base21":456.47,"tobaccoFactor":1}}}],"ded":{"ind":7500,"fam":15000,"embedded":true},"drugDed":null,"oop":{"ind":7800,"fam":15600},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","The SBC has no specialty drug row; every drug tier is priced the same, and specialty drugs are priced like them.","Generic drugs (used here): no charge (retail and mail order).","Formulary brand drugs (used here): no charge (retail and mail order).","Non-formulary brand drugs (used here): no charge (retail and mail order).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, emergency room care, imaging, therapy, outpatient mental health, generic drugs, formulary brand drugs, non-formulary brand drugs, specialty drugs, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245917720/SE_2245917720_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":322.4,"tobaccoFactor":1},"2":{"base21":368.91,"tobaccoFactor":1},"4":{"base21":368.91,"tobaccoFactor":1},"5":{"base21":374.07,"tobaccoFactor":1},"6":{"base21":382.34,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1300001-00","standardId":"33709PA1300001-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $0 100/80 Platinum","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Butler","Erie","Fayette","Indiana","Lawrence","Washington","Westmoreland"],"rates":{"1":{"base21":551.77,"tobaccoFactor":1},"4":{"base21":636.91,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":562.9,"tobaccoFactor":1},"4":{"base21":649.76,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":574.28,"tobaccoFactor":1},"4":{"base21":662.88,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":585.89,"tobaccoFactor":1},"4":{"base21":676.29,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":9500,"fam":19000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","No network deductible: copays and coinsurance apply from the first visit.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245887638/SE_2245887638_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"4":{"base21":584.15,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1300002-00","standardId":"33709PA1300002-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $250 100/80 Platinum","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Butler","Erie","Fayette","Indiana","Lawrence","Washington","Westmoreland"],"rates":{"1":{"base21":542.34,"tobaccoFactor":1},"4":{"base21":626.02,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":553.29,"tobaccoFactor":1},"4":{"base21":638.65,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":564.46,"tobaccoFactor":1},"4":{"base21":651.56,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":575.88,"tobaccoFactor":1},"4":{"base21":664.74,"tobaccoFactor":1}}}],"ded":{"ind":250,"fam":500,"embedded":true},"drugDed":null,"oop":{"ind":6500,"fam":13000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245879912/SE_2245879912_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"4":{"base21":570,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1300003-00","standardId":"33709PA1300003-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $250 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Butler","Erie","Fayette","Indiana","Lawrence","Washington","Westmoreland"],"rates":{"1":{"base21":493.97,"tobaccoFactor":1},"4":{"base21":570.19,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":503.94,"tobaccoFactor":1},"4":{"base21":581.69,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":514.12,"tobaccoFactor":1},"4":{"base21":593.45,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":524.52,"tobaccoFactor":1},"4":{"base21":605.45,"tobaccoFactor":1}}}],"ded":{"ind":250,"fam":500,"embedded":true},"drugDed":null,"oop":{"ind":8900,"fam":17800},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $20 copay for a 31-day retail supply ($40 for 60 days, $60 for 90 days); $20 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245917097/SE_2245917097_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"4":{"base21":521.03,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1300004-00","standardId":"33709PA1300004-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $500 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Butler","Erie","Fayette","Indiana","Lawrence","Washington","Westmoreland"],"rates":{"1":{"base21":489.72,"tobaccoFactor":1},"4":{"base21":565.28,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":499.6,"tobaccoFactor":1},"4":{"base21":576.69,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":509.7,"tobaccoFactor":1},"4":{"base21":588.34,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":520.01,"tobaccoFactor":1},"4":{"base21":600.24,"tobaccoFactor":1}}}],"ded":{"ind":500,"fam":1000,"embedded":true},"drugDed":null,"oop":{"ind":10100,"fam":20200},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":275,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":55,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $20 copay for a 31-day retail supply ($40 for 60 days, $60 for 90 days); $20 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245916874/SE_2245916874_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"4":{"base21":514.77,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1300005-00","standardId":"33709PA1300005-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $750 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Butler","Erie","Fayette","Indiana","Lawrence","Washington","Westmoreland"],"rates":{"1":{"base21":486.84,"tobaccoFactor":1},"4":{"base21":561.96,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":496.66,"tobaccoFactor":1},"4":{"base21":573.29,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":506.7,"tobaccoFactor":1},"4":{"base21":584.88,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":516.94,"tobaccoFactor":1},"4":{"base21":596.71,"tobaccoFactor":1}}}],"ded":{"ind":750,"fam":1500,"embedded":true},"drugDed":null,"oop":{"ind":10100,"fam":20200},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":225,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":55,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245917386/SE_2245917386_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"4":{"base21":510.49,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1300006-00","standardId":"33709PA1300006-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $1000 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Butler","Erie","Fayette","Indiana","Lawrence","Washington","Westmoreland"],"rates":{"1":{"base21":479.24,"tobaccoFactor":1},"4":{"base21":553.19,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":488.91,"tobaccoFactor":1},"4":{"base21":564.35,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":498.79,"tobaccoFactor":1},"4":{"base21":575.75,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":508.88,"tobaccoFactor":1},"4":{"base21":587.4,"tobaccoFactor":1}}}],"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":9100,"fam":18200},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":225,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":55,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245892267/SE_2245892267_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"4":{"base21":501.21,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1300007-00","standardId":"33709PA1300007-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $1250 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Butler","Erie","Fayette","Indiana","Lawrence","Washington","Westmoreland"],"rates":{"1":{"base21":468.2,"tobaccoFactor":1},"4":{"base21":540.44,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":477.64,"tobaccoFactor":1},"4":{"base21":551.34,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":487.29,"tobaccoFactor":1},"4":{"base21":562.48,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":497.15,"tobaccoFactor":1},"4":{"base21":573.86,"tobaccoFactor":1}}}],"ded":{"ind":1250,"fam":2500,"embedded":true},"drugDed":null,"oop":{"ind":9100,"fam":18200},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":225,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":225,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":55,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245899314/SE_2245899314_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"4":{"base21":488.87,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1300008-00","standardId":"33709PA1300008-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $1400 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Butler","Erie","Fayette","Indiana","Lawrence","Washington","Westmoreland"],"rates":{"1":{"base21":453.94,"tobaccoFactor":1},"4":{"base21":523.98,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":463.1,"tobaccoFactor":1},"4":{"base21":534.56,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":472.46,"tobaccoFactor":1},"4":{"base21":545.36,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":482.01,"tobaccoFactor":1},"4":{"base21":556.39,"tobaccoFactor":1}}}],"ded":{"ind":1400,"fam":2800,"embedded":true},"drugDed":null,"oop":{"ind":9100,"fam":18200},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":70,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245912738/SE_2245912738_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"4":{"base21":472.14,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1300009-00","standardId":"33709PA1300009-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $1500 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Butler","Erie","Fayette","Indiana","Lawrence","Washington","Westmoreland"],"rates":{"1":{"base21":464.26,"tobaccoFactor":1},"4":{"base21":535.89,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":473.63,"tobaccoFactor":1},"4":{"base21":546.7,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":483.19,"tobaccoFactor":1},"4":{"base21":557.75,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":492.97,"tobaccoFactor":1},"4":{"base21":569.03,"tobaccoFactor":1}}}],"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":null,"oop":{"ind":9100,"fam":18200},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":225,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":225,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":55,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $20 copay for a 31-day retail supply ($40 for 60 days, $60 for 90 days); $20 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245913338/SE_2245913338_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"4":{"base21":483.94,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1300010-00","standardId":"33709PA1300010-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $1550 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Butler","Erie","Fayette","Indiana","Lawrence","Washington","Westmoreland"],"rates":{"1":{"base21":466.57,"tobaccoFactor":1},"4":{"base21":538.56,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":475.98,"tobaccoFactor":1},"4":{"base21":549.42,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":485.6,"tobaccoFactor":1},"4":{"base21":560.52,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":495.42,"tobaccoFactor":1},"4":{"base21":571.86,"tobaccoFactor":1}}}],"ded":{"ind":1550,"fam":3100,"embedded":true},"drugDed":null,"oop":{"ind":11100,"fam":22200},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":175,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":30,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":175,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":250,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $250 copay per admission, charged on the first day of each stay. The other days count toward the deductible until it is met, then cost nothing more. The SBC prints \"$250 copay/visit\"; a hospital visit is read as one stay (Highmark's 2026 SBCs said \"per admission\").","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Outpatient surgeon fees: the chart marks it \"Deductible does not apply\"; page 1 does not list it among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245913515/SE_2245913515_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"4":{"base21":484.98,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1300011-00","standardId":"33709PA1300011-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $2000 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Butler","Erie","Fayette","Indiana","Lawrence","Washington","Westmoreland"],"rates":{"1":{"base21":454.16,"tobaccoFactor":1},"4":{"base21":524.23,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":463.32,"tobaccoFactor":1},"4":{"base21":534.81,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":472.68,"tobaccoFactor":1},"4":{"base21":545.61,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":482.24,"tobaccoFactor":1},"4":{"base21":556.65,"tobaccoFactor":1}}}],"ded":{"ind":2000,"fam":4000,"embedded":true},"drugDed":null,"oop":{"ind":9100,"fam":18200},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":225,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":225,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":55,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $20 copay for a 31-day retail supply ($40 for 60 days, $60 for 90 days); $20 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245916459/SE_2245916459_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"4":{"base21":471.34,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1300012-00","standardId":"33709PA1300012-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $2500 1x 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Butler","Erie","Fayette","Indiana","Lawrence","Washington","Westmoreland"],"rates":{"1":{"base21":465,"tobaccoFactor":1},"4":{"base21":536.74,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":474.38,"tobaccoFactor":1},"4":{"base21":547.57,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":483.96,"tobaccoFactor":1},"4":{"base21":558.63,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":493.75,"tobaccoFactor":1},"4":{"base21":569.93,"tobaccoFactor":1}}}],"ded":{"ind":2500,"fam":2500,"embedded":true},"drugDed":null,"oop":{"ind":9100,"fam":9100},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":35,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":35,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":35,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":300,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $300 copay per admission, charged on the first day of each stay. The other days count toward the deductible until it is met, then cost nothing more. The SBC prints \"$300 copay/visit\"; a hospital visit is read as one stay (Highmark's 2026 SBCs said \"per admission\").","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $20 copay for a 31-day retail supply ($40 for 60 days, $60 for 90 days); $20 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245897174/SE_2245897174_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"4":{"base21":482.42,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1300013-00","standardId":"33709PA1300013-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $5000 1x 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Butler","Erie","Fayette","Indiana","Lawrence","Washington","Westmoreland"],"rates":{"1":{"base21":437.24,"tobaccoFactor":1},"4":{"base21":504.7,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":446.06,"tobaccoFactor":1},"4":{"base21":514.89,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":455.07,"tobaccoFactor":1},"4":{"base21":525.29,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":464.28,"tobaccoFactor":1},"4":{"base21":535.91,"tobaccoFactor":1}}}],"ded":{"ind":5000,"fam":5000,"embedded":true},"drugDed":null,"oop":{"ind":9100,"fam":9100},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":325,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":45,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $20 copay for a 31-day retail supply ($40 for 60 days, $60 for 90 days); $20 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245892508/SE_2245892508_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"4":{"base21":451.5,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1300014-00","standardId":"33709PA1300014-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $0 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Butler","Erie","Fayette","Indiana","Lawrence","Washington","Westmoreland"],"rates":{"1":{"base21":491.84,"tobaccoFactor":1},"4":{"base21":567.72,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":501.76,"tobaccoFactor":1},"4":{"base21":579.18,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":511.9,"tobaccoFactor":1},"4":{"base21":590.88,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":522.25,"tobaccoFactor":1},"4":{"base21":602.83,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":70,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":500,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $500 copay per admission, charged on the first day of each stay. The SBC prints \"$500 copay/visit\"; a hospital visit is read as one stay (Highmark's 2026 SBCs said \"per admission\").","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $20 copay for a 31-day retail supply ($40 for 60 days, $60 for 90 days); $20 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","No network deductible: copays and coinsurance apply from the first visit.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245885112/SE_2245885112_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"4":{"base21":519.47,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1300016-00","standardId":"33709PA1300016-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $1000 90/70 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Butler","Erie","Fayette","Indiana","Lawrence","Washington","Westmoreland"],"rates":{"1":{"base21":439.64,"tobaccoFactor":1},"4":{"base21":507.48,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":448.51,"tobaccoFactor":1},"4":{"base21":517.72,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":457.57,"tobaccoFactor":1},"4":{"base21":528.18,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":466.83,"tobaccoFactor":1},"4":{"base21":538.86,"tobaccoFactor":1}}}],"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":7900,"fam":15800},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":75,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245962768/SE_2245962768_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"4":{"base21":459.87,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1300017-00","standardId":"33709PA1300017-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $1750 90/70 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Butler","Erie","Fayette","Indiana","Lawrence","Washington","Westmoreland"],"rates":{"1":{"base21":437.73,"tobaccoFactor":1},"4":{"base21":505.27,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":446.56,"tobaccoFactor":1},"4":{"base21":515.47,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":455.59,"tobaccoFactor":1},"4":{"base21":525.88,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":464.8,"tobaccoFactor":1},"4":{"base21":536.52,"tobaccoFactor":1}}}],"ded":{"ind":1750,"fam":3500,"embedded":true},"drugDed":null,"oop":{"ind":7900,"fam":15800},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245916175/SE_2245916175_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"4":{"base21":455.46,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1300018-00","standardId":"33709PA1300018-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $2000 90/70 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Butler","Erie","Fayette","Indiana","Lawrence","Washington","Westmoreland"],"rates":{"1":{"base21":433.52,"tobaccoFactor":1},"4":{"base21":500.41,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":442.26,"tobaccoFactor":1},"4":{"base21":510.5,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":451.2,"tobaccoFactor":1},"4":{"base21":520.82,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":460.32,"tobaccoFactor":1},"4":{"base21":531.35,"tobaccoFactor":1}}}],"ded":{"ind":2000,"fam":4000,"embedded":true},"drugDed":null,"oop":{"ind":7900,"fam":15800},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245918620/SE_2245918620_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"4":{"base21":450.28,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1300019-00","standardId":"33709PA1300019-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $600 50/40 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Butler","Erie","Fayette","Indiana","Lawrence","Washington","Westmoreland"],"rates":{"1":{"base21":376.16,"tobaccoFactor":1},"4":{"base21":434.2,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":383.75,"tobaccoFactor":1},"4":{"base21":442.96,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":391.5,"tobaccoFactor":1},"4":{"base21":451.91,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":399.42,"tobaccoFactor":1},"4":{"base21":461.05,"tobaccoFactor":1}}}],"ded":{"ind":600,"fam":1200,"embedded":true},"drugDed":null,"oop":{"ind":11500,"fam":23000},"rules":{"pcp":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":95,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":195,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245917164/SE_2245917164_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"4":{"base21":403.85,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1300020-00","standardId":"33709PA1300020-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $2600 70/50 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Butler","Erie","Fayette","Indiana","Lawrence","Washington","Westmoreland"],"rates":{"1":{"base21":364.28,"tobaccoFactor":1},"4":{"base21":420.48,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":371.63,"tobaccoFactor":1},"4":{"base21":428.97,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":379.14,"tobaccoFactor":1},"4":{"base21":437.63,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":386.8,"tobaccoFactor":1},"4":{"base21":446.49,"tobaccoFactor":1}}}],"ded":{"ind":2600,"fam":5200,"embedded":true},"drugDed":null,"oop":{"ind":11500,"fam":23000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":90,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":90,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":85,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":140,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Primary care visits: the chart marks it \"Deductible does not apply\"; page 1 does not list it among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Preventive care services, urgent care, outpatient mental health, outpatient substance abuse, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245916591/SE_2245916591_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"4":{"base21":381.25,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1300021-00","standardId":"33709PA1300021-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $5000 1x 70/50 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Butler","Erie","Fayette","Indiana","Lawrence","Washington","Westmoreland"],"rates":{"1":{"base21":377.76,"tobaccoFactor":1},"4":{"base21":436.04,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":385.38,"tobaccoFactor":1},"4":{"base21":444.84,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":393.17,"tobaccoFactor":1},"4":{"base21":453.83,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":401.12,"tobaccoFactor":1},"4":{"base21":463.01,"tobaccoFactor":1}}}],"ded":{"ind":5000,"fam":5000,"embedded":true},"drugDed":null,"oop":{"ind":9200,"fam":9200},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":140,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Primary care visits: the chart marks it \"Deductible does not apply\"; page 1 does not list it among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Preventive care services, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245901890/SE_2245901890_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"4":{"base21":392.07,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1300022-00","standardId":"33709PA1300022-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO $4500 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Butler","Erie","Fayette","Indiana","Lawrence","Washington","Westmoreland"],"rates":{"1":{"base21":394.98,"tobaccoFactor":1},"4":{"base21":455.92,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":402.95,"tobaccoFactor":1},"4":{"base21":465.12,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":411.09,"tobaccoFactor":1},"4":{"base21":474.52,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":419.4,"tobaccoFactor":1},"4":{"base21":484.12,"tobaccoFactor":1}}}],"ded":{"ind":4500,"fam":9000,"embedded":true},"drugDed":null,"oop":{"ind":7700,"fam":15400},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":100,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $100 copay per admission, charged on the first day of each stay. The other days count toward the deductible until it is met, then cost nothing more. The SBC prints \"$100 copay/visit\"; a hospital visit is read as one stay (Highmark's 2026 SBCs said \"per admission\").","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgery facility fees, outpatient surgeon fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245912975/SE_2245912975_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"4":{"base21":428.19,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1310001-00","standardId":"33709PA1310001-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO Qualified $1800 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Allegheny","Armstrong","Beaver","Butler","Erie","Fayette","Indiana","Lawrence","Washington","Westmoreland"],"rates":{"1":{"base21":450.36,"tobaccoFactor":1},"4":{"base21":519.84,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":459.44,"tobaccoFactor":1},"4":{"base21":530.33,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":468.72,"tobaccoFactor":1},"4":{"base21":541.05,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":478.21,"tobaccoFactor":1},"4":{"base21":551.99,"tobaccoFactor":1}}}],"ded":{"ind":1800,"fam":3600,"embedded":false},"drugDed":null,"oop":{"ind":6000,"fam":12000,"famPerPerson":12000},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":25,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":25,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":65,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","Family deductible: the SBC says the overall family deductible must be met before the plan begins to pay (an aggregate family deductible), and the estimate uses the aggregate family deductible.","Out-of-pocket limit: this SBC says $6,000 for one person; the Rate Pages of the approved rate filing say $7,000 (hmk-rate-change-decision-sm-grp-mkt.pdf, page 44). They agree on the deductible, coinsurance and primary care copay; the SBC, Highmark's January 2027 document, is followed.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245916320/SE_2245916320_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"4":{"base21":475.25,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1310002-00","standardId":"33709PA1310002-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO Qualified Embedded $3500 100/80 Silver","metal":"Silver","network":"PPO","hsaEligible":true,"counties":["Allegheny","Armstrong","Beaver","Butler","Erie","Fayette","Indiana","Lawrence","Washington","Westmoreland"],"rates":{"1":{"base21":390.74,"tobaccoFactor":1},"4":{"base21":451.03,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":398.63,"tobaccoFactor":1},"4":{"base21":460.13,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":406.68,"tobaccoFactor":1},"4":{"base21":469.43,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":414.91,"tobaccoFactor":1},"4":{"base21":478.93,"tobaccoFactor":1}}}],"ded":{"ind":3500,"fam":7000,"embedded":true},"drugDed":null,"oop":{"ind":8500,"fam":17000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":45,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":275,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":30,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":165,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245917613/SE_2245917613_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"4":{"base21":410.94,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1310003-00","standardId":"33709PA1310003-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO Qualified Embedded $3700 100/100 Silver","metal":"Silver","network":"PPO","hsaEligible":true,"counties":["Allegheny","Armstrong","Beaver","Butler","Erie","Fayette","Indiana","Lawrence","Washington","Westmoreland"],"rates":{"1":{"base21":403.14,"tobaccoFactor":1},"4":{"base21":465.34,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":411.27,"tobaccoFactor":1},"4":{"base21":474.73,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":419.58,"tobaccoFactor":1},"4":{"base21":484.32,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":428.07,"tobaccoFactor":1},"4":{"base21":494.12,"tobaccoFactor":1}}}],"ded":{"ind":3700,"fam":7400,"embedded":true},"drugDed":null,"oop":{"ind":7050,"fam":14100},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":70,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $70 copay for a 31-day retail supply ($140 for 60 days, $210 for 90 days); $140 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $100 copay for a 31-day retail supply ($200 for 60 days, $300 for 90 days); $200 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, emergency room care, lab tests, x-rays, imaging, therapy, outpatient mental health, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245961076/SE_2245961076_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"4":{"base21":418.55,"tobaccoFactor":1}}}},{"market":"group","id":"33709PA1310006-00","standardId":"33709PA1310006-00","variant":"standard","issuer":"Highmark Inc.","name":"Performance Blue PPO Qualified Embedded $7500 100/100 Bronze","metal":"Bronze","network":"PPO","hsaEligible":true,"counties":["Allegheny","Armstrong","Beaver","Butler","Erie","Fayette","Indiana","Lawrence","Washington","Westmoreland"],"rates":{"1":{"base21":339.01,"tobaccoFactor":1},"4":{"base21":391.32,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":345.85,"tobaccoFactor":1},"4":{"base21":399.22,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":352.84,"tobaccoFactor":1},"4":{"base21":407.28,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":359.98,"tobaccoFactor":1},"4":{"base21":415.52,"tobaccoFactor":1}}}],"ded":{"ind":7500,"fam":15000,"embedded":true},"drugDed":null,"oop":{"ind":7800,"fam":15600},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","The SBC has no specialty drug row; every drug tier is priced the same, and specialty drugs are priced like them.","Generic drugs (used here): no charge (retail and mail order).","Formulary brand drugs (used here): no charge (retail and mail order).","Non-formulary brand drugs (used here): no charge (retail and mail order).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, emergency room care, imaging, therapy, outpatient mental health, generic drugs, formulary brand drugs, non-formulary brand drugs, specialty drugs, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. 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The first OB visit is charged at the specialist office-visit cost share and later prenatal visits are no charge (part of the delivery fee), as every Independence SBC prices prenatal 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The rules use Tier 1 (Preferred), the tier the deductible ($0 individual / $0 family) and out-of-pocket limit describe. Tier 2 (Enhanced) and Tier 3 (Standard) providers have a $6,000 individual / $12,000 family deductible and higher cost sharing (each rule's text gives all three tiers).","Primary care: Tier 1 $40 (used here); Tier 2 $70 no deductible; Tier 3 $80 no deductible.","Specialist: Tier 1 $90 (used here); Tier 2 $140 no deductible; Tier 3 $150 no deductible.","Emergency room: Tier 1 $950 (used here); Tier 2 $950 no deductible; Tier 3 $950 no deductible.","Hospital stay facility fee: Tier 1 $600/Day; max of 5 copays per admission (used here); Tier 2 Subject to deductible and $900/Day; max of 5 copays per admission; Tier 3 Subject to deductible and $1,300/Day; max of 5 copays per admission.","Outpatient surgery facility fee: Tier 1 $350 (used here); Tier 2 Subject to deductible and $950; Tier 3 Subject to deductible and $1,500.","Prenatal care: the Benefit Highlights have no prenatal row. 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The rules use Tier 1 (Preferred), the tier the deductible ($1,500 individual / $3,000 family) and out-of-pocket limit describe. Tier 2 (Enhanced) and Tier 3 (Standard) providers have a $6,000 individual / $12,000 family deductible and higher cost sharing (each rule's text gives all three tiers).","Primary care: Tier 1 $40 no deductible (used here); Tier 2 $70 no deductible; Tier 3 $80 no deductible.","Specialist: Tier 1 $90 no deductible (used here); Tier 2 $140 no deductible; Tier 3 $150 no deductible.","Emergency room: Tier 1 $950 no deductible (used here); Tier 2 $950 no deductible; Tier 3 $950 no deductible.","Hospital stay facility fee: Tier 1 Subject to deductible and $600/Day; max of 5 copays per admission (used here); Tier 2 Subject to deductible and $900/Day; max of 5 copays per admission; Tier 3 Subject to deductible and $1,300/Day; max of 5 copays per admission.","Outpatient surgery facility fee: Tier 1 Subject to deductible and $350 (used here); Tier 2 Subject to deductible and $950; Tier 3 Subject to deductible and $1,500.","Prenatal care: the Benefit Highlights have no prenatal row. 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The first OB visit is charged at the specialist office-visit cost share and later prenatal visits are no charge (part of the delivery fee), as every Independence SBC prices prenatal care."],"sbcUrl":"https://eapics.ibx.com/services/sbc7/bh?requestingApp=ibx&medCompCd=12&medId=10074535&phCompCd=12&phId=10074578&denCompCd=12&denId=10074696&visCompCd=12&visId=10074706&effDate=2027-01-01#page=1","prev":{"planYear":2026,"rates":{"8":{"base21":520.93,"tobaccoFactor":1.125007,"tobaccoFactorByAge":{"21":1.125007,"22":1.125007,"23":1.125007,"24":1.125007,"25":1.125007,"26":1.125002,"27":1.125016,"28":1.124998,"29":1.125009,"30":1.174999,"31":1.175003,"32":1.175007,"33":1.175012,"34":1.174997,"35":1.174998,"36":1.175001,"37":1.175001,"38":1.175002,"39":1.175005,"40":1.224994,"41":1.225006,"42":1.224997,"43":1.224996,"44":1.224998,"45":1.225001,"46":1.224994,"47":1.225003,"48":1.225004,"49":1.225,"50":1.374997,"51":1.375006,"52":1.374998,"53":1.374998,"54":1.374999,"55":1.375003,"56":1.375001,"57":1.374995,"58":1.375001,"59":1.374998,"60":1.375004,"61":1.375001,"62":1.375003,"63":1.374993,"64+":1.375002}}}}},{"market":"group","id":"45127PA0010055-00","standardId":"45127PA0010055-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Platinum PPO 0/0/20 Rx 0","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Union","York"],"rates":{"6":{"base21":847.82,"tobaccoFactor":1},"7":{"base21":915.65,"tobaccoFactor":1},"9":{"base21":864.78,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":870.23,"tobaccoFactor":1},"7":{"base21":939.85,"tobaccoFactor":1},"9":{"base21":887.63,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":893.23,"tobaccoFactor":1},"7":{"base21":964.69,"tobaccoFactor":1},"9":{"base21":911.1,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":916.85,"tobaccoFactor":1},"7":{"base21":990.2,"tobaccoFactor":1},"9":{"base21":935.19,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":5500,"fam":11000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"free","ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":4,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":700}},"outpatientFacility":{"base":{"kind":"free","ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Emergency room: $150 copay per visit, waived if you are admitted as an inpatient.","Lab tests: $20 copay per visit at an independent lab (used here); $40 copay per visit at a facility-owned lab (hospital or outpatient facility).","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $4 copay per prescription (used here), non-preferred generics $15 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $8 copay per prescription, non-preferred generic $30 copay per prescription; preferred brand $90 copay per prescription; non-preferred brand $140 copay per prescription.","Specialty drugs: 30% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","This is a small-business (small-group) plan. Capital's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://capbluecross1.my.salesforce.com/sfc/p/3j000000hUJ1/a/Vv000009Qby5/fF8MuIu7VJ8gaKG6OVvXZS4czVp0HOtMyDKQzcAAds8","prev":{"planYear":2026,"rates":{"6":{"base21":761.48,"tobaccoFactor":1},"7":{"base21":822.4,"tobaccoFactor":1},"9":{"base21":776.71,"tobaccoFactor":1}}}},{"market":"group","id":"45127PA0010058-00","standardId":"45127PA0010058-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Platinum PPO 250/0/15 Rx 0","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Union","York"],"rates":{"6":{"base21":828.06,"tobaccoFactor":1},"7":{"base21":894.31,"tobaccoFactor":1},"9":{"base21":844.62,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":849.95,"tobaccoFactor":1},"7":{"base21":917.95,"tobaccoFactor":1},"9":{"base21":866.95,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":872.42,"tobaccoFactor":1},"7":{"base21":942.21,"tobaccoFactor":1},"9":{"base21":889.87,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":895.48,"tobaccoFactor":1},"7":{"base21":967.12,"tobaccoFactor":1},"9":{"base21":913.39,"tobaccoFactor":1}}}],"ded":{"ind":250,"fam":500,"embedded":true},"drugDed":null,"oop":{"ind":6000,"fam":12000},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":30,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":4,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":700}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $200 copay per visit, waived if you are admitted as an inpatient.","Lab tests: $15 copay per visit at an independent lab (used here); $30 copay per visit at a facility-owned lab (hospital or outpatient facility).","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $4 copay per prescription (used here), non-preferred generics $15 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $8 copay per prescription, non-preferred generic $30 copay per prescription; preferred brand $90 copay per prescription; non-preferred brand $140 copay per prescription.","Specialty drugs: 30% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This is a small-business (small-group) plan. Capital's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://capbluecross1.my.salesforce.com/sfc/p/3j000000hUJ1/a/Vv000009QbyJ/AUazvDbTqHUEJWJ2zj_Ffk7PbqlTWfV_fyDqywTs93o","prev":{"planYear":2026,"rates":{"6":{"base21":745.2,"tobaccoFactor":1},"7":{"base21":804.82,"tobaccoFactor":1},"9":{"base21":760.11,"tobaccoFactor":1}}}},{"market":"group","id":"45127PA0010084-00","standardId":"45127PA0010084-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Gold PPO 1000/0/20 Rx 500","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Union","York"],"rates":{"6":{"base21":668.77,"tobaccoFactor":1},"7":{"base21":722.27,"tobaccoFactor":1},"9":{"base21":682.14,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":686.44,"tobaccoFactor":1},"7":{"base21":741.36,"tobaccoFactor":1},"9":{"base21":700.17,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":704.59,"tobaccoFactor":1},"7":{"base21":760.95,"tobaccoFactor":1},"9":{"base21":718.68,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":723.21,"tobaccoFactor":1},"7":{"base21":781.07,"tobaccoFactor":1},"9":{"base21":737.68,"tobaccoFactor":1}}}],"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":10200,"fam":20400},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":7,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded","max":700}},"outpatientFacility":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $400 copay per visit, waived if you are admitted as an inpatient.","Lab tests: $20 copay per visit at an independent lab (used here); $40 copay per visit at a facility-owned lab (hospital or outpatient facility).","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $7 copay per prescription (used here), non-preferred generics $25 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $14 copay per prescription, non-preferred generic $50 copay per prescription; preferred brand $110 copay per prescription; non-preferred brand $160 copay per prescription.","Specialty drugs: 30% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Specialty drugs: generic specialty drugs are exempt from the drug deductible (\"Deductible does not apply\"); brand specialty drugs are not. The rule follows the preferred brand specialty drug.","Separate prescription drug deductible ($500 individual / $1,000 family), which \"Applies to brand only\" (SBC page 1): generic drugs are exempt (\"Deductible does not apply\"); brand drugs are charged after that drug deductible.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This is a small-business (small-group) plan. Capital's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://capbluecross1.my.salesforce.com/sfc/p/3j000000hUJ1/a/Vv000009QbyE/UY7kVeroRvBwynnr74EI9Pkx__rsiv0aETWRleiMJp8","prev":{"planYear":2026,"rates":{"6":{"base21":602.24,"tobaccoFactor":1},"7":{"base21":650.42,"tobaccoFactor":1},"9":{"base21":614.28,"tobaccoFactor":1}}}},{"market":"group","id":"45127PA0010085-00","standardId":"45127PA0010085-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Gold PPO 1000/0/20 Rx 0","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Union","York"],"rates":{"6":{"base21":714.56,"tobaccoFactor":1},"7":{"base21":771.72,"tobaccoFactor":1},"9":{"base21":728.85,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":733.45,"tobaccoFactor":1},"7":{"base21":792.12,"tobaccoFactor":1},"9":{"base21":748.12,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":752.83,"tobaccoFactor":1},"7":{"base21":813.06,"tobaccoFactor":1},"9":{"base21":767.89,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":772.73,"tobaccoFactor":1},"7":{"base21":834.55,"tobaccoFactor":1},"9":{"base21":788.19,"tobaccoFactor":1}}}],"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":10200,"fam":20400},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":4,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":700}},"outpatientFacility":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $400 copay per visit, waived if you are admitted as an inpatient.","Lab tests: $20 copay per visit at an independent lab (used here); $40 copay per visit at a facility-owned lab (hospital or outpatient facility).","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $4 copay per prescription (used here), non-preferred generics $15 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $8 copay per prescription, non-preferred generic $30 copay per prescription; preferred brand $90 copay per prescription; non-preferred brand $140 copay per prescription.","Specialty drugs: 30% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This is a small-business (small-group) plan. Capital's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://capbluecross1.my.salesforce.com/sfc/p/3j000000hUJ1/a/Vv000009QbyU/KyoKnLqRcCb.jhRH2VUxlhz9QJN.oTZDQcs0O1WBmpg","prev":{"planYear":2026,"rates":{"6":{"base21":639.98,"tobaccoFactor":1},"7":{"base21":691.18,"tobaccoFactor":1},"9":{"base21":652.78,"tobaccoFactor":1}}}},{"market":"group","id":"45127PA0010089-00","standardId":"45127PA0010089-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Gold PPO 2000/0/20 Rx 500","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Union","York"],"rates":{"6":{"base21":633.11,"tobaccoFactor":1},"7":{"base21":683.76,"tobaccoFactor":1},"9":{"base21":645.78,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":649.85,"tobaccoFactor":1},"7":{"base21":701.84,"tobaccoFactor":1},"9":{"base21":662.85,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":667.02,"tobaccoFactor":1},"7":{"base21":720.39,"tobaccoFactor":1},"9":{"base21":680.36,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":684.66,"tobaccoFactor":1},"7":{"base21":739.43,"tobaccoFactor":1},"9":{"base21":698.35,"tobaccoFactor":1}}}],"ded":{"ind":2000,"fam":4000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":7700,"fam":15400},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":7,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded","max":700}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $250 copay per visit, waived if you are admitted as an inpatient.","Lab tests: $20 copay per visit at an independent lab (used here); $40 copay per visit at a facility-owned lab (hospital or outpatient facility).","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $7 copay per prescription (used here), non-preferred generics $25 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $14 copay per prescription, non-preferred generic $50 copay per prescription; preferred brand $110 copay per prescription; non-preferred brand $160 copay per prescription.","Specialty drugs: 30% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Specialty drugs: generic specialty drugs are exempt from the drug deductible (\"Deductible does not apply\"); brand specialty drugs are not. The rule follows the preferred brand specialty drug.","Separate prescription drug deductible ($500 individual / $1,000 family), which \"Applies to brand only\" (SBC page 1): generic drugs are exempt (\"Deductible does not apply\"); brand drugs are charged after that drug deductible.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This is a small-business (small-group) plan. Capital's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://capbluecross1.my.salesforce.com/sfc/p/3j000000hUJ1/a/Vv000009Qby6/EIlObwv7TdDrTyNrraeSWEu8wacfltQeeKjEqalK9gs","prev":{"planYear":2026,"rates":{"6":{"base21":562.25,"tobaccoFactor":1},"7":{"base21":607.23,"tobaccoFactor":1},"9":{"base21":573.5,"tobaccoFactor":1}}}},{"market":"group","id":"45127PA0010090-00","standardId":"45127PA0010090-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Gold PPO 2000/0/20 Rx 0","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Union","York"],"rates":{"6":{"base21":675.35,"tobaccoFactor":1},"7":{"base21":729.38,"tobaccoFactor":1},"9":{"base21":688.85,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":693.2,"tobaccoFactor":1},"7":{"base21":748.65,"tobaccoFactor":1},"9":{"base21":707.06,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":711.53,"tobaccoFactor":1},"7":{"base21":768.45,"tobaccoFactor":1},"9":{"base21":725.76,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":730.34,"tobaccoFactor":1},"7":{"base21":788.76,"tobaccoFactor":1},"9":{"base21":744.94,"tobaccoFactor":1}}}],"ded":{"ind":2000,"fam":4000,"embedded":true},"drugDed":null,"oop":{"ind":7700,"fam":15400},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":4,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":700}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $250 copay per visit, waived if you are admitted as an inpatient.","Lab tests: $20 copay per visit at an independent lab (used here); $40 copay per visit at a facility-owned lab (hospital or outpatient facility).","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $4 copay per prescription (used here), non-preferred generics $15 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $8 copay per prescription, non-preferred generic $30 copay per prescription; preferred brand $90 copay per prescription; non-preferred brand $140 copay per prescription.","Specialty drugs: 30% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This is a small-business (small-group) plan. Capital's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://capbluecross1.my.salesforce.com/sfc/p/3j000000hUJ1/a/Vv000009QbyR/HkoB5WOiRAqiQ_2KFGUwQfNVw1N6pGTet4GVfp09dJo","prev":{"planYear":2026,"rates":{"6":{"base21":596.39,"tobaccoFactor":1},"7":{"base21":644.11,"tobaccoFactor":1},"9":{"base21":608.32,"tobaccoFactor":1}}}},{"market":"group","id":"45127PA0010131-00","standardId":"45127PA0010131-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Silver PPO 4000/0/40 Rx 500","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Union","York"],"rates":{"6":{"base21":581.11,"tobaccoFactor":1},"7":{"base21":627.6,"tobaccoFactor":1},"9":{"base21":592.73,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":596.47,"tobaccoFactor":1},"7":{"base21":644.19,"tobaccoFactor":1},"9":{"base21":608.4,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":612.24,"tobaccoFactor":1},"7":{"base21":661.22,"tobaccoFactor":1},"9":{"base21":624.48,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":628.42,"tobaccoFactor":1},"7":{"base21":678.7,"tobaccoFactor":1},"9":{"base21":640.99,"tobaccoFactor":1}}}],"ded":{"ind":4000,"fam":8000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":10700,"fam":21400},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":7,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded","max":700}},"outpatientFacility":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $400 copay per visit, waived if you are admitted as an inpatient.","Lab tests: $40 copay per visit at an independent lab (used here); $80 copay per visit at a facility-owned lab (hospital or outpatient facility).","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $7 copay per prescription (used here), non-preferred generics $25 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $14 copay per prescription, non-preferred generic $50 copay per prescription; preferred brand $110 copay per prescription; non-preferred brand $160 copay per prescription.","Specialty drugs: 30% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Specialty drugs: generic specialty drugs are exempt from the drug deductible (\"Deductible does not apply\"); brand specialty drugs are not. The rule follows the preferred brand specialty drug.","Separate prescription drug deductible ($500 individual / $1,000 family), which \"Applies to brand only\" (SBC page 1): generic drugs are exempt (\"Deductible does not apply\"); brand drugs are charged after that drug deductible.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This is a small-business (small-group) plan. Capital's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://capbluecross1.my.salesforce.com/sfc/p/3j000000hUJ1/a/Vv000009QbyF/VB2nNMrvQ9wjNuOUBBX8EVXse2dI2JslwgKnSuEhCPk","prev":{"planYear":2026,"rates":{"6":{"base21":492.1,"tobaccoFactor":1},"7":{"base21":531.47,"tobaccoFactor":1},"9":{"base21":501.94,"tobaccoFactor":1}}}},{"market":"group","id":"45127PA0010132-00","standardId":"45127PA0010132-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Silver PPO 4000/0/40 Rx 0","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Union","York"],"rates":{"6":{"base21":625.53,"tobaccoFactor":1},"7":{"base21":675.57,"tobaccoFactor":1},"9":{"base21":638.04,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":642.06,"tobaccoFactor":1},"7":{"base21":693.42,"tobaccoFactor":1},"9":{"base21":654.9,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":659.04,"tobaccoFactor":1},"7":{"base21":711.76,"tobaccoFactor":1},"9":{"base21":672.22,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":676.45,"tobaccoFactor":1},"7":{"base21":730.57,"tobaccoFactor":1},"9":{"base21":689.98,"tobaccoFactor":1}}}],"ded":{"ind":4000,"fam":8000,"embedded":true},"drugDed":null,"oop":{"ind":10700,"fam":21400},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":4,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":700}},"outpatientFacility":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $400 copay per visit, waived if you are admitted as an inpatient.","Lab tests: $40 copay per visit at an independent lab (used here); $80 copay per visit at a facility-owned lab (hospital or outpatient facility).","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $4 copay per prescription (used here), non-preferred generics $15 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $8 copay per prescription, non-preferred generic $30 copay per prescription; preferred brand $90 copay per prescription; non-preferred brand $140 copay per prescription.","Specialty drugs: 30% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This is a small-business (small-group) plan. Capital's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://capbluecross1.my.salesforce.com/sfc/p/3j000000hUJ1/a/Vv000009Qby8/1ez4JpCD6t6z2BTBPBU80Z8SmqZVyRQCC0TtfGr9WGI","prev":{"planYear":2026,"rates":{"6":{"base21":525,"tobaccoFactor":1},"7":{"base21":567,"tobaccoFactor":1},"9":{"base21":535.5,"tobaccoFactor":1}}}},{"market":"group","id":"45127PA0010135-00","standardId":"45127PA0010135-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Bronze QHDHP-E PPO 7600/0/0","metal":"Bronze","network":"PPO","hsaEligible":true,"counties":["Adams","Berks","Centre","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Union","York"],"rates":{"6":{"base21":515.22,"tobaccoFactor":1},"7":{"base21":556.44,"tobaccoFactor":1},"9":{"base21":525.53,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":528.85,"tobaccoFactor":1},"7":{"base21":571.15,"tobaccoFactor":1},"9":{"base21":539.42,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":542.82,"tobaccoFactor":1},"7":{"base21":586.25,"tobaccoFactor":1},"9":{"base21":553.68,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":557.17,"tobaccoFactor":1},"7":{"base21":601.75,"tobaccoFactor":1},"9":{"base21":568.32,"tobaccoFactor":1}}}],"ded":{"ind":7600,"fam":15200,"embedded":true},"drugDed":null,"oop":{"ind":8500,"fam":17000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":7,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded","max":700}},"outpatientFacility":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $300 copay per visit, waived if you are admitted as an inpatient.","Lab tests: no charge at independent and facility-owned labs.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $7 copay per prescription (used here), non-preferred generics $25 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $14 copay per prescription, non-preferred generic $50 copay per prescription; preferred brand $110 copay per prescription; non-preferred brand $160 copay per prescription.","Specialty drugs: 30% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","High-deductible plan: the deductible applies to all services, including prescriptions, before any copay or coinsurance (SBC page 1). Each family member meets their own individual deductible until the family deductible is met (embedded).","This is a small-business (small-group) plan. Capital's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://capbluecross1.my.salesforce.com/sfc/p/3j000000hUJ1/a/Vv000009Qbyk/DJVtkMwh1HWO5W2yYBqXkJFoh1Ri5Z5r4rZfqBFuSw0","prev":{"planYear":2026,"rates":{"6":{"base21":428.87,"tobaccoFactor":1},"7":{"base21":463.18,"tobaccoFactor":1},"9":{"base21":437.45,"tobaccoFactor":1}}}},{"market":"group","id":"45127PA0010161-00","standardId":"45127PA0010161-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Gold QHDHP PPO 2000/0/10","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Adams","Berks","Centre","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Union","York"],"rates":{"6":{"base21":666.78,"tobaccoFactor":1},"7":{"base21":720.12,"tobaccoFactor":1},"9":{"base21":680.12,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":684.41,"tobaccoFactor":1},"7":{"base21":739.16,"tobaccoFactor":1},"9":{"base21":698.1,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":702.5,"tobaccoFactor":1},"7":{"base21":758.7,"tobaccoFactor":1},"9":{"base21":716.55,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":721.07,"tobaccoFactor":1},"7":{"base21":778.76,"tobaccoFactor":1},"9":{"base21":735.49,"tobaccoFactor":1}}}],"ded":{"ind":2000,"fam":4000,"embedded":false},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":175,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":10,"ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":7,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded","max":700}},"outpatientFacility":{"base":{"kind":"copay","amount":175,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":20,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $175 copay per visit, waived if you are admitted as an inpatient.","Lab tests: $10 copay per visit at an independent lab (used here); $20 copay per visit at a facility-owned lab (hospital or outpatient facility).","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $7 copay per prescription (used here), non-preferred generics $25 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $14 copay per prescription, non-preferred generic $50 copay per prescription; preferred brand $110 copay per prescription; non-preferred brand $160 copay per prescription.","Specialty drugs: 30% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","High-deductible plan: the deductible applies to all services, including prescriptions, before any copay or coinsurance (SBC page 1). The family deductible is an aggregate: it must be met by the family as a whole, not per person.","This is a small-business (small-group) plan. Capital's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://capbluecross1.my.salesforce.com/sfc/p/3j000000hUJ1/a/Vv000009QbyZ/aw5cxyGBLu4PcWh05lTQF4pisAo15nDoB_li67s5QUQ","prev":{"planYear":2026,"rates":{"6":{"base21":588.54,"tobaccoFactor":1},"7":{"base21":635.63,"tobaccoFactor":1},"9":{"base21":600.32,"tobaccoFactor":1}}}},{"market":"group","id":"45127PA0010170-00","standardId":"45127PA0010170-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Silver QHDHP PPO 3250/0/30","metal":"Silver","network":"PPO","hsaEligible":true,"counties":["Adams","Berks","Centre","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Union","York"],"rates":{"6":{"base21":596.17,"tobaccoFactor":1},"7":{"base21":643.86,"tobaccoFactor":1},"9":{"base21":608.09,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":611.93,"tobaccoFactor":1},"7":{"base21":660.88,"tobaccoFactor":1},"9":{"base21":624.17,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":628.1,"tobaccoFactor":1},"7":{"base21":678.35,"tobaccoFactor":1},"9":{"base21":640.67,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":644.7,"tobaccoFactor":1},"7":{"base21":696.28,"tobaccoFactor":1},"9":{"base21":657.6,"tobaccoFactor":1}}}],"ded":{"ind":3250,"fam":6500,"embedded":false},"drugDed":null,"oop":{"ind":8500,"fam":17000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":7,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded","max":700}},"outpatientFacility":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":60,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $400 copay per visit, waived if you are admitted as an inpatient.","Lab tests: $30 copay per visit at an independent lab (used here); $60 copay per visit at a facility-owned lab (hospital or outpatient facility).","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $7 copay per prescription (used here), non-preferred generics $25 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $14 copay per prescription, non-preferred generic $50 copay per prescription; preferred brand $110 copay per prescription; non-preferred brand $160 copay per prescription.","Specialty drugs: 30% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","High-deductible plan: the deductible applies to all services, including prescriptions, before any copay or coinsurance (SBC page 1). The family deductible is an aggregate: it must be met by the family as a whole, not per person.","This is a small-business (small-group) plan. Capital's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://capbluecross1.my.salesforce.com/sfc/p/3j000000hUJ1/a/Vv000009QbyI/FTO_ryE8pL4LmZaOiZT1QuK0QxaDbVowoxGoniOY4AI","prev":{"planYear":2026,"rates":{"6":{"base21":493.84,"tobaccoFactor":1},"7":{"base21":533.35,"tobaccoFactor":1},"9":{"base21":503.72,"tobaccoFactor":1}}}},{"market":"group","id":"45127PA0010186-00","standardId":"45127PA0010186-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Silver PPO 6000/0/35 Rx 500","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Union","York"],"rates":{"6":{"base21":551.3,"tobaccoFactor":1},"7":{"base21":595.41,"tobaccoFactor":1},"9":{"base21":562.33,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":565.88,"tobaccoFactor":1},"7":{"base21":611.15,"tobaccoFactor":1},"9":{"base21":577.19,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":580.84,"tobaccoFactor":1},"7":{"base21":627.31,"tobaccoFactor":1},"9":{"base21":592.46,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":596.19,"tobaccoFactor":1},"7":{"base21":643.89,"tobaccoFactor":1},"9":{"base21":608.11,"tobaccoFactor":1}}}],"ded":{"ind":6000,"fam":12000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":10700,"fam":21400},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":7,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded","max":700}},"outpatientFacility":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $400 copay per visit, waived if you are admitted as an inpatient.","Lab tests: $35 copay per visit at an independent lab (used here); $65 copay per visit at a facility-owned lab (hospital or outpatient facility).","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $7 copay per prescription (used here), non-preferred generics $25 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $14 copay per prescription, non-preferred generic $50 copay per prescription; preferred brand $110 copay per prescription; non-preferred brand $160 copay per prescription.","Specialty drugs: 30% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Specialty drugs: generic specialty drugs are exempt from the drug deductible (\"Deductible does not apply\"); brand specialty drugs are not. The rule follows the preferred brand specialty drug.","Separate prescription drug deductible ($500 individual / $1,000 family), which \"Applies to brand only\" (SBC page 1): generic drugs are exempt (\"Deductible does not apply\"); brand drugs are charged after that drug deductible.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This is a small-business (small-group) plan. Capital's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://capbluecross1.my.salesforce.com/sfc/p/3j000000hUJ1/a/Vv000009QbyA/awo1b.7_S3Ok_H46Z8fltO6BPDVqwmonO696iatYAPI","prev":{"planYear":2026,"rates":{"6":{"base21":467.62,"tobaccoFactor":1},"7":{"base21":505.03,"tobaccoFactor":1},"9":{"base21":476.97,"tobaccoFactor":1}}}},{"market":"group","id":"45127PA0010187-00","standardId":"45127PA0010187-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Silver PPO 6000/0/35 Rx 0","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Union","York"],"rates":{"6":{"base21":594.76,"tobaccoFactor":1},"7":{"base21":642.34,"tobaccoFactor":1},"9":{"base21":606.65,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":610.48,"tobaccoFactor":1},"7":{"base21":659.31,"tobaccoFactor":1},"9":{"base21":622.68,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":626.62,"tobaccoFactor":1},"7":{"base21":676.75,"tobaccoFactor":1},"9":{"base21":639.15,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":643.18,"tobaccoFactor":1},"7":{"base21":694.64,"tobaccoFactor":1},"9":{"base21":656.05,"tobaccoFactor":1}}}],"ded":{"ind":6000,"fam":12000,"embedded":true},"drugDed":null,"oop":{"ind":10700,"fam":21400},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":4,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":700}},"outpatientFacility":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $400 copay per visit, waived if you are admitted as an inpatient.","Lab tests: $35 copay per visit at an independent lab (used here); $65 copay per visit at a facility-owned lab (hospital or outpatient facility).","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $4 copay per prescription (used here), non-preferred generics $15 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $8 copay per prescription, non-preferred generic $30 copay per prescription; preferred brand $90 copay per prescription; non-preferred brand $140 copay per prescription.","Specialty drugs: 30% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This is a small-business (small-group) plan. Capital's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://capbluecross1.my.salesforce.com/sfc/p/3j000000hUJ1/a/Vv000009QbyD/KvHODoqNno.ElSPyMo6oZGG99_pk4.WNXNzAI.HsOzs","prev":{"planYear":2026,"rates":{"6":{"base21":500.26,"tobaccoFactor":1},"7":{"base21":540.28,"tobaccoFactor":1},"9":{"base21":510.26,"tobaccoFactor":1}}}},{"market":"group","id":"45127PA0010194-00","standardId":"45127PA0010194-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Gold PPO 3000/0/15 Rx 500","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Union","York"],"rates":{"6":{"base21":624.95,"tobaccoFactor":1},"7":{"base21":674.95,"tobaccoFactor":1},"9":{"base21":637.45,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":641.48,"tobaccoFactor":1},"7":{"base21":692.8,"tobaccoFactor":1},"9":{"base21":654.31,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":658.43,"tobaccoFactor":1},"7":{"base21":711.1,"tobaccoFactor":1},"9":{"base21":671.6,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":675.83,"tobaccoFactor":1},"7":{"base21":729.9,"tobaccoFactor":1},"9":{"base21":689.35,"tobaccoFactor":1}}}],"ded":{"ind":3000,"fam":6000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":6900,"fam":13800},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":7,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded","max":700}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $250 copay per visit, waived if you are admitted as an inpatient.","Lab tests: $15 copay per visit at an independent lab (used here); $40 copay per visit at a facility-owned lab (hospital or outpatient facility).","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $7 copay per prescription (used here), non-preferred generics $25 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $14 copay per prescription, non-preferred generic $50 copay per prescription; preferred brand $110 copay per prescription; non-preferred brand $160 copay per prescription.","Specialty drugs: 30% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Specialty drugs: generic specialty drugs are exempt from the drug deductible (\"Deductible does not apply\"); brand specialty drugs are not. The rule follows the preferred brand specialty drug.","Separate prescription drug deductible ($500 individual / $1,000 family), which \"Applies to brand only\" (SBC page 1): generic drugs are exempt (\"Deductible does not apply\"); brand drugs are charged after that drug deductible.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This is a small-business (small-group) plan. Capital's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://capbluecross1.my.salesforce.com/sfc/p/3j000000hUJ1/a/Vv000009QbyQ/NqR_BAf6r5e6a0cWGRpVD31EMOZItYazeWi5z9V7k7E","prev":{"planYear":2026,"rates":{"6":{"base21":555.73,"tobaccoFactor":1},"7":{"base21":600.19,"tobaccoFactor":1},"9":{"base21":566.84,"tobaccoFactor":1}}}},{"market":"group","id":"45127PA0010195-00","standardId":"45127PA0010195-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Gold PPO 3000/0/15 Rx 0","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Union","York"],"rates":{"6":{"base21":663.78,"tobaccoFactor":1},"7":{"base21":716.88,"tobaccoFactor":1},"9":{"base21":677.05,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":681.32,"tobaccoFactor":1},"7":{"base21":735.82,"tobaccoFactor":1},"9":{"base21":694.94,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":699.33,"tobaccoFactor":1},"7":{"base21":755.28,"tobaccoFactor":1},"9":{"base21":713.32,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":717.81,"tobaccoFactor":1},"7":{"base21":775.24,"tobaccoFactor":1},"9":{"base21":732.17,"tobaccoFactor":1}}}],"ded":{"ind":3000,"fam":6000,"embedded":true},"drugDed":null,"oop":{"ind":6900,"fam":13800},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":4,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":700}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $250 copay per visit, waived if you are admitted as an inpatient.","Lab tests: $15 copay per visit at an independent lab (used here); $40 copay per visit at a facility-owned lab (hospital or outpatient facility).","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $4 copay per prescription (used here), non-preferred generics $15 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $8 copay per prescription, non-preferred generic $30 copay per prescription; preferred brand $90 copay per prescription; non-preferred brand $140 copay per prescription.","Specialty drugs: 30% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This is a small-business (small-group) plan. Capital's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://capbluecross1.my.salesforce.com/sfc/p/3j000000hUJ1/a/Vv000009QbyT/b74iYBMvtPU0HRfWsRBugSAwvK6H2OaOwYczZKd.8Gs","prev":{"planYear":2026,"rates":{"6":{"base21":588.05,"tobaccoFactor":1},"7":{"base21":635.09,"tobaccoFactor":1},"9":{"base21":599.81,"tobaccoFactor":1}}}},{"market":"group","id":"45127PA0010210-00","standardId":"45127PA0010210-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Silver QHDHP-E PPO 5300/0/15","metal":"Silver","network":"PPO","hsaEligible":true,"counties":["Adams","Berks","Centre","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Union","York"],"rates":{"6":{"base21":547.83,"tobaccoFactor":1},"7":{"base21":591.66,"tobaccoFactor":1},"9":{"base21":558.79,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":562.31,"tobaccoFactor":1},"7":{"base21":607.3,"tobaccoFactor":1},"9":{"base21":573.56,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":577.18,"tobaccoFactor":1},"7":{"base21":623.35,"tobaccoFactor":1},"9":{"base21":588.72,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":592.44,"tobaccoFactor":1},"7":{"base21":639.84,"tobaccoFactor":1},"9":{"base21":604.29,"tobaccoFactor":1}}}],"ded":{"ind":5300,"fam":10600,"embedded":true},"drugDed":null,"oop":{"ind":7400,"fam":14800},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":30,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":7,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded","max":700}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $350 copay per visit, waived if you are admitted as an inpatient.","Lab tests: $15 copay per visit at an independent lab (used here); $30 copay per visit at a facility-owned lab (hospital or outpatient facility).","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $7 copay per prescription (used here), non-preferred generics $25 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $14 copay per prescription, non-preferred generic $50 copay per prescription; preferred brand $110 copay per prescription; non-preferred brand $160 copay per prescription.","Specialty drugs: 30% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","High-deductible plan: the deductible applies to all services, including prescriptions, before any copay or coinsurance (SBC page 1). Each family member meets their own individual deductible until the family deductible is met (embedded).","This is a small-business (small-group) plan. Capital's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://capbluecross1.my.salesforce.com/sfc/p/3j000000hUJ1/a/Vv000009QbyS/4rAtruqKKy38VSserorJ.Xk6RUHJP5ChFTFSow4CtEY","prev":{"planYear":2026,"rates":{"6":{"base21":448.07,"tobaccoFactor":1},"7":{"base21":483.92,"tobaccoFactor":1},"9":{"base21":457.03,"tobaccoFactor":1}}}},{"market":"group","id":"45127PA0010211-00","standardId":"45127PA0010211-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Silver PPO 8000/0/40 Rx 500","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Union","York"],"rates":{"6":{"base21":545.32,"tobaccoFactor":1},"7":{"base21":588.95,"tobaccoFactor":1},"9":{"base21":556.23,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":559.73,"tobaccoFactor":1},"7":{"base21":604.51,"tobaccoFactor":1},"9":{"base21":570.93,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":574.53,"tobaccoFactor":1},"7":{"base21":620.49,"tobaccoFactor":1},"9":{"base21":586.02,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":589.72,"tobaccoFactor":1},"7":{"base21":636.89,"tobaccoFactor":1},"9":{"base21":601.51,"tobaccoFactor":1}}}],"ded":{"ind":8000,"fam":16000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":10700,"fam":21400},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":70,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":7,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded","max":700}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $350 copay per visit, waived if you are admitted as an inpatient.","Lab tests: $40 copay per visit at an independent lab (used here); $70 copay per visit at a facility-owned lab (hospital or outpatient facility).","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $7 copay per prescription (used here), non-preferred generics $25 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $14 copay per prescription, non-preferred generic $50 copay per prescription; preferred brand $110 copay per prescription; non-preferred brand $160 copay per prescription.","Specialty drugs: 30% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Specialty drugs: generic specialty drugs are exempt from the drug deductible (\"Deductible does not apply\"); brand specialty drugs are not. The rule follows the preferred brand specialty drug.","Separate prescription drug deductible ($500 individual / $1,000 family), which \"Applies to brand only\" (SBC page 1): generic drugs are exempt (\"Deductible does not apply\"); brand drugs are charged after that drug deductible.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This is a small-business (small-group) plan. Capital's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://capbluecross1.my.salesforce.com/sfc/p/3j000000hUJ1/a/Vv000009QbyO/F0HSNIZu24nNjX1_q7HPim_1MJrfdtMtUrm0W95ge_I","prev":{"planYear":2026,"rates":{"6":{"base21":456.76,"tobaccoFactor":1},"7":{"base21":493.3,"tobaccoFactor":1},"9":{"base21":465.9,"tobaccoFactor":1}}}},{"market":"group","id":"45127PA0010212-00","standardId":"45127PA0010212-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Silver PPO 8000/0/40 Rx 0","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Schuylkill","Snyder","Union","York"],"rates":{"6":{"base21":585.98,"tobaccoFactor":1},"7":{"base21":632.85,"tobaccoFactor":1},"9":{"base21":597.7,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":601.47,"tobaccoFactor":1},"7":{"base21":649.59,"tobaccoFactor":1},"9":{"base21":613.5,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":617.38,"tobaccoFactor":1},"7":{"base21":666.77,"tobaccoFactor":1},"9":{"base21":629.72,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":633.7,"tobaccoFactor":1},"7":{"base21":684.39,"tobaccoFactor":1},"9":{"base21":646.37,"tobaccoFactor":1}}}],"ded":{"ind":8000,"fam":16000,"embedded":true},"drugDed":null,"oop":{"ind":10700,"fam":21400},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":70,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":4,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":700}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $350 copay per visit, waived if you are admitted as an inpatient.","Lab tests: $40 copay per visit at an independent lab (used here); $70 copay per visit at a facility-owned lab (hospital or outpatient facility).","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $4 copay per prescription (used here), non-preferred generics $15 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $8 copay per prescription, non-preferred generic $30 copay per prescription; preferred brand $90 copay per prescription; non-preferred brand $140 copay per prescription.","Specialty drugs: 30% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This is a small-business (small-group) plan. Capital's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://capbluecross1.my.salesforce.com/sfc/p/3j000000hUJ1/a/Vv000009Qby9/8SSgfiN2mIrcTgDQYwwKJyh1lq3FQ1s_ELTpRUArNcE","prev":{"planYear":2026,"rates":{"6":{"base21":487.74,"tobaccoFactor":1},"7":{"base21":526.76,"tobaccoFactor":1},"9":{"base21":497.49,"tobaccoFactor":1}}}},{"market":"group","id":"45127PA0010213-00","standardId":"45127PA0010213-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Bronze PPO 9400/0/0","metal":"Bronze","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Union","York"],"rates":{"6":{"base21":463.06,"tobaccoFactor":1},"7":{"base21":500.11,"tobaccoFactor":1},"9":{"base21":472.32,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":475.3,"tobaccoFactor":1},"7":{"base21":513.33,"tobaccoFactor":1},"9":{"base21":484.81,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":487.87,"tobaccoFactor":1},"7":{"base21":526.9,"tobaccoFactor":1},"9":{"base21":497.63,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":500.77,"tobaccoFactor":1},"7":{"base21":540.83,"tobaccoFactor":1},"9":{"base21":510.79,"tobaccoFactor":1}}}],"ded":{"ind":9400,"fam":18800,"embedded":true},"drugDed":null,"oop":{"ind":9400,"fam":18800},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Lab tests: no charge at independent and facility-owned labs.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics no charge (used here), non-preferred generics no charge, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic no charge, non-preferred generic no charge; preferred brand no charge; non-preferred brand no charge.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This is a small-business (small-group) plan. Capital's SBC prints no plan ID; its title is the plan name of the small-group filing as its Rate Pages and Capital's grid write it (\"Bronze PPO 9400/0/0\"; the Plan Design Summary says \"Bronze PPO 9200/0/0\")."],"sbcUrl":"https://capbluecross1.my.salesforce.com/sfc/p/3j000000hUJ1/a/Vv000009QbyM/wXGmJSQKNCPjUr4PXBMAGy._rTwQ0SriLsl45KUtpkg","prev":{"planYear":2026,"rates":{"6":{"base21":377.06,"tobaccoFactor":1},"7":{"base21":407.23,"tobaccoFactor":1},"9":{"base21":384.6,"tobaccoFactor":1}}}},{"market":"group","id":"45127PA0010214-00","standardId":"45127PA0010214-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Silver QHDHP-E PPO 3750/0/25","metal":"Silver","network":"PPO","hsaEligible":true,"counties":["Adams","Berks","Centre","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Union","York"],"rates":{"6":{"base21":555.56,"tobaccoFactor":1},"7":{"base21":600,"tobaccoFactor":1},"9":{"base21":566.67,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":570.24,"tobaccoFactor":1},"7":{"base21":615.86,"tobaccoFactor":1},"9":{"base21":581.64,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":585.32,"tobaccoFactor":1},"7":{"base21":632.14,"tobaccoFactor":1},"9":{"base21":597.02,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":600.78,"tobaccoFactor":1},"7":{"base21":648.85,"tobaccoFactor":1},"9":{"base21":612.8,"tobaccoFactor":1}}}],"ded":{"ind":3750,"fam":7500,"embedded":true},"drugDed":null,"oop":{"ind":8500,"fam":17000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":25,"ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":7,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded","max":700}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. Capital's public small-group grid (PSI-504) links no SBC of this plan (its row links another plan's SBC); this plan's cost sharing comes from the 2027 small-group benefit grid Capital filed with the PA Insurance Department (SERFF filing CABC-134923379, \"2027 Small Group benefit grid_CAAC PPO.xlsx\", column \"Silver QHDHP-E PPO 3750/0/25\"), checked against the Department's rate decision (pp. 48-49: deductible, coinsurance, out-of-pocket maximum, office, ER and drug copays). The grid gives the plans with a public SBC the same cost sharing as their SBCs, and the filing's sample SBCs equal Capital's published ones.","The grid says for each service whether the deductible applies; copays it lists without \"after deductible\" are charged from the first visit.","The rate decision names this plan \"Silver QHDHP-E PPO 3750/0/20\", but its own benefit exhibits (pp. 48-49) give a $25 primary care copay after the deductible for 2026 and 2027, and Capital names its plans deductible/coinsurance/office-visit copay (decision p. 48, note 5); the filed grid and Capital's public grid PSI-504 call it \"Silver QHDHP-E PPO 3750/0/25\", as the 2026 SBC of this plan ID did. The grid's name is used.","High-deductible plan: every service in the grid except contraceptives (preventive care is not in the grid) is charged after the deductible, and prescriptions count toward the same deductible (\"Combined with Medical\"). Each family member meets their own individual deductible until the family deductible is met (embedded: \"single amount embedded on the family plan\").","Lab tests: $25 copay after deductible at an independent lab or drawn at a physician's office (used here); $50 copay after deductible at a facility- or hospital-owned lab.","Physical and occupational therapy: limited to 30 rehabilitative visits per benefit period combined (the filing's benefit booklet, \"CAAC-SG-QHDHP-PPO-Med-Rx-BB_clean_revised_090326.pdf\", p. 46); visits above the limit are not paid by the plan.","Prenatal office visits: the grid lists maternity services as one row (used for the delivery); the specialist office visit copay is used for prenatal visits, as Capital's SBCs print it for every plan of this grid. The grid has no surgeon or hospital physician row: its \"Inpatient Consultations\" value is used, which equals those SBC rows on every plan with an SBC.","Generic drugs: preferred generics $7 copay after deductible (used here), non-preferred generics $25 copay after deductible, for a retail supply.","Home delivery: preferred generic $14 copay after deductible, non-preferred generic $50 copay after deductible; preferred brand $110 copay after deductible; non-preferred brand $160 copay after deductible.","Specialty drugs: preferred 30% coinsurance ($700 coinsurance maximum) after deductible (modelled here); non-preferred 30% coinsurance ($1,000 coinsurance maximum) after deductible. Formulary: Advantage."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#CABC-134923379/2027 Small Group benefit grid_CAAC PPO.xlsx","prev":{"planYear":2026,"rates":{"6":{"base21":461.83,"tobaccoFactor":1},"7":{"base21":498.78,"tobaccoFactor":1},"9":{"base21":471.07,"tobaccoFactor":1}}}},{"market":"group","id":"45127PA0010215-00","standardId":"45127PA0010215-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Gold Simple PPO 0/0/40","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Union","York"],"rates":{"6":{"base21":752.03,"tobaccoFactor":1},"7":{"base21":812.2,"tobaccoFactor":1},"9":{"base21":767.07,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":771.91,"tobaccoFactor":1},"7":{"base21":833.66,"tobaccoFactor":1},"9":{"base21":787.35,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":792.32,"tobaccoFactor":1},"7":{"base21":855.71,"tobaccoFactor":1},"9":{"base21":808.17,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":813.26,"tobaccoFactor":1},"7":{"base21":878.32,"tobaccoFactor":1},"9":{"base21":829.53,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":9200,"fam":18400},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":4,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":700}},"outpatientFacility":{"base":{"kind":"copay","amount":2000,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":4000,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":4000,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Emergency room: $350 copay per visit, waived if you are admitted as an inpatient.","Hospital stay: $4,000 copay per admission; the stay's remaining days cost nothing more.","Delivery facility: $4,000 copay per admission; the stay's remaining days cost nothing more.","Lab tests: $40 copay per visit at an independent lab (used here); $65 copay per visit at a facility-owned lab (hospital or outpatient facility).","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $4 copay per prescription (used here), non-preferred generics $15 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $8 copay per prescription, non-preferred generic $30 copay per prescription; preferred brand $90 copay per prescription; non-preferred brand $140 copay per prescription.","Specialty drugs: 30% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","This is a small-business (small-group) plan. Capital's SBC prints no plan ID; its title is the plan name of the small-group filing as its Rate Pages and Capital's grid write it (\"Gold Simple PPO 0/0/40\"; the Plan Design Summary says \"Gold Simple PPO 0/0/40 Rx 0 Rx 0\")."],"sbcUrl":"https://capbluecross1.my.salesforce.com/sfc/p/3j000000hUJ1/a/Vv000009QbyX/kC6nreRF18JwrQ0j5_SQFi16DjklTsxUrf8_.GvMEx4","prev":{"planYear":2026,"rates":{"6":{"base21":656.28,"tobaccoFactor":1},"7":{"base21":708.78,"tobaccoFactor":1},"9":{"base21":669.4,"tobaccoFactor":1}}}},{"market":"group","id":"45127PA0010217-00","standardId":"45127PA0010217-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Gold Convenience PPO 1000/0/20","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Franklin","Lancaster","Lebanon","Lehigh","Northampton","York"],"rates":{"6":{"base21":642.45,"tobaccoFactor":1},"7":{"base21":693.84,"tobaccoFactor":1},"9":{"base21":655.3,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":659.43,"tobaccoFactor":1},"7":{"base21":712.18,"tobaccoFactor":1},"9":{"base21":672.61,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":676.86,"tobaccoFactor":1},"7":{"base21":731.01,"tobaccoFactor":1},"9":{"base21":690.4,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":694.75,"tobaccoFactor":1},"7":{"base21":750.33,"tobaccoFactor":1},"9":{"base21":708.64,"tobaccoFactor":1}}}],"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":11100,"fam":22200},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":4,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":700}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $350 copay per visit, waived if you are admitted as an inpatient.","Lab tests: no charge at independent and facility-owned labs.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $4 copay per prescription (used here), non-preferred generics $15 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $8 copay per prescription, non-preferred generic $30 copay per prescription; preferred brand $90 copay per prescription; non-preferred brand $140 copay per prescription.","Specialty drugs: 30% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $40 copay per visit; specialist $60 copay per visit; imaging 20% coinsurance; outpatient surgery facility $500 copay; outpatient surgeon 20% coinsurance; hospital stay facility 20% coinsurance; hospital stay physician 20% coinsurance; prenatal visits $60 copay per visit; delivery professional 20% coinsurance; delivery facility 20% coinsurance; rehabilitation $60 copay per visit; lab tests 20% coinsurance.","This is a small-business (small-group) plan. Capital's SBC prints no plan ID; its title is the plan name of the small-group filing without the filing's \"Rx $0\" (the plan is sold with one drug benefit only)."],"sbcUrl":"https://capbluecross1.my.salesforce.com/sfc/p/3j000000hUJ1/a/Vv000009Qbyj/6hnYBxRfW7zxq2BPUc45En9qRwYxhboYIhM_CZmtTtw","prev":{"planYear":2026,"rates":{"6":{"base21":559.25,"tobaccoFactor":1},"7":{"base21":603.99,"tobaccoFactor":1},"9":{"base21":570.43,"tobaccoFactor":1}}}},{"market":"group","id":"45127PA0010218-00","standardId":"45127PA0010218-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Gold Advance PPO 1000/0/20","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Lancaster"],"rates":{"7":{"base21":700.04,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"7":{"base21":718.54,"tobaccoFactor":1}}},{"from":7,"rates":{"7":{"base21":737.54,"tobaccoFactor":1}}},{"from":10,"rates":{"7":{"base21":757.03,"tobaccoFactor":1}}}],"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":11100,"fam":22200},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":4,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":700}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $350 copay per visit, waived if you are admitted as an inpatient.","Lab tests: no charge at independent and facility-owned labs.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $4 copay per prescription (used here), non-preferred generics $15 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $8 copay per prescription, non-preferred generic $30 copay per prescription; preferred brand $90 copay per prescription; non-preferred brand $140 copay per prescription.","Specialty drugs: 30% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $40 copay per visit; specialist $60 copay per visit; imaging 20% coinsurance; outpatient surgery facility $500 copay; outpatient surgeon 20% coinsurance; hospital stay facility 20% coinsurance; hospital stay physician 20% coinsurance; prenatal visits $60 copay per visit; delivery professional 20% coinsurance; delivery facility 20% coinsurance; rehabilitation $60 copay per visit; lab tests 20% coinsurance.","This is a small-business (small-group) plan. Capital's SBC prints no plan ID; its title is the plan name of the small-group filing without the filing's \"Rx $0\" (the plan is sold with one drug benefit only)."],"sbcUrl":"https://capbluecross1.my.salesforce.com/sfc/p/3j000000hUJ1/a/Vv000009Qbyg/ytMxU6dm5vR..FUM94IN0YGAUSFcxmeo2tb3Hk58cpM","prev":{"planYear":2026,"rates":{"7":{"base21":609.34,"tobaccoFactor":1}}}},{"market":"group","id":"45127PA0010219-00","standardId":"45127PA0010219-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Gold Capital Advantage PPO 1000/0/20","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Cumberland","Dauphin","Perry","York"],"rates":{"7":{"base21":665.62,"tobaccoFactor":1},"9":{"base21":628.65,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"7":{"base21":683.22,"tobaccoFactor":1},"9":{"base21":645.26,"tobaccoFactor":1}}},{"from":7,"rates":{"7":{"base21":701.28,"tobaccoFactor":1},"9":{"base21":662.32,"tobaccoFactor":1}}},{"from":10,"rates":{"7":{"base21":719.82,"tobaccoFactor":1},"9":{"base21":679.83,"tobaccoFactor":1}}}],"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":11100,"fam":22200},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":4,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":700}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $350 copay per visit, waived if you are admitted as an inpatient.","Lab tests: no charge at independent and facility-owned labs.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $4 copay per prescription (used here), non-preferred generics $15 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $8 copay per prescription, non-preferred generic $30 copay per prescription; preferred brand $90 copay per prescription; non-preferred brand $140 copay per prescription.","Specialty drugs: 30% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $40 copay per visit; specialist $60 copay per visit; imaging 20% coinsurance; outpatient surgery facility $500 copay; outpatient surgeon 20% coinsurance; hospital stay facility 20% coinsurance; hospital stay physician 20% coinsurance; prenatal visits $60 copay per visit; delivery professional 20% coinsurance; delivery facility 20% coinsurance; rehabilitation $60 copay per visit; lab tests 20% coinsurance.","This is a small-business (small-group) plan. Capital's SBC prints no plan ID; its title is the plan name of the small-group filing without the filing's \"Rx $0\" (the plan is sold with one drug benefit only)."],"sbcUrl":"https://capbluecross1.my.salesforce.com/sfc/p/3j000000hUJ1/a/Vv000009Qbyf/o03GSLx7c.hkz4EGgeLPbt.wQWgqtAMhr65LyuuwcYc","prev":{"planYear":2026,"rates":{"7":{"base21":579.62,"tobaccoFactor":1},"9":{"base21":547.42,"tobaccoFactor":1}}}},{"market":"group","id":"45127PA0010223-00","standardId":"45127PA0010223-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Silver Convenience PPO 5500/0/30","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Adams","Franklin","Lancaster","Lebanon","Lehigh","Northampton","York"],"rates":{"6":{"base21":527.31,"tobaccoFactor":1},"7":{"base21":569.49,"tobaccoFactor":1},"9":{"base21":537.85,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":541.24,"tobaccoFactor":1},"7":{"base21":584.54,"tobaccoFactor":1},"9":{"base21":552.07,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":555.55,"tobaccoFactor":1},"7":{"base21":599.99,"tobaccoFactor":1},"9":{"base21":566.66,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":570.24,"tobaccoFactor":1},"7":{"base21":615.86,"tobaccoFactor":1},"9":{"base21":581.64,"tobaccoFactor":1}}}],"ded":{"ind":5500,"fam":11000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":4,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":700}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $350 copay per visit, waived if you are admitted as an inpatient.","Lab tests: no charge at independent and facility-owned labs.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $4 copay per prescription (used here), non-preferred generics $15 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $8 copay per prescription, non-preferred generic $30 copay per prescription; preferred brand $90 copay per prescription; non-preferred brand $140 copay per prescription.","Specialty drugs: 30% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $60 copay per visit; specialist $80 copay per visit; imaging 20% coinsurance; outpatient surgery facility $500 copay; outpatient surgeon 20% coinsurance; hospital stay facility 20% coinsurance; hospital stay physician 20% coinsurance; prenatal visits $80 copay per visit; delivery professional 20% coinsurance; delivery facility 20% coinsurance; rehabilitation $80 copay per visit; lab tests 20% coinsurance.","This is a small-business (small-group) plan. Capital's SBC prints no plan ID; its title is the plan name of the small-group filing without the filing's \"Rx $0\" (the plan is sold with one drug benefit only)."],"sbcUrl":"https://capbluecross1.my.salesforce.com/sfc/p/3j000000hUJ1/a/Vv000009QbyP/DMh9JpnfJ64DcifjGyTIXG8RELaX7.P9GI4lp_v3PbY","prev":{"planYear":2026,"rates":{"6":{"base21":438.62,"tobaccoFactor":1},"7":{"base21":473.71,"tobaccoFactor":1},"9":{"base21":447.39,"tobaccoFactor":1}}}},{"market":"group","id":"45127PA0010224-00","standardId":"45127PA0010224-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Silver Advance PPO 5500/0/30","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Lancaster"],"rates":{"7":{"base21":574.48,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"7":{"base21":589.67,"tobaccoFactor":1}}},{"from":7,"rates":{"7":{"base21":605.25,"tobaccoFactor":1}}},{"from":10,"rates":{"7":{"base21":621.26,"tobaccoFactor":1}}}],"ded":{"ind":5500,"fam":11000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":4,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":700}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $350 copay per visit, waived if you are admitted as an inpatient.","Lab tests: no charge at independent and facility-owned labs.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $4 copay per prescription (used here), non-preferred generics $15 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $8 copay per prescription, non-preferred generic $30 copay per prescription; preferred brand $90 copay per prescription; non-preferred brand $140 copay per prescription.","Specialty drugs: 30% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $60 copay per visit; specialist $80 copay per visit; imaging 20% coinsurance; outpatient surgery facility $500 copay; outpatient surgeon 20% coinsurance; hospital stay facility 20% coinsurance; hospital stay physician 20% coinsurance; prenatal visits $80 copay per visit; delivery professional 20% coinsurance; delivery facility 20% coinsurance; rehabilitation $80 copay per visit; lab tests 20% coinsurance.","This is a small-business (small-group) plan. Capital's SBC prints no plan ID; its title is the plan name of the small-group filing without the filing's \"Rx $0\" (the plan is sold with one drug benefit only)."],"sbcUrl":"https://capbluecross1.my.salesforce.com/sfc/p/3j000000hUJ1/a/Vv000009Qby2/GFIW8AZeC93NVSq.o7kC6aXBlsk1AllUSuUdi8eobV0","prev":{"planYear":2026,"rates":{"7":{"base21":477.8,"tobaccoFactor":1}}}},{"market":"group","id":"45127PA0010225-00","standardId":"45127PA0010225-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Silver Capital Advantage PPO 5500/0/30","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Cumberland","Dauphin","Perry","York"],"rates":{"7":{"base21":546.72,"tobaccoFactor":1},"9":{"base21":516.34,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"7":{"base21":561.17,"tobaccoFactor":1},"9":{"base21":529.99,"tobaccoFactor":1}}},{"from":7,"rates":{"7":{"base21":576,"tobaccoFactor":1},"9":{"base21":544,"tobaccoFactor":1}}},{"from":10,"rates":{"7":{"base21":591.23,"tobaccoFactor":1},"9":{"base21":558.38,"tobaccoFactor":1}}}],"ded":{"ind":5500,"fam":11000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":4,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":700}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $350 copay per visit, waived if you are admitted as an inpatient.","Lab tests: no charge at independent and facility-owned labs.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $4 copay per prescription (used here), non-preferred generics $15 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $8 copay per prescription, non-preferred generic $30 copay per prescription; preferred brand $90 copay per prescription; non-preferred brand $140 copay per prescription.","Specialty drugs: 30% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $60 copay per visit; specialist $80 copay per visit; imaging 20% coinsurance; outpatient surgery facility $500 copay; outpatient surgeon 20% coinsurance; hospital stay facility 20% coinsurance; hospital stay physician 20% coinsurance; prenatal visits $80 copay per visit; delivery professional 20% coinsurance; delivery facility 20% coinsurance; rehabilitation $80 copay per visit; lab tests 20% coinsurance.","This is a small-business (small-group) plan. Capital's SBC prints no plan ID; its title is the plan name of the small-group filing without the filing's \"Rx $0\" (the plan is sold with one drug benefit only)."],"sbcUrl":"https://capbluecross1.my.salesforce.com/sfc/p/3j000000hUJ1/a/Vv000009Qbyh/vqrtvP1M9g1gdBknMcV0FuY_4cyxx63CyERcyH4LBfk","prev":{"planYear":2026,"rates":{"7":{"base21":455.06,"tobaccoFactor":1},"9":{"base21":429.78,"tobaccoFactor":1}}}},{"market":"group","id":"45127PA0010227-00","standardId":"45127PA0010227-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Platinum PPO 500/0/25 Rx 0","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Union","York"],"rates":{"6":{"base21":804.72,"tobaccoFactor":1},"7":{"base21":869.1,"tobaccoFactor":1},"9":{"base21":820.82,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":826.01,"tobaccoFactor":1},"7":{"base21":892.09,"tobaccoFactor":1},"9":{"base21":842.53,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":847.84,"tobaccoFactor":1},"7":{"base21":915.67,"tobaccoFactor":1},"9":{"base21":864.8,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":870.25,"tobaccoFactor":1},"7":{"base21":939.87,"tobaccoFactor":1},"9":{"base21":887.65,"tobaccoFactor":1}}}],"ded":{"ind":500,"fam":1000,"embedded":true},"drugDed":null,"oop":{"ind":4500,"fam":9000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":4,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":700}},"outpatientFacility":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $300 copay per visit, waived if you are admitted as an inpatient.","Lab tests: $25 copay per visit at an independent lab (used here); $50 copay per visit at a facility-owned lab (hospital or outpatient facility).","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $4 copay per prescription (used here), non-preferred generics $15 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $8 copay per prescription, non-preferred generic $30 copay per prescription; preferred brand $90 copay per prescription; non-preferred brand $140 copay per prescription.","Specialty drugs: 30% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This is a small-business (small-group) plan. Capital's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://capbluecross1.my.salesforce.com/sfc/p/3j000000hUJ1/a/Vv000009QbyC/dXn13BO6QoGV4jE70.9Cr60KnXRxvRwo58RY2foFYYg"},{"market":"group","id":"45127PA0010228-00","standardId":"45127PA0010228-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Platinum Convenience PPO 0/0/15","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Adams","Franklin","Lancaster","Lebanon","Lehigh","Northampton","York"],"rates":{"6":{"base21":787.55,"tobaccoFactor":1},"7":{"base21":850.56,"tobaccoFactor":1},"9":{"base21":803.3,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":808.37,"tobaccoFactor":1},"7":{"base21":873.04,"tobaccoFactor":1},"9":{"base21":824.54,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":829.74,"tobaccoFactor":1},"7":{"base21":896.12,"tobaccoFactor":1},"9":{"base21":846.33,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":851.68,"tobaccoFactor":1},"7":{"base21":919.81,"tobaccoFactor":1},"9":{"base21":868.71,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":5000,"fam":10000},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"free","ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":30,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":4,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":700}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Small-business plan. Capital's public small-group grid (PSI-504) links no SBC of this plan (its row links another plan's SBC); this plan's cost sharing comes from the 2027 small-group benefit grid Capital filed with the PA Insurance Department (SERFF filing CABC-134923379, \"2027 Small Group benefit grid_CAAC PPO.xlsx\", column \"Platinum Convenience PPO 0/0/15\", \"Choice 1\"), checked against the Department's rate decision (pp. 48-49: deductible, coinsurance, out-of-pocket maximum, office, ER and drug copays). The grid gives the plans with a public SBC the same cost sharing as their SBCs, and the filing's sample SBCs equal Capital's published ones.","The grid says for each service whether the deductible applies; copays it lists without \"after deductible\" are charged from the first visit.","Lab tests: no charge at independent and facility-owned labs.","Physical and occupational therapy: limited to 30 rehabilitative visits per benefit period combined (the filing's benefit booklet, \"CAAC-SG-PPOTier-Med-Rx-BB_clean_revised_090326.pdf\", p. 49); visits above the limit are not paid by the plan.","Prenatal office visits: the grid lists maternity services as one row (used for the delivery); the specialist office visit copay is used for prenatal visits, as Capital's SBCs print it for every plan of this grid. The grid has no surgeon or hospital physician row: its \"Inpatient Consultations\" value is used, which equals those SBC rows on every plan with an SBC.","Generic drugs: preferred generics $4 copay (used here), non-preferred generics $15 copay, for a retail supply.","Home delivery: preferred generic $8 copay, non-preferred generic $30 copay; preferred brand $90 copay; non-preferred brand $140 copay.","Specialty drugs: preferred 30% coinsurance ($700 coinsurance maximum) (modelled here); non-preferred 30% coinsurance ($1,000 coinsurance maximum). Formulary: Advantage.","This plan has a preferred (\"Choice 1\") and a non-preferred (\"Choice 2\") in-network tier; the rules use the preferred tier. At non-preferred in-network providers the deductible is $3,500 ($7,000 family), with the same out-of-pocket maximum: primary care $30 copay; specialist $45 copay; imaging 20% coinsurance after deductible; outpatient surgery facility $500 copay after deductible; hospital stay 20% coinsurance after deductible; delivery 20% coinsurance after deductible; physician and surgeon services 20% coinsurance after deductible; rehabilitation $45 copay; lab tests 20% coinsurance after deductible."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#CABC-134923379/2027 Small Group benefit grid_CAAC PPO.xlsx"},{"market":"group","id":"45127PA0010229-00","standardId":"45127PA0010229-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Platinum Capital Advantage PPO 0/0/15","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Cumberland","Dauphin","Perry","York"],"rates":{"7":{"base21":815.47,"tobaccoFactor":1},"9":{"base21":770.17,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"7":{"base21":837.03,"tobaccoFactor":1},"9":{"base21":790.53,"tobaccoFactor":1}}},{"from":7,"rates":{"7":{"base21":859.16,"tobaccoFactor":1},"9":{"base21":811.43,"tobaccoFactor":1}}},{"from":10,"rates":{"7":{"base21":881.87,"tobaccoFactor":1},"9":{"base21":832.88,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":5000,"fam":10000},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"free","ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":30,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":4,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":700}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Emergency room: $250 copay per visit, waived if you are admitted as an inpatient.","Lab tests: no charge at independent and facility-owned labs.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $4 copay per prescription (used here), non-preferred generics $15 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $8 copay per prescription, non-preferred generic $30 copay per prescription; preferred brand $90 copay per prescription; non-preferred brand $140 copay per prescription.","Specialty drugs: 30% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $30 copay per visit; specialist $45 copay per visit; imaging 20% coinsurance; outpatient surgery facility $500 copay; outpatient surgeon 20% coinsurance; hospital stay facility 20% coinsurance; hospital stay physician 20% coinsurance; prenatal visits $45 copay per visit; delivery professional 20% coinsurance; delivery facility 20% coinsurance; rehabilitation $45 copay per visit; lab tests 20% coinsurance.","This is a small-business (small-group) plan. Capital's SBC prints no plan ID; its title is the plan name of the small-group filing without the filing's \"Rx $0\" (the plan is sold with one drug benefit only)."],"sbcUrl":"https://capbluecross1.my.salesforce.com/sfc/p/3j000000hUJ1/a/Vv000009QbyH/7cktLmkUCIhMjIK2UKyCtcIMllVziJW6Ipzqqghnh88"},{"market":"group","id":"45127PA0010230-00","standardId":"45127PA0010230-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Platinum Advance PPO 0/0/15","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Lancaster"],"rates":{"7":{"base21":858.26,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"7":{"base21":880.95,"tobaccoFactor":1}}},{"from":7,"rates":{"7":{"base21":904.24,"tobaccoFactor":1}}},{"from":10,"rates":{"7":{"base21":928.13,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":5000,"fam":10000},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"free","ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":30,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":4,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":700}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Emergency room: $250 copay per visit, waived if you are admitted as an inpatient.","Lab tests: no charge at independent and facility-owned labs.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $4 copay per prescription (used here), non-preferred generics $15 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $8 copay per prescription, non-preferred generic $30 copay per prescription; preferred brand $90 copay per prescription; non-preferred brand $140 copay per prescription.","Specialty drugs: 30% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $30 copay per visit; specialist $45 copay per visit; imaging 20% coinsurance; outpatient surgery facility $500 copay; outpatient surgeon 20% coinsurance; hospital stay facility 20% coinsurance; hospital stay physician 20% coinsurance; prenatal visits $45 copay per visit; delivery professional 20% coinsurance; delivery facility 20% coinsurance; rehabilitation $45 copay per visit; lab tests 20% coinsurance.","This is a small-business (small-group) plan. Capital's SBC prints no plan ID; its title is the plan name of the small-group filing without the filing's \"Rx $0\" (the plan is sold with one drug benefit only)."],"sbcUrl":"https://capbluecross1.my.salesforce.com/sfc/p/3j000000hUJ1/a/Vv000009Qby7/uUA5H5cZnM_AI1aRZHz188q1.TT7bCQrXO0Wnyknjic"},{"market":"group","id":"45127PA0010231-00","standardId":"45127PA0010231-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Gold QHDHP Capital Advantage PPO 2500/0/15","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Cumberland","Dauphin","Perry","York"],"rates":{"7":{"base21":623.46,"tobaccoFactor":1},"9":{"base21":588.82,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"7":{"base21":639.93,"tobaccoFactor":1},"9":{"base21":604.38,"tobaccoFactor":1}}},{"from":7,"rates":{"7":{"base21":656.85,"tobaccoFactor":1},"9":{"base21":620.36,"tobaccoFactor":1}}},{"from":10,"rates":{"7":{"base21":674.22,"tobaccoFactor":1},"9":{"base21":636.76,"tobaccoFactor":1}}}],"ded":{"ind":2500,"fam":5000,"embedded":false},"drugDed":null,"oop":{"ind":6000,"fam":12000},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":30,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":7,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded","max":700}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $250 copay per visit, waived if you are admitted as an inpatient.","Lab tests: no charge at independent and facility-owned labs.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $7 copay per prescription (used here), non-preferred generics $25 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $14 copay per prescription, non-preferred generic $50 copay per prescription; preferred brand $110 copay per prescription; non-preferred brand $160 copay per prescription.","Specialty drugs: 30% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","High-deductible plan: the deductible applies to all services, including prescriptions, before any copay or coinsurance (SBC page 1). The family deductible is an aggregate: it must be met by the family as a whole, not per person.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $30 copay per visit; specialist $45 copay per visit; imaging 20% coinsurance; outpatient surgery facility $500 copay; outpatient surgeon 20% coinsurance; hospital stay facility 20% coinsurance; hospital stay physician 20% coinsurance; prenatal visits $45 copay per visit; delivery professional 20% coinsurance; delivery facility 20% coinsurance; rehabilitation $45 copay per visit; lab tests 20% coinsurance.","This is a small-business (small-group) plan. Capital's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://capbluecross1.my.salesforce.com/sfc/p/3j000000hUJ1/a/Vv000009Qbyi/2nRuyowsj2PcaWabmM_IVk6f7WebmtXwYv5zSJlyAho"},{"market":"group","id":"45127PA0010232-00","standardId":"45127PA0010232-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Gold QHDHP Advance PPO 2500/0/15","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Adams","Berks","Lancaster"],"rates":{"7":{"base21":655.5,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"7":{"base21":672.84,"tobaccoFactor":1}}},{"from":7,"rates":{"7":{"base21":690.62,"tobaccoFactor":1}}},{"from":10,"rates":{"7":{"base21":708.88,"tobaccoFactor":1}}}],"ded":{"ind":2500,"fam":5000,"embedded":false},"drugDed":null,"oop":{"ind":6000,"fam":12000},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":30,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":7,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded","max":700}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $250 copay per visit, waived if you are admitted as an inpatient.","Lab tests: no charge at independent and facility-owned labs.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $7 copay per prescription (used here), non-preferred generics $25 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $14 copay per prescription, non-preferred generic $50 copay per prescription; preferred brand $110 copay per prescription; non-preferred brand $160 copay per prescription.","Specialty drugs: 30% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","High-deductible plan: the deductible applies to all services, including prescriptions, before any copay or coinsurance (SBC page 1). The family deductible is an aggregate: it must be met by the family as a whole, not per person.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $30 copay per visit; specialist $45 copay per visit; imaging 20% coinsurance; outpatient surgery facility $500 copay; outpatient surgeon 20% coinsurance; hospital stay facility 20% coinsurance; hospital stay physician 20% coinsurance; prenatal visits $45 copay per visit; delivery professional 20% coinsurance; delivery facility 20% coinsurance; rehabilitation $45 copay per visit; lab tests 20% coinsurance.","This is a small-business (small-group) plan. Capital's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://capbluecross1.my.salesforce.com/sfc/p/3j000000hUJ1/a/Vv000009Qbyl/ysnkPI.Yl6qCPKAFKGZvyIbOR5oV2QOk7hH2Qf3oiPw"},{"market":"group","id":"45127PA0010233-00","standardId":"45127PA0010233-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Gold QHDHP Convenience PPO 2500/0/15","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Adams","Franklin","Lancaster","Lebanon","Lehigh","Northampton","York"],"rates":{"6":{"base21":601.61,"tobaccoFactor":1},"7":{"base21":649.74,"tobaccoFactor":1},"9":{"base21":613.64,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":617.51,"tobaccoFactor":1},"7":{"base21":666.91,"tobaccoFactor":1},"9":{"base21":629.86,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":633.83,"tobaccoFactor":1},"7":{"base21":684.54,"tobaccoFactor":1},"9":{"base21":646.51,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":650.59,"tobaccoFactor":1},"7":{"base21":702.63,"tobaccoFactor":1},"9":{"base21":663.6,"tobaccoFactor":1}}}],"ded":{"ind":2500,"fam":5000,"embedded":false},"drugDed":null,"oop":{"ind":6000,"fam":12000},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":30,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":7,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded","max":700}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $250 copay per visit, waived if you are admitted as an inpatient.","Lab tests: no charge at independent and facility-owned labs.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $7 copay per prescription (used here), non-preferred generics $25 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $14 copay per prescription, non-preferred generic $50 copay per prescription; preferred brand $110 copay per prescription; non-preferred brand $160 copay per prescription.","Specialty drugs: 30% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","High-deductible plan: the deductible applies to all services, including prescriptions, before any copay or coinsurance (SBC page 1). The family deductible is an aggregate: it must be met by the family as a whole, not per person.","This plan has a preferred and a non-preferred in-network tier; the rules use the preferred tier. At non-preferred in-network providers: primary care $30 copay per visit; specialist $45 copay per visit; imaging 20% coinsurance; outpatient surgery facility $500 copay; outpatient surgeon 20% coinsurance; hospital stay facility 20% coinsurance; hospital stay physician 20% coinsurance; prenatal visits $45 copay per visit; delivery professional 20% coinsurance; delivery facility 20% coinsurance; rehabilitation $45 copay per visit; lab tests 20% coinsurance.","This is a small-business (small-group) plan. Capital's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://capbluecross1.my.salesforce.com/sfc/p/3j000000hUJ1/a/Vv000009Qbym/1y_uP.YThqyfz8fUss2Yosb65Nla2JRbYD6ajR6fpcg"},{"market":"group","id":"45127PA0130063-00","standardId":"45127PA0130063-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Gold Valley Advantage EPO 2000/0/30","metal":"Gold","network":"EPO","hsaEligible":false,"counties":["Lehigh","Northampton"],"rates":{"6":{"base21":594.97,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":610.7,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":626.84,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":643.42,"tobaccoFactor":1}}}],"ded":{"ind":2000,"fam":4000,"embedded":true},"drugDed":null,"oop":{"ind":8550,"fam":17100},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":4,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":700}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $200 copay per visit, waived if you are admitted as an inpatient.","Lab tests: $30 copay per visit at independent and facility-owned labs.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $4 copay per prescription (used here), non-preferred generics $15 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $8 copay per prescription, non-preferred generic $30 copay per prescription; preferred brand $90 copay per prescription; non-preferred brand $140 copay per prescription.","Specialty drugs: 30% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This is a small-business (small-group) plan. Capital's SBC prints no plan ID; its title is the plan name of the small-group filing without the filing's \"Rx $0\" (the plan is sold with one drug benefit only)."],"sbcUrl":"https://capbluecross1.my.salesforce.com/sfc/p/3j000000hUJ1/a/Vv000009QbyB/GP_V0GpCKC5lVAP3T_RCeIPzzwVhk5H37ehLvCM2xOw"},{"market":"group","id":"45127PA0130064-00","standardId":"45127PA0130064-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Silver Valley Advantage EPO 5000/0/35","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Lehigh","Northampton"],"rates":{"6":{"base21":534.5,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":548.63,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":563.13,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":578.02,"tobaccoFactor":1}}}],"ded":{"ind":5000,"fam":10000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":35,"ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":70,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":4,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":700}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $350 copay per visit, waived if you are admitted as an inpatient.","Lab tests: $35 copay per visit at independent and facility-owned labs.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $4 copay per prescription (used here), non-preferred generics $15 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $8 copay per prescription, non-preferred generic $30 copay per prescription; preferred brand $90 copay per prescription; non-preferred brand $140 copay per prescription.","Specialty drugs: 30% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This is a small-business (small-group) plan. Capital's SBC prints no plan ID; its title is the plan name of the small-group filing without the filing's \"Rx $0\" (the plan is sold with one drug benefit only)."],"sbcUrl":"https://capbluecross1.my.salesforce.com/sfc/p/3j000000hUJ1/a/Vv000009Qby1/apE8AQgs.mum39aVC8RDfcv7rF.MUtxycFJUE8Yf7z4"},{"market":"group","id":"45127PA0130065-00","standardId":"45127PA0130065-00","variant":"standard","issuer":"Capital Advantage Assurance Company","name":"Silver QHDHP Valley Advantage EPO 3750/0/25","metal":"Silver","network":"EPO","hsaEligible":true,"counties":["Lehigh","Northampton"],"rates":{"6":{"base21":534.47,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":548.6,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":563.1,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":577.98,"tobaccoFactor":1}}}],"ded":{"ind":3750,"fam":7500,"embedded":false},"drugDed":null,"oop":{"ind":8500,"fam":17000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":25,"ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":7,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded","max":700}},"outpatientFacility":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: $300 copay per visit, waived if you are admitted as an inpatient.","Lab tests: $25 copay per visit at independent and facility-owned labs.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics $7 copay per prescription (used here), non-preferred generics $25 copay per prescription, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic $14 copay per prescription, non-preferred generic $50 copay per prescription; preferred brand $110 copay per prescription; non-preferred brand $160 copay per prescription.","Specialty drugs: 30% coinsurance, at most $700 per 30-day prescription for a preferred specialty drug (modelled here) and at most $1,000 for a non-preferred one.","High-deductible plan: the deductible applies to all services, including prescriptions, before any copay or coinsurance (SBC page 1). The family deductible is an aggregate: it must be met by the family as a whole, not per person.","This is a small-business (small-group) plan. Capital's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://capbluecross1.my.salesforce.com/sfc/p/3j000000hUJ1/a/Vv000009Qbyn/2cIQQ__RiUhV7FJEveRxGPgGMP9mrMHBR2as0Go6agU"},{"market":"group","id":"49740PA0010002-00","standardId":"49740PA0010002-00","variant":"standard","issuer":"Highmark Care Benefits","name":"AffordaBlue $1500 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":593.92,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":613.12,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":627.68,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":645.49,"tobaccoFactor":1}}}],"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":null,"oop":{"ind":8000,"fam":16000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":55,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":25,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: primary care 40% coinsurance; specialist 40% coinsurance; lab and x-ray 40% coinsurance (blood work lab) 40% coinsurance (x-ray); imaging 40% coinsurance; outpatient surgery facility fee 40% coinsurance; outpatient surgeon fees 40% coinsurance; urgent care 40% coinsurance; hospital facility fee 40% coinsurance; hospital physician fees 40% coinsurance; prenatal office visits 40% coinsurance; delivery professional fees 40% coinsurance; delivery facility fee 40% coinsurance; rehabilitation 40% coinsurance.","Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $20 copay for a 31-day retail supply ($40 for 60 days, $60 for 90 days); $20 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, urgent care, outpatient mental health, outpatient substance abuse, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Lab tests, x-rays, imaging, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245874891/SE_2245874891_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":519.81,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0010003-00","standardId":"49740PA0010003-00","variant":"standard","issuer":"Highmark Care Benefits","name":"AffordaBlue $250 Platinum","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":689.09,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":711.38,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":728.26,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":748.93,"tobaccoFactor":1}}}],"ded":{"ind":250,"fam":500,"embedded":true},"drugDed":null,"oop":{"ind":4000,"fam":8000},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":30,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":45,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: primary care 40% coinsurance; specialist 40% coinsurance; lab and x-ray 40% coinsurance (blood work lab) 40% coinsurance (x-ray); imaging 40% coinsurance; outpatient surgery facility fee 40% coinsurance; outpatient surgeon fees 40% coinsurance; urgent care 40% coinsurance; hospital facility fee 40% coinsurance; hospital physician fees 40% coinsurance; prenatal office visits 40% coinsurance; delivery professional fees 40% coinsurance; delivery facility fee 40% coinsurance; rehabilitation 40% coinsurance.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $80 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, urgent care, outpatient mental health, outpatient substance abuse, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Emergency room care, lab tests, x-rays, imaging, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245874368/SE_2245874368_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":606.28,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0010004-00","standardId":"49740PA0010004-00","variant":"standard","issuer":"Highmark Care Benefits","name":"AffordaBlue $3000 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":507.14,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":523.54,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":535.97,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":551.18,"tobaccoFactor":1}}}],"ded":{"ind":3000,"fam":6000,"embedded":true},"drugDed":null,"oop":{"ind":10100,"fam":20200},"rules":{"pcp":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: primary care 50% coinsurance; specialist 50% coinsurance; lab and x-ray 50% coinsurance (blood work lab) 50% coinsurance (x-ray); imaging $600 copay; outpatient surgery facility fee $200 copay; outpatient surgeon fees 50% coinsurance; urgent care 50% coinsurance; hospital facility fee 50% coinsurance; hospital physician fees 50% coinsurance; prenatal office visits 50% coinsurance; delivery professional fees 50% coinsurance; delivery facility fee 50% coinsurance; rehabilitation 50% coinsurance.","Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $120 copay for a 31-day retail supply ($240 for 60 days, $360 for 90 days); $240 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $250 copay for a 31-day retail supply ($500 for 60 days, $750 for 90 days); $500 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, urgent care, outpatient mental health, outpatient substance abuse, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Lab tests, x-rays, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245875322/SE_2245875322_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":445.93,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0020001-00","standardId":"49740PA0020001-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare Custom PPO $0 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":734.66,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":758.41,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":776.42,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":798.45,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":9100,"fam":18200},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":70,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"no_ded"},"perDay":{"maxDays":3}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $500 copay per day for the first 3 days of a stay, then no charge. The SBC prints \"$500 copay, up to 3 days, then no charge\" without \"per day\"; it is read as a copay per day, as Highmark's 2026 SBCs printed \"$N copay per day, up to N days, then no charge\" (no 2027 SBC says \"per day\").","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","No network deductible: copays and coinsurance apply from the first visit.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245822712/SE_2245822712_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":633.83,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0020002-00","standardId":"49740PA0020002-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare Custom PPO $0 Platinum","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":798.75,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":824.58,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":844.16,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":868.11,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":8000,"fam":16000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $80 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","No network deductible: copays and coinsurance apply from the first visit.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245820556/SE_2245820556_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":678.39,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0020003-00","standardId":"49740PA0020003-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare Custom PPO $0 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":662.12,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":683.54,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":699.76,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":719.62,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":650,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":750,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":1500,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $1,500 copay per admission, charged on the first day of each stay. The SBC prints \"$1,500 copay/visit\"; a hospital visit is read as one stay (Highmark's 2026 SBCs said \"per admission\").","Diagnostic tests: $150 copay for lab tests and $250 copay for x-rays.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","No network deductible: copays and coinsurance apply from the first visit.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245841719/SE_2245841719_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":581.73,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0020005-00","standardId":"49740PA0020005-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare Custom PPO $1000 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":689.94,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":712.25,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":729.15,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":749.84,"tobaccoFactor":1}}}],"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":225,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245822843/SE_2245822843_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":578.89,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0020006-00","standardId":"49740PA0020006-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare Custom PPO $1250 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":675.93,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":697.79,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":714.35,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":734.62,"tobaccoFactor":1}}}],"ded":{"ind":1250,"fam":2500,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":70,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":225,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Lab tests, x-rays, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245868085/SE_2245868085_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":582.06,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0020007-00","standardId":"49740PA0020007-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare Custom PPO $1400 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":656.59,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":677.82,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":693.91,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":713.6,"tobaccoFactor":1}}}],"ded":{"ind":1400,"fam":2800,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":225,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":325,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":75,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $95 copay for a 31-day retail supply ($190 for 60 days, $285 for 90 days); $190 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $150 copay for a 31-day retail supply ($300 for 60 days, $450 for 90 days); $300 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245824208/SE_2245824208_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":559,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0020008-00","standardId":"49740PA0020008-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare Custom PPO $1500 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":680.74,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":702.76,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":719.44,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":739.85,"tobaccoFactor":1}}}],"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":290,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":200,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $200 copay per admission, charged on the first day of each stay. The SBC prints \"$200 copay/visit\"; a hospital visit is read as one stay (Highmark's 2026 SBCs said \"per admission\").","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Hospital facility fee: the chart marks it \"Deductible does not apply\"; page 1 does not list it among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245828052/SE_2245828052_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":578.18,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0020009-00","standardId":"49740PA0020009-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare Custom PPO $2000 1x Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":683.75,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":705.86,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":722.61,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":743.12,"tobaccoFactor":1}}}],"ded":{"ind":2000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":10600},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":370,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":360,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":175,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Lab tests, x-rays, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245833056/SE_2245833056_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":587.98,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0020010-00","standardId":"49740PA0020010-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare Custom PPO $2000 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":614.6,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":634.47,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":649.53,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":667.96,"tobaccoFactor":1}}}],"ded":{"ind":2000,"fam":4000,"embedded":true},"drugDed":null,"oop":{"ind":7900,"fam":15800},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":65,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245833745/SE_2245833745_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":534.72,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0020011-00","standardId":"49740PA0020011-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare Custom PPO $250 Platinum","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":802.34,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":828.29,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":847.95,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":872.01,"tobaccoFactor":1}}}],"ded":{"ind":250,"fam":500,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":120,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":25,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":225,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $80 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Lab tests, x-rays, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245842539/SE_2245842539_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":687.62,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0020012-00","standardId":"49740PA0020012-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare Custom PPO $2500 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":612.69,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":632.5,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":647.51,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":665.89,"tobaccoFactor":1}}}],"ded":{"ind":2500,"fam":5000,"embedded":true},"drugDed":null,"oop":{"ind":8200,"fam":16400},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $95 copay for a 31-day retail supply ($190 for 60 days, $285 for 90 days); $190 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $150 copay for a 31-day retail supply ($300 for 60 days, $450 for 90 days); $300 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245833855/SE_2245833855_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":532.71,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0020013-00","standardId":"49740PA0020013-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare Custom PPO $2600 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":554.91,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":572.86,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":586.46,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":603.1,"tobaccoFactor":1}}}],"ded":{"ind":2600,"fam":5200,"embedded":true},"drugDed":null,"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":140,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":140,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":85,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":110,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $95 copay for a 31-day retail supply ($190 for 60 days, $285 for 90 days); $190 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $110 copay for a 31-day retail supply ($220 for 60 days, $330 for 90 days); $220 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245800368/SE_2245800368_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":481.69,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0020014-00","standardId":"49740PA0020014-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare Custom PPO $3000 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":657.96,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":679.24,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":695.36,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":715.09,"tobaccoFactor":1}}}],"ded":{"ind":3000,"fam":6000,"embedded":true},"drugDed":null,"oop":{"ind":9500,"fam":19000},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":175,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":175,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":30,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $20 copay for a 31-day retail supply ($40 for 60 days, $60 for 90 days); $20 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245834227/SE_2245834227_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":557.69,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0020015-00","standardId":"49740PA0020015-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare Custom PPO $3000 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":555.57,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":573.54,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":587.15,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":603.81,"tobaccoFactor":1}}}],"ded":{"ind":3000,"fam":6000,"embedded":true},"drugDed":null,"oop":{"ind":11200,"fam":22400},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":85,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":160,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $120 copay for a 31-day retail supply ($240 for 60 days, $360 for 90 days); $240 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $250 copay for a 31-day retail supply ($500 for 60 days, $750 for 90 days); $500 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245800525/SE_2245800525_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":476.64,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0020016-00","standardId":"49740PA0020016-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare Custom PPO $4000 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":615.21,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":635.11,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":650.18,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":668.63,"tobaccoFactor":1}}}],"ded":{"ind":4000,"fam":8000,"embedded":true},"drugDed":null,"oop":{"ind":7900,"fam":15800},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Lab tests, x-rays, outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245835476/SE_2245835476_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":530.07,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0020017-00","standardId":"49740PA0020017-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare Custom PPO $500 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":698.54,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":721.12,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":738.24,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":759.19,"tobaccoFactor":1}}}],"ded":{"ind":500,"fam":1000,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":360,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":65,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":360,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245835803/SE_2245835803_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":598.83,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0020018-00","standardId":"49740PA0020018-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare Custom PPO $500 Platinum","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":794.36,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":820.05,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":839.51,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":863.33,"tobaccoFactor":1}}}],"ded":{"ind":500,"fam":1000,"embedded":true},"drugDed":null,"oop":{"ind":6000,"fam":12000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":225,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $80 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Lab tests, x-rays, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245868178/SE_2245868178_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":681,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0020019-00","standardId":"49740PA0020019-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare Custom PPO $5000 1x Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":621.42,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":641.51,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":656.74,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":675.38,"tobaccoFactor":1}}}],"ded":{"ind":5000,"fam":5000,"embedded":true},"drugDed":null,"oop":{"ind":7300,"fam":7300},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":70,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $20 copay for a 31-day retail supply ($40 for 60 days, $60 for 90 days); $20 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245840613/SE_2245840613_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":542.85,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0020020-00","standardId":"49740PA0020020-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare Custom PPO $5000 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":595.82,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":615.09,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":629.69,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":647.56,"tobaccoFactor":1}}}],"ded":{"ind":5000,"fam":10000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":90,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":90,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":175,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":110,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":365,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":350,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $350 copay per admission, charged on the first day of each stay. The other days count toward the deductible until it is met, then cost nothing more. The SBC prints \"$350 copay/visit\"; a hospital visit is read as one stay (Highmark's 2026 SBCs said \"per admission\").","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $20 copay for a 31-day retail supply ($40 for 60 days, $60 for 90 days); $20 for a 90-day mail-order supply.","Formulary brand drugs (used here): $95 copay for a 31-day retail supply ($190 for 60 days, $285 for 90 days); $190 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $110 copay for a 31-day retail supply ($220 for 60 days, $330 for 90 days); $220 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Outpatient surgery facility and surgeon fees: the chart marks them \"Deductible does not apply\"; page 1 does not list them among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245800620/SE_2245800620_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":506.06,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0020021-00","standardId":"49740PA0020021-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare Custom PPO $6000 Bronze","metal":"Bronze","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":504.96,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":521.29,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":533.66,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":548.81,"tobaccoFactor":1}}}],"ded":{"ind":6000,"fam":12000,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $120 copay for a 31-day retail supply ($240 for 60 days, $360 for 90 days); $240 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $250 copay for a 31-day retail supply ($500 for 60 days, $750 for 90 days); $500 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245800879/SE_2245800879_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":428,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0020022-00","standardId":"49740PA0020022-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare Custom PPO $750 Platinum","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":782.45,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":807.75,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":826.93,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":850.39,"tobaccoFactor":1}}}],"ded":{"ind":750,"fam":1500,"embedded":true},"drugDed":null,"oop":{"ind":5000,"fam":10000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":225,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $80 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Lab tests, x-rays, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245822394/SE_2245822394_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":666.83,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0030001-00","standardId":"49740PA0030001-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare Custom QHD PPO $1800 Gold","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":664.93,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":686.43,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":702.72,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":722.66,"tobaccoFactor":1}}}],"ded":{"ind":1800,"fam":3600,"embedded":false},"drugDed":null,"oop":{"ind":5000,"fam":10000,"famPerPerson":10000},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","Family deductible: the SBC says the overall family deductible must be met before the plan begins to pay (an aggregate family deductible), and the estimate uses the aggregate family deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245906055/SE_2245906055_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":567.54,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0030002-00","standardId":"49740PA0030002-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare Custom QHD PPO $2750 Gold","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":616.01,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":635.93,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":651.03,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":669.5,"tobaccoFactor":1}}}],"ded":{"ind":2750,"fam":5500,"embedded":false},"drugDed":null,"oop":{"ind":4800,"fam":9600,"famPerPerson":9600},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":30,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded","max":350}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","Family deductible: the SBC says the overall family deductible must be met before the plan begins to pay (an aggregate family deductible), and the estimate uses the aggregate family deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245801530/SE_2245801530_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":547.38,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0030003-00","standardId":"49740PA0030003-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare Custom QHD PPO $3500 Silver","metal":"Silver","network":"PPO","hsaEligible":true,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":610.36,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":630.09,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":645.05,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":663.35,"tobaccoFactor":1}}}],"ded":{"ind":3500,"fam":7000,"embedded":true},"drugDed":null,"oop":{"ind":8500,"fam":17000},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":30,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":190,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245802354/SE_2245802354_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":509.45,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0040001-00","standardId":"49740PA0040001-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare PPO $0 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":844.68,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":871.99,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":892.69,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":918.02,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":9100,"fam":18200},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":70,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"no_ded"},"perDay":{"maxDays":3}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $500 copay per day for the first 3 days of a stay, then no charge. The SBC prints \"$500 copay, up to 3 days, then no charge\" without \"per day\"; it is read as a copay per day, as Highmark's 2026 SBCs printed \"$N copay per day, up to N days, then no charge\" (no 2027 SBC says \"per day\").","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","No network deductible: copays and coinsurance apply from the first visit.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245851280/SE_2245851280_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":745.98,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0040002-00","standardId":"49740PA0040002-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare PPO $0 Platinum","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":918.66,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":948.36,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":970.88,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":998.42,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":8000,"fam":16000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $80 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","No network deductible: copays and coinsurance apply from the first visit.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245824328/SE_2245824328_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":798.7,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0040003-00","standardId":"49740PA0040003-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare PPO $0 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":760.96,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":785.56,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":804.21,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":827.03,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":650,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":750,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":1500,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $1,500 copay per admission, charged on the first day of each stay. The SBC prints \"$1,500 copay/visit\"; a hospital visit is read as one stay (Highmark's 2026 SBCs said \"per admission\").","Diagnostic tests: $150 copay for lab tests and $250 copay for x-rays.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","No network deductible: copays and coinsurance apply from the first visit.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245843633/SE_2245843633_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":684.36,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0040005-00","standardId":"49740PA0040005-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare PPO $1000 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":793.06,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":818.7,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":838.14,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":861.92,"tobaccoFactor":1}}}],"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":225,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245852837/SE_2245852837_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":680.99,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0040006-00","standardId":"49740PA0040006-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare PPO $1250 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":776.89,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":802.01,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":821.05,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":844.35,"tobaccoFactor":1}}}],"ded":{"ind":1250,"fam":2500,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":70,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":225,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Lab tests, x-rays, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245854037/SE_2245854037_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":684.74,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0040007-00","standardId":"49740PA0040007-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare PPO $1400 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":754.57,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":778.97,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":797.46,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":820.09,"tobaccoFactor":1}}}],"ded":{"ind":1400,"fam":2800,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":225,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":325,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":75,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $95 copay for a 31-day retail supply ($190 for 60 days, $285 for 90 days); $190 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $150 copay for a 31-day retail supply ($300 for 60 days, $450 for 90 days); $300 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245854966/SE_2245854966_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":657.47,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0040008-00","standardId":"49740PA0040008-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare PPO $1500 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":782.45,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":807.75,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":826.92,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":850.38,"tobaccoFactor":1}}}],"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":290,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":200,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $200 copay per admission, charged on the first day of each stay. The SBC prints \"$200 copay/visit\"; a hospital visit is read as one stay (Highmark's 2026 SBCs said \"per admission\").","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Hospital facility fee: the chart marks it \"Deductible does not apply\"; page 1 does not list it among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245856320/SE_2245856320_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":680.15,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0040009-00","standardId":"49740PA0040009-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare PPO $2000 1x Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":785.92,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":811.33,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":830.59,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":854.16,"tobaccoFactor":1}}}],"ded":{"ind":2000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":10600},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":370,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":360,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":175,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Lab tests, x-rays, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245857061/SE_2245857061_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":691.74,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0040010-00","standardId":"49740PA0040010-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare PPO $2000 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":706.1,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":728.94,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":746.24,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":767.41,"tobaccoFactor":1}}}],"ded":{"ind":2000,"fam":4000,"embedded":true},"drugDed":null,"oop":{"ind":7900,"fam":15800},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":65,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245862468/SE_2245862468_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":628.75,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0040011-00","standardId":"49740PA0040011-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare PPO $250 Platinum","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":922.8,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":952.64,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":975.26,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":1002.93,"tobaccoFactor":1}}}],"ded":{"ind":250,"fam":500,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":120,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":25,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":225,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $80 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Lab tests, x-rays, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245836628/SE_2245836628_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":809.61,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0040012-00","standardId":"49740PA0040012-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare PPO $2500 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":703.9,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":726.66,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":743.91,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":765.02,"tobaccoFactor":1}}}],"ded":{"ind":2500,"fam":5000,"embedded":true},"drugDed":null,"oop":{"ind":8200,"fam":16400},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $95 copay for a 31-day retail supply ($190 for 60 days, $285 for 90 days); $190 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $150 copay for a 31-day retail supply ($300 for 60 days, $450 for 90 days); $300 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245868397/SE_2245868397_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":626.37,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0040013-00","standardId":"49740PA0040013-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare PPO $2600 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":637.22,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":657.83,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":673.45,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":692.55,"tobaccoFactor":1}}}],"ded":{"ind":2600,"fam":5200,"embedded":true},"drugDed":null,"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":140,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":140,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":85,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":110,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $95 copay for a 31-day retail supply ($190 for 60 days, $285 for 90 days); $190 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $110 copay for a 31-day retail supply ($220 for 60 days, $330 for 90 days); $220 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245845590/SE_2245845590_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":566.03,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0040014-00","standardId":"49740PA0040014-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare PPO $3000 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":756.15,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":780.6,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":799.13,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":821.81,"tobaccoFactor":1}}}],"ded":{"ind":3000,"fam":6000,"embedded":true},"drugDed":null,"oop":{"ind":9500,"fam":19000},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":175,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":175,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":30,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $20 copay for a 31-day retail supply ($40 for 60 days, $60 for 90 days); $20 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245868728/SE_2245868728_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":655.91,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0040015-00","standardId":"49740PA0040015-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare PPO $3000 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":637.98,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":658.61,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":674.25,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":693.38,"tobaccoFactor":1}}}],"ded":{"ind":3000,"fam":6000,"embedded":true},"drugDed":null,"oop":{"ind":11200,"fam":22400},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":85,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":160,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $120 copay for a 31-day retail supply ($240 for 60 days, $360 for 90 days); $240 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $250 copay for a 31-day retail supply ($500 for 60 days, $750 for 90 days); $500 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245812394/SE_2245812394_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":560.05,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0040016-00","standardId":"49740PA0040016-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare PPO $4000 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":706.81,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":729.67,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":746.99,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":768.19,"tobaccoFactor":1}}}],"ded":{"ind":4000,"fam":8000,"embedded":true},"drugDed":null,"oop":{"ind":7900,"fam":15800},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Lab tests, x-rays, outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245869122/SE_2245869122_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":623.25,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0040017-00","standardId":"49740PA0040017-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare PPO $500 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":802.98,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":828.95,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":848.63,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":872.71,"tobaccoFactor":1}}}],"ded":{"ind":500,"fam":1000,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":360,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":65,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":360,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245869316/SE_2245869316_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":704.59,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0040018-00","standardId":"49740PA0040018-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare PPO $500 Platinum","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":913.59,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":943.13,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":965.52,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":992.91,"tobaccoFactor":1}}}],"ded":{"ind":500,"fam":1000,"embedded":true},"drugDed":null,"oop":{"ind":6000,"fam":12000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":225,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $80 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Lab tests, x-rays, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245847902/SE_2245847902_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":801.78,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0040019-00","standardId":"49740PA0040019-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare PPO $5000 1x Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":713.98,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":737.07,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":754.56,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":775.97,"tobaccoFactor":1}}}],"ded":{"ind":5000,"fam":5000,"embedded":true},"drugDed":null,"oop":{"ind":7300,"fam":7300},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":70,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $20 copay for a 31-day retail supply ($40 for 60 days, $60 for 90 days); $20 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245870193/SE_2245870193_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":638.36,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0040020-00","standardId":"49740PA0040020-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare PPO $5000 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":684.44,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":706.57,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":723.34,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":743.87,"tobaccoFactor":1}}}],"ded":{"ind":5000,"fam":10000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":90,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":90,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":175,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":110,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":365,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":350,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $350 copay per admission, charged on the first day of each stay. The other days count toward the deductible until it is met, then cost nothing more. The SBC prints \"$350 copay/visit\"; a hospital visit is read as one stay (Highmark's 2026 SBCs said \"per admission\").","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $20 copay for a 31-day retail supply ($40 for 60 days, $60 for 90 days); $20 for a 90-day mail-order supply.","Formulary brand drugs (used here): $95 copay for a 31-day retail supply ($190 for 60 days, $285 for 90 days); $190 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $110 copay for a 31-day retail supply ($220 for 60 days, $330 for 90 days); $220 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Outpatient surgery facility and surgeon fees: the chart marks them \"Deductible does not apply\"; page 1 does not list them among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245817453/SE_2245817453_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":594.85,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0040022-00","standardId":"49740PA0040022-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare PPO $6000 Bronze","metal":"Bronze","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":579.58,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":598.32,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":612.53,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":629.91,"tobaccoFactor":1}}}],"ded":{"ind":6000,"fam":12000,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $120 copay for a 31-day retail supply ($240 for 60 days, $360 for 90 days); $240 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $250 copay for a 31-day retail supply ($500 for 60 days, $750 for 90 days); $500 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245818943/SE_2245818943_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":502.54,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0040023-00","standardId":"49740PA0040023-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare PPO $750 Platinum","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":899.84,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":928.94,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":950.99,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":977.98,"tobaccoFactor":1}}}],"ded":{"ind":750,"fam":1500,"embedded":true},"drugDed":null,"oop":{"ind":5000,"fam":10000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":225,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $80 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Lab tests, x-rays, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245849236/SE_2245849236_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":785.02,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0050001-00","standardId":"49740PA0050001-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare QHD PPO $1800 Gold","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":764.19,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":788.9,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":807.63,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":830.54,"tobaccoFactor":1}}}],"ded":{"ind":1800,"fam":3600,"embedded":false},"drugDed":null,"oop":{"ind":5000,"fam":10000,"famPerPerson":10000},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","Family deductible: the SBC says the overall family deductible must be met before the plan begins to pay (an aggregate family deductible), and the estimate uses the aggregate family deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245809411/SE_2245809411_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":667.56,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0050002-00","standardId":"49740PA0050002-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare QHD PPO $2750 Gold","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":707.74,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":730.63,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":747.97,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":769.19,"tobaccoFactor":1}}}],"ded":{"ind":2750,"fam":5500,"embedded":false},"drugDed":null,"oop":{"ind":4800,"fam":9600,"famPerPerson":9600},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":30,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded","max":350}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","Family deductible: the SBC says the overall family deductible must be met before the plan begins to pay (an aggregate family deductible), and the estimate uses the aggregate family deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245819877/SE_2245819877_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":643.73,"tobaccoFactor":1}}}},{"market":"group","id":"49740PA0050003-00","standardId":"49740PA0050003-00","variant":"standard","issuer":"Highmark Care Benefits","name":"BlueCare QHD PPO $3500 Silver","metal":"Silver","network":"PPO","hsaEligible":true,"counties":["Bradford","Carbon","Clinton","Lackawanna","Luzerne","Lycoming","Monroe","Pike","Sullivan","Susquehanna","Tioga","Wayne","Wyoming"],"rates":{"3":{"base21":701.21,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":723.88,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":741.07,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":762.09,"tobaccoFactor":1}}}],"ded":{"ind":3500,"fam":7000,"embedded":true},"drugDed":null,"oop":{"ind":8500,"fam":17000},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":30,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":190,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245816357/SE_2245816357_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":598.86,"tobaccoFactor":1}}}},{"market":"group","id":"52899PA0020051-00","standardId":"52899PA0020051-00","variant":"standard","issuer":"UPMC Health Plan","name":"UPMC Small Business Advantage Platinum HMO $0 $20/$40 - Standard Network","metal":"Platinum","network":"HMO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":518.79,"tobaccoFactor":1},"2":{"base21":617.24,"tobaccoFactor":1},"4":{"base21":502.86,"tobaccoFactor":1},"5":{"base21":551.2,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":532.65,"tobaccoFactor":1},"2":{"base21":633.73,"tobaccoFactor":1},"4":{"base21":516.3,"tobaccoFactor":1},"5":{"base21":565.93,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":546.89,"tobaccoFactor":1},"2":{"base21":650.67,"tobaccoFactor":1},"4":{"base21":530.1,"tobaccoFactor":1},"5":{"base21":581.05,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":561.5,"tobaccoFactor":1},"2":{"base21":668.06,"tobaccoFactor":1},"4":{"base21":544.27,"tobaccoFactor":1},"5":{"base21":596.58,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":5000,"fam":10000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":20,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134931224, \"SG 2027 HMO Health Plan Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hp-rate-change-decision-sm-grp-mkt.pdf, rate pages 40, 43, 46, 49: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $20 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $40 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $40 copay (its other imaging row, used here). Other diagnostic testing: $40 copay.","Mental health: office visits, psychotherapy and counseling $20 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134931224/SG 2027 HMO Health Plan Benefit Matrix.xlsx","prev":{"planYear":2026,"rates":{"1":{"base21":460.78,"tobaccoFactor":1},"2":{"base21":548.22,"tobaccoFactor":1},"4":{"base21":446.64,"tobaccoFactor":1},"5":{"base21":489.57,"tobaccoFactor":1}}}},{"market":"group","id":"52899PA0020052-00","standardId":"52899PA0020052-00","variant":"standard","issuer":"UPMC Health Plan","name":"UPMC Small Business Advantage Platinum HMO $250 $20/$40 - Standard Network","metal":"Platinum","network":"HMO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":521.9,"tobaccoFactor":1},"2":{"base21":620.94,"tobaccoFactor":1},"4":{"base21":505.88,"tobaccoFactor":1},"5":{"base21":554.5,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":535.84,"tobaccoFactor":1},"2":{"base21":637.53,"tobaccoFactor":1},"4":{"base21":519.4,"tobaccoFactor":1},"5":{"base21":569.32,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":550.16,"tobaccoFactor":1},"2":{"base21":654.57,"tobaccoFactor":1},"4":{"base21":533.28,"tobaccoFactor":1},"5":{"base21":584.54,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":564.87,"tobaccoFactor":1},"2":{"base21":672.06,"tobaccoFactor":1},"4":{"base21":547.53,"tobaccoFactor":1},"5":{"base21":600.16,"tobaccoFactor":1}}}],"ded":{"ind":250,"fam":500,"embedded":true},"drugDed":null,"oop":{"ind":4500,"fam":9000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":20,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134931224, \"SG 2027 HMO Health Plan Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hp-rate-change-decision-sm-grp-mkt.pdf, rate pages 40, 43, 46, 49: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $20 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $20 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $20 copay (its other imaging row, used here). Other diagnostic testing: $40 copay.","Mental health: office visits, psychotherapy and counseling $20 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134931224/SG 2027 HMO Health Plan Benefit Matrix.xlsx","prev":{"planYear":2026,"rates":{"1":{"base21":456.04,"tobaccoFactor":1},"2":{"base21":542.59,"tobaccoFactor":1},"4":{"base21":442.05,"tobaccoFactor":1},"5":{"base21":484.54,"tobaccoFactor":1}}}},{"market":"group","id":"52899PA0020053-00","standardId":"52899PA0020053-00","variant":"standard","issuer":"UPMC Health Plan","name":"UPMC Small Business Advantage Gold HMO $1,000 $40/$50 - Standard Network","metal":"Gold","network":"HMO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":480.98,"tobaccoFactor":1},"2":{"base21":572.26,"tobaccoFactor":1},"4":{"base21":466.22,"tobaccoFactor":1},"5":{"base21":511.03,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":493.84,"tobaccoFactor":1},"2":{"base21":587.55,"tobaccoFactor":1},"4":{"base21":478.68,"tobaccoFactor":1},"5":{"base21":524.69,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":507.03,"tobaccoFactor":1},"2":{"base21":603.25,"tobaccoFactor":1},"4":{"base21":491.47,"tobaccoFactor":1},"5":{"base21":538.71,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":520.58,"tobaccoFactor":1},"2":{"base21":619.37,"tobaccoFactor":1},"4":{"base21":504.6,"tobaccoFactor":1},"5":{"base21":553.11,"tobaccoFactor":1}}}],"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":40,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134931224, \"SG 2027 HMO Health Plan Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hp-rate-change-decision-sm-grp-mkt.pdf, rate pages 40, 41, 43, 44, 46, 47, 49, 50: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $40 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $50 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay (its other imaging row, used here). Other diagnostic testing: $50 copay.","Mental health: office visits, psychotherapy and counseling $40 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134931224/SG 2027 HMO Health Plan Benefit Matrix.xlsx","prev":{"planYear":2026,"rates":{"1":{"base21":416.22,"tobaccoFactor":1},"2":{"base21":495.21,"tobaccoFactor":1},"4":{"base21":403.45,"tobaccoFactor":1},"5":{"base21":442.23,"tobaccoFactor":1}}}},{"market":"group","id":"52899PA0020054-00","standardId":"52899PA0020054-00","variant":"standard","issuer":"UPMC Health Plan","name":"UPMC Small Business Advantage Gold HMO $1,500 $40/$50 - Standard Network","metal":"Gold","network":"HMO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":472.77,"tobaccoFactor":1},"2":{"base21":562.49,"tobaccoFactor":1},"4":{"base21":458.26,"tobaccoFactor":1},"5":{"base21":502.31,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":485.41,"tobaccoFactor":1},"2":{"base21":577.52,"tobaccoFactor":1},"4":{"base21":470.51,"tobaccoFactor":1},"5":{"base21":515.73,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":498.38,"tobaccoFactor":1},"2":{"base21":592.96,"tobaccoFactor":1},"4":{"base21":483.08,"tobaccoFactor":1},"5":{"base21":529.52,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":511.7,"tobaccoFactor":1},"2":{"base21":608.8,"tobaccoFactor":1},"4":{"base21":495.99,"tobaccoFactor":1},"5":{"base21":543.67,"tobaccoFactor":1}}}],"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":40,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134931224, \"SG 2027 HMO Health Plan Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hp-rate-change-decision-sm-grp-mkt.pdf, rate pages 41, 44, 47, 50: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $40 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $50 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay (its other imaging row, used here). Other diagnostic testing: $50 copay.","Mental health: office visits, psychotherapy and counseling $40 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134931224/SG 2027 HMO Health Plan Benefit Matrix.xlsx","prev":{"planYear":2026,"rates":{"1":{"base21":408.88,"tobaccoFactor":1},"2":{"base21":486.47,"tobaccoFactor":1},"4":{"base21":396.33,"tobaccoFactor":1},"5":{"base21":434.42,"tobaccoFactor":1}}}},{"market":"group","id":"52899PA0020055-00","standardId":"52899PA0020055-00","variant":"standard","issuer":"UPMC Health Plan","name":"UPMC Small Business Advantage Silver HMO $4,400 $60/$80 - Standard Network","metal":"Silver","network":"HMO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":400.35,"tobaccoFactor":1},"2":{"base21":476.33,"tobaccoFactor":1},"4":{"base21":388.07,"tobaccoFactor":1},"5":{"base21":425.37,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":411.05,"tobaccoFactor":1},"2":{"base21":489.06,"tobaccoFactor":1},"4":{"base21":398.44,"tobaccoFactor":1},"5":{"base21":436.73,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":422.04,"tobaccoFactor":1},"2":{"base21":502.13,"tobaccoFactor":1},"4":{"base21":409.08,"tobaccoFactor":1},"5":{"base21":448.41,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":433.32,"tobaccoFactor":1},"2":{"base21":515.55,"tobaccoFactor":1},"4":{"base21":420.02,"tobaccoFactor":1},"5":{"base21":460.39,"tobaccoFactor":1}}}],"ded":{"ind":4400,"fam":8800,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":750,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":750,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":60,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":750,"ded":"after_ded"}}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134931224, \"SG 2027 HMO Health Plan Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hp-rate-change-decision-sm-grp-mkt.pdf, rate pages 41, 42, 44, 45, 47, 48, 50, 51: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $60 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $60 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay after the deductible (its other imaging row, used here). Other diagnostic testing: $80 copay.","Mental health: office visits, psychotherapy and counseling $60 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge after the deductible.","Hospital stay: $750 copay after the deductible once per admission.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134931224/SG 2027 HMO Health Plan Benefit Matrix.xlsx","prev":{"planYear":2026,"rates":{"1":{"base21":348.03,"tobaccoFactor":1},"2":{"base21":414.07,"tobaccoFactor":1},"4":{"base21":337.35,"tobaccoFactor":1},"5":{"base21":369.77,"tobaccoFactor":1}}}},{"market":"group","id":"52899PA0020056-00","standardId":"52899PA0020056-00","variant":"standard","issuer":"UPMC Health Plan","name":"UPMC Small Business Advantage Bronze HMO $9,100 - Standard Network","metal":"Bronze","network":"HMO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Clarion","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":315,"tobaccoFactor":1},"2":{"base21":374.78,"tobaccoFactor":1},"4":{"base21":305.33,"tobaccoFactor":1},"5":{"base21":334.68,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":323.42,"tobaccoFactor":1},"2":{"base21":384.79,"tobaccoFactor":1},"4":{"base21":313.49,"tobaccoFactor":1},"5":{"base21":343.63,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":332.06,"tobaccoFactor":1},"2":{"base21":395.08,"tobaccoFactor":1},"4":{"base21":321.87,"tobaccoFactor":1},"5":{"base21":352.81,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":340.94,"tobaccoFactor":1},"2":{"base21":405.64,"tobaccoFactor":1},"4":{"base21":330.47,"tobaccoFactor":1},"5":{"base21":362.24,"tobaccoFactor":1}}}],"ded":{"ind":9100,"fam":18200,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"copay","amount":95,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134931224, \"SG 2027 HMO Health Plan Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hp-rate-change-decision-sm-grp-mkt.pdf, rate pages 42, 45, 48, 51: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced as free (the primary care visit costs nothing on this plan; UPMC's SBCs print \"No cost\" for prenatal visits, read as before the deductible as for UPMC's individual plans); later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: no charge after the deductible (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: no charge after the deductible (its other imaging row, used here). Other diagnostic testing: no charge after the deductible.","Mental health: office visits, psychotherapy and counseling no charge after the deductible (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge after the deductible.","Prescription drugs: retail (not mail-order) cost shares are used.","Prescription drugs: the medical deductible applies (no separate drug deductible).","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134931224/SG 2027 HMO Health Plan Benefit Matrix.xlsx","prev":{"planYear":2026,"rates":{"1":{"base21":275.79,"tobaccoFactor":1},"2":{"base21":328.12,"tobaccoFactor":1},"4":{"base21":267.32,"tobaccoFactor":1},"5":{"base21":293.02,"tobaccoFactor":1}}}},{"market":"group","id":"53789PA0090004-00","standardId":"53789PA0090004-00","variant":"standard","issuer":"Keystone Health Plan Central","name":"Bronze HMO 8000/0/50","metal":"Bronze","network":"HMO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Union","York"],"rates":{"6":{"base21":505.98,"tobaccoFactor":1},"7":{"base21":546.45,"tobaccoFactor":1},"9":{"base21":516.1,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":519.35,"tobaccoFactor":1},"7":{"base21":560.9,"tobaccoFactor":1},"9":{"base21":529.74,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":533.08,"tobaccoFactor":1},"7":{"base21":575.73,"tobaccoFactor":1},"9":{"base21":543.74,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":547.17,"tobaccoFactor":1},"7":{"base21":590.95,"tobaccoFactor":1},"9":{"base21":558.12,"tobaccoFactor":1}}}],"ded":{"ind":8000,"fam":16000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":85,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Lab tests: $50 copay per visit at an independent lab (used here); $85 copay per visit at a facility-owned lab (hospital or outpatient facility).","Mental health: $85 copay per individual or group outpatient session.","Physical and occupational therapy: limited to 30 visits per benefit period combined (speech therapy has its own 30-visit limit); visits above the limit are not paid by the plan (the limit does not apply to a mental health or substance use diagnosis).","Generic drugs: preferred generics no charge (used here), non-preferred generics no charge, for a 30-day retail supply.","Drug amounts above are for a 30-day retail supply. Prices for a 90-day home-delivery fill: preferred generic no charge, non-preferred generic no charge; preferred brand no charge; non-preferred brand no charge.","Copays marked \"Deductible does not apply\" are charged from the first visit; Capital marks every service it exempts from the deductible that way. Other copays and coinsurance are charged after the deductible (the chart says its costs are after the deductible \"if a deductible applies\"). \"No Charge\" without that marking is read as no charge after the deductible: the SBC coverage examples count those services as \"coinsurance 0%\", and their totals are consistent with this reading. This is a reading, not something the SBC states outright.","This is a small-business (small-group) plan. Capital's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://capbluecross1.my.salesforce.com/sfc/p/3j000000hUJ1/a/Vv000009QbyN/oTt66BZWnYq.hpXmqTjLumesvgGPPdpQYhc8s6UGeuc","prev":{"planYear":2026,"rates":{"6":{"base21":418.41,"tobaccoFactor":1},"7":{"base21":451.88,"tobaccoFactor":1},"9":{"base21":426.77,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0010001-00","standardId":"61389PA0010001-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue Qualified $1750 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Bucks"],"rates":{"8":{"base21":579.45,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":593.78,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":606.34,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":620.87,"tobaccoFactor":1}}}],"ded":{"ind":1750,"fam":3500,"embedded":false},"drugDed":null,"oop":{"ind":8700,"fam":17400,"famPerPerson":12000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":175,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays no charge; at all other network providers lab tests 20% coinsurance and x-rays 20% coinsurance.","Imaging (CT/PET/MRI): no charge at a Member Saving Site (used here); 20% coinsurance at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, lab tests, x-rays, imaging, therapy, outpatient mental health, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","Family deductible: the SBC says the overall family deductible must be met before the plan begins to pay (an aggregate family deductible), and the estimate uses the aggregate family deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245085213/SE_2245085213_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":511.84,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0010002-00","standardId":"61389PA0010002-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue Qualified $2400 90/70 Gold","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Bucks"],"rates":{"8":{"base21":548.2,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":561.76,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":573.64,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":587.38,"tobaccoFactor":1}}}],"ded":{"ind":2400,"fam":4800,"embedded":false},"drugDed":null,"oop":{"ind":8700,"fam":17400,"famPerPerson":12000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests 10% coinsurance and x-rays 10% coinsurance; at all other network providers lab tests 30% coinsurance and x-rays 30% coinsurance.","Imaging (CT/PET/MRI): 10% coinsurance at a Member Saving Site (used here); 30% coinsurance at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","The SBC has no specialty drug row; every drug tier is priced the same, and specialty drugs are priced like them.","Generic drugs (used here): no charge (retail and mail order).","Formulary brand drugs (used here): no charge (retail and mail order).","Non-formulary brand drugs (used here): no charge (retail and mail order).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Generic drugs, formulary brand drugs, non-formulary brand drugs and specialty drugs show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","Family deductible: the SBC says the overall family deductible must be met before the plan begins to pay (an aggregate family deductible), and the estimate uses the aggregate family deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245122879/SE_2245122879_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":473.94,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0010004-00","standardId":"61389PA0010004-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue Qualified Embedded $4250 100/80 Silver","metal":"Silver","network":"PPO","hsaEligible":true,"counties":["Bucks"],"rates":{"8":{"base21":534.9,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":548.13,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":559.72,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":573.14,"tobaccoFactor":1}}}],"ded":{"ind":4250,"fam":8500,"embedded":true},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays no charge; at all other network providers lab tests 20% coinsurance and x-rays 20% coinsurance.","Imaging (CT/PET/MRI): no charge at a Member Saving Site (used here); 20% coinsurance at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $80 copay for a 31-day retail supply ($160 for 60 days, $240 for 90 days); $160 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $150 copay for a 31-day retail supply ($300 for 60 days, $450 for 90 days); $300 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, lab tests, x-rays, imaging, therapy, outpatient mental health, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","Out-of-pocket limit: this SBC says $8,700 for one person; the Rate Pages of the approved rate filing say $11,500 (hshc-rate-change-decision-sm-grp-mkt.pdf, page 45). They agree on the deductible, coinsurance and primary care copay; the SBC, Highmark's January 2027 document, is followed. The Rate Pages amount is far above the federal out-of-pocket limit for an HSA-qualified high deductible plan (2026: $8,500 for one person), which this plan is; the SBC's amount is within it.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245741620/SE_2245741620_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":502.21,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0010005-00","standardId":"61389PA0010005-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue Qualified Embedded $6000 100/80 Silver","metal":"Silver","network":"PPO","hsaEligible":true,"counties":["Bucks"],"rates":{"8":{"base21":525.61,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":538.61,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":550,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":563.18,"tobaccoFactor":1}}}],"ded":{"ind":6000,"fam":12000,"embedded":true},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays no charge; at all other network providers lab tests 20% coinsurance and x-rays 20% coinsurance.","Imaging (CT/PET/MRI): no charge at a Member Saving Site (used here); 20% coinsurance at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","The SBC has no specialty drug row; every drug tier is priced the same, and specialty drugs are priced like them.","Generic drugs (used here): no charge (retail and mail order).","Formulary brand drugs (used here): no charge (retail and mail order).","Non-formulary brand drugs (used here): no charge (retail and mail order).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, emergency room care, lab tests, x-rays, imaging, therapy, outpatient mental health, generic drugs, formulary brand drugs, non-formulary brand drugs, specialty drugs, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245744131/SE_2245744131_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":476.66,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0010006-00","standardId":"61389PA0010006-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue Qualified Embedded $8700 100/80 Bronze","metal":"Bronze","network":"PPO","hsaEligible":true,"counties":["Bucks"],"rates":{"8":{"base21":447.01,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":458.07,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":467.76,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":478.97,"tobaccoFactor":1}}}],"ded":{"ind":8700,"fam":17400,"embedded":true},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays no charge; at all other network providers lab tests 20% coinsurance and x-rays 20% coinsurance.","Imaging (CT/PET/MRI): no charge at a Member Saving Site (used here); 20% coinsurance at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","The SBC has no specialty drug row; every drug tier is priced the same, and specialty drugs are priced like them.","Generic drugs (used here): no charge (retail and mail order).","Formulary brand drugs (used here): no charge (retail and mail order).","Non-formulary brand drugs (used here): no charge (retail and mail order).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, emergency room care, lab tests, x-rays, imaging, therapy, outpatient mental health, generic drugs, formulary brand drugs, non-formulary brand drugs, specialty drugs, outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245745602/SE_2245745602_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":405.86,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0020001-00","standardId":"61389PA0020001-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue Qualified $1750 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Chester"],"rates":{"8":{"base21":579.45,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":593.78,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":606.34,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":620.87,"tobaccoFactor":1}}}],"ded":{"ind":1750,"fam":3500,"embedded":false},"drugDed":null,"oop":{"ind":8700,"fam":17400,"famPerPerson":12000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":175,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays no charge; at all other network providers lab tests 20% coinsurance and x-rays 20% coinsurance.","Imaging (CT/PET/MRI): no charge at a Member Saving Site (used here); 20% coinsurance at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, lab tests, x-rays, imaging, therapy, outpatient mental health, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","Family deductible: the SBC says the overall family deductible must be met before the plan begins to pay (an aggregate family deductible), and the estimate uses the aggregate family deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245086793/SE_2245086793_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":511.84,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0020002-00","standardId":"61389PA0020002-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue Qualified $2400 90/70 Gold","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Chester"],"rates":{"8":{"base21":548.2,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":561.76,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":573.64,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":587.38,"tobaccoFactor":1}}}],"ded":{"ind":2400,"fam":4800,"embedded":false},"drugDed":null,"oop":{"ind":8700,"fam":17400,"famPerPerson":12000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests 10% coinsurance and x-rays 10% coinsurance; at all other network providers lab tests 30% coinsurance and x-rays 30% coinsurance.","Imaging (CT/PET/MRI): 10% coinsurance at a Member Saving Site (used here); 30% coinsurance at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","The SBC has no specialty drug row; every drug tier is priced the same, and specialty drugs are priced like them.","Generic drugs (used here): no charge (retail and mail order).","Formulary brand drugs (used here): no charge (retail and mail order).","Non-formulary brand drugs (used here): no charge (retail and mail order).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Generic drugs, formulary brand drugs, non-formulary brand drugs and specialty drugs show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","Family deductible: the SBC says the overall family deductible must be met before the plan begins to pay (an aggregate family deductible), and the estimate uses the aggregate family deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245123452/SE_2245123452_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":473.94,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0020003-00","standardId":"61389PA0020003-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue Qualified Embedded $3500 1x 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Chester"],"rates":{"8":{"base21":557.66,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":571.45,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":583.54,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":597.52,"tobaccoFactor":1}}}],"ded":{"ind":3500,"fam":3500,"embedded":true},"drugDed":null,"oop":{"ind":8700,"fam":8700},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays no charge; at all other network providers lab tests 20% coinsurance and x-rays 20% coinsurance.","Imaging (CT/PET/MRI): no charge at a Member Saving Site (used here); 20% coinsurance at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, lab tests, x-rays, imaging, therapy, outpatient mental health, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245101365/SE_2245101365_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":489.18,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0020004-00","standardId":"61389PA0020004-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue Qualified Embedded $4250 100/80 Silver","metal":"Silver","network":"PPO","hsaEligible":true,"counties":["Chester"],"rates":{"8":{"base21":534.9,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":548.13,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":559.72,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":573.14,"tobaccoFactor":1}}}],"ded":{"ind":4250,"fam":8500,"embedded":true},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays no charge; at all other network providers lab tests 20% coinsurance and x-rays 20% coinsurance.","Imaging (CT/PET/MRI): no charge at a Member Saving Site (used here); 20% coinsurance at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $80 copay for a 31-day retail supply ($160 for 60 days, $240 for 90 days); $160 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $150 copay for a 31-day retail supply ($300 for 60 days, $450 for 90 days); $300 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, lab tests, x-rays, imaging, therapy, outpatient mental health, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","Out-of-pocket limit: this SBC says $8,700 for one person; the Rate Pages of the approved rate filing say $11,500 (hshc-rate-change-decision-sm-grp-mkt.pdf, page 46). They agree on the deductible, coinsurance and primary care copay; the SBC, Highmark's January 2027 document, is followed. The Rate Pages amount is far above the federal out-of-pocket limit for an HSA-qualified high deductible plan (2026: $8,500 for one person), which this plan is; the SBC's amount is within it.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245742562/SE_2245742562_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":502.21,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0020005-00","standardId":"61389PA0020005-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue Qualified Embedded $6000 100/80 Silver","metal":"Silver","network":"PPO","hsaEligible":true,"counties":["Chester"],"rates":{"8":{"base21":525.61,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":538.61,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":550,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":563.18,"tobaccoFactor":1}}}],"ded":{"ind":6000,"fam":12000,"embedded":true},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays no charge; at all other network providers lab tests 20% coinsurance and x-rays 20% coinsurance.","Imaging (CT/PET/MRI): no charge at a Member Saving Site (used here); 20% coinsurance at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","The SBC has no specialty drug row; every drug tier is priced the same, and specialty drugs are priced like them.","Generic drugs (used here): no charge (retail and mail order).","Formulary brand drugs (used here): no charge (retail and mail order).","Non-formulary brand drugs (used here): no charge (retail and mail order).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, emergency room care, lab tests, x-rays, imaging, therapy, outpatient mental health, generic drugs, formulary brand drugs, non-formulary brand drugs, specialty drugs, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245744302/SE_2245744302_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":476.66,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0020006-00","standardId":"61389PA0020006-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue Qualified Embedded $8700 100/80 Bronze","metal":"Bronze","network":"PPO","hsaEligible":true,"counties":["Chester"],"rates":{"8":{"base21":447.01,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":458.07,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":467.76,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":478.97,"tobaccoFactor":1}}}],"ded":{"ind":8700,"fam":17400,"embedded":true},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays no charge; at all other network providers lab tests 20% coinsurance and x-rays 20% coinsurance.","Imaging (CT/PET/MRI): no charge at a Member Saving Site (used here); 20% coinsurance at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","The SBC has no specialty drug row; every drug tier is priced the same, and specialty drugs are priced like them.","Generic drugs (used here): no charge (retail and mail order).","Formulary brand drugs (used here): no charge (retail and mail order).","Non-formulary brand drugs (used here): no charge (retail and mail order).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, emergency room care, lab tests, x-rays, imaging, therapy, outpatient mental health, generic drugs, formulary brand drugs, non-formulary brand drugs, specialty drugs, outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245745750/SE_2245745750_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":405.86,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0030001-00","standardId":"61389PA0030001-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue Qualified $1750 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Delaware"],"rates":{"8":{"base21":617.56,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":632.83,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":646.22,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":661.7,"tobaccoFactor":1}}}],"ded":{"ind":1750,"fam":3500,"embedded":false},"drugDed":null,"oop":{"ind":8700,"fam":17400,"famPerPerson":12000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":125,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays no charge; at all other network providers lab tests 20% coinsurance and x-rays 20% coinsurance.","Imaging (CT/PET/MRI): no charge at a Member Saving Site (used here); 20% coinsurance at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, emergency room care, lab tests, x-rays, imaging, therapy, outpatient mental health, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","Family deductible: the SBC says the overall family deductible must be met before the plan begins to pay (an aggregate family deductible), and the estimate uses the aggregate family deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245093106/SE_2245093106_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":536.14,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0030002-00","standardId":"61389PA0030002-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue Qualified $2400 95/75 Gold","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Delaware"],"rates":{"8":{"base21":585.79,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":600.28,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":612.97,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":627.66,"tobaccoFactor":1}}}],"ded":{"ind":2400,"fam":4800,"embedded":false},"drugDed":null,"oop":{"ind":7450,"fam":14900,"famPerPerson":12000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.05,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.05,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.05,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.05,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.05,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.05,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.05,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.05,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.05,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.05,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.05,"ded":"after_ded"}}},"notes":["Lab tests and x-rays: at a Member Saving Site (used here) lab tests 5% coinsurance and x-rays 5% coinsurance; at all other network providers lab tests 5% coinsurance and x-rays 5% coinsurance.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","The SBC has no specialty drug row; every drug tier is priced the same, and specialty drugs are priced like them.","Generic drugs (used here): no charge (retail and mail order).","Formulary brand drugs (used here): no charge (retail and mail order).","Non-formulary brand drugs (used here): no charge (retail and mail order).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Generic drugs, formulary brand drugs, non-formulary brand drugs and specialty drugs show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","Family deductible: the SBC says the overall family deductible must be met before the plan begins to pay (an aggregate family deductible), and the estimate uses the aggregate family deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245124648/SE_2245124648_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":496.34,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0030003-00","standardId":"61389PA0030003-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue Qualified Embedded $3500 1x 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Delaware"],"rates":{"8":{"base21":575.9,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":590.15,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":602.63,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":617.07,"tobaccoFactor":1}}}],"ded":{"ind":3500,"fam":3500,"embedded":true},"drugDed":null,"oop":{"ind":5200,"fam":5200},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded","max":350}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays no charge; at all other network providers lab tests 20% coinsurance and x-rays 20% coinsurance.","Imaging (CT/PET/MRI): no charge at a Member Saving Site (used here); 20% coinsurance at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, emergency room care, lab tests, x-rays, imaging, therapy, outpatient mental health, outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245101431/SE_2245101431_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":512.35,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0030005-00","standardId":"61389PA0030005-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue Qualified Embedded $5500 100/80 Silver","metal":"Silver","network":"PPO","hsaEligible":true,"counties":["Delaware"],"rates":{"8":{"base21":543.32,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":556.76,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":568.53,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":582.16,"tobaccoFactor":1}}}],"ded":{"ind":5500,"fam":11000,"embedded":true},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays no charge; at all other network providers lab tests 20% coinsurance and x-rays 20% coinsurance.","Imaging (CT/PET/MRI): no charge at a Member Saving Site (used here); 20% coinsurance at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","The SBC has no specialty drug row; every drug tier is priced the same, and specialty drugs are priced like them.","Generic drugs (used here): no charge (retail and mail order).","Formulary brand drugs (used here): no charge (retail and mail order).","Non-formulary brand drugs (used here): no charge (retail and mail order).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, emergency room care, lab tests, x-rays, imaging, therapy, outpatient mental health, generic drugs, formulary brand drugs, non-formulary brand drugs, specialty drugs, outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245125264/SE_2245125264_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":499.2,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0030006-00","standardId":"61389PA0030006-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue Qualified Embedded $7850 100/80 Bronze","metal":"Bronze","network":"PPO","hsaEligible":true,"counties":["Delaware"],"rates":{"8":{"base21":475.18,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":486.93,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":497.23,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":509.15,"tobaccoFactor":1}}}],"ded":{"ind":7850,"fam":15700,"embedded":true},"drugDed":null,"oop":{"ind":7850,"fam":15700},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays no charge; at all other network providers lab tests 20% coinsurance and x-rays 20% coinsurance.","Imaging (CT/PET/MRI): no charge at a Member Saving Site (used here); 20% coinsurance at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","The SBC has no specialty drug row; every drug tier is priced the same, and specialty drugs are priced like them.","Generic drugs (used here): no charge (retail and mail order).","Formulary brand drugs (used here): no charge (retail and mail order).","Non-formulary brand drugs (used here): no charge (retail and mail order).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, emergency room care, lab tests, x-rays, imaging, therapy, outpatient mental health, generic drugs, formulary brand drugs, non-formulary brand drugs, specialty drugs, outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245077579/SE_2245077579_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":424.89,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0040001-00","standardId":"61389PA0040001-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue Qualified $1750 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Montgomery"],"rates":{"8":{"base21":579.45,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":593.78,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":606.34,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":620.87,"tobaccoFactor":1}}}],"ded":{"ind":1750,"fam":3500,"embedded":false},"drugDed":null,"oop":{"ind":8700,"fam":17400,"famPerPerson":12000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":175,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays no charge; at all other network providers lab tests 20% coinsurance and x-rays 20% coinsurance.","Imaging (CT/PET/MRI): no charge at a Member Saving Site (used here); 20% coinsurance at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, lab tests, x-rays, imaging, therapy, outpatient mental health, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","Family deductible: the SBC says the overall family deductible must be met before the plan begins to pay (an aggregate family deductible), and the estimate uses the aggregate family deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245093996/SE_2245093996_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":487.54,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0040002-00","standardId":"61389PA0040002-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue Qualified $2400 90/70 Gold","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Montgomery"],"rates":{"8":{"base21":548.2,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":561.76,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":573.64,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":587.38,"tobaccoFactor":1}}}],"ded":{"ind":2400,"fam":4800,"embedded":false},"drugDed":null,"oop":{"ind":8700,"fam":17400,"famPerPerson":12000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests 10% coinsurance and x-rays 10% coinsurance; at all other network providers lab tests 30% coinsurance and x-rays 30% coinsurance.","Imaging (CT/PET/MRI): 10% coinsurance at a Member Saving Site (used here); 30% coinsurance at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","The SBC has no specialty drug row; every drug tier is priced the same, and specialty drugs are priced like them.","Generic drugs (used here): no charge (retail and mail order).","Formulary brand drugs (used here): no charge (retail and mail order).","Non-formulary brand drugs (used here): no charge (retail and mail order).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Generic drugs, formulary brand drugs, non-formulary brand drugs and specialty drugs show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","Family deductible: the SBC says the overall family deductible must be met before the plan begins to pay (an aggregate family deductible), and the estimate uses the aggregate family deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245124418/SE_2245124418_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":451.52,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0040003-00","standardId":"61389PA0040003-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue Qualified Embedded $3500 1x 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Montgomery"],"rates":{"8":{"base21":557.66,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":571.45,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":583.54,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":597.52,"tobaccoFactor":1}}}],"ded":{"ind":3500,"fam":3500,"embedded":true},"drugDed":null,"oop":{"ind":8700,"fam":8700},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays no charge; at all other network providers lab tests 20% coinsurance and x-rays 20% coinsurance.","Imaging (CT/PET/MRI): no charge at a Member Saving Site (used here); 20% coinsurance at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, lab tests, x-rays, imaging, therapy, outpatient mental health, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245101508/SE_2245101508_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":466.01,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0040004-00","standardId":"61389PA0040004-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue Qualified Embedded $4250 100/80 Silver","metal":"Silver","network":"PPO","hsaEligible":true,"counties":["Montgomery"],"rates":{"8":{"base21":534.9,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":548.13,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":559.72,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":573.14,"tobaccoFactor":1}}}],"ded":{"ind":4250,"fam":8500,"embedded":true},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays no charge; at all other network providers lab tests 20% coinsurance and x-rays 20% coinsurance.","Imaging (CT/PET/MRI): no charge at a Member Saving Site (used here); 20% coinsurance at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $80 copay for a 31-day retail supply ($160 for 60 days, $240 for 90 days); $160 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $150 copay for a 31-day retail supply ($300 for 60 days, $450 for 90 days); $300 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, lab tests, x-rays, imaging, therapy, outpatient mental health, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","Out-of-pocket limit: this SBC says $8,700 for one person; the Rate Pages of the approved rate filing say $11,500 (hshc-rate-change-decision-sm-grp-mkt.pdf, page 48). They agree on the deductible, coinsurance and primary care copay; the SBC, Highmark's January 2027 document, is followed. The Rate Pages amount is far above the federal out-of-pocket limit for an HSA-qualified high deductible plan (2026: $8,500 for one person), which this plan is; the SBC's amount is within it.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245743510/SE_2245743510_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":478.39,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0040005-00","standardId":"61389PA0040005-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue Qualified Embedded $6000 100/80 Silver","metal":"Silver","network":"PPO","hsaEligible":true,"counties":["Montgomery"],"rates":{"8":{"base21":525.61,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":538.61,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":550,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":563.18,"tobaccoFactor":1}}}],"ded":{"ind":6000,"fam":12000,"embedded":true},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays no charge; at all other network providers lab tests 20% coinsurance and x-rays 20% coinsurance.","Imaging (CT/PET/MRI): no charge at a Member Saving Site (used here); 20% coinsurance at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","The SBC has no specialty drug row; every drug tier is priced the same, and specialty drugs are priced like them.","Generic drugs (used here): no charge (retail and mail order).","Formulary brand drugs (used here): no charge (retail and mail order).","Non-formulary brand drugs (used here): no charge (retail and mail order).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, emergency room care, lab tests, x-rays, imaging, therapy, outpatient mental health, generic drugs, formulary brand drugs, non-formulary brand drugs, specialty drugs, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245745094/SE_2245745094_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":454.11,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0040006-00","standardId":"61389PA0040006-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue Qualified Embedded $8700 100/80 Bronze","metal":"Bronze","network":"PPO","hsaEligible":true,"counties":["Montgomery"],"rates":{"8":{"base21":447.01,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":458.07,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":467.76,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":478.97,"tobaccoFactor":1}}}],"ded":{"ind":8700,"fam":17400,"embedded":true},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays no charge; at all other network providers lab tests 20% coinsurance and x-rays 20% coinsurance.","Imaging (CT/PET/MRI): no charge at a Member Saving Site (used here); 20% coinsurance at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","The SBC has no specialty drug row; every drug tier is priced the same, and specialty drugs are priced like them.","Generic drugs (used here): no charge (retail and mail order).","Formulary brand drugs (used here): no charge (retail and mail order).","Non-formulary brand drugs (used here): no charge (retail and mail order).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, emergency room care, lab tests, x-rays, imaging, therapy, outpatient mental health, generic drugs, formulary brand drugs, non-formulary brand drugs, specialty drugs, outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245745871/SE_2245745871_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":386.82,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0050001-00","standardId":"61389PA0050001-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue Qualified $1750 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Philadelphia"],"rates":{"8":{"base21":579.45,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":593.78,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":606.34,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":620.87,"tobaccoFactor":1}}}],"ded":{"ind":1750,"fam":3500,"embedded":false},"drugDed":null,"oop":{"ind":8700,"fam":17400,"famPerPerson":12000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":175,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays no charge; at all other network providers lab tests 20% coinsurance and x-rays 20% coinsurance.","Imaging (CT/PET/MRI): no charge at a Member Saving Site (used here); 20% coinsurance at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, lab tests, x-rays, imaging, therapy, outpatient mental health, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","Family deductible: the SBC says the overall family deductible must be met before the plan begins to pay (an aggregate family deductible), and the estimate uses the aggregate family deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245096791/SE_2245096791_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":499.69,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0050002-00","standardId":"61389PA0050002-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue Qualified $2400 90/70 Gold","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Philadelphia"],"rates":{"8":{"base21":548.2,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":561.76,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":573.64,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":587.38,"tobaccoFactor":1}}}],"ded":{"ind":2400,"fam":4800,"embedded":false},"drugDed":null,"oop":{"ind":8700,"fam":17400,"famPerPerson":12000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests 10% coinsurance and x-rays 10% coinsurance; at all other network providers lab tests 30% coinsurance and x-rays 30% coinsurance.","Imaging (CT/PET/MRI): 10% coinsurance at a Member Saving Site (used here); 30% coinsurance at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","The SBC has no specialty drug row; every drug tier is priced the same, and specialty drugs are priced like them.","Generic drugs (used here): no charge (retail and mail order).","Formulary brand drugs (used here): no charge (retail and mail order).","Non-formulary brand drugs (used here): no charge (retail and mail order).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Generic drugs, formulary brand drugs, non-formulary brand drugs and specialty drugs show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","Family deductible: the SBC says the overall family deductible must be met before the plan begins to pay (an aggregate family deductible), and the estimate uses the aggregate family deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245124574/SE_2245124574_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":462.73,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0050003-00","standardId":"61389PA0050003-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue Qualified Embedded $3500 1x 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Philadelphia"],"rates":{"8":{"base21":557.66,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":571.45,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":583.54,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":597.52,"tobaccoFactor":1}}}],"ded":{"ind":3500,"fam":3500,"embedded":true},"drugDed":null,"oop":{"ind":8700,"fam":8700},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays no charge; at all other network providers lab tests 20% coinsurance and x-rays 20% coinsurance.","Imaging (CT/PET/MRI): no charge at a Member Saving Site (used here); 20% coinsurance at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, lab tests, x-rays, imaging, therapy, outpatient mental health, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245101998/SE_2245101998_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":477.6,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0050004-00","standardId":"61389PA0050004-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue Qualified Embedded $4250 100/80 Silver","metal":"Silver","network":"PPO","hsaEligible":true,"counties":["Philadelphia"],"rates":{"8":{"base21":534.9,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":548.13,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":559.72,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":573.14,"tobaccoFactor":1}}}],"ded":{"ind":4250,"fam":8500,"embedded":true},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays no charge; at all other network providers lab tests 20% coinsurance and x-rays 20% coinsurance.","Imaging (CT/PET/MRI): no charge at a Member Saving Site (used here); 20% coinsurance at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $80 copay for a 31-day retail supply ($160 for 60 days, $240 for 90 days); $160 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $150 copay for a 31-day retail supply ($300 for 60 days, $450 for 90 days); $300 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, lab tests, x-rays, imaging, therapy, outpatient mental health, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","Out-of-pocket limit: this SBC says $8,700 for one person; the Rate Pages of the approved rate filing say $11,500 (hshc-rate-change-decision-sm-grp-mkt.pdf, page 49). They agree on the deductible, coinsurance and primary care copay; the SBC, Highmark's January 2027 document, is followed. The Rate Pages amount is far above the federal out-of-pocket limit for an HSA-qualified high deductible plan (2026: $8,500 for one person), which this plan is; the SBC's amount is within it.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245743816/SE_2245743816_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":490.3,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0050005-00","standardId":"61389PA0050005-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue Qualified Embedded $6000 100/80 Silver","metal":"Silver","network":"PPO","hsaEligible":true,"counties":["Philadelphia"],"rates":{"8":{"base21":525.61,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":538.61,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":550,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":563.18,"tobaccoFactor":1}}}],"ded":{"ind":6000,"fam":12000,"embedded":true},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays no charge; at all other network providers lab tests 20% coinsurance and x-rays 20% coinsurance.","Imaging (CT/PET/MRI): no charge at a Member Saving Site (used here); 20% coinsurance at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","The SBC has no specialty drug row; every drug tier is priced the same, and specialty drugs are priced like them.","Generic drugs (used here): no charge (retail and mail order).","Formulary brand drugs (used here): no charge (retail and mail order).","Non-formulary brand drugs (used here): no charge (retail and mail order).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, emergency room care, lab tests, x-rays, imaging, therapy, outpatient mental health, generic drugs, formulary brand drugs, non-formulary brand drugs, specialty drugs, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245745491/SE_2245745491_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":465.39,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0050006-00","standardId":"61389PA0050006-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue Qualified Embedded $8700 100/80 Bronze","metal":"Bronze","network":"PPO","hsaEligible":true,"counties":["Philadelphia"],"rates":{"8":{"base21":447.01,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":458.07,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":467.76,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":478.97,"tobaccoFactor":1}}}],"ded":{"ind":8700,"fam":17400,"embedded":true},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays no charge; at all other network providers lab tests 20% coinsurance and x-rays 20% coinsurance.","Imaging (CT/PET/MRI): no charge at a Member Saving Site (used here); 20% coinsurance at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","The SBC has no specialty drug row; every drug tier is priced the same, and specialty drugs are priced like them.","Generic drugs (used here): no charge (retail and mail order).","Formulary brand drugs (used here): no charge (retail and mail order).","Non-formulary brand drugs (used here): no charge (retail and mail order).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, emergency room care, lab tests, x-rays, imaging, therapy, outpatient mental health, generic drugs, formulary brand drugs, non-formulary brand drugs, specialty drugs, outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245745979/SE_2245745979_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":396.34,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0060001-00","standardId":"61389PA0060001-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $0 100/80 Platinum","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Bucks"],"rates":{"8":{"base21":684.99,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":701.93,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":716.78,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":733.95,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":8000,"fam":16000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":225,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":170,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":35,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"no_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $500 copay per day for the first 5 days of a stay, then no charge. The SBC prints \"$500 copay, up to 5 days, then no charge\" without \"per day\"; it is read as a copay per day, as Highmark's 2026 SBCs printed \"$N copay per day, up to N days, then no charge\" (no 2027 SBC says \"per day\").","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $75 copay and x-rays $75 copay; at all other network providers lab tests $150 copay and x-rays $150 copay.","Imaging (CT/PET/MRI): $170 copay at a Member Saving Site (used here); $340 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","No network deductible: copays and coinsurance apply from the first visit.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245126690/SE_2245126690_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":645.91,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0060002-00","standardId":"61389PA0060002-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $0 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bucks"],"rates":{"8":{"base21":585.39,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":599.87,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":612.56,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":627.24,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":650,"ded":"no_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $650 copay per day for the first 5 days of a stay, then no charge. The SBC prints \"$650 copay, up to 5 days, then no charge\" without \"per day\"; it is read as a copay per day, as Highmark's 2026 SBCs printed \"$N copay per day, up to N days, then no charge\" (no 2027 SBC says \"per day\").","Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays $150 copay; at all other network providers lab tests 20% coinsurance and x-rays $300 copay.","Imaging (CT/PET/MRI): $300 copay at a Member Saving Site (used here); $600 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $150 copay for a 31-day retail supply ($300 for 60 days, $450 for 90 days); $150 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","No network deductible: copays and coinsurance apply from the first visit.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245079879/SE_2245079879_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":543.4,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0060003-00","standardId":"61389PA0060003-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $5500 100/80 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bucks"],"rates":{"8":{"base21":477.65,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":489.46,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":499.81,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":511.79,"tobaccoFactor":1}}}],"ded":{"ind":5500,"fam":11000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":600,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":150,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":1750,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $1,750 copay per admission, charged on the first day of each stay. The other days count toward the deductible until it is met, then cost nothing more. The SBC prints \"$1,750 copay/visit\"; a hospital visit is read as one stay (Highmark's 2026 SBCs said \"per admission\").","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $150 copay and x-rays $150 copay; at all other network providers lab tests $300 copay and x-rays $300 copay.","Imaging (CT/PET/MRI): $500 copay at a Member Saving Site (used here); $1,000 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Lab tests, x-rays and imaging: the chart marks them \"Deductible does not apply\"; page 1 does not list them among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245118809/SE_2245118809_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":445.63,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0060004-00","standardId":"61389PA0060004-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $1000 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bucks"],"rates":{"8":{"base21":561.74,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":575.64,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":587.81,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":601.9,"tobaccoFactor":1}}}],"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $80 copay and x-rays $80 copay; at all other network providers lab tests $160 copay and x-rays $160 copay.","Imaging (CT/PET/MRI): $450 copay at a Member Saving Site (used here); $900 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Lab tests, x-rays and imaging: the chart marks them \"Deductible does not apply\"; page 1 does not list them among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245111181/SE_2245111181_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":500.33,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0060005-00","standardId":"61389PA0060005-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $1400 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bucks"],"rates":{"8":{"base21":560.06,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":573.92,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":586.05,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":600.1,"tobaccoFactor":1}}}],"ded":{"ind":1400,"fam":2800,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":150,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $150 copay and x-rays $150 copay; at all other network providers lab tests $300 copay and x-rays $300 copay.","Imaging (CT/PET/MRI): $350 copay at a Member Saving Site (used here); $700 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $75 copay for a 31-day retail supply ($150 for 60 days, $225 for 90 days); $150 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $150 copay for a 31-day retail supply ($300 for 60 days, $450 for 90 days); $300 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Outpatient surgery facility fee: the chart marks it \"Deductible does not apply\"; page 1 does not list it among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245126598/SE_2245126598_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":507.77,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0060006-00","standardId":"61389PA0060006-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $2500 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bucks"],"rates":{"8":{"base21":532.45,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":545.62,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":557.16,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":570.51,"tobaccoFactor":1}}}],"ded":{"ind":2500,"fam":5000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":115,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":125,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays $70 copay; at all other network providers lab tests 20% coinsurance and x-rays $140 copay.","Imaging (CT/PET/MRI): $250 copay at a Member Saving Site (used here); $500 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $20 copay for a 31-day retail supply ($40 for 60 days, $60 for 90 days); $20 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","X-rays and imaging: the chart marks them \"Deductible does not apply\"; page 1 does not list them among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Lab tests, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245078349/SE_2245078349_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":484.08,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0060007-00","standardId":"61389PA0060007-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $3500 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bucks"],"rates":{"8":{"base21":544.21,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":557.67,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":569.46,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":583.11,"tobaccoFactor":1}}}],"ded":{"ind":3500,"fam":7000,"embedded":true},"drugDed":null,"oop":{"ind":10000,"fam":20000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":180,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays no charge; at all other network providers lab tests 20% coinsurance and x-rays 20% coinsurance.","Imaging (CT/PET/MRI): no charge at a Member Saving Site (used here); 20% coinsurance at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $80 copay for a 31-day retail supply ($160 for 60 days, $240 for 90 days); $160 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, lab tests, x-rays, imaging, therapy, outpatient mental health, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245099730/SE_2245099730_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":474.85,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0060008-00","standardId":"61389PA0060008-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $0 100/80 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bucks"],"rates":{"8":{"base21":547.96,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":561.52,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":573.39,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":587.13,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":650,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":600,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":750,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":1500,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $1,500 copay per admission, charged on the first day of each stay. The SBC prints \"$1,500 copay/visit\"; a hospital visit is read as one stay (Highmark's 2026 SBCs said \"per admission\").","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $200 copay and x-rays $200 copay; at all other network providers lab tests $400 copay and x-rays $400 copay.","Imaging (CT/PET/MRI): $600 copay at a Member Saving Site (used here); $1,200 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","No network deductible: copays and coinsurance apply from the first visit.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245099592/SE_2245099592_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":508.56,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0060009-00","standardId":"61389PA0060009-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $5000 60/40 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bucks"],"rates":{"8":{"base21":456.1,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":467.38,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":477.27,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":488.71,"tobaccoFactor":1}}}],"ded":{"ind":5000,"fam":10000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":600,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":150,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":600,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Lab tests and x-rays: at a Member Saving Site (used here) lab tests 40% coinsurance and x-rays 40% coinsurance; at all other network providers lab tests 60% coinsurance and x-rays 60% coinsurance.","Imaging (CT/PET/MRI): 40% coinsurance at a Member Saving Site (used here); 60% coinsurance at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245731452/SE_2245731452_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":460.13,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0060010-00","standardId":"61389PA0060010-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $500 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Bucks"],"rates":{"8":{"base21":582.34,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":596.74,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":609.36,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":623.97,"tobaccoFactor":1}}}],"ded":{"ind":500,"fam":1000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":600,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":375,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":70,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $65 copay and x-rays $65 copay; at all other network providers lab tests $130 copay and x-rays $130 copay.","Imaging (CT/PET/MRI): $375 copay at a Member Saving Site (used here); $750 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $20 copay for a 31-day retail supply ($40 for 60 days, $60 for 90 days); $20 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Lab tests, x-rays and imaging: the chart marks them \"Deductible does not apply\"; page 1 does not list them among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245102749/SE_2245102749_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":514.71,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0060011-00","standardId":"61389PA0060011-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $7000 100/80 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Bucks"],"rates":{"8":{"base21":449.32,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":460.44,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":470.17,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":481.44,"tobaccoFactor":1}}}],"ded":{"ind":7000,"fam":14000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":600,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":150,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":750,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":1500,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $1,500 copay per admission, charged on the first day of each stay. The other days count toward the deductible until it is met, then cost nothing more. The SBC prints \"$1,500 copay/visit\"; a hospital visit is read as one stay (Highmark's 2026 SBCs said \"per admission\").","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $150 copay and x-rays $200 copay; at all other network providers lab tests $300 copay and x-rays $400 copay.","Imaging (CT/PET/MRI): $350 copay at a Member Saving Site (used here); $700 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Lab tests and x-rays: the chart marks them \"Deductible does not apply\"; page 1 does not list them among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245736474/SE_2245736474_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":429.52,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0060012-00","standardId":"61389PA0060012-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $1000 100/80 Platinum","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Bucks"],"rates":{"8":{"base21":669.68,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":686.24,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":700.76,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":717.55,"tobaccoFactor":1}}}],"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":35,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $40 copay and x-rays $40 copay; at all other network providers lab tests $80 copay and x-rays $80 copay.","Imaging (CT/PET/MRI): $100 copay at a Member Saving Site (used here); $200 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Lab tests, x-rays and imaging: the chart marks them \"Deductible does not apply\"; page 1 does not list them among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245725938/SE_2245725938_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":623.96,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0070001-00","standardId":"61389PA0070001-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $0 100/80 Platinum","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Chester"],"rates":{"8":{"base21":684.99,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":701.93,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":716.78,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":733.95,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":8000,"fam":16000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":225,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":170,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":35,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"no_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $500 copay per day for the first 5 days of a stay, then no charge. The SBC prints \"$500 copay, up to 5 days, then no charge\" without \"per day\"; it is read as a copay per day, as Highmark's 2026 SBCs printed \"$N copay per day, up to N days, then no charge\" (no 2027 SBC says \"per day\").","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $75 copay and x-rays $75 copay; at all other network providers lab tests $150 copay and x-rays $150 copay.","Imaging (CT/PET/MRI): $170 copay at a Member Saving Site (used here); $340 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","No network deductible: copays and coinsurance apply from the first visit.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245127438/SE_2245127438_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":645.91,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0070002-00","standardId":"61389PA0070002-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $0 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Chester"],"rates":{"8":{"base21":585.39,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":599.87,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":612.56,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":627.24,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":650,"ded":"no_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $650 copay per day for the first 5 days of a stay, then no charge. The SBC prints \"$650 copay, up to 5 days, then no charge\" without \"per day\"; it is read as a copay per day, as Highmark's 2026 SBCs printed \"$N copay per day, up to N days, then no charge\" (no 2027 SBC says \"per day\").","Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays $150 copay; at all other network providers lab tests 20% coinsurance and x-rays $300 copay.","Imaging (CT/PET/MRI): $300 copay at a Member Saving Site (used here); $600 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $150 copay for a 31-day retail supply ($300 for 60 days, $450 for 90 days); $150 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","No network deductible: copays and coinsurance apply from the first visit.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245072342/SE_2245072342_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":543.4,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0070003-00","standardId":"61389PA0070003-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $5500 100/80 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Chester"],"rates":{"8":{"base21":477.65,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":489.46,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":499.81,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":511.79,"tobaccoFactor":1}}}],"ded":{"ind":5500,"fam":11000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":600,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":150,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":1750,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $1,750 copay per admission, charged on the first day of each stay. The other days count toward the deductible until it is met, then cost nothing more. The SBC prints \"$1,750 copay/visit\"; a hospital visit is read as one stay (Highmark's 2026 SBCs said \"per admission\").","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $150 copay and x-rays $150 copay; at all other network providers lab tests $300 copay and x-rays $300 copay.","Imaging (CT/PET/MRI): $500 copay at a Member Saving Site (used here); $1,000 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Lab tests, x-rays and imaging: the chart marks them \"Deductible does not apply\"; page 1 does not list them among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245119735/SE_2245119735_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":445.63,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0070004-00","standardId":"61389PA0070004-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $1000 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Chester"],"rates":{"8":{"base21":561.74,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":575.64,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":587.81,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":601.9,"tobaccoFactor":1}}}],"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $80 copay and x-rays $80 copay; at all other network providers lab tests $160 copay and x-rays $160 copay.","Imaging (CT/PET/MRI): $450 copay at a Member Saving Site (used here); $900 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Lab tests, x-rays and imaging: the chart marks them \"Deductible does not apply\"; page 1 does not list them among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245112498/SE_2245112498_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":500.33,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0070005-00","standardId":"61389PA0070005-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $1400 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Chester"],"rates":{"8":{"base21":560.06,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":573.92,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":586.05,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":600.1,"tobaccoFactor":1}}}],"ded":{"ind":1400,"fam":2800,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":150,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $150 copay and x-rays $150 copay; at all other network providers lab tests $300 copay and x-rays $300 copay.","Imaging (CT/PET/MRI): $350 copay at a Member Saving Site (used here); $700 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $75 copay for a 31-day retail supply ($150 for 60 days, $225 for 90 days); $150 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $150 copay for a 31-day retail supply ($300 for 60 days, $450 for 90 days); $300 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Outpatient surgery facility fee: the chart marks it \"Deductible does not apply\"; page 1 does not list it among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245724666/SE_2245724666_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":507.77,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0070006-00","standardId":"61389PA0070006-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $2500 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Chester"],"rates":{"8":{"base21":532.45,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":545.62,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":557.16,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":570.51,"tobaccoFactor":1}}}],"ded":{"ind":2500,"fam":5000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":115,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":125,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays $70 copay; at all other network providers lab tests 20% coinsurance and x-rays $140 copay.","Imaging (CT/PET/MRI): $250 copay at a Member Saving Site (used here); $500 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $20 copay for a 31-day retail supply ($40 for 60 days, $60 for 90 days); $20 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","X-rays and imaging: the chart marks them \"Deductible does not apply\"; page 1 does not list them among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Lab tests, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245071580/SE_2245071580_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":484.08,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0070007-00","standardId":"61389PA0070007-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $3500 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Chester"],"rates":{"8":{"base21":544.21,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":557.67,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":569.46,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":583.11,"tobaccoFactor":1}}}],"ded":{"ind":3500,"fam":7000,"embedded":true},"drugDed":null,"oop":{"ind":10000,"fam":20000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":180,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays no charge; at all other network providers lab tests 20% coinsurance and x-rays 20% coinsurance.","Imaging (CT/PET/MRI): no charge at a Member Saving Site (used here); 20% coinsurance at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $80 copay for a 31-day retail supply ($160 for 60 days, $240 for 90 days); $160 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, lab tests, x-rays, imaging, therapy, outpatient mental health, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245099974/SE_2245099974_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":474.85,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0070008-00","standardId":"61389PA0070008-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $0 100/80 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Chester"],"rates":{"8":{"base21":547.96,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":561.52,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":573.39,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":587.13,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":650,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":600,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":750,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":1500,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $1,500 copay per admission, charged on the first day of each stay. The SBC prints \"$1,500 copay/visit\"; a hospital visit is read as one stay (Highmark's 2026 SBCs said \"per admission\").","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $200 copay and x-rays $200 copay; at all other network providers lab tests $400 copay and x-rays $400 copay.","Imaging (CT/PET/MRI): $600 copay at a Member Saving Site (used here); $1,200 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","No network deductible: copays and coinsurance apply from the first visit.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245099501/SE_2245099501_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":508.56,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0070009-00","standardId":"61389PA0070009-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $5000 60/40 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Chester"],"rates":{"8":{"base21":456.1,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":467.38,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":477.27,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":488.71,"tobaccoFactor":1}}}],"ded":{"ind":5000,"fam":10000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":600,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":150,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":600,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Lab tests and x-rays: at a Member Saving Site (used here) lab tests 40% coinsurance and x-rays 40% coinsurance; at all other network providers lab tests 60% coinsurance and x-rays 60% coinsurance.","Imaging (CT/PET/MRI): 40% coinsurance at a Member Saving Site (used here); 60% coinsurance at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245732013/SE_2245732013_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":460.13,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0070010-00","standardId":"61389PA0070010-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $500 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Chester"],"rates":{"8":{"base21":582.34,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":596.74,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":609.36,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":623.97,"tobaccoFactor":1}}}],"ded":{"ind":500,"fam":1000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":600,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":375,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":70,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $65 copay and x-rays $65 copay; at all other network providers lab tests $130 copay and x-rays $130 copay.","Imaging (CT/PET/MRI): $375 copay at a Member Saving Site (used here); $750 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $20 copay for a 31-day retail supply ($40 for 60 days, $60 for 90 days); $20 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Lab tests, x-rays and imaging: the chart marks them \"Deductible does not apply\"; page 1 does not list them among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245103235/SE_2245103235_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":514.71,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0070011-00","standardId":"61389PA0070011-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $7000 100/80 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Chester"],"rates":{"8":{"base21":449.32,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":460.44,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":470.17,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":481.44,"tobaccoFactor":1}}}],"ded":{"ind":7000,"fam":14000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":600,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":150,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":750,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":1500,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $1,500 copay per admission, charged on the first day of each stay. The other days count toward the deductible until it is met, then cost nothing more. The SBC prints \"$1,500 copay/visit\"; a hospital visit is read as one stay (Highmark's 2026 SBCs said \"per admission\").","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $150 copay and x-rays $200 copay; at all other network providers lab tests $300 copay and x-rays $400 copay.","Imaging (CT/PET/MRI): $350 copay at a Member Saving Site (used here); $700 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Lab tests and x-rays: the chart marks them \"Deductible does not apply\"; page 1 does not list them among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245737496/SE_2245737496_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":429.52,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0070012-00","standardId":"61389PA0070012-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $1000 100/80 Platinum","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Chester"],"rates":{"8":{"base21":669.68,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":686.24,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":700.76,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":717.55,"tobaccoFactor":1}}}],"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":35,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $40 copay and x-rays $40 copay; at all other network providers lab tests $80 copay and x-rays $80 copay.","Imaging (CT/PET/MRI): $100 copay at a Member Saving Site (used here); $200 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Lab tests, x-rays and imaging: the chart marks them \"Deductible does not apply\"; page 1 does not list them among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245726292/SE_2245726292_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":623.96,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0080001-00","standardId":"61389PA0080001-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $0 100/80 Platinum","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Delaware"],"rates":{"8":{"base21":712.05,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":729.66,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":745.09,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":762.95,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":6000,"fam":12000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":175,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":35,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"no_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $200 copay per day for the first 5 days of a stay, then no charge. The SBC prints \"$200 copay, up to 5 days, then no charge\" without \"per day\"; it is read as a copay per day, as Highmark's 2026 SBCs printed \"$N copay per day, up to N days, then no charge\" (no 2027 SBC says \"per day\").","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $20 copay and x-rays $30 copay; at all other network providers lab tests $40 copay and x-rays $60 copay.","Imaging (CT/PET/MRI): $100 copay at a Member Saving Site (used here); $200 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","No network deductible: copays and coinsurance apply from the first visit.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245095704/SE_2245095704_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":676.88,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0080002-00","standardId":"61389PA0080002-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $0 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Delaware"],"rates":{"8":{"base21":631.49,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":647.11,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":660.79,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":676.63,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"no_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $500 copay per day for the first 5 days of a stay, then no charge. The SBC prints \"$500 copay, up to 5 days, then no charge\" without \"per day\"; it is read as a copay per day, as Highmark's 2026 SBCs printed \"$N copay per day, up to N days, then no charge\" (no 2027 SBC says \"per day\").","Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays $80 copay; at all other network providers lab tests 20% coinsurance and x-rays $160 copay.","Imaging (CT/PET/MRI): $150 copay at a Member Saving Site (used here); $300 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $150 copay for a 31-day retail supply ($300 for 60 days, $450 for 90 days); $150 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","No network deductible: copays and coinsurance apply from the first visit.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245072481/SE_2245072481_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":569.26,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0080003-00","standardId":"61389PA0080003-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $4600 100/80 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Delaware"],"rates":{"8":{"base21":507.35,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":519.9,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":530.89,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":543.62,"tobaccoFactor":1}}}],"ded":{"ind":4600,"fam":9200,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":355,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":70,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $70 copay and x-rays $70 copay; at all other network providers lab tests $140 copay and x-rays $140 copay.","Imaging (CT/PET/MRI): $300 copay at a Member Saving Site (used here); $600 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Lab tests, x-rays and imaging: the chart marks them \"Deductible does not apply\"; page 1 does not list them among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245116998/SE_2245116998_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":466.63,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0080004-00","standardId":"61389PA0080004-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $1000 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Delaware"],"rates":{"8":{"base21":594.4,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":609.11,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":621.99,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":636.89,"tobaccoFactor":1}}}],"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":9100,"fam":18200},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $60 copay and x-rays $60 copay; at all other network providers lab tests $120 copay and x-rays $120 copay.","Imaging (CT/PET/MRI): $350 copay at a Member Saving Site (used here); $700 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Lab tests, x-rays and imaging: the chart marks them \"Deductible does not apply\"; page 1 does not list them among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245115595/SE_2245115595_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":524.05,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0080005-00","standardId":"61389PA0080005-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $1400 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Delaware"],"rates":{"8":{"base21":610.47,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":625.57,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":638.8,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":654.11,"tobaccoFactor":1}}}],"ded":{"ind":1400,"fam":2800,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $50 copay and x-rays $50 copay; at all other network providers lab tests $100 copay and x-rays $100 copay.","Imaging (CT/PET/MRI): $200 copay at a Member Saving Site (used here); $400 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $75 copay for a 31-day retail supply ($150 for 60 days, $225 for 90 days); $150 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $150 copay for a 31-day retail supply ($300 for 60 days, $450 for 90 days); $300 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Outpatient surgery facility fee: the chart marks it \"Deductible does not apply\"; page 1 does not list it among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245725756/SE_2245725756_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":531.86,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0080006-00","standardId":"61389PA0080006-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $2500 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Delaware"],"rates":{"8":{"base21":569.01,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":583.08,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":595.42,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":609.68,"tobaccoFactor":1}}}],"ded":{"ind":2500,"fam":5000,"embedded":true},"drugDed":null,"oop":{"ind":7000,"fam":14000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays $70 copay; at all other network providers lab tests 20% coinsurance and x-rays $140 copay.","Imaging (CT/PET/MRI): $150 copay at a Member Saving Site (used here); $300 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $20 copay for a 31-day retail supply ($40 for 60 days, $60 for 90 days); $20 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","X-rays and imaging: the chart marks them \"Deductible does not apply\"; page 1 does not list them among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Lab tests, outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245083065/SE_2245083065_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":507,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0080007-00","standardId":"61389PA0080007-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $3500 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Delaware"],"rates":{"8":{"base21":562.52,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":576.43,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":588.62,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":602.73,"tobaccoFactor":1}}}],"ded":{"ind":3500,"fam":7000,"embedded":true},"drugDed":null,"oop":{"ind":7450,"fam":14900},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays no charge; at all other network providers lab tests 20% coinsurance and x-rays 20% coinsurance.","Imaging (CT/PET/MRI): no charge at a Member Saving Site (used here); 20% coinsurance at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $80 copay for a 31-day retail supply ($160 for 60 days, $240 for 90 days); $160 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, emergency room care, lab tests, x-rays, imaging, therapy, outpatient mental health, outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245100199/SE_2245100199_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":497.3,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0080009-00","standardId":"61389PA0080009-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $3800 70/50 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Delaware"],"rates":{"8":{"base21":482.4,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":494.33,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":504.79,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":516.89,"tobaccoFactor":1}}}],"ded":{"ind":3800,"fam":7600,"embedded":true},"drugDed":null,"oop":{"ind":10650,"fam":21300},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Lab tests and x-rays: at a Member Saving Site (used here) lab tests 30% coinsurance and x-rays 30% coinsurance; at all other network providers lab tests 50% coinsurance and x-rays 50% coinsurance.","Imaging (CT/PET/MRI): 30% coinsurance at a Member Saving Site (used here); 50% coinsurance at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245102235/SE_2245102235_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":481.85,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0080010-00","standardId":"61389PA0080010-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $500 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Delaware"],"rates":{"8":{"base21":622.17,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":637.56,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":651.05,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":666.65,"tobaccoFactor":1}}}],"ded":{"ind":500,"fam":1000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":405,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":375,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":70,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $65 copay and x-rays $65 copay; at all other network providers lab tests $130 copay and x-rays $130 copay.","Imaging (CT/PET/MRI): $375 copay at a Member Saving Site (used here); $750 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $20 copay for a 31-day retail supply ($40 for 60 days, $60 for 90 days); $20 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Lab tests, x-rays and imaging: the chart marks them \"Deductible does not apply\"; page 1 does not list them among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245103883/SE_2245103883_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":539.15,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0080011-00","standardId":"61389PA0080011-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $6000 100/80 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Delaware"],"rates":{"8":{"base21":472.42,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":484.11,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":494.34,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":506.19,"tobaccoFactor":1}}}],"ded":{"ind":6000,"fam":12000,"embedded":true},"drugDed":null,"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":275,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":125,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $125 copay and x-rays $125 copay; at all other network providers lab tests $250 copay and x-rays $250 copay.","Imaging (CT/PET/MRI): $275 copay at a Member Saving Site (used here); $550 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Lab tests and x-rays: the chart marks them \"Deductible does not apply\"; page 1 does not list them among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245735119/SE_2245735119_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":449.72,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0080012-00","standardId":"61389PA0080012-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $750 100/80 Platinum","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Delaware"],"rates":{"8":{"base21":702.17,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":719.54,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":734.75,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":752.36,"tobaccoFactor":1}}}],"ded":{"ind":750,"fam":1500,"embedded":true},"drugDed":null,"oop":{"ind":3500,"fam":7000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":35,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $40 copay and x-rays $40 copay; at all other network providers lab tests $80 copay and x-rays $80 copay.","Imaging (CT/PET/MRI): $100 copay at a Member Saving Site (used here); $200 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245739340/SE_2245739340_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":653.84,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0090001-00","standardId":"61389PA0090001-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $0 100/80 Platinum","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Montgomery"],"rates":{"8":{"base21":684.99,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":701.93,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":716.78,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":733.95,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":8000,"fam":16000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":225,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":170,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":35,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"no_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $500 copay per day for the first 5 days of a stay, then no charge. The SBC prints \"$500 copay, up to 5 days, then no charge\" without \"per day\"; it is read as a copay per day, as Highmark's 2026 SBCs printed \"$N copay per day, up to N days, then no charge\" (no 2027 SBC says \"per day\").","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $75 copay and x-rays $75 copay; at all other network providers lab tests $150 copay and x-rays $150 copay.","Imaging (CT/PET/MRI): $170 copay at a Member Saving Site (used here); $340 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","No network deductible: copays and coinsurance apply from the first visit.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245097779/SE_2245097779_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":614.94,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0090002-00","standardId":"61389PA0090002-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $0 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Montgomery"],"rates":{"8":{"base21":585.39,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":599.87,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":612.56,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":627.24,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":650,"ded":"no_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $650 copay per day for the first 5 days of a stay, then no charge. The SBC prints \"$650 copay, up to 5 days, then no charge\" without \"per day\"; it is read as a copay per day, as Highmark's 2026 SBCs printed \"$N copay per day, up to N days, then no charge\" (no 2027 SBC says \"per day\").","Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays $150 copay; at all other network providers lab tests 20% coinsurance and x-rays $300 copay.","Imaging (CT/PET/MRI): $300 copay at a Member Saving Site (used here); $600 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $150 copay for a 31-day retail supply ($300 for 60 days, $450 for 90 days); $150 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","No network deductible: copays and coinsurance apply from the first visit.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245081024/SE_2245081024_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":517.53,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0090003-00","standardId":"61389PA0090003-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $5500 100/80 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Montgomery"],"rates":{"8":{"base21":477.65,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":489.46,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":499.81,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":511.79,"tobaccoFactor":1}}}],"ded":{"ind":5500,"fam":11000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":600,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":150,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":1750,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $1,750 copay per admission, charged on the first day of each stay. The other days count toward the deductible until it is met, then cost nothing more. The SBC prints \"$1,750 copay/visit\"; a hospital visit is read as one stay (Highmark's 2026 SBCs said \"per admission\").","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $150 copay and x-rays $150 copay; at all other network providers lab tests $300 copay and x-rays $300 copay.","Imaging (CT/PET/MRI): $500 copay at a Member Saving Site (used here); $1,000 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Lab tests, x-rays and imaging: the chart marks them \"Deductible does not apply\"; page 1 does not list them among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245120376/SE_2245120376_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":424.62,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0090004-00","standardId":"61389PA0090004-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $1000 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Montgomery"],"rates":{"8":{"base21":561.74,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":575.64,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":587.81,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":601.9,"tobaccoFactor":1}}}],"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $80 copay and x-rays $80 copay; at all other network providers lab tests $160 copay and x-rays $160 copay.","Imaging (CT/PET/MRI): $450 copay at a Member Saving Site (used here); $900 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Lab tests, x-rays and imaging: the chart marks them \"Deductible does not apply\"; page 1 does not list them among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245114182/SE_2245114182_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":476.61,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0090005-00","standardId":"61389PA0090005-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $1400 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Montgomery"],"rates":{"8":{"base21":560.06,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":573.92,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":586.05,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":600.1,"tobaccoFactor":1}}}],"ded":{"ind":1400,"fam":2800,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":150,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $150 copay and x-rays $150 copay; at all other network providers lab tests $300 copay and x-rays $300 copay.","Imaging (CT/PET/MRI): $350 copay at a Member Saving Site (used here); $700 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $75 copay for a 31-day retail supply ($150 for 60 days, $225 for 90 days); $150 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $150 copay for a 31-day retail supply ($300 for 60 days, $450 for 90 days); $300 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Outpatient surgery facility fee: the chart marks it \"Deductible does not apply\"; page 1 does not list it among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245729397/SE_2245729397_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":483.67,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0090006-00","standardId":"61389PA0090006-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $2500 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Montgomery"],"rates":{"8":{"base21":532.45,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":545.62,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":557.16,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":570.51,"tobaccoFactor":1}}}],"ded":{"ind":2500,"fam":5000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":115,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":125,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays $70 copay; at all other network providers lab tests 20% coinsurance and x-rays $140 copay.","Imaging (CT/PET/MRI): $250 copay at a Member Saving Site (used here); $500 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $20 copay for a 31-day retail supply ($40 for 60 days, $60 for 90 days); $20 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","X-rays and imaging: the chart marks them \"Deductible does not apply\"; page 1 does not list them among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Lab tests, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245072037/SE_2245072037_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":461.16,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0090007-00","standardId":"61389PA0090007-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $3500 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Montgomery"],"rates":{"8":{"base21":544.21,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":557.67,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":569.46,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":583.11,"tobaccoFactor":1}}}],"ded":{"ind":3500,"fam":7000,"embedded":true},"drugDed":null,"oop":{"ind":10000,"fam":20000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":180,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays no charge; at all other network providers lab tests 20% coinsurance and x-rays 20% coinsurance.","Imaging (CT/PET/MRI): no charge at a Member Saving Site (used here); 20% coinsurance at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $80 copay for a 31-day retail supply ($160 for 60 days, $240 for 90 days); $160 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, lab tests, x-rays, imaging, therapy, outpatient mental health, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245100986/SE_2245100986_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":452.39,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0090008-00","standardId":"61389PA0090008-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $0 100/80 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Montgomery"],"rates":{"8":{"base21":547.96,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":561.52,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":573.39,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":587.13,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":650,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":600,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":750,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":1500,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $1,500 copay per admission, charged on the first day of each stay. The SBC prints \"$1,500 copay/visit\"; a hospital visit is read as one stay (Highmark's 2026 SBCs said \"per admission\").","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $200 copay and x-rays $200 copay; at all other network providers lab tests $400 copay and x-rays $400 copay.","Imaging (CT/PET/MRI): $600 copay at a Member Saving Site (used here); $1,200 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","No network deductible: copays and coinsurance apply from the first visit.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245728259/SE_2245728259_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":484.42,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0090009-00","standardId":"61389PA0090009-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $5000 60/40 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Montgomery"],"rates":{"8":{"base21":456.1,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":467.38,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":477.27,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":488.71,"tobaccoFactor":1}}}],"ded":{"ind":5000,"fam":10000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":600,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":150,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":600,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Lab tests and x-rays: at a Member Saving Site (used here) lab tests 40% coinsurance and x-rays 40% coinsurance; at all other network providers lab tests 60% coinsurance and x-rays 60% coinsurance.","Imaging (CT/PET/MRI): 40% coinsurance at a Member Saving Site (used here); 60% coinsurance at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245733023/SE_2245733023_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":438.4,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0090010-00","standardId":"61389PA0090010-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $500 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Montgomery"],"rates":{"8":{"base21":582.34,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":596.74,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":609.36,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":623.97,"tobaccoFactor":1}}}],"ded":{"ind":500,"fam":1000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":600,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":375,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":70,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $65 copay and x-rays $65 copay; at all other network providers lab tests $130 copay and x-rays $130 copay.","Imaging (CT/PET/MRI): $375 copay at a Member Saving Site (used here); $750 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $20 copay for a 31-day retail supply ($40 for 60 days, $60 for 90 days); $20 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Lab tests, x-rays and imaging: the chart marks them \"Deductible does not apply\"; page 1 does not list them among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245104808/SE_2245104808_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":490.27,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0090011-00","standardId":"61389PA0090011-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $7000 100/80 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Montgomery"],"rates":{"8":{"base21":449.32,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":460.44,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":470.17,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":481.44,"tobaccoFactor":1}}}],"ded":{"ind":7000,"fam":14000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":600,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":150,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":750,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":1500,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $1,500 copay per admission, charged on the first day of each stay. The other days count toward the deductible until it is met, then cost nothing more. The SBC prints \"$1,500 copay/visit\"; a hospital visit is read as one stay (Highmark's 2026 SBCs said \"per admission\").","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $150 copay and x-rays $200 copay; at all other network providers lab tests $300 copay and x-rays $400 copay.","Imaging (CT/PET/MRI): $350 copay at a Member Saving Site (used here); $700 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Lab tests and x-rays: the chart marks them \"Deductible does not apply\"; page 1 does not list them among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245738560/SE_2245738560_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":409.31,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0090012-00","standardId":"61389PA0090012-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $1000 100/80 Platinum","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Montgomery"],"rates":{"8":{"base21":669.68,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":686.24,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":700.76,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":717.55,"tobaccoFactor":1}}}],"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":35,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $40 copay and x-rays $40 copay; at all other network providers lab tests $80 copay and x-rays $80 copay.","Imaging (CT/PET/MRI): $100 copay at a Member Saving Site (used here); $200 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Lab tests, x-rays and imaging: the chart marks them \"Deductible does not apply\"; page 1 does not list them among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245726732/SE_2245726732_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":594.08,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0100001-00","standardId":"61389PA0100001-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $0 100/80 Platinum","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Philadelphia"],"rates":{"8":{"base21":684.99,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":701.93,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":716.78,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":733.95,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":8000,"fam":16000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":225,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":170,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":35,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"no_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $500 copay per day for the first 5 days of a stay, then no charge. The SBC prints \"$500 copay, up to 5 days, then no charge\" without \"per day\"; it is read as a copay per day, as Highmark's 2026 SBCs printed \"$N copay per day, up to N days, then no charge\" (no 2027 SBC says \"per day\").","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $75 copay and x-rays $75 copay; at all other network providers lab tests $150 copay and x-rays $150 copay.","Imaging (CT/PET/MRI): $170 copay at a Member Saving Site (used here); $340 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","No network deductible: copays and coinsurance apply from the first visit.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245098564/SE_2245098564_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":630.43,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0100002-00","standardId":"61389PA0100002-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $0 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Philadelphia"],"rates":{"8":{"base21":585.39,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":599.87,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":612.56,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":627.24,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":650,"ded":"no_ded"},"perDay":{"maxDays":5}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $650 copay per day for the first 5 days of a stay, then no charge. The SBC prints \"$650 copay, up to 5 days, then no charge\" without \"per day\"; it is read as a copay per day, as Highmark's 2026 SBCs printed \"$N copay per day, up to N days, then no charge\" (no 2027 SBC says \"per day\").","Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays $150 copay; at all other network providers lab tests 20% coinsurance and x-rays $300 copay.","Imaging (CT/PET/MRI): $300 copay at a Member Saving Site (used here); $600 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $150 copay for a 31-day retail supply ($300 for 60 days, $450 for 90 days); $150 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","No network deductible: copays and coinsurance apply from the first visit.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245072620/SE_2245072620_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":530.46,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0100003-00","standardId":"61389PA0100003-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $5500 100/80 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Philadelphia"],"rates":{"8":{"base21":477.65,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":489.46,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":499.81,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":511.79,"tobaccoFactor":1}}}],"ded":{"ind":5500,"fam":11000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":600,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":150,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":1750,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $1,750 copay per admission, charged on the first day of each stay. The other days count toward the deductible until it is met, then cost nothing more. The SBC prints \"$1,750 copay/visit\"; a hospital visit is read as one stay (Highmark's 2026 SBCs said \"per admission\").","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $150 copay and x-rays $150 copay; at all other network providers lab tests $300 copay and x-rays $300 copay.","Imaging (CT/PET/MRI): $500 copay at a Member Saving Site (used here); $1,000 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Lab tests, x-rays and imaging: the chart marks them \"Deductible does not apply\"; page 1 does not list them among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245121275/SE_2245121275_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":435.12,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0100004-00","standardId":"61389PA0100004-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $1000 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Philadelphia"],"rates":{"8":{"base21":561.74,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":575.64,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":587.81,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":601.9,"tobaccoFactor":1}}}],"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":450,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $80 copay and x-rays $80 copay; at all other network providers lab tests $160 copay and x-rays $160 copay.","Imaging (CT/PET/MRI): $450 copay at a Member Saving Site (used here); $900 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Lab tests, x-rays and imaging: the chart marks them \"Deductible does not apply\"; page 1 does not list them among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245730169/SE_2245730169_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":488.47,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0100005-00","standardId":"61389PA0100005-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $1400 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Philadelphia"],"rates":{"8":{"base21":560.06,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":573.92,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":586.05,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":600.1,"tobaccoFactor":1}}}],"ded":{"ind":1400,"fam":2800,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":150,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $150 copay and x-rays $150 copay; at all other network providers lab tests $300 copay and x-rays $300 copay.","Imaging (CT/PET/MRI): $350 copay at a Member Saving Site (used here); $700 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $75 copay for a 31-day retail supply ($150 for 60 days, $225 for 90 days); $150 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $150 copay for a 31-day retail supply ($300 for 60 days, $450 for 90 days); $300 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Outpatient surgery facility fee: the chart marks it \"Deductible does not apply\"; page 1 does not list it among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245744965/SE_2245744965_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":495.72,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0100006-00","standardId":"61389PA0100006-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $2500 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Philadelphia"],"rates":{"8":{"base21":532.45,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":545.62,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":557.16,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":570.51,"tobaccoFactor":1}}}],"ded":{"ind":2500,"fam":5000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":115,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":125,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays $70 copay; at all other network providers lab tests 20% coinsurance and x-rays $140 copay.","Imaging (CT/PET/MRI): $250 copay at a Member Saving Site (used here); $500 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $20 copay for a 31-day retail supply ($40 for 60 days, $60 for 90 days); $20 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","X-rays and imaging: the chart marks them \"Deductible does not apply\"; page 1 does not list them among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Lab tests, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245078926/SE_2245078926_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":472.63,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0100007-00","standardId":"61389PA0100007-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $3500 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Philadelphia"],"rates":{"8":{"base21":544.21,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":557.67,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":569.46,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":583.11,"tobaccoFactor":1}}}],"ded":{"ind":3500,"fam":7000,"embedded":true},"drugDed":null,"oop":{"ind":10000,"fam":20000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":180,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests no charge and x-rays no charge; at all other network providers lab tests 20% coinsurance and x-rays 20% coinsurance.","Imaging (CT/PET/MRI): no charge at a Member Saving Site (used here); 20% coinsurance at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $80 copay for a 31-day retail supply ($160 for 60 days, $240 for 90 days); $160 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, lab tests, x-rays, imaging, therapy, outpatient mental health, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245101206/SE_2245101206_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":463.62,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0100008-00","standardId":"61389PA0100008-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $0 100/80 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Philadelphia"],"rates":{"8":{"base21":547.96,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":561.52,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":573.39,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":587.13,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":650,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":600,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":750,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":1500,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $1,500 copay per admission, charged on the first day of each stay. The SBC prints \"$1,500 copay/visit\"; a hospital visit is read as one stay (Highmark's 2026 SBCs said \"per admission\").","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $200 copay and x-rays $200 copay; at all other network providers lab tests $400 copay and x-rays $400 copay.","Imaging (CT/PET/MRI): $600 copay at a Member Saving Site (used here); $1,200 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","No network deductible: copays and coinsurance apply from the first visit.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245728978/SE_2245728978_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":496.49,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0100009-00","standardId":"61389PA0100009-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $5000 60/40 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Philadelphia"],"rates":{"8":{"base21":456.1,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":467.38,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":477.27,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":488.71,"tobaccoFactor":1}}}],"ded":{"ind":5000,"fam":10000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":600,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":150,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":600,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.4,"ded":"after_ded"}}},"notes":["Lab tests and x-rays: at a Member Saving Site (used here) lab tests 40% coinsurance and x-rays 40% coinsurance; at all other network providers lab tests 60% coinsurance and x-rays 60% coinsurance.","Imaging (CT/PET/MRI): 40% coinsurance at a Member Saving Site (used here); 60% coinsurance at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245734210/SE_2245734210_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":449.26,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0100010-00","standardId":"61389PA0100010-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $500 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Philadelphia"],"rates":{"8":{"base21":582.34,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":596.74,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":609.36,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":623.97,"tobaccoFactor":1}}}],"ded":{"ind":500,"fam":1000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":600,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":375,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":70,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $65 copay and x-rays $65 copay; at all other network providers lab tests $130 copay and x-rays $130 copay.","Imaging (CT/PET/MRI): $375 copay at a Member Saving Site (used here); $750 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $20 copay for a 31-day retail supply ($40 for 60 days, $60 for 90 days); $20 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Lab tests, x-rays and imaging: the chart marks them \"Deductible does not apply\"; page 1 does not list them among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245730951/SE_2245730951_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":502.49,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0100011-00","standardId":"61389PA0100011-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $7000 100/80 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Philadelphia"],"rates":{"8":{"base21":449.32,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":460.44,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":470.17,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":481.44,"tobaccoFactor":1}}}],"ded":{"ind":7000,"fam":14000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":600,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":150,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":750,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":1500,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $1,500 copay per admission, charged on the first day of each stay. The other days count toward the deductible until it is met, then cost nothing more. The SBC prints \"$1,500 copay/visit\"; a hospital visit is read as one stay (Highmark's 2026 SBCs said \"per admission\").","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $150 copay and x-rays $200 copay; at all other network providers lab tests $300 copay and x-rays $400 copay.","Imaging (CT/PET/MRI): $350 copay at a Member Saving Site (used here); $700 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Lab tests and x-rays: the chart marks them \"Deductible does not apply\"; page 1 does not list them among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245109471/SE_2245109471_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":419.41,"tobaccoFactor":1}}}},{"market":"group","id":"61389PA0100012-00","standardId":"61389PA0100012-00","variant":"standard","issuer":"Highmark Senior Health Company","name":"PPO Blue $1000 100/80 Platinum","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Philadelphia"],"rates":{"8":{"base21":669.68,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"8":{"base21":686.24,"tobaccoFactor":1}}},{"from":7,"rates":{"8":{"base21":700.76,"tobaccoFactor":1}}},{"from":10,"rates":{"8":{"base21":717.55,"tobaccoFactor":1}}}],"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":35,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Lab tests and x-rays: at a Member Saving Site (used here) lab tests $40 copay and x-rays $40 copay; at all other network providers lab tests $80 copay and x-rays $80 copay.","Imaging (CT/PET/MRI): $100 copay at a Member Saving Site (used here); $200 copay at all other network providers.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Lab tests, x-rays and imaging: the chart marks them \"Deductible does not apply\"; page 1 does not list them among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, emergency medical transportation, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245727164/SE_2245727164_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"8":{"base21":609.02,"tobaccoFactor":1}}}},{"market":"group","id":"67430PA0070026-00","standardId":"67430PA0070026-00","variant":"standard","issuer":"UPMC Health Benefits","name":"UPMC Small Business Advantage Gold PPO $1,000 $40/$50 - Premium Network","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Clearfield","Crawford"],"rates":{"1":{"base21":596.28,"tobaccoFactor":1},"5":{"base21":633.53,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":612.22,"tobaccoFactor":1},"5":{"base21":650.46,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":628.58,"tobaccoFactor":1},"5":{"base21":667.85,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":645.38,"tobaccoFactor":1},"5":{"base21":685.7,"tobaccoFactor":1}}}],"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":40,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134931390, \"SG 2027 PPO Health Benefits Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hb-rate-change-decision-sm-grp-mkt.pdf, rate pages 40, 44, 48, 52: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $40 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $50 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay (its other imaging row, used here). Other diagnostic testing: $50 copay.","Mental health: office visits, psychotherapy and counseling $40 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134931390/SG 2027 PPO Health Benefits Benefit Matrix.xlsx","prev":{"planYear":2026,"rates":{"1":{"base21":537.55,"tobaccoFactor":1},"5":{"base21":571.14,"tobaccoFactor":1}}}},{"market":"group","id":"67430PA0070028-00","standardId":"67430PA0070028-00","variant":"standard","issuer":"UPMC Health Benefits","name":"UPMC Small Business Advantage Gold PPO $1,500 $40/$50 - Premium Network","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Clearfield","Crawford"],"rates":{"1":{"base21":585.16,"tobaccoFactor":1},"5":{"base21":621.72,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":600.8,"tobaccoFactor":1},"5":{"base21":638.33,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":616.85,"tobaccoFactor":1},"5":{"base21":655.39,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":633.34,"tobaccoFactor":1},"5":{"base21":672.91,"tobaccoFactor":1}}}],"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":40,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134931390, \"SG 2027 PPO Health Benefits Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hb-rate-change-decision-sm-grp-mkt.pdf, rate pages 40, 44, 48, 52: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $40 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $50 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay (its other imaging row, used here). Other diagnostic testing: $50 copay.","Mental health: office visits, psychotherapy and counseling $40 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134931390/SG 2027 PPO Health Benefits Benefit Matrix.xlsx","prev":{"planYear":2026,"rates":{"1":{"base21":527.19,"tobaccoFactor":1},"5":{"base21":560.12,"tobaccoFactor":1}}}},{"market":"group","id":"67430PA0070031-00","standardId":"67430PA0070031-00","variant":"standard","issuer":"UPMC Health Benefits","name":"UPMC Small Business Advantage Silver PPO $4,400 $60/$80 - Premium Network","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Clearfield","Crawford"],"rates":{"1":{"base21":492.35,"tobaccoFactor":1},"5":{"base21":523.11,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":505.51,"tobaccoFactor":1},"5":{"base21":537.09,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":519.02,"tobaccoFactor":1},"5":{"base21":551.45,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":532.89,"tobaccoFactor":1},"5":{"base21":566.18,"tobaccoFactor":1}}}],"ded":{"ind":4400,"fam":8800,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":750,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":750,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":60,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":750,"ded":"after_ded"}}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134931390, \"SG 2027 PPO Health Benefits Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hb-rate-change-decision-sm-grp-mkt.pdf, rate pages 40, 44, 48, 52: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $60 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $60 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay after the deductible (its other imaging row, used here). Other diagnostic testing: $80 copay.","Mental health: office visits, psychotherapy and counseling $60 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge after the deductible.","Hospital stay: $750 copay after the deductible once per admission.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134931390/SG 2027 PPO Health Benefits Benefit Matrix.xlsx","prev":{"planYear":2026,"rates":{"1":{"base21":446.99,"tobaccoFactor":1},"5":{"base21":474.91,"tobaccoFactor":1}}}},{"market":"group","id":"67430PA0070032-00","standardId":"67430PA0070032-00","variant":"standard","issuer":"UPMC Health Benefits","name":"UPMC Small Business Advantage Bronze PPO $9,100 - Premium Network","metal":"Bronze","network":"PPO","hsaEligible":false,"counties":["Clearfield","Crawford"],"rates":{"1":{"base21":387.95,"tobaccoFactor":1},"5":{"base21":412.19,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":398.32,"tobaccoFactor":1},"5":{"base21":423.2,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":408.96,"tobaccoFactor":1},"5":{"base21":434.51,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":419.89,"tobaccoFactor":1},"5":{"base21":446.13,"tobaccoFactor":1}}}],"ded":{"ind":9100,"fam":18200,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"copay","amount":95,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134931390, \"SG 2027 PPO Health Benefits Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hb-rate-change-decision-sm-grp-mkt.pdf, rate pages 40, 44, 48, 52: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced as free (the primary care visit costs nothing on this plan; UPMC's SBCs print \"No cost\" for prenatal visits, read as before the deductible as for UPMC's individual plans); later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: no charge after the deductible (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: no charge after the deductible (its other imaging row, used here). Other diagnostic testing: no charge after the deductible.","Mental health: office visits, psychotherapy and counseling no charge after the deductible (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge after the deductible.","Prescription drugs: retail (not mail-order) cost shares are used.","Prescription drugs: the medical deductible applies (no separate drug deductible).","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134931390/SG 2027 PPO Health Benefits Benefit Matrix.xlsx","prev":{"planYear":2026,"rates":{"1":{"base21":354.13,"tobaccoFactor":1},"5":{"base21":376.25,"tobaccoFactor":1}}}},{"market":"group","id":"67430PA0070034-00","standardId":"67430PA0070034-00","variant":"standard","issuer":"UPMC Health Benefits","name":"UPMC Small Business Advantage Gold HSA PPO $2,200/10% - Premium Network","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Clearfield","Crawford"],"rates":{"1":{"base21":505.53,"tobaccoFactor":1},"5":{"base21":537.12,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":519.04,"tobaccoFactor":1},"5":{"base21":551.47,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":532.92,"tobaccoFactor":1},"5":{"base21":566.21,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":547.16,"tobaccoFactor":1},"5":{"base21":581.34,"tobaccoFactor":1}}}],"ded":{"ind":2200,"fam":4400,"embedded":false},"drugDed":null,"oop":{"ind":7500,"fam":12000,"famPerPerson":12000},"rules":{"pcp":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134931422, \"SG 2027 PPO HSA Health Benefits Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hb-rate-change-decision-sm-grp-mkt.pdf, rate pages 40, 41, 44, 45, 48, 49, 52, 53: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at 10% coinsurance after the deductible; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: 10% coinsurance after the deductible (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: 10% coinsurance after the deductible (its other imaging row, used here). Other diagnostic testing: 10% coinsurance after the deductible.","Mental health: office visits, psychotherapy and counseling 10% coinsurance after the deductible (used here); other outpatient services (intensive outpatient, partial hospitalization) 10% coinsurance after the deductible.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Prescription drugs: the medical deductible applies (no separate drug deductible).","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered.","The deductible is aggregate (the matrix's accumulation type): the whole family deductible must be met before the plan pays for anyone in the family, and the estimate uses it."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134931422/SG 2027 PPO HSA Health Benefits Benefit Matrix.xlsx","prev":{"planYear":2026,"rates":{"1":{"base21":460.49,"tobaccoFactor":1},"5":{"base21":489.26,"tobaccoFactor":1}}}},{"market":"group","id":"67430PA0070037-00","standardId":"67430PA0070037-00","variant":"standard","issuer":"UPMC Health Benefits","name":"UPMC Small Business Advantage Silver HSA PPO $5,200 - Premium Network","metal":"Silver","network":"PPO","hsaEligible":true,"counties":["Clearfield","Crawford"],"rates":{"1":{"base21":448.15,"tobaccoFactor":1},"5":{"base21":476.15,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":460.12,"tobaccoFactor":1},"5":{"base21":488.87,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":472.42,"tobaccoFactor":1},"5":{"base21":501.94,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":485.05,"tobaccoFactor":1},"5":{"base21":515.35,"tobaccoFactor":1}}}],"ded":{"ind":5200,"fam":10400,"embedded":true},"drugDed":null,"oop":{"ind":8500,"fam":17000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134931422, \"SG 2027 PPO HSA Health Benefits Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hb-rate-change-decision-sm-grp-mkt.pdf, rate pages 41, 45, 49, 53: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced as free (the primary care visit costs nothing on this plan; UPMC's SBCs print \"No cost\" for prenatal visits, read as before the deductible as for UPMC's individual plans); later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: no charge after the deductible (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: no charge after the deductible (its other imaging row, used here). Other diagnostic testing: no charge after the deductible.","Mental health: office visits, psychotherapy and counseling no charge after the deductible (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge after the deductible.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Prescription drugs: the medical deductible applies (no separate drug deductible).","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134931422/SG 2027 PPO HSA Health Benefits Benefit Matrix.xlsx","prev":{"planYear":2026,"rates":{"1":{"base21":418.72,"tobaccoFactor":1},"5":{"base21":444.87,"tobaccoFactor":1}}}},{"market":"group","id":"67430PA0070038-00","standardId":"67430PA0070038-00","variant":"standard","issuer":"UPMC Health Benefits","name":"UPMC First Care Silver PPO $7,500 $80/$100 - Premium Network","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Clearfield","Crawford"],"rates":{"1":{"base21":469.63,"tobaccoFactor":1},"5":{"base21":498.97,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":482.18,"tobaccoFactor":1},"5":{"base21":512.3,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":495.07,"tobaccoFactor":1},"5":{"base21":525.99,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":508.3,"tobaccoFactor":1},"5":{"base21":540.05,"tobaccoFactor":1}}}],"ded":{"ind":7500,"fam":15000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"no_ded"}}},"specialist":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"no_ded"}}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":550,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":350,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":80,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":350,"ded":"after_ded"}}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134931390, \"SG 2027 PPO Health Benefits Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hb-rate-change-decision-sm-grp-mkt.pdf, rate pages 41, 45, 49, 53: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Primary care visits: the first visit is free; later visits are $80 copay.","Specialist visits: the first visit is free; later visits are $100 copay.","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $80 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $80 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $200 copay after the deductible (its other imaging row, used here). Other diagnostic testing: $100 copay.","Mental health: office visits, psychotherapy and counseling no charge (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge after the deductible.","Hospital stay: $350 copay after the deductible once per admission.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134931390/SG 2027 PPO Health Benefits Benefit Matrix.xlsx","prev":{"planYear":2026,"rates":{"1":{"base21":428.78,"tobaccoFactor":1},"5":{"base21":455.57,"tobaccoFactor":1}}}},{"market":"group","id":"67430PA0080019-00","standardId":"67430PA0080019-00","variant":"standard","issuer":"UPMC Health Benefits","name":"UPMC Small Business Advantage Gold EPO $1,000 $40/$50 - Premium Network","metal":"Gold","network":"EPO","hsaEligible":false,"counties":["Clearfield","Crawford"],"rates":{"1":{"base21":573.26,"tobaccoFactor":1},"5":{"base21":609.08,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":588.58,"tobaccoFactor":1},"5":{"base21":625.35,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":604.31,"tobaccoFactor":1},"5":{"base21":642.07,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":620.46,"tobaccoFactor":1},"5":{"base21":659.23,"tobaccoFactor":1}}}],"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":40,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134931444, \"SG 2027 EPO Health Benefits Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hb-rate-change-decision-sm-grp-mkt.pdf, rate pages 41, 45, 49, 53: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $40 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $50 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay (its other imaging row, used here). Other diagnostic testing: $50 copay.","Mental health: office visits, psychotherapy and counseling $40 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134931444/SG 2027 EPO Health Benefits Benefit Matrix.xlsx","prev":{"planYear":2026,"rates":{"1":{"base21":517.97,"tobaccoFactor":1},"5":{"base21":550.33,"tobaccoFactor":1}}}},{"market":"group","id":"67430PA0080021-00","standardId":"67430PA0080021-00","variant":"standard","issuer":"UPMC Health Benefits","name":"UPMC Small Business Advantage Gold EPO $1,500 $40/$50 - Premium Network","metal":"Gold","network":"EPO","hsaEligible":false,"counties":["Clearfield","Crawford"],"rates":{"1":{"base21":563.48,"tobaccoFactor":1},"5":{"base21":598.68,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":578.54,"tobaccoFactor":1},"5":{"base21":614.68,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":594,"tobaccoFactor":1},"5":{"base21":631.11,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":609.88,"tobaccoFactor":1},"5":{"base21":647.98,"tobaccoFactor":1}}}],"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":40,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134931444, \"SG 2027 EPO Health Benefits Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hb-rate-change-decision-sm-grp-mkt.pdf, rate pages 41, 42, 45, 46, 49, 50, 53, 54: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $40 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $50 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay (its other imaging row, used here). Other diagnostic testing: $50 copay.","Mental health: office visits, psychotherapy and counseling $40 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134931444/SG 2027 EPO Health Benefits Benefit Matrix.xlsx","prev":{"planYear":2026,"rates":{"1":{"base21":508.83,"tobaccoFactor":1},"5":{"base21":540.62,"tobaccoFactor":1}}}},{"market":"group","id":"67430PA0080024-00","standardId":"67430PA0080024-00","variant":"standard","issuer":"UPMC Health Benefits","name":"UPMC Small Business Advantage Silver EPO $4,400 $60/$80 - Premium Network","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Clearfield","Crawford"],"rates":{"1":{"base21":477.17,"tobaccoFactor":1},"5":{"base21":506.98,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":489.92,"tobaccoFactor":1},"5":{"base21":520.53,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":503.01,"tobaccoFactor":1},"5":{"base21":534.44,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":516.45,"tobaccoFactor":1},"5":{"base21":548.72,"tobaccoFactor":1}}}],"ded":{"ind":4400,"fam":8800,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":750,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":750,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":60,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":750,"ded":"after_ded"}}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134931444, \"SG 2027 EPO Health Benefits Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hb-rate-change-decision-sm-grp-mkt.pdf, rate pages 42, 46, 50, 54: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $60 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $60 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $150 copay after the deductible (its other imaging row, used here). Other diagnostic testing: $80 copay.","Mental health: office visits, psychotherapy and counseling $60 copay (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge after the deductible.","Hospital stay: $750 copay after the deductible once per admission.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134931444/SG 2027 EPO Health Benefits Benefit Matrix.xlsx","prev":{"planYear":2026,"rates":{"1":{"base21":433.11,"tobaccoFactor":1},"5":{"base21":460.17,"tobaccoFactor":1}}}},{"market":"group","id":"67430PA0080025-00","standardId":"67430PA0080025-00","variant":"standard","issuer":"UPMC Health Benefits","name":"UPMC Small Business Advantage Bronze EPO $9,100 - Premium Network","metal":"Bronze","network":"EPO","hsaEligible":false,"counties":["Clearfield","Crawford"],"rates":{"1":{"base21":375.44,"tobaccoFactor":1},"5":{"base21":398.89,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":385.47,"tobaccoFactor":1},"5":{"base21":409.55,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":395.77,"tobaccoFactor":1},"5":{"base21":420.5,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":406.35,"tobaccoFactor":1},"5":{"base21":431.74,"tobaccoFactor":1}}}],"ded":{"ind":9100,"fam":18200,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"copay","amount":95,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134931444, \"SG 2027 EPO Health Benefits Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hb-rate-change-decision-sm-grp-mkt.pdf, rate pages 42, 46, 50, 54: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced as free (the primary care visit costs nothing on this plan; UPMC's SBCs print \"No cost\" for prenatal visits, read as before the deductible as for UPMC's individual plans); later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: no charge after the deductible (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: no charge after the deductible (its other imaging row, used here). Other diagnostic testing: no charge after the deductible.","Mental health: office visits, psychotherapy and counseling no charge after the deductible (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge after the deductible.","Prescription drugs: retail (not mail-order) cost shares are used.","Prescription drugs: the medical deductible applies (no separate drug deductible).","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134931444/SG 2027 EPO Health Benefits Benefit Matrix.xlsx","prev":{"planYear":2026,"rates":{"1":{"base21":343.21,"tobaccoFactor":1},"5":{"base21":364.65,"tobaccoFactor":1}}}},{"market":"group","id":"67430PA0080027-00","standardId":"67430PA0080027-00","variant":"standard","issuer":"UPMC Health Benefits","name":"UPMC Small Business Advantage Gold HSA EPO $2,200/10% - Premium Network","metal":"Gold","network":"EPO","hsaEligible":true,"counties":["Clearfield","Crawford"],"rates":{"1":{"base21":487.97,"tobaccoFactor":1},"5":{"base21":518.46,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":501.01,"tobaccoFactor":1},"5":{"base21":532.31,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":514.4,"tobaccoFactor":1},"5":{"base21":546.54,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":528.15,"tobaccoFactor":1},"5":{"base21":561.14,"tobaccoFactor":1}}}],"ded":{"ind":2200,"fam":4400,"embedded":false},"drugDed":null,"oop":{"ind":7500,"fam":12000,"famPerPerson":12000},"rules":{"pcp":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134931432, \"SG 2027 EPO HSA Health Benefits Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hb-rate-change-decision-sm-grp-mkt.pdf, rate pages 42, 46, 50, 54: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at 10% coinsurance after the deductible; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: 10% coinsurance after the deductible (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: 10% coinsurance after the deductible (its other imaging row, used here). Other diagnostic testing: 10% coinsurance after the deductible.","Mental health: office visits, psychotherapy and counseling 10% coinsurance after the deductible (used here); other outpatient services (intensive outpatient, partial hospitalization) 10% coinsurance after the deductible.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Prescription drugs: the medical deductible applies (no separate drug deductible).","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered.","The deductible is aggregate (the matrix's accumulation type): the whole family deductible must be met before the plan pays for anyone in the family, and the estimate uses it."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134931432/SG 2027 EPO HSA Health Benefits Benefit Matrix.xlsx","prev":{"planYear":2026,"rates":{"1":{"base21":445.72,"tobaccoFactor":1},"5":{"base21":473.57,"tobaccoFactor":1}}}},{"market":"group","id":"67430PA0080028-00","standardId":"67430PA0080028-00","variant":"standard","issuer":"UPMC Health Benefits","name":"UPMC Small Business Advantage Silver HSA EPO $5,200 - Premium Network","metal":"Silver","network":"EPO","hsaEligible":true,"counties":["Clearfield","Crawford"],"rates":{"1":{"base21":433.56,"tobaccoFactor":1},"5":{"base21":460.65,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":445.15,"tobaccoFactor":1},"5":{"base21":472.96,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":457.05,"tobaccoFactor":1},"5":{"base21":485.6,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":469.26,"tobaccoFactor":1},"5":{"base21":498.58,"tobaccoFactor":1}}}],"ded":{"ind":5200,"fam":10400,"embedded":true},"drugDed":null,"oop":{"ind":8500,"fam":17000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded","max":500}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134931432, \"SG 2027 EPO HSA Health Benefits Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hb-rate-change-decision-sm-grp-mkt.pdf, rate pages 42, 43, 46, 50, 51, 54, 55: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced as free (the primary care visit costs nothing on this plan; UPMC's SBCs print \"No cost\" for prenatal visits, read as before the deductible as for UPMC's individual plans); later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: no charge after the deductible (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: no charge after the deductible (its other imaging row, used here). Other diagnostic testing: no charge after the deductible.","Mental health: office visits, psychotherapy and counseling no charge after the deductible (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge after the deductible.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Prescription drugs: the medical deductible applies (no separate drug deductible).","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134931432/SG 2027 EPO HSA Health Benefits Benefit Matrix.xlsx","prev":{"planYear":2026,"rates":{"1":{"base21":406.08,"tobaccoFactor":1},"5":{"base21":431.45,"tobaccoFactor":1}}}},{"market":"group","id":"67430PA0080029-00","standardId":"67430PA0080029-00","variant":"standard","issuer":"UPMC Health Benefits","name":"UPMC First Care Silver EPO $7,500 $80/$100 - Premium Network","metal":"Silver","network":"EPO","hsaEligible":false,"counties":["Clearfield","Crawford"],"rates":{"1":{"base21":455.35,"tobaccoFactor":1},"5":{"base21":483.79,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":467.52,"tobaccoFactor":1},"5":{"base21":496.72,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":480.01,"tobaccoFactor":1},"5":{"base21":510,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":492.84,"tobaccoFactor":1},"5":{"base21":523.63,"tobaccoFactor":1}}}],"ded":{"ind":7500,"fam":15000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"no_ded"}}},"specialist":{"base":{"kind":"copay","amount":100,"ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"free","ded":"no_ded"}}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":550,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":120,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.3,"ded":"no_ded","max":500}},"outpatientFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":350,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":80,"ded":"no_ded"}}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":350,"ded":"after_ded"}}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Small-business plan. UPMC publishes no SBC for its small-business plans; this plan's cost sharing comes from the benefit matrix UPMC filed with the PA Insurance Department (SERFF filing UPMC-134931444, \"SG 2027 EPO Health Benefits Benefit Matrix.xlsx\", in-network column), checked against the Department's rate decision (upmc-hb-rate-change-decision-sm-grp-mkt.pdf, rate pages 43, 47, 51, 55: metal, deductible, out-of-pocket maximum, coinsurance) and the filing's plan overview.","The matrix says for each service whether the deductible applies; copays it lists without \"after Deductible\" are charged before the deductible, as the filing's sample SBCs say (\"Deductible does not apply\").","Primary care visits: the first visit is free; later visits are $80 copay.","Specialist visits: the first visit is free; later visits are $100 copay.","Prenatal care: the benefit matrix has no prenatal row. UPMC's SBCs charge the first prenatal office visit the primary care visit's cost share and say it applies to the first visit only (this filing's sample SBCs do), so the first visit is priced at $80 copay; later prenatal visits are free here, and the delivery rows carry the rest of the maternity cost.","Lab tests: $80 copay (the matrix's laboratory services row, used here). X-rays and other imaging such as sonograms: $200 copay after the deductible (its other imaging row, used here). Other diagnostic testing: $100 copay.","Mental health: office visits, psychotherapy and counseling no charge (used here); other outpatient services (intensive outpatient, partial hospitalization) no charge after the deductible.","Hospital stay: $350 copay after the deductible once per admission.","Specialty drugs: 30% coinsurance, at most $500 per prescription (the cap is modelled here).","Prescription drugs: retail (not mail-order) cost shares are used.","Physical and occupational therapy: covered up to 30 visits per benefit period for both therapies combined; visits above the limit are not covered."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#UPMC-134931444/SG 2027 EPO Health Benefits Benefit Matrix.xlsx","prev":{"planYear":2026,"rates":{"1":{"base21":416.71,"tobaccoFactor":1},"5":{"base21":442.75,"tobaccoFactor":1}}}},{"market":"group","id":"75729PA0050062-00","standardId":"75729PA0050062-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger All-Access QHDHP PPO 8000","metal":"Bronze","network":"PPO","hsaEligible":true,"counties":["Adams","Bedford","Berks","Blair","Bradford","Cambria","Cameron","Carbon","Centre","Clearfield","Clinton","Columbia","Cumberland","Dauphin","Elk","Franklin","Fulton","Huntingdon","Jefferson","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northampton","Northumberland","Perry","Pike","Potter","Schuylkill","Snyder","Somerset","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"2":{"base21":454.82,"tobaccoFactor":1},"3":{"base21":432.08,"tobaccoFactor":1},"5":{"base21":432.08,"tobaccoFactor":1},"6":{"base21":454.82,"tobaccoFactor":1},"7":{"base21":568.52,"tobaccoFactor":1},"9":{"base21":545.78,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"2":{"base21":463.19,"tobaccoFactor":1},"3":{"base21":440.03,"tobaccoFactor":1},"5":{"base21":440.03,"tobaccoFactor":1},"6":{"base21":463.19,"tobaccoFactor":1},"7":{"base21":578.99,"tobaccoFactor":1},"9":{"base21":555.83,"tobaccoFactor":1}}},{"from":7,"rates":{"2":{"base21":471.72,"tobaccoFactor":1},"3":{"base21":448.14,"tobaccoFactor":1},"5":{"base21":448.14,"tobaccoFactor":1},"6":{"base21":471.72,"tobaccoFactor":1},"7":{"base21":589.65,"tobaccoFactor":1},"9":{"base21":566.07,"tobaccoFactor":1}}},{"from":10,"rates":{"2":{"base21":480.41,"tobaccoFactor":1},"3":{"base21":456.39,"tobaccoFactor":1},"5":{"base21":456.39,"tobaccoFactor":1},"6":{"base21":480.41,"tobaccoFactor":1},"7":{"base21":600.51,"tobaccoFactor":1},"9":{"base21":576.49,"tobaccoFactor":1}}}],"ded":{"ind":8000,"fam":16000,"embedded":true},"drugDed":null,"oop":{"ind":8000,"fam":16000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"}},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are no charge after the deductible.","Prescription drugs share the medical deductible (the SBC says the drug deductible is combined with medical).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (primary care visits, specialist visits, urgent care, emergency room care, lab tests, x-rays, imaging, rehabilitation therapy, outpatient mental health visits, generic drugs, preferred brand drugs, non-preferred brand drugs, specialty drugs, outpatient surgery facility fees, outpatient surgeon fees, hospital stay facility fees, hospital stay physician fees, delivery facility fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/75729PA0050062-00.pdf","prev":{"planYear":2026,"rates":{"2":{"base21":448.66,"tobaccoFactor":1},"3":{"base21":426.22,"tobaccoFactor":1},"5":{"base21":426.22,"tobaccoFactor":1},"6":{"base21":448.66,"tobaccoFactor":1},"7":{"base21":560.82,"tobaccoFactor":1},"9":{"base21":538.39,"tobaccoFactor":1}}}},{"market":"group","id":"75729PA0050068-00","standardId":"75729PA0050068-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger All-Access Extra PPO 10/60/1000","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Carbon","Centre","Clinton","Columbia","Cumberland","Dauphin","Juniata","Lackawanna","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Susquehanna","Union","Wayne","Wyoming"],"rates":{"3":{"base21":625.85,"tobaccoFactor":1},"6":{"base21":658.79,"tobaccoFactor":1},"9":{"base21":790.55,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":637.38,"tobaccoFactor":1},"6":{"base21":670.92,"tobaccoFactor":1},"9":{"base21":805.1,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":649.11,"tobaccoFactor":1},"6":{"base21":683.28,"tobaccoFactor":1},"9":{"base21":819.93,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":661.07,"tobaccoFactor":1},"6":{"base21":695.86,"tobaccoFactor":1},"9":{"base21":835.03,"tobaccoFactor":1}}}],"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":250}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":200,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Primary care visits: $60 copay (used here); $10 copay only at a primary care site designated as an \"Extra\" or ProvenHealth Navigator site.","Imaging: $150 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $200 copay per day of service, charged once per service here.","Hospital stay: $200 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $200 copay per admission.","Specialty drugs: 40% coinsurance up to $250 per fill (the cap is modelled here).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, outpatient surgeon fees, hospital stay physician fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/75729PA0050068-00.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":594.32,"tobaccoFactor":1},"6":{"base21":625.6,"tobaccoFactor":1},"9":{"base21":750.72,"tobaccoFactor":1}}}},{"market":"group","id":"75729PA0050071-00","standardId":"75729PA0050071-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger All-Access PPO 25/50/3300","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Bedford","Berks","Blair","Bradford","Cambria","Cameron","Carbon","Centre","Clearfield","Clinton","Columbia","Cumberland","Dauphin","Elk","Franklin","Fulton","Huntingdon","Jefferson","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northampton","Northumberland","Perry","Pike","Potter","Schuylkill","Snyder","Somerset","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"2":{"base21":598.64,"tobaccoFactor":1},"3":{"base21":568.71,"tobaccoFactor":1},"5":{"base21":568.71,"tobaccoFactor":1},"6":{"base21":598.64,"tobaccoFactor":1},"7":{"base21":748.3,"tobaccoFactor":1},"9":{"base21":718.37,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"2":{"base21":609.67,"tobaccoFactor":1},"3":{"base21":579.18,"tobaccoFactor":1},"5":{"base21":579.18,"tobaccoFactor":1},"6":{"base21":609.67,"tobaccoFactor":1},"7":{"base21":762.08,"tobaccoFactor":1},"9":{"base21":731.6,"tobaccoFactor":1}}},{"from":7,"rates":{"2":{"base21":620.89,"tobaccoFactor":1},"3":{"base21":589.85,"tobaccoFactor":1},"5":{"base21":589.85,"tobaccoFactor":1},"6":{"base21":620.89,"tobaccoFactor":1},"7":{"base21":776.12,"tobaccoFactor":1},"9":{"base21":745.07,"tobaccoFactor":1}}},{"from":10,"rates":{"2":{"base21":632.33,"tobaccoFactor":1},"3":{"base21":600.71,"tobaccoFactor":1},"5":{"base21":600.71,"tobaccoFactor":1},"6":{"base21":632.33,"tobaccoFactor":1},"7":{"base21":790.41,"tobaccoFactor":1},"9":{"base21":758.79,"tobaccoFactor":1}}}],"ded":{"ind":3300,"fam":6600,"embedded":true},"drugDed":null,"oop":{"ind":8550,"fam":17100},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":250}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Specialty drugs: 40% coinsurance up to $250 per fill (the cap is modelled here).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, imaging, outpatient surgery facility fees, outpatient surgeon fees, hospital stay facility fees, hospital stay physician fees, delivery facility fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/75729PA0050071-00.pdf","prev":{"planYear":2026,"rates":{"2":{"base21":578.85,"tobaccoFactor":1},"3":{"base21":549.91,"tobaccoFactor":1},"5":{"base21":549.91,"tobaccoFactor":1},"6":{"base21":578.85,"tobaccoFactor":1},"7":{"base21":723.56,"tobaccoFactor":1},"9":{"base21":694.62,"tobaccoFactor":1}}}},{"market":"group","id":"75729PA0050073-00","standardId":"75729PA0050073-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger All-Access PPO 30/60/6000","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Adams","Bedford","Berks","Blair","Bradford","Cambria","Cameron","Carbon","Centre","Clearfield","Clinton","Columbia","Cumberland","Dauphin","Elk","Franklin","Fulton","Huntingdon","Jefferson","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northampton","Northumberland","Perry","Pike","Potter","Schuylkill","Snyder","Somerset","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"2":{"base21":506.1,"tobaccoFactor":1},"3":{"base21":480.79,"tobaccoFactor":1},"5":{"base21":480.79,"tobaccoFactor":1},"6":{"base21":506.1,"tobaccoFactor":1},"7":{"base21":632.62,"tobaccoFactor":1},"9":{"base21":607.32,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"2":{"base21":515.42,"tobaccoFactor":1},"3":{"base21":489.65,"tobaccoFactor":1},"5":{"base21":489.65,"tobaccoFactor":1},"6":{"base21":515.42,"tobaccoFactor":1},"7":{"base21":644.27,"tobaccoFactor":1},"9":{"base21":618.5,"tobaccoFactor":1}}},{"from":7,"rates":{"2":{"base21":524.91,"tobaccoFactor":1},"3":{"base21":498.66,"tobaccoFactor":1},"5":{"base21":498.66,"tobaccoFactor":1},"6":{"base21":524.91,"tobaccoFactor":1},"7":{"base21":656.14,"tobaccoFactor":1},"9":{"base21":629.89,"tobaccoFactor":1}}},{"from":10,"rates":{"2":{"base21":534.58,"tobaccoFactor":1},"3":{"base21":507.85,"tobaccoFactor":1},"5":{"base21":507.85,"tobaccoFactor":1},"6":{"base21":534.58,"tobaccoFactor":1},"7":{"base21":668.22,"tobaccoFactor":1},"9":{"base21":641.49,"tobaccoFactor":1}}}],"ded":{"ind":6000,"fam":12000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":45,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Outpatient surgery facility fees: $100 copay per day of service, charged once per service here.","Separate prescription drug deductible: $500 individual / $1,000 family. Drug rows that say \"Deductible does not apply\" (generic drugs) are charged from the first fill; the others (preferred brand drugs, non-preferred brand drugs, specialty drugs) do not say, so they are read as after the drug deductible.","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, imaging, outpatient surgeon fees, hospital stay facility fees, hospital stay physician fees, delivery facility fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/75729PA0050073-00.pdf","prev":{"planYear":2026,"rates":{"2":{"base21":465.21,"tobaccoFactor":1},"3":{"base21":441.95,"tobaccoFactor":1},"5":{"base21":441.95,"tobaccoFactor":1},"6":{"base21":465.21,"tobaccoFactor":1},"7":{"base21":581.51,"tobaccoFactor":1},"9":{"base21":558.25,"tobaccoFactor":1}}}},{"market":"group","id":"75729PA0050078-00","standardId":"75729PA0050078-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger All-Access QHDHP PPO 3500","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Adams","Bedford","Berks","Blair","Bradford","Cambria","Cameron","Carbon","Centre","Clearfield","Clinton","Columbia","Cumberland","Dauphin","Elk","Franklin","Fulton","Huntingdon","Jefferson","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northampton","Northumberland","Perry","Pike","Potter","Schuylkill","Snyder","Somerset","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"2":{"base21":596.49,"tobaccoFactor":1},"3":{"base21":566.66,"tobaccoFactor":1},"5":{"base21":566.66,"tobaccoFactor":1},"6":{"base21":596.49,"tobaccoFactor":1},"7":{"base21":745.61,"tobaccoFactor":1},"9":{"base21":715.78,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"2":{"base21":607.47,"tobaccoFactor":1},"3":{"base21":577.1,"tobaccoFactor":1},"5":{"base21":577.1,"tobaccoFactor":1},"6":{"base21":607.47,"tobaccoFactor":1},"7":{"base21":759.34,"tobaccoFactor":1},"9":{"base21":728.96,"tobaccoFactor":1}}},{"from":7,"rates":{"2":{"base21":618.66,"tobaccoFactor":1},"3":{"base21":587.72,"tobaccoFactor":1},"5":{"base21":587.72,"tobaccoFactor":1},"6":{"base21":618.66,"tobaccoFactor":1},"7":{"base21":773.32,"tobaccoFactor":1},"9":{"base21":742.39,"tobaccoFactor":1}}},{"from":10,"rates":{"2":{"base21":630.05,"tobaccoFactor":1},"3":{"base21":598.55,"tobaccoFactor":1},"5":{"base21":598.55,"tobaccoFactor":1},"6":{"base21":630.05,"tobaccoFactor":1},"7":{"base21":787.56,"tobaccoFactor":1},"9":{"base21":756.06,"tobaccoFactor":1}}}],"ded":{"ind":3500,"fam":7000,"embedded":true},"drugDed":null,"oop":{"ind":3500,"fam":7000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"}},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are no charge after the deductible.","Prescription drugs share the medical deductible (the SBC says the drug deductible is combined with medical).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (primary care visits, specialist visits, urgent care, emergency room care, lab tests, x-rays, imaging, rehabilitation therapy, outpatient mental health visits, generic drugs, preferred brand drugs, non-preferred brand drugs, specialty drugs, outpatient surgery facility fees, outpatient surgeon fees, hospital stay facility fees, hospital stay physician fees, delivery facility fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/75729PA0050078-00.pdf","prev":{"planYear":2026,"rates":{"2":{"base21":579.9,"tobaccoFactor":1},"3":{"base21":550.9,"tobaccoFactor":1},"5":{"base21":550.9,"tobaccoFactor":1},"6":{"base21":579.9,"tobaccoFactor":1},"7":{"base21":724.87,"tobaccoFactor":1},"9":{"base21":695.88,"tobaccoFactor":1}}}},{"market":"group","id":"75729PA0050079-00","standardId":"75729PA0050079-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger All-Access QHDHP PPO 5750","metal":"Silver","network":"PPO","hsaEligible":true,"counties":["Adams","Bedford","Berks","Blair","Bradford","Cambria","Cameron","Carbon","Centre","Clearfield","Clinton","Columbia","Cumberland","Dauphin","Elk","Franklin","Fulton","Huntingdon","Jefferson","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northampton","Northumberland","Perry","Pike","Potter","Schuylkill","Snyder","Somerset","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"2":{"base21":528.52,"tobaccoFactor":1},"3":{"base21":502.1,"tobaccoFactor":1},"5":{"base21":502.1,"tobaccoFactor":1},"6":{"base21":528.52,"tobaccoFactor":1},"7":{"base21":660.65,"tobaccoFactor":1},"9":{"base21":634.23,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"2":{"base21":538.26,"tobaccoFactor":1},"3":{"base21":511.34,"tobaccoFactor":1},"5":{"base21":511.34,"tobaccoFactor":1},"6":{"base21":538.26,"tobaccoFactor":1},"7":{"base21":672.82,"tobaccoFactor":1},"9":{"base21":645.91,"tobaccoFactor":1}}},{"from":7,"rates":{"2":{"base21":548.17,"tobaccoFactor":1},"3":{"base21":520.76,"tobaccoFactor":1},"5":{"base21":520.76,"tobaccoFactor":1},"6":{"base21":548.17,"tobaccoFactor":1},"7":{"base21":685.21,"tobaccoFactor":1},"9":{"base21":657.8,"tobaccoFactor":1}}},{"from":10,"rates":{"2":{"base21":558.26,"tobaccoFactor":1},"3":{"base21":530.35,"tobaccoFactor":1},"5":{"base21":530.35,"tobaccoFactor":1},"6":{"base21":558.26,"tobaccoFactor":1},"7":{"base21":697.83,"tobaccoFactor":1},"9":{"base21":669.91,"tobaccoFactor":1}}}],"ded":{"ind":5750,"fam":11500,"embedded":true},"drugDed":null,"oop":{"ind":5750,"fam":11500},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"}},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are no charge after the deductible.","Prescription drugs share the medical deductible (the SBC says the drug deductible is combined with medical).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (primary care visits, specialist visits, urgent care, emergency room care, lab tests, x-rays, imaging, rehabilitation therapy, outpatient mental health visits, generic drugs, preferred brand drugs, non-preferred brand drugs, specialty drugs, outpatient surgery facility fees, outpatient surgeon fees, hospital stay facility fees, hospital stay physician fees, delivery facility fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/75729PA0050079-00.pdf","prev":{"planYear":2026,"rates":{"2":{"base21":522.24,"tobaccoFactor":1},"3":{"base21":496.13,"tobaccoFactor":1},"5":{"base21":496.13,"tobaccoFactor":1},"6":{"base21":522.24,"tobaccoFactor":1},"7":{"base21":652.8,"tobaccoFactor":1},"9":{"base21":626.69,"tobaccoFactor":1}}}},{"market":"group","id":"75729PA0050080-00","standardId":"75729PA0050080-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger All-Access PPO 20/50/250","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Adams","Bedford","Berks","Blair","Bradford","Cambria","Cameron","Carbon","Centre","Clearfield","Clinton","Columbia","Cumberland","Dauphin","Elk","Franklin","Fulton","Huntingdon","Jefferson","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northampton","Northumberland","Perry","Pike","Potter","Schuylkill","Snyder","Somerset","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"2":{"base21":710.74,"tobaccoFactor":1},"3":{"base21":675.2,"tobaccoFactor":1},"5":{"base21":675.2,"tobaccoFactor":1},"6":{"base21":710.74,"tobaccoFactor":1},"7":{"base21":888.42,"tobaccoFactor":1},"9":{"base21":852.89,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"2":{"base21":723.83,"tobaccoFactor":1},"3":{"base21":687.64,"tobaccoFactor":1},"5":{"base21":687.64,"tobaccoFactor":1},"6":{"base21":723.83,"tobaccoFactor":1},"7":{"base21":904.78,"tobaccoFactor":1},"9":{"base21":868.59,"tobaccoFactor":1}}},{"from":7,"rates":{"2":{"base21":737.16,"tobaccoFactor":1},"3":{"base21":700.3,"tobaccoFactor":1},"5":{"base21":700.3,"tobaccoFactor":1},"6":{"base21":737.16,"tobaccoFactor":1},"7":{"base21":921.45,"tobaccoFactor":1},"9":{"base21":884.59,"tobaccoFactor":1}}},{"from":10,"rates":{"2":{"base21":750.73,"tobaccoFactor":1},"3":{"base21":713.2,"tobaccoFactor":1},"5":{"base21":713.2,"tobaccoFactor":1},"6":{"base21":750.73,"tobaccoFactor":1},"7":{"base21":938.41,"tobaccoFactor":1},"9":{"base21":900.88,"tobaccoFactor":1}}}],"ded":{"ind":250,"fam":500,"embedded":true},"drugDed":null,"oop":{"ind":9000,"fam":18000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":100,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $15 copay.","Outpatient surgery facility fees: $100 copay per day of service, charged once per service here.","Hospital stay: $100 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $100 copay per admission.","Specialty drugs: 40% coinsurance up to $150 per fill (the cap is modelled here).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, imaging, outpatient surgeon fees, hospital stay physician fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/75729PA0050080-00.pdf","prev":{"planYear":2026,"rates":{"2":{"base21":688.49,"tobaccoFactor":1},"3":{"base21":654.06,"tobaccoFactor":1},"5":{"base21":654.06,"tobaccoFactor":1},"6":{"base21":688.49,"tobaccoFactor":1},"7":{"base21":860.61,"tobaccoFactor":1},"9":{"base21":826.19,"tobaccoFactor":1}}}},{"market":"group","id":"75729PA0050082-00","standardId":"75729PA0050082-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger All-Access Extra PPO 10/50/250","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Carbon","Centre","Clinton","Columbia","Cumberland","Dauphin","Juniata","Lackawanna","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Susquehanna","Union","Wayne","Wyoming"],"rates":{"3":{"base21":665.51,"tobaccoFactor":1},"6":{"base21":700.54,"tobaccoFactor":1},"9":{"base21":840.64,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":677.77,"tobaccoFactor":1},"6":{"base21":713.44,"tobaccoFactor":1},"9":{"base21":856.12,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":690.25,"tobaccoFactor":1},"6":{"base21":726.58,"tobaccoFactor":1},"9":{"base21":871.89,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":702.96,"tobaccoFactor":1},"6":{"base21":739.96,"tobaccoFactor":1},"9":{"base21":887.95,"tobaccoFactor":1}}}],"ded":{"ind":250,"fam":500,"embedded":true},"drugDed":null,"oop":{"ind":3000,"fam":6000},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":200,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $15 copay.","Primary care visits: $50 copay (used here); $10 copay only at a primary care site designated as an \"Extra\" or ProvenHealth Navigator site.","Imaging: $100 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $200 copay per day of service, charged once per service here.","Hospital stay: $200 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $200 copay per admission.","Specialty drugs: 40% coinsurance up to $150 per fill (the cap is modelled here).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, outpatient surgeon fees, hospital stay physician fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/75729PA0050082-00.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":657.62,"tobaccoFactor":1},"6":{"base21":692.23,"tobaccoFactor":1},"9":{"base21":830.68,"tobaccoFactor":1}}}},{"market":"group","id":"75729PA0050096-00","standardId":"75729PA0050096-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger All-Access PPO 30/60/3500","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Bedford","Berks","Blair","Bradford","Cambria","Cameron","Carbon","Centre","Clearfield","Clinton","Columbia","Cumberland","Dauphin","Elk","Franklin","Fulton","Huntingdon","Jefferson","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northampton","Northumberland","Perry","Pike","Potter","Schuylkill","Snyder","Somerset","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"2":{"base21":596.49,"tobaccoFactor":1},"3":{"base21":566.66,"tobaccoFactor":1},"5":{"base21":566.66,"tobaccoFactor":1},"6":{"base21":596.49,"tobaccoFactor":1},"7":{"base21":745.61,"tobaccoFactor":1},"9":{"base21":715.78,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"2":{"base21":607.47,"tobaccoFactor":1},"3":{"base21":577.1,"tobaccoFactor":1},"5":{"base21":577.1,"tobaccoFactor":1},"6":{"base21":607.47,"tobaccoFactor":1},"7":{"base21":759.34,"tobaccoFactor":1},"9":{"base21":728.96,"tobaccoFactor":1}}},{"from":7,"rates":{"2":{"base21":618.66,"tobaccoFactor":1},"3":{"base21":587.72,"tobaccoFactor":1},"5":{"base21":587.72,"tobaccoFactor":1},"6":{"base21":618.66,"tobaccoFactor":1},"7":{"base21":773.32,"tobaccoFactor":1},"9":{"base21":742.39,"tobaccoFactor":1}}},{"from":10,"rates":{"2":{"base21":630.05,"tobaccoFactor":1},"3":{"base21":598.55,"tobaccoFactor":1},"5":{"base21":598.55,"tobaccoFactor":1},"6":{"base21":630.05,"tobaccoFactor":1},"7":{"base21":787.56,"tobaccoFactor":1},"9":{"base21":756.06,"tobaccoFactor":1}}}],"ded":{"ind":3500,"fam":7000,"embedded":true},"drugDed":null,"oop":{"ind":7350,"fam":14700},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":250}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Specialty drugs: 40% coinsurance up to $250 per fill (the cap is modelled here).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, imaging, outpatient surgery facility fees, outpatient surgeon fees, hospital stay facility fees, hospital stay physician fees, delivery facility fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/75729PA0050096-00.pdf","prev":{"planYear":2026,"rates":{"2":{"base21":576.77,"tobaccoFactor":1},"3":{"base21":547.93,"tobaccoFactor":1},"5":{"base21":547.93,"tobaccoFactor":1},"6":{"base21":576.77,"tobaccoFactor":1},"7":{"base21":720.96,"tobaccoFactor":1},"9":{"base21":692.12,"tobaccoFactor":1}}}},{"market":"group","id":"75729PA0050097-00","standardId":"75729PA0050097-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger All-Access Extra PPO 20/60/3500","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Carbon","Centre","Clinton","Columbia","Cumberland","Dauphin","Juniata","Lackawanna","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Susquehanna","Union","Wayne","Wyoming"],"rates":{"3":{"base21":567.69,"tobaccoFactor":1},"6":{"base21":597.56,"tobaccoFactor":1},"9":{"base21":717.08,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":578.14,"tobaccoFactor":1},"6":{"base21":608.57,"tobaccoFactor":1},"9":{"base21":730.28,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":588.79,"tobaccoFactor":1},"6":{"base21":619.77,"tobaccoFactor":1},"9":{"base21":743.73,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":599.63,"tobaccoFactor":1},"6":{"base21":631.19,"tobaccoFactor":1},"9":{"base21":757.42,"tobaccoFactor":1}}}],"ded":{"ind":3500,"fam":7000,"embedded":true},"drugDed":null,"oop":{"ind":7350,"fam":14700},"rules":{"pcp":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":250}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Primary care visits: $60 copay (used here); $20 copay only at a primary care site designated as an \"Extra\" or ProvenHealth Navigator site.","Specialty drugs: 40% coinsurance up to $250 per fill (the cap is modelled here).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, imaging, outpatient surgery facility fees, outpatient surgeon fees, hospital stay facility fees, hospital stay physician fees, delivery facility fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/75729PA0050097-00.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":549.91,"tobaccoFactor":1},"6":{"base21":578.85,"tobaccoFactor":1},"9":{"base21":694.62,"tobaccoFactor":1}}}},{"market":"group","id":"75729PA0050102-00","standardId":"75729PA0050102-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger All-Access PPO Gold 25/50/500","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Bedford","Berks","Blair","Bradford","Cambria","Cameron","Carbon","Centre","Clearfield","Clinton","Columbia","Cumberland","Dauphin","Elk","Franklin","Fulton","Huntingdon","Jefferson","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northampton","Northumberland","Perry","Pike","Potter","Schuylkill","Snyder","Somerset","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"2":{"base21":597.56,"tobaccoFactor":1},"3":{"base21":567.69,"tobaccoFactor":1},"5":{"base21":567.69,"tobaccoFactor":1},"6":{"base21":597.56,"tobaccoFactor":1},"7":{"base21":746.95,"tobaccoFactor":1},"9":{"base21":717.08,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"2":{"base21":608.57,"tobaccoFactor":1},"3":{"base21":578.14,"tobaccoFactor":1},"5":{"base21":578.14,"tobaccoFactor":1},"6":{"base21":608.57,"tobaccoFactor":1},"7":{"base21":760.71,"tobaccoFactor":1},"9":{"base21":730.28,"tobaccoFactor":1}}},{"from":7,"rates":{"2":{"base21":619.77,"tobaccoFactor":1},"3":{"base21":588.79,"tobaccoFactor":1},"5":{"base21":588.79,"tobaccoFactor":1},"6":{"base21":619.77,"tobaccoFactor":1},"7":{"base21":774.72,"tobaccoFactor":1},"9":{"base21":743.73,"tobaccoFactor":1}}},{"from":10,"rates":{"2":{"base21":631.19,"tobaccoFactor":1},"3":{"base21":599.63,"tobaccoFactor":1},"5":{"base21":599.63,"tobaccoFactor":1},"6":{"base21":631.19,"tobaccoFactor":1},"7":{"base21":788.98,"tobaccoFactor":1},"9":{"base21":757.42,"tobaccoFactor":1}}}],"ded":{"ind":500,"fam":1000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":275,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":5,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":500,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $15 copay.","Imaging: $275 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $500 copay per day of service, charged once per service here.","Hospital stay: $500 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $500 copay per admission.","Specialty drugs: 40% coinsurance up to $150 per fill (the cap is modelled here).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, outpatient surgeon fees, hospital stay physician fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/75729PA0050102-00.pdf","prev":{"planYear":2026,"rates":{"2":{"base21":608.88,"tobaccoFactor":1},"3":{"base21":578.44,"tobaccoFactor":1},"5":{"base21":578.44,"tobaccoFactor":1},"6":{"base21":608.88,"tobaccoFactor":1},"7":{"base21":761.1,"tobaccoFactor":1},"9":{"base21":730.65,"tobaccoFactor":1}}}},{"market":"group","id":"75729PA0050103-00","standardId":"75729PA0050103-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger All-Access PPO 20/40/1500","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Bedford","Berks","Blair","Bradford","Cambria","Cameron","Carbon","Centre","Clearfield","Clinton","Columbia","Cumberland","Dauphin","Elk","Franklin","Fulton","Huntingdon","Jefferson","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northampton","Northumberland","Perry","Pike","Potter","Schuylkill","Snyder","Somerset","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"2":{"base21":636.56,"tobaccoFactor":1},"3":{"base21":604.73,"tobaccoFactor":1},"5":{"base21":604.73,"tobaccoFactor":1},"6":{"base21":636.56,"tobaccoFactor":1},"7":{"base21":795.7,"tobaccoFactor":1},"9":{"base21":763.87,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"2":{"base21":648.28,"tobaccoFactor":1},"3":{"base21":615.87,"tobaccoFactor":1},"5":{"base21":615.87,"tobaccoFactor":1},"6":{"base21":648.28,"tobaccoFactor":1},"7":{"base21":810.35,"tobaccoFactor":1},"9":{"base21":777.94,"tobaccoFactor":1}}},{"from":7,"rates":{"2":{"base21":660.22,"tobaccoFactor":1},"3":{"base21":627.21,"tobaccoFactor":1},"5":{"base21":627.21,"tobaccoFactor":1},"6":{"base21":660.22,"tobaccoFactor":1},"7":{"base21":825.27,"tobaccoFactor":1},"9":{"base21":792.26,"tobaccoFactor":1}}},{"from":10,"rates":{"2":{"base21":672.38,"tobaccoFactor":1},"3":{"base21":638.76,"tobaccoFactor":1},"5":{"base21":638.76,"tobaccoFactor":1},"6":{"base21":672.38,"tobaccoFactor":1},"7":{"base21":840.47,"tobaccoFactor":1},"9":{"base21":806.85,"tobaccoFactor":1}}}],"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":250}},"outpatientFacility":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":500,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":500,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Imaging: $200 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $400 copay per day of service, charged once per service here.","Hospital stay: $500 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $500 copay per admission.","Specialty drugs: 40% coinsurance up to $250 per fill (the cap is modelled here).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, outpatient surgeon fees, hospital stay physician fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/75729PA0050103-00.pdf","prev":{"planYear":2026,"rates":{"2":{"base21":619.98,"tobaccoFactor":1},"3":{"base21":588.98,"tobaccoFactor":1},"5":{"base21":588.98,"tobaccoFactor":1},"6":{"base21":619.98,"tobaccoFactor":1},"7":{"base21":774.97,"tobaccoFactor":1},"9":{"base21":743.97,"tobaccoFactor":1}}}},{"market":"group","id":"75729PA0050104-00","standardId":"75729PA0050104-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger All-Access PPO 25/50/3000","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Bedford","Berks","Blair","Bradford","Cambria","Cameron","Carbon","Centre","Clearfield","Clinton","Columbia","Cumberland","Dauphin","Elk","Franklin","Fulton","Huntingdon","Jefferson","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northampton","Northumberland","Perry","Pike","Potter","Schuylkill","Snyder","Somerset","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"2":{"base21":609.55,"tobaccoFactor":1},"3":{"base21":579.08,"tobaccoFactor":1},"5":{"base21":579.08,"tobaccoFactor":1},"6":{"base21":609.55,"tobaccoFactor":1},"7":{"base21":761.94,"tobaccoFactor":1},"9":{"base21":731.46,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"2":{"base21":620.78,"tobaccoFactor":1},"3":{"base21":589.74,"tobaccoFactor":1},"5":{"base21":589.74,"tobaccoFactor":1},"6":{"base21":620.78,"tobaccoFactor":1},"7":{"base21":775.97,"tobaccoFactor":1},"9":{"base21":744.93,"tobaccoFactor":1}}},{"from":7,"rates":{"2":{"base21":632.21,"tobaccoFactor":1},"3":{"base21":600.6,"tobaccoFactor":1},"5":{"base21":600.6,"tobaccoFactor":1},"6":{"base21":632.21,"tobaccoFactor":1},"7":{"base21":790.26,"tobaccoFactor":1},"9":{"base21":758.65,"tobaccoFactor":1}}},{"from":10,"rates":{"2":{"base21":643.85,"tobaccoFactor":1},"3":{"base21":611.66,"tobaccoFactor":1},"5":{"base21":611.66,"tobaccoFactor":1},"6":{"base21":643.85,"tobaccoFactor":1},"7":{"base21":804.81,"tobaccoFactor":1},"9":{"base21":772.62,"tobaccoFactor":1}}}],"ded":{"ind":3000,"fam":6000,"embedded":true},"drugDed":null,"oop":{"ind":9500,"fam":19000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":250}},"outpatientFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":150,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Imaging: $100 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $150 copay per day of service, charged once per service here.","Hospital stay: $150 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $150 copay per admission.","Specialty drugs: 40% coinsurance up to $250 per fill (the cap is modelled here).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, outpatient surgeon fees, hospital stay physician fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/75729PA0050104-00.pdf","prev":{"planYear":2026,"rates":{"2":{"base21":602.32,"tobaccoFactor":1},"3":{"base21":572.2,"tobaccoFactor":1},"5":{"base21":572.2,"tobaccoFactor":1},"6":{"base21":602.32,"tobaccoFactor":1},"7":{"base21":752.89,"tobaccoFactor":1},"9":{"base21":722.78,"tobaccoFactor":1}}}},{"market":"group","id":"75729PA0050105-00","standardId":"75729PA0050105-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger All-Access PPO 35/70/4300","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Adams","Bedford","Berks","Blair","Bradford","Cambria","Cameron","Carbon","Centre","Clearfield","Clinton","Columbia","Cumberland","Dauphin","Elk","Franklin","Fulton","Huntingdon","Jefferson","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northampton","Northumberland","Perry","Pike","Potter","Schuylkill","Snyder","Somerset","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"2":{"base21":529.48,"tobaccoFactor":1},"3":{"base21":503,"tobaccoFactor":1},"5":{"base21":503,"tobaccoFactor":1},"6":{"base21":529.48,"tobaccoFactor":1},"7":{"base21":661.85,"tobaccoFactor":1},"9":{"base21":635.37,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"2":{"base21":539.23,"tobaccoFactor":1},"3":{"base21":512.27,"tobaccoFactor":1},"5":{"base21":512.27,"tobaccoFactor":1},"6":{"base21":539.23,"tobaccoFactor":1},"7":{"base21":674.03,"tobaccoFactor":1},"9":{"base21":647.07,"tobaccoFactor":1}}},{"from":7,"rates":{"2":{"base21":549.16,"tobaccoFactor":1},"3":{"base21":521.7,"tobaccoFactor":1},"5":{"base21":521.7,"tobaccoFactor":1},"6":{"base21":549.16,"tobaccoFactor":1},"7":{"base21":686.45,"tobaccoFactor":1},"9":{"base21":658.99,"tobaccoFactor":1}}},{"from":10,"rates":{"2":{"base21":559.27,"tobaccoFactor":1},"3":{"base21":531.31,"tobaccoFactor":1},"5":{"base21":531.31,"tobaccoFactor":1},"6":{"base21":559.27,"tobaccoFactor":1},"7":{"base21":699.09,"tobaccoFactor":1},"9":{"base21":671.12,"tobaccoFactor":1}}}],"ded":{"ind":4300,"fam":8600,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":200,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Imaging: $250 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $250 copay per day of service, charged once per service here.","Hospital stay: $200 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $200 copay per admission.","Separate prescription drug deductible: $500 individual / $1,000 family. Drug rows that say \"Deductible does not apply\" (generic drugs) are charged from the first fill; the others (preferred brand drugs, non-preferred brand drugs, specialty drugs) do not say, so they are read as after the drug deductible.","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, outpatient surgeon fees, hospital stay physician fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/75729PA0050105-00.pdf","prev":{"planYear":2026,"rates":{"2":{"base21":492.03,"tobaccoFactor":1},"3":{"base21":467.43,"tobaccoFactor":1},"5":{"base21":467.43,"tobaccoFactor":1},"6":{"base21":492.03,"tobaccoFactor":1},"7":{"base21":615.03,"tobaccoFactor":1},"9":{"base21":590.43,"tobaccoFactor":1}}}},{"market":"group","id":"75729PA0050107-00","standardId":"75729PA0050107-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger All-Access PPO 40/90/8400","metal":"Bronze","network":"PPO","hsaEligible":false,"counties":["Adams","Bedford","Berks","Blair","Bradford","Cambria","Cameron","Carbon","Centre","Clearfield","Clinton","Columbia","Cumberland","Dauphin","Elk","Franklin","Fulton","Huntingdon","Jefferson","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northampton","Northumberland","Perry","Pike","Potter","Schuylkill","Snyder","Somerset","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"2":{"base21":450.7,"tobaccoFactor":1},"3":{"base21":428.17,"tobaccoFactor":1},"5":{"base21":428.17,"tobaccoFactor":1},"6":{"base21":450.7,"tobaccoFactor":1},"7":{"base21":563.38,"tobaccoFactor":1},"9":{"base21":540.84,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"2":{"base21":459,"tobaccoFactor":1},"3":{"base21":436.05,"tobaccoFactor":1},"5":{"base21":436.05,"tobaccoFactor":1},"6":{"base21":459,"tobaccoFactor":1},"7":{"base21":573.75,"tobaccoFactor":1},"9":{"base21":550.8,"tobaccoFactor":1}}},{"from":7,"rates":{"2":{"base21":467.46,"tobaccoFactor":1},"3":{"base21":444.08,"tobaccoFactor":1},"5":{"base21":444.08,"tobaccoFactor":1},"6":{"base21":467.46,"tobaccoFactor":1},"7":{"base21":584.32,"tobaccoFactor":1},"9":{"base21":560.95,"tobaccoFactor":1}}},{"from":10,"rates":{"2":{"base21":476.06,"tobaccoFactor":1},"3":{"base21":452.26,"tobaccoFactor":1},"5":{"base21":452.26,"tobaccoFactor":1},"6":{"base21":476.06,"tobaccoFactor":1},"7":{"base21":595.08,"tobaccoFactor":1},"9":{"base21":571.28,"tobaccoFactor":1}}}],"ded":{"ind":8400,"fam":16800,"embedded":true},"drugDed":null,"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are no charge after the deductible.","Prescription drugs share the medical deductible (the SBC says the drug deductible is combined with medical).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (emergency room care, lab tests, x-rays, imaging, generic drugs, preferred brand drugs, non-preferred brand drugs, specialty drugs, outpatient surgery facility fees, outpatient surgeon fees, hospital stay facility fees, hospital stay physician fees, delivery facility fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/75729PA0050107-00.pdf","prev":{"planYear":2026,"rates":{"2":{"base21":433.45,"tobaccoFactor":1},"3":{"base21":411.78,"tobaccoFactor":1},"5":{"base21":411.78,"tobaccoFactor":1},"6":{"base21":433.45,"tobaccoFactor":1},"7":{"base21":541.81,"tobaccoFactor":1},"9":{"base21":520.14,"tobaccoFactor":1}}}},{"market":"group","id":"75729PA0050108-00","standardId":"75729PA0050108-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger All-Access Extra PPO 20/60/4300","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Carbon","Centre","Clinton","Columbia","Cumberland","Dauphin","Juniata","Lackawanna","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Susquehanna","Union","Wayne","Wyoming"],"rates":{"3":{"base21":508.48,"tobaccoFactor":1},"6":{"base21":535.25,"tobaccoFactor":1},"9":{"base21":642.29,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":517.85,"tobaccoFactor":1},"6":{"base21":545.1,"tobaccoFactor":1},"9":{"base21":654.12,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":527.38,"tobaccoFactor":1},"6":{"base21":555.14,"tobaccoFactor":1},"9":{"base21":666.17,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":537.1,"tobaccoFactor":1},"6":{"base21":565.36,"tobaccoFactor":1},"9":{"base21":678.44,"tobaccoFactor":1}}}],"ded":{"ind":4300,"fam":8600,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":11000,"fam":22000},"rules":{"pcp":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":175,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":200,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Primary care visits: $60 copay (used here); $20 copay only at a primary care site designated as an \"Extra\" or ProvenHealth Navigator site.","Imaging: $150 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $175 copay per day of service, charged once per service here.","Hospital stay: $200 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $200 copay per admission.","Separate prescription drug deductible: $500 individual / $1,000 family. Drug rows that say \"Deductible does not apply\" (generic drugs) are charged from the first fill; the others (preferred brand drugs, non-preferred brand drugs, specialty drugs) do not say, so they are read as after the drug deductible.","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, outpatient surgeon fees, hospital stay physician fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/75729PA0050108-00.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":471.67,"tobaccoFactor":1},"6":{"base21":496.49,"tobaccoFactor":1},"9":{"base21":595.79,"tobaccoFactor":1}}}},{"market":"group","id":"75729PA0050127-00","standardId":"75729PA0050127-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger All-Access PPO 25/50/3000 1x ded","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Bedford","Berks","Blair","Bradford","Cambria","Cameron","Carbon","Centre","Clearfield","Clinton","Columbia","Cumberland","Dauphin","Elk","Franklin","Fulton","Huntingdon","Jefferson","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northampton","Northumberland","Perry","Pike","Potter","Schuylkill","Snyder","Somerset","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"2":{"base21":609.55,"tobaccoFactor":1},"3":{"base21":579.08,"tobaccoFactor":1},"5":{"base21":579.08,"tobaccoFactor":1},"6":{"base21":609.55,"tobaccoFactor":1},"7":{"base21":761.94,"tobaccoFactor":1},"9":{"base21":731.46,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"2":{"base21":620.78,"tobaccoFactor":1},"3":{"base21":589.74,"tobaccoFactor":1},"5":{"base21":589.74,"tobaccoFactor":1},"6":{"base21":620.78,"tobaccoFactor":1},"7":{"base21":775.97,"tobaccoFactor":1},"9":{"base21":744.93,"tobaccoFactor":1}}},{"from":7,"rates":{"2":{"base21":632.21,"tobaccoFactor":1},"3":{"base21":600.6,"tobaccoFactor":1},"5":{"base21":600.6,"tobaccoFactor":1},"6":{"base21":632.21,"tobaccoFactor":1},"7":{"base21":790.26,"tobaccoFactor":1},"9":{"base21":758.65,"tobaccoFactor":1}}},{"from":10,"rates":{"2":{"base21":643.85,"tobaccoFactor":1},"3":{"base21":611.66,"tobaccoFactor":1},"5":{"base21":611.66,"tobaccoFactor":1},"6":{"base21":643.85,"tobaccoFactor":1},"7":{"base21":804.81,"tobaccoFactor":1},"9":{"base21":772.62,"tobaccoFactor":1}}}],"ded":{"ind":3000,"fam":3000,"embedded":true},"drugDed":null,"oop":{"ind":9500,"fam":19000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":250}},"outpatientFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":150,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Imaging: $100 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $150 copay per day of service, charged once per service here.","Hospital stay: $150 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $150 copay per admission.","Specialty drugs: 40% coinsurance up to $250 per fill (the cap is modelled here).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, outpatient surgeon fees, hospital stay physician fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/75729PA0050127-00.pdf","prev":{"planYear":2026,"rates":{"2":{"base21":602.32,"tobaccoFactor":1},"3":{"base21":572.2,"tobaccoFactor":1},"5":{"base21":572.2,"tobaccoFactor":1},"6":{"base21":602.32,"tobaccoFactor":1},"7":{"base21":752.89,"tobaccoFactor":1},"9":{"base21":722.78,"tobaccoFactor":1}}}},{"market":"group","id":"75729PA0050128-00","standardId":"75729PA0050128-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger All-Access PPO 25/50/0","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Adams","Bedford","Berks","Blair","Bradford","Cambria","Cameron","Carbon","Centre","Clearfield","Clinton","Columbia","Cumberland","Dauphin","Elk","Franklin","Fulton","Huntingdon","Jefferson","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northampton","Northumberland","Perry","Pike","Potter","Schuylkill","Snyder","Somerset","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"2":{"base21":731.59,"tobaccoFactor":1},"3":{"base21":695.01,"tobaccoFactor":1},"5":{"base21":695.01,"tobaccoFactor":1},"6":{"base21":731.59,"tobaccoFactor":1},"7":{"base21":914.49,"tobaccoFactor":1},"9":{"base21":877.91,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"2":{"base21":745.06,"tobaccoFactor":1},"3":{"base21":707.81,"tobaccoFactor":1},"5":{"base21":707.81,"tobaccoFactor":1},"6":{"base21":745.06,"tobaccoFactor":1},"7":{"base21":931.33,"tobaccoFactor":1},"9":{"base21":894.08,"tobaccoFactor":1}}},{"from":7,"rates":{"2":{"base21":758.78,"tobaccoFactor":1},"3":{"base21":720.85,"tobaccoFactor":1},"5":{"base21":720.85,"tobaccoFactor":1},"6":{"base21":758.78,"tobaccoFactor":1},"7":{"base21":948.48,"tobaccoFactor":1},"9":{"base21":910.54,"tobaccoFactor":1}}},{"from":10,"rates":{"2":{"base21":772.76,"tobaccoFactor":1},"3":{"base21":734.12,"tobaccoFactor":1},"5":{"base21":734.12,"tobaccoFactor":1},"6":{"base21":772.76,"tobaccoFactor":1},"7":{"base21":965.95,"tobaccoFactor":1},"9":{"base21":927.31,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":7000,"fam":14000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":300,"ded":"no_ded"},"perDay":{"maxDays":1}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $5 copay.","Imaging: $250 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $300 copay per day of service, charged once per service here.","Hospital stay: $300 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $300 copay per admission.","Specialty drugs: 40% coinsurance up to $150 per fill (the cap is modelled here).","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/75729PA0050128-00.pdf","prev":{"planYear":2026,"rates":{"2":{"base21":702.31,"tobaccoFactor":1},"3":{"base21":667.2,"tobaccoFactor":1},"5":{"base21":667.2,"tobaccoFactor":1},"6":{"base21":702.31,"tobaccoFactor":1},"7":{"base21":877.89,"tobaccoFactor":1},"9":{"base21":842.77,"tobaccoFactor":1}}}},{"market":"group","id":"75729PA0050131-00","standardId":"75729PA0050131-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger All-Access Extra PPO 10/50/0","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Carbon","Centre","Clinton","Columbia","Cumberland","Dauphin","Juniata","Lackawanna","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Susquehanna","Union","Wayne","Wyoming"],"rates":{"3":{"base21":705.13,"tobaccoFactor":1},"6":{"base21":742.25,"tobaccoFactor":1},"9":{"base21":890.69,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":718.12,"tobaccoFactor":1},"6":{"base21":755.91,"tobaccoFactor":1},"9":{"base21":907.1,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":731.34,"tobaccoFactor":1},"6":{"base21":769.83,"tobaccoFactor":1},"9":{"base21":923.8,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":744.81,"tobaccoFactor":1},"6":{"base21":784.01,"tobaccoFactor":1},"9":{"base21":940.81,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":5000,"fam":10000},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":300,"ded":"no_ded"},"perDay":{"maxDays":1}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $5 copay.","Primary care visits: $50 copay (used here); $10 copay only at a primary care site designated as an \"Extra\" or ProvenHealth Navigator site.","Imaging: $200 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $300 copay per day of service, charged once per service here.","Hospital stay: $300 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $300 copay per admission.","Specialty drugs: 40% coinsurance up to $150 per fill (the cap is modelled here).","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/75729PA0050131-00.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":680.59,"tobaccoFactor":1},"6":{"base21":716.41,"tobaccoFactor":1},"9":{"base21":859.7,"tobaccoFactor":1}}}},{"market":"group","id":"75729PA0050133-00","standardId":"75729PA0050133-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger All-Access Extra PPO 10/60/2000","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Carbon","Centre","Clinton","Columbia","Cumberland","Dauphin","Juniata","Lackawanna","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","Susquehanna","Union","Wayne","Wyoming"],"rates":{"3":{"base21":594.98,"tobaccoFactor":1},"6":{"base21":626.29,"tobaccoFactor":1},"9":{"base21":751.55,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":605.93,"tobaccoFactor":1},"6":{"base21":637.83,"tobaccoFactor":1},"9":{"base21":765.39,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":617.09,"tobaccoFactor":1},"6":{"base21":649.57,"tobaccoFactor":1},"9":{"base21":779.49,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":628.46,"tobaccoFactor":1},"6":{"base21":661.53,"tobaccoFactor":1},"9":{"base21":793.84,"tobaccoFactor":1}}}],"ded":{"ind":2000,"fam":4000,"embedded":true},"drugDed":null,"oop":{"ind":7350,"fam":14700},"rules":{"pcp":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":250}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":100,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Primary care visits: $60 copay (used here); $10 copay only at a primary care site designated as an \"Extra\" or ProvenHealth Navigator site.","Imaging: $100 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $100 copay per day of service, charged once per service here.","Hospital stay: $100 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $100 copay per admission.","Specialty drugs: 40% coinsurance up to $250 per fill (the cap is modelled here).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, outpatient surgeon fees, hospital stay physician fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/75729PA0050133-00.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":576.35,"tobaccoFactor":1},"6":{"base21":606.68,"tobaccoFactor":1},"9":{"base21":728.02,"tobaccoFactor":1}}}},{"market":"group","id":"75729PA0050137-00","standardId":"75729PA0050137-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger All-Access PPO 25/50/4500 1x ded","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Bedford","Berks","Blair","Bradford","Cambria","Cameron","Carbon","Centre","Clearfield","Clinton","Columbia","Cumberland","Dauphin","Elk","Franklin","Fulton","Huntingdon","Jefferson","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northampton","Northumberland","Perry","Pike","Potter","Schuylkill","Snyder","Somerset","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"2":{"base21":584.75,"tobaccoFactor":1},"3":{"base21":555.52,"tobaccoFactor":1},"5":{"base21":555.52,"tobaccoFactor":1},"6":{"base21":584.75,"tobaccoFactor":1},"7":{"base21":730.94,"tobaccoFactor":1},"9":{"base21":701.7,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"2":{"base21":595.52,"tobaccoFactor":1},"3":{"base21":565.75,"tobaccoFactor":1},"5":{"base21":565.75,"tobaccoFactor":1},"6":{"base21":595.52,"tobaccoFactor":1},"7":{"base21":744.4,"tobaccoFactor":1},"9":{"base21":714.63,"tobaccoFactor":1}}},{"from":7,"rates":{"2":{"base21":606.49,"tobaccoFactor":1},"3":{"base21":576.17,"tobaccoFactor":1},"5":{"base21":576.17,"tobaccoFactor":1},"6":{"base21":606.49,"tobaccoFactor":1},"7":{"base21":758.11,"tobaccoFactor":1},"9":{"base21":727.79,"tobaccoFactor":1}}},{"from":10,"rates":{"2":{"base21":617.66,"tobaccoFactor":1},"3":{"base21":586.78,"tobaccoFactor":1},"5":{"base21":586.78,"tobaccoFactor":1},"6":{"base21":617.66,"tobaccoFactor":1},"7":{"base21":772.07,"tobaccoFactor":1},"9":{"base21":741.19,"tobaccoFactor":1}}}],"ded":{"ind":4500,"fam":4500,"embedded":true},"drugDed":null,"oop":{"ind":7350,"fam":14700},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":250}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":100,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Imaging: $100 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $100 copay per day of service, charged once per service here.","Hospital stay: $100 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $100 copay per admission.","Specialty drugs: 40% coinsurance up to $250 per fill (the cap is modelled here).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, outpatient surgeon fees, hospital stay physician fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/75729PA0050137-00.pdf","prev":{"planYear":2026,"rates":{"2":{"base21":566.44,"tobaccoFactor":1},"3":{"base21":538.12,"tobaccoFactor":1},"5":{"base21":538.12,"tobaccoFactor":1},"6":{"base21":566.44,"tobaccoFactor":1},"7":{"base21":708.05,"tobaccoFactor":1},"9":{"base21":679.73,"tobaccoFactor":1}}}},{"market":"group","id":"75729PA0050140-00","standardId":"75729PA0050140-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger Choices PPO 10/20/0","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Centre","Columbia","Mifflin","Montour","Northumberland","Snyder","Union"],"rates":{"6":{"base21":678.11,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":690.6,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":703.32,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":716.27,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":5000,"fam":10000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"no_ded"},"perDay":{"maxDays":1}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $5 copay.","Tiered network: the costs here are for Tier 1 preferred providers (deductible $0 / individual or $0 / family). Tier 2 preferred providers cost more (deductible $500 / individual or $1,000 / family; primary care visit to treat an injury or illness: $50 copay / visit; specialist visit: $80 copay / visit; imaging (ct/pet scans, mris): $300 copay / day; facility fee (e.g., ambulatory surgery center): $500 copay / day; facility fee (e.g., hospital room): $500 copay / admission; childbirth/delivery facility services: $500 copay / admission; rehabilitation services: $80 copay / visit; habilitation services: $80 copay / visit; children’s eye exam: $80 copay / visit).","Imaging: $100 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $200 copay per day of service, charged once per service here.","Hospital stay: $200 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $200 copay per admission.","Specialty drugs: 40% coinsurance up to $150 per fill (the cap is modelled here).","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/75729PA0050140-00.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":659.26,"tobaccoFactor":1}}}},{"market":"group","id":"75729PA0050141-00","standardId":"75729PA0050141-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger Choices PPO 20/40/1500","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Centre","Columbia","Mifflin","Montour","Northumberland","Snyder","Union"],"rates":{"6":{"base21":590.06,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":600.92,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":611.99,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":623.26,"tobaccoFactor":1}}}],"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":250}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":200,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Tiered network: the costs here are for Tier 1 preferred providers (deductible $1,500 / individual or $3,000 / family). Tier 2 preferred providers cost more (deductible $2,500 / individual or $5,000 / family; primary care visit to treat an injury or illness: $40 copay / visit; specialist visit: $80 copay / visit; rehabilitation services: $80 copay / visit; habilitation services: $80 copay / visit; children’s eye exam: $80 copay / visit).","Imaging: $100 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $200 copay per day of service, charged once per service here.","Hospital stay: $200 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $200 copay per admission.","Specialty drugs: 40% coinsurance up to $250 per fill (the cap is modelled here).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, outpatient surgeon fees, hospital stay physician fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/75729PA0050141-00.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":583.05,"tobaccoFactor":1}}}},{"market":"group","id":"75729PA0050142-00","standardId":"75729PA0050142-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger Choices PPO 20/40/2000","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Centre","Columbia","Mifflin","Montour","Northumberland","Snyder","Union"],"rates":{"6":{"base21":574.29,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":584.87,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":595.64,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":606.61,"tobaccoFactor":1}}}],"ded":{"ind":2000,"fam":4000,"embedded":true},"drugDed":null,"oop":{"ind":9000,"fam":18000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":250}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":200,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Tiered network: the costs here are for Tier 1 preferred providers (deductible $2,000 / individual or $4,000 / family). Tier 2 preferred providers cost more (deductible $4,000 / individual or $8,000 / family; primary care visit to treat an injury or illness: $40 copay / visit; specialist visit: $80 copay / visit; rehabilitation services: $80 copay / visit; habilitation services: $80 copay / visit; children’s eye exam: $80 copay / visit).","Imaging: $100 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $100 copay per day of service, charged once per service here.","Hospital stay: $200 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $200 copay per admission.","Specialty drugs: 40% coinsurance up to $250 per fill (the cap is modelled here).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, outpatient surgeon fees, hospital stay physician fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/75729PA0050142-00.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":556.31,"tobaccoFactor":1}}}},{"market":"group","id":"75729PA0050143-00","standardId":"75729PA0050143-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger Choices PPO 20/40/4000","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Centre","Columbia","Mifflin","Montour","Northumberland","Snyder","Union"],"rates":{"6":{"base21":495.24,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":504.36,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":513.64,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":523.1,"tobaccoFactor":1}}}],"ded":{"ind":4000,"fam":8000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":200,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Tiered network: the costs here are for Tier 1 preferred providers (deductible $4,000 / individual or $8,000 / family). Tier 2 preferred providers cost more (deductible $8,000 / individual or $16,000 / family; primary care visit to treat an injury or illness: $60 copay / visit; specialist visit: $80 copay / visit; rehabilitation services: $80 copay / visit; habilitation services: $80 copay / visit; children’s eye exam: $80 copay / visit).","Imaging: $150 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $200 copay per day of service, charged once per service here.","Hospital stay: $200 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $200 copay per admission.","Separate prescription drug deductible: $500 individual / $1,000 family. Drug rows that say \"Deductible does not apply\" (generic drugs) are charged from the first fill; the others (preferred brand drugs, non-preferred brand drugs, specialty drugs) do not say, so they are read as after the drug deductible.","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, outpatient surgeon fees, hospital stay physician fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/75729PA0050143-00.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":459.35,"tobaccoFactor":1}}}},{"market":"group","id":"75729PA0050144-00","standardId":"75729PA0050144-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger Choices PPO 10/20/0","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Carbon","Lehigh","Monroe","Northampton","Schuylkill"],"rates":{"3":{"base21":644.21,"tobaccoFactor":1},"6":{"base21":678.11,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":656.07,"tobaccoFactor":1},"6":{"base21":690.6,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":668.15,"tobaccoFactor":1},"6":{"base21":703.32,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":680.46,"tobaccoFactor":1},"6":{"base21":716.27,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":5000,"fam":10000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"no_ded"},"perDay":{"maxDays":1}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $5 copay.","Tiered network: the costs here are for Tier 1 preferred providers (deductible $0 / individual or $0 / family). Tier 2 preferred providers cost more (deductible $500 / individual or $1,000 / family; primary care visit to treat an injury or illness: $50 copay / visit; specialist visit: $80 copay / visit; imaging (ct/pet scans, mris): $300 copay / day; facility fee (e.g., ambulatory surgery center): $500 copay / day; facility fee (e.g., hospital room): $500 copay / admission; childbirth/delivery facility services: $500 copay / admission; rehabilitation services: $80 copay / visit; habilitation services: $80 copay / visit; children’s eye exam: $80 copay / visit).","Imaging: $100 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $200 copay per day of service, charged once per service here.","Hospital stay: $200 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $200 copay per admission.","Specialty drugs: 40% coinsurance up to $150 per fill (the cap is modelled here).","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/75729PA0050144-00.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":626.3,"tobaccoFactor":1},"6":{"base21":659.26,"tobaccoFactor":1}}}},{"market":"group","id":"75729PA0050145-00","standardId":"75729PA0050145-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger Choices PPO 20/40/1500","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Carbon","Lehigh","Monroe","Northampton","Schuylkill"],"rates":{"3":{"base21":560.56,"tobaccoFactor":1},"6":{"base21":590.06,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":570.88,"tobaccoFactor":1},"6":{"base21":600.92,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":581.39,"tobaccoFactor":1},"6":{"base21":611.99,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":592.1,"tobaccoFactor":1},"6":{"base21":623.26,"tobaccoFactor":1}}}],"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":250}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":200,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Tiered network: the costs here are for Tier 1 preferred providers (deductible $1,500 / individual or $3,000 / family). Tier 2 preferred providers cost more (deductible $2,500 / individual or $5,000 / family; primary care visit to treat an injury or illness: $40 copay / visit; specialist visit: $80 copay / visit; rehabilitation services: $80 copay / visit; habilitation services: $80 copay / visit; children’s eye exam: $80 copay / visit).","Imaging: $100 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $200 copay per day of service, charged once per service here.","Hospital stay: $200 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $200 copay per admission.","Specialty drugs: 40% coinsurance up to $250 per fill (the cap is modelled here).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, outpatient surgeon fees, hospital stay physician fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/75729PA0050145-00.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":553.9,"tobaccoFactor":1},"6":{"base21":583.05,"tobaccoFactor":1}}}},{"market":"group","id":"75729PA0050146-00","standardId":"75729PA0050146-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger Choices PPO 20/40/2000","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Carbon","Lehigh","Monroe","Northampton","Schuylkill"],"rates":{"3":{"base21":545.58,"tobaccoFactor":1},"6":{"base21":574.29,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":555.62,"tobaccoFactor":1},"6":{"base21":584.87,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":565.86,"tobaccoFactor":1},"6":{"base21":595.64,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":576.28,"tobaccoFactor":1},"6":{"base21":606.61,"tobaccoFactor":1}}}],"ded":{"ind":2000,"fam":4000,"embedded":true},"drugDed":null,"oop":{"ind":9000,"fam":18000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":250}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":200,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Tiered network: the costs here are for Tier 1 preferred providers (deductible $2,000 / individual or $4,000 / family). Tier 2 preferred providers cost more (deductible $4,000 / individual or $8,000 / family; primary care visit to treat an injury or illness: $40 copay / visit; specialist visit: $80 copay / visit; rehabilitation services: $80 copay / visit; habilitation services: $80 copay / visit; children’s eye exam: $80 copay / visit).","Imaging: $100 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $100 copay per day of service, charged once per service here.","Hospital stay: $200 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $200 copay per admission.","Specialty drugs: 40% coinsurance up to $250 per fill (the cap is modelled here).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, outpatient surgeon fees, hospital stay physician fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/75729PA0050146-00.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":528.49,"tobaccoFactor":1},"6":{"base21":556.31,"tobaccoFactor":1}}}},{"market":"group","id":"75729PA0050147-00","standardId":"75729PA0050147-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger Choices PPO 20/40/4000","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Carbon","Lehigh","Monroe","Northampton","Schuylkill"],"rates":{"3":{"base21":470.48,"tobaccoFactor":1},"6":{"base21":495.24,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":479.14,"tobaccoFactor":1},"6":{"base21":504.36,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":487.96,"tobaccoFactor":1},"6":{"base21":513.64,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":496.95,"tobaccoFactor":1},"6":{"base21":523.1,"tobaccoFactor":1}}}],"ded":{"ind":4000,"fam":8000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":200,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Tiered network: the costs here are for Tier 1 preferred providers (deductible $4,000 / individual or $8,000 / family). Tier 2 preferred providers cost more (deductible $8,000 / individual or $16,000 / family; primary care visit to treat an injury or illness: $60 copay / visit; specialist visit: $80 copay / visit; rehabilitation services: $80 copay / visit; habilitation services: $80 copay / visit; children’s eye exam: $80 copay / visit).","Imaging: $150 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $200 copay per day of service, charged once per service here.","Hospital stay: $200 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $200 copay per admission.","Separate prescription drug deductible: $500 individual / $1,000 family. Drug rows that say \"Deductible does not apply\" (generic drugs) are charged from the first fill; the others (preferred brand drugs, non-preferred brand drugs, specialty drugs) do not say, so they are read as after the drug deductible.","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, outpatient surgeon fees, hospital stay physician fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/75729PA0050147-00.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":436.38,"tobaccoFactor":1},"6":{"base21":459.35,"tobaccoFactor":1}}}},{"market":"group","id":"75729PA0050148-00","standardId":"75729PA0050148-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger Choices PPO 10/20/0","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Lackawanna","Luzerne","Wayne"],"rates":{"3":{"base21":644.21,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":656.07,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":668.15,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":680.46,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":5000,"fam":10000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"no_ded"}},"xray":{"base":{"kind":"free","ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":150}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"no_ded"},"perDay":{"maxDays":1}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $5 copay.","Tiered network: the costs here are for Tier 1 preferred providers (deductible $0 / individual or $0 / family). Tier 2 preferred providers cost more (deductible $500 / individual or $1,000 / family; primary care visit to treat an injury or illness: $50 copay / visit; specialist visit: $80 copay / visit; imaging (ct/pet scans, mris): $300 copay / day; facility fee (e.g., ambulatory surgery center): $500 copay / day; facility fee (e.g., hospital room): $500 copay / admission; childbirth/delivery facility services: $500 copay / admission; rehabilitation services: $80 copay / visit; habilitation services: $80 copay / visit; children’s eye exam: $80 copay / visit).","Imaging: $100 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $200 copay per day of service, charged once per service here.","Hospital stay: $200 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $200 copay per admission.","Specialty drugs: 40% coinsurance up to $150 per fill (the cap is modelled here).","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/75729PA0050148-00.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":626.3,"tobaccoFactor":1}}}},{"market":"group","id":"75729PA0050149-00","standardId":"75729PA0050149-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger Choices PPO 20/40/1500","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Lackawanna","Luzerne","Wayne"],"rates":{"3":{"base21":560.56,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":570.88,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":581.39,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":592.1,"tobaccoFactor":1}}}],"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":250}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":200,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Tiered network: the costs here are for Tier 1 preferred providers (deductible $1,500 / individual or $3,000 / family). Tier 2 preferred providers cost more (deductible $2,500 / individual or $5,000 / family; primary care visit to treat an injury or illness: $40 copay / visit; specialist visit: $80 copay / visit; rehabilitation services: $80 copay / visit; habilitation services: $80 copay / visit; children’s eye exam: $80 copay / visit).","Imaging: $100 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $200 copay per day of service, charged once per service here.","Hospital stay: $200 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $200 copay per admission.","Specialty drugs: 40% coinsurance up to $250 per fill (the cap is modelled here).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, outpatient surgeon fees, hospital stay physician fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/75729PA0050149-00.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":553.9,"tobaccoFactor":1}}}},{"market":"group","id":"75729PA0050150-00","standardId":"75729PA0050150-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger Choices PPO 20/40/2000","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Lackawanna","Luzerne","Wayne"],"rates":{"3":{"base21":545.58,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":555.62,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":565.86,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":576.28,"tobaccoFactor":1}}}],"ded":{"ind":2000,"fam":4000,"embedded":true},"drugDed":null,"oop":{"ind":9000,"fam":18000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.4,"ded":"no_ded","max":250}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":200,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Tiered network: the costs here are for Tier 1 preferred providers (deductible $2,000 / individual or $4,000 / family). Tier 2 preferred providers cost more (deductible $4,000 / individual or $8,000 / family; primary care visit to treat an injury or illness: $40 copay / visit; specialist visit: $80 copay / visit; rehabilitation services: $80 copay / visit; habilitation services: $80 copay / visit; children’s eye exam: $80 copay / visit).","Imaging: $100 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $100 copay per day of service, charged once per service here.","Hospital stay: $200 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $200 copay per admission.","Specialty drugs: 40% coinsurance up to $250 per fill (the cap is modelled here).","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, outpatient surgeon fees, hospital stay physician fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/75729PA0050150-00.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":528.49,"tobaccoFactor":1}}}},{"market":"group","id":"75729PA0050151-00","standardId":"75729PA0050151-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger Choices PPO 20/40/4000","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Lackawanna","Luzerne","Wayne"],"rates":{"3":{"base21":470.48,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"3":{"base21":479.14,"tobaccoFactor":1}}},{"from":7,"rates":{"3":{"base21":487.96,"tobaccoFactor":1}}},{"from":10,"rates":{"3":{"base21":496.95,"tobaccoFactor":1}}}],"ded":{"ind":4000,"fam":8000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":200,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Tiered network: the costs here are for Tier 1 preferred providers (deductible $4,000 / individual or $8,000 / family). Tier 2 preferred providers cost more (deductible $8,000 / individual or $16,000 / family; primary care visit to treat an injury or illness: $60 copay / visit; specialist visit: $80 copay / visit; rehabilitation services: $80 copay / visit; habilitation services: $80 copay / visit; children’s eye exam: $80 copay / visit).","Imaging: $150 copay per day of service, charged once per service here.","Outpatient surgery facility fees: $200 copay per day of service, charged once per service here.","Hospital stay: $200 copay per admission (the first inpatient day of each admission is charged, later days are not).","Delivery facility: $200 copay per admission.","Separate prescription drug deductible: $500 individual / $1,000 family. Drug rows that say \"Deductible does not apply\" (generic drugs) are charged from the first fill; the others (preferred brand drugs, non-preferred brand drugs, specialty drugs) do not say, so they are read as after the drug deductible.","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (lab tests, x-rays, outpatient surgeon fees, hospital stay physician fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/75729PA0050151-00.pdf","prev":{"planYear":2026,"rates":{"3":{"base21":436.38,"tobaccoFactor":1}}}},{"market":"group","id":"75729PA0050158-00","standardId":"75729PA0050158-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger All-Access PPO $0 PCP/11000","metal":"Bronze","network":"PPO","hsaEligible":false,"counties":["Adams","Bedford","Berks","Blair","Bradford","Cambria","Cameron","Carbon","Centre","Clearfield","Clinton","Columbia","Cumberland","Dauphin","Elk","Franklin","Fulton","Huntingdon","Jefferson","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northampton","Northumberland","Perry","Pike","Potter","Schuylkill","Snyder","Somerset","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"2":{"base21":440.17,"tobaccoFactor":1},"3":{"base21":418.16,"tobaccoFactor":1},"5":{"base21":418.16,"tobaccoFactor":1},"6":{"base21":440.17,"tobaccoFactor":1},"7":{"base21":550.21,"tobaccoFactor":1},"9":{"base21":528.21,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"2":{"base21":448.28,"tobaccoFactor":1},"3":{"base21":425.86,"tobaccoFactor":1},"5":{"base21":425.86,"tobaccoFactor":1},"6":{"base21":448.28,"tobaccoFactor":1},"7":{"base21":560.35,"tobaccoFactor":1},"9":{"base21":537.93,"tobaccoFactor":1}}},{"from":7,"rates":{"2":{"base21":456.53,"tobaccoFactor":1},"3":{"base21":433.71,"tobaccoFactor":1},"5":{"base21":433.71,"tobaccoFactor":1},"6":{"base21":456.53,"tobaccoFactor":1},"7":{"base21":570.66,"tobaccoFactor":1},"9":{"base21":547.84,"tobaccoFactor":1}}},{"from":10,"rates":{"2":{"base21":464.94,"tobaccoFactor":1},"3":{"base21":441.69,"tobaccoFactor":1},"5":{"base21":441.69,"tobaccoFactor":1},"6":{"base21":464.94,"tobaccoFactor":1},"7":{"base21":581.17,"tobaccoFactor":1},"9":{"base21":557.93,"tobaccoFactor":1}}}],"ded":{"ind":11000,"fam":22000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"free","ded":"no_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"no_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"}},"mentalHealth":{"base":{"kind":"free","ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Separate prescription drug deductible: $500 individual / $1,000 family. Drug rows that say \"Deductible does not apply\" (generic drugs) are charged from the first fill; the others (preferred brand drugs, non-preferred brand drugs, specialty drugs) do not say, so they are read as after the drug deductible.","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (specialist visits, emergency room care, lab tests, x-rays, imaging, rehabilitation therapy, outpatient surgery facility fees, outpatient surgeon fees, hospital stay facility fees, hospital stay physician fees, delivery facility fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/75729PA0050158-00.pdf","prev":{"planYear":2026,"rates":{"2":{"base21":389.15,"tobaccoFactor":1},"3":{"base21":369.7,"tobaccoFactor":1},"5":{"base21":369.7,"tobaccoFactor":1},"6":{"base21":389.15,"tobaccoFactor":1},"7":{"base21":486.44,"tobaccoFactor":1},"9":{"base21":466.98,"tobaccoFactor":1}}}},{"market":"group","id":"75729PA0050159-00","standardId":"75729PA0050159-00","variant":"standard","issuer":"Geisinger Quality Options","name":"Geisinger All-Access PPO 60/150/12000 Essential","metal":"Bronze","network":"PPO","hsaEligible":false,"counties":["Adams","Bedford","Berks","Blair","Bradford","Cambria","Cameron","Carbon","Centre","Clearfield","Clinton","Columbia","Cumberland","Dauphin","Elk","Franklin","Fulton","Huntingdon","Jefferson","Juniata","Lackawanna","Lancaster","Lebanon","Lehigh","Luzerne","Lycoming","Mifflin","Monroe","Montour","Northampton","Northumberland","Perry","Pike","Potter","Schuylkill","Snyder","Somerset","Sullivan","Susquehanna","Tioga","Union","Wayne","Wyoming","York"],"rates":{"2":{"base21":441.78,"tobaccoFactor":1},"3":{"base21":419.69,"tobaccoFactor":1},"5":{"base21":419.69,"tobaccoFactor":1},"6":{"base21":441.78,"tobaccoFactor":1},"7":{"base21":552.22,"tobaccoFactor":1},"9":{"base21":530.13,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"2":{"base21":449.91,"tobaccoFactor":1},"3":{"base21":427.42,"tobaccoFactor":1},"5":{"base21":427.42,"tobaccoFactor":1},"6":{"base21":449.91,"tobaccoFactor":1},"7":{"base21":562.39,"tobaccoFactor":1},"9":{"base21":539.89,"tobaccoFactor":1}}},{"from":7,"rates":{"2":{"base21":458.2,"tobaccoFactor":1},"3":{"base21":435.29,"tobaccoFactor":1},"5":{"base21":435.29,"tobaccoFactor":1},"6":{"base21":458.2,"tobaccoFactor":1},"7":{"base21":572.75,"tobaccoFactor":1},"9":{"base21":549.84,"tobaccoFactor":1}}},{"from":10,"rates":{"2":{"base21":466.64,"tobaccoFactor":1},"3":{"base21":443.3,"tobaccoFactor":1},"5":{"base21":443.3,"tobaccoFactor":1},"6":{"base21":466.64,"tobaccoFactor":1},"7":{"base21":583.29,"tobaccoFactor":1},"9":{"base21":559.96,"tobaccoFactor":1}}}],"ded":{"ind":12000,"fam":24000,"embedded":true},"drugDed":{"ind":500,"fam":1000,"embedded":true},"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Prescription drugs: generic drugs = Tier 2 preferred generics, preferred brand = Tier 4, non-preferred brand = Tier 5, specialty = Tier 6. Costs are for one retail or mail-order fill (up to 34 days); a 90-day retail fill costs twice as much. Tier 1 generics are $0 and Tier 3 non-preferred generics are $20 copay.","Imaging: $300 copay per day of service, charged once per service here.","Separate prescription drug deductible: $500 individual / $1,000 family. Drug rows that say \"Deductible does not apply\" (generic drugs) are charged from the first fill; the others (preferred brand drugs, non-preferred brand drugs, specialty drugs) do not say, so they are read as after the drug deductible.","\"No charge\" rows that do not say \"Deductible does not apply\" are read as no charge after the deductible (emergency room care, outpatient surgery facility fees, outpatient surgeon fees, hospital stay facility fees, hospital stay physician fees, delivery facility fees, delivery professional fees); the SBC coverage examples show the full deductible being paid for care billed under these rows.","Costs and limits here are for in-network (participating or preferred) providers; out-of-network providers have a higher deductible and out-of-pocket limit and cost more.","This is a small-business (small-group) plan. Geisinger's SBC prints no plan ID; its title is the plan name of the small-group filing."],"sbcUrl":"https://www.geisinger.org/-/media/External/SBCs-2027/75729PA0050159-00.pdf"},{"market":"group","id":"79279PA0200001-00","standardId":"79279PA0200001-00","variant":"standard","issuer":"Highmark Coverage Advantage","name":"PPO Blue $0 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":552.13,"tobaccoFactor":1},"2":{"base21":656.44,"tobaccoFactor":1},"4":{"base21":637.32,"tobaccoFactor":1},"5":{"base21":665.68,"tobaccoFactor":1},"6":{"base21":675.41,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":563.4,"tobaccoFactor":1},"2":{"base21":669.85,"tobaccoFactor":1},"4":{"base21":650.34,"tobaccoFactor":1},"5":{"base21":679.27,"tobaccoFactor":1},"6":{"base21":689.21,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":574.92,"tobaccoFactor":1},"2":{"base21":683.54,"tobaccoFactor":1},"4":{"base21":663.63,"tobaccoFactor":1},"5":{"base21":693.16,"tobaccoFactor":1},"6":{"base21":703.3,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":586.69,"tobaccoFactor":1},"2":{"base21":697.53,"tobaccoFactor":1},"4":{"base21":677.22,"tobaccoFactor":1},"5":{"base21":707.35,"tobaccoFactor":1},"6":{"base21":717.7,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":9100,"fam":18200},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":405,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":360,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":75,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":250,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $250 copay per admission, charged on the first day of each stay. The SBC prints \"$250 copay/visit\"; a hospital visit is read as one stay (Highmark's 2026 SBCs said \"per admission\").","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $20 copay for a 31-day retail supply ($40 for 60 days, $60 for 90 days); $20 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","No network deductible: copays and coinsurance apply from the first visit.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245893308/SE_2245893308_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":505.42,"tobaccoFactor":1},"2":{"base21":577.13,"tobaccoFactor":1},"4":{"base21":577.13,"tobaccoFactor":1},"5":{"base21":585.21,"tobaccoFactor":1},"6":{"base21":619.4,"tobaccoFactor":1}}}},{"market":"group","id":"79279PA0200002-00","standardId":"79279PA0200002-00","variant":"standard","issuer":"Highmark Coverage Advantage","name":"PPO Blue $0 100/80 Platinum","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":609.63,"tobaccoFactor":1},"2":{"base21":724.8,"tobaccoFactor":1},"4":{"base21":703.69,"tobaccoFactor":1},"5":{"base21":735.01,"tobaccoFactor":1},"6":{"base21":745.76,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":622.08,"tobaccoFactor":1},"2":{"base21":739.61,"tobaccoFactor":1},"4":{"base21":718.07,"tobaccoFactor":1},"5":{"base21":750.02,"tobaccoFactor":1},"6":{"base21":760.99,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":634.8,"tobaccoFactor":1},"2":{"base21":754.73,"tobaccoFactor":1},"4":{"base21":732.75,"tobaccoFactor":1},"5":{"base21":765.35,"tobaccoFactor":1},"6":{"base21":776.55,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":647.79,"tobaccoFactor":1},"2":{"base21":770.18,"tobaccoFactor":1},"4":{"base21":747.75,"tobaccoFactor":1},"5":{"base21":781.02,"tobaccoFactor":1},"6":{"base21":792.44,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":6000,"fam":12000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":35,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"free","ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","No network deductible: copays and coinsurance apply from the first visit.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245893803/SE_2245893803_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":566.58,"tobaccoFactor":1},"2":{"base21":646.97,"tobaccoFactor":1},"4":{"base21":646.97,"tobaccoFactor":1},"5":{"base21":656.03,"tobaccoFactor":1},"6":{"base21":694.35,"tobaccoFactor":1}}}},{"market":"group","id":"79279PA0200003-00","standardId":"79279PA0200003-00","variant":"standard","issuer":"Highmark Coverage Advantage","name":"PPO Blue $1000 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":525.96,"tobaccoFactor":1},"2":{"base21":625.33,"tobaccoFactor":1},"4":{"base21":607.12,"tobaccoFactor":1},"5":{"base21":634.13,"tobaccoFactor":1},"6":{"base21":643.41,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":536.71,"tobaccoFactor":1},"2":{"base21":638.1,"tobaccoFactor":1},"4":{"base21":619.52,"tobaccoFactor":1},"5":{"base21":647.08,"tobaccoFactor":1},"6":{"base21":656.55,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":547.68,"tobaccoFactor":1},"2":{"base21":651.15,"tobaccoFactor":1},"4":{"base21":632.18,"tobaccoFactor":1},"5":{"base21":660.32,"tobaccoFactor":1},"6":{"base21":669.97,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":558.89,"tobaccoFactor":1},"2":{"base21":664.48,"tobaccoFactor":1},"4":{"base21":645.12,"tobaccoFactor":1},"5":{"base21":673.83,"tobaccoFactor":1},"6":{"base21":683.68,"tobaccoFactor":1}}}],"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":9100,"fam":18200},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245892076/SE_2245892076_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":477.88,"tobaccoFactor":1},"2":{"base21":545.69,"tobaccoFactor":1},"4":{"base21":545.69,"tobaccoFactor":1},"5":{"base21":553.33,"tobaccoFactor":1},"6":{"base21":585.65,"tobaccoFactor":1}}}},{"market":"group","id":"79279PA0200004-00","standardId":"79279PA0200004-00","variant":"standard","issuer":"Highmark Coverage Advantage","name":"PPO Blue $1000 80/60 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":448.64,"tobaccoFactor":1},"2":{"base21":533.39,"tobaccoFactor":1},"4":{"base21":517.86,"tobaccoFactor":1},"5":{"base21":540.9,"tobaccoFactor":1},"6":{"base21":548.81,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":457.8,"tobaccoFactor":1},"2":{"base21":544.29,"tobaccoFactor":1},"4":{"base21":528.44,"tobaccoFactor":1},"5":{"base21":551.95,"tobaccoFactor":1},"6":{"base21":560.02,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":467.16,"tobaccoFactor":1},"2":{"base21":555.42,"tobaccoFactor":1},"4":{"base21":539.24,"tobaccoFactor":1},"5":{"base21":563.24,"tobaccoFactor":1},"6":{"base21":571.47,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":476.72,"tobaccoFactor":1},"2":{"base21":566.79,"tobaccoFactor":1},"4":{"base21":550.28,"tobaccoFactor":1},"5":{"base21":574.76,"tobaccoFactor":1},"6":{"base21":583.17,"tobaccoFactor":1}}}],"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":6900,"fam":13800},"rules":{"pcp":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":80,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245891909/SE_2245891909_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":417.58,"tobaccoFactor":1},"2":{"base21":476.83,"tobaccoFactor":1},"4":{"base21":476.83,"tobaccoFactor":1},"5":{"base21":483.51,"tobaccoFactor":1},"6":{"base21":511.75,"tobaccoFactor":1}}}},{"market":"group","id":"79279PA0200005-00","standardId":"79279PA0200005-00","variant":"standard","issuer":"Highmark Coverage Advantage","name":"PPO Blue $1400 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":498.35,"tobaccoFactor":1},"2":{"base21":592.5,"tobaccoFactor":1},"4":{"base21":575.25,"tobaccoFactor":1},"5":{"base21":600.85,"tobaccoFactor":1},"6":{"base21":609.63,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":508.53,"tobaccoFactor":1},"2":{"base21":604.61,"tobaccoFactor":1},"4":{"base21":587,"tobaccoFactor":1},"5":{"base21":613.12,"tobaccoFactor":1},"6":{"base21":622.08,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":518.93,"tobaccoFactor":1},"2":{"base21":616.97,"tobaccoFactor":1},"4":{"base21":599,"tobaccoFactor":1},"5":{"base21":625.65,"tobaccoFactor":1},"6":{"base21":634.8,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":529.55,"tobaccoFactor":1},"2":{"base21":629.6,"tobaccoFactor":1},"4":{"base21":611.26,"tobaccoFactor":1},"5":{"base21":638.46,"tobaccoFactor":1},"6":{"base21":647.8,"tobaccoFactor":1}}}],"ded":{"ind":1400,"fam":2800,"embedded":true},"drugDed":null,"oop":{"ind":7900,"fam":15800},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":325,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":75,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245894898/SE_2245894898_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":455.39,"tobaccoFactor":1},"2":{"base21":520,"tobaccoFactor":1},"4":{"base21":520,"tobaccoFactor":1},"5":{"base21":527.28,"tobaccoFactor":1},"6":{"base21":558.08,"tobaccoFactor":1}}}},{"market":"group","id":"79279PA0200006-00","standardId":"79279PA0200006-00","variant":"standard","issuer":"Highmark Coverage Advantage","name":"PPO Blue $2000 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":500.66,"tobaccoFactor":1},"2":{"base21":595.24,"tobaccoFactor":1},"4":{"base21":577.91,"tobaccoFactor":1},"5":{"base21":603.62,"tobaccoFactor":1},"6":{"base21":612.45,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":510.88,"tobaccoFactor":1},"2":{"base21":607.4,"tobaccoFactor":1},"4":{"base21":589.71,"tobaccoFactor":1},"5":{"base21":615.95,"tobaccoFactor":1},"6":{"base21":624.96,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":521.33,"tobaccoFactor":1},"2":{"base21":619.82,"tobaccoFactor":1},"4":{"base21":601.77,"tobaccoFactor":1},"5":{"base21":628.54,"tobaccoFactor":1},"6":{"base21":637.74,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":532,"tobaccoFactor":1},"2":{"base21":632.51,"tobaccoFactor":1},"4":{"base21":614.08,"tobaccoFactor":1},"5":{"base21":641.41,"tobaccoFactor":1},"6":{"base21":650.79,"tobaccoFactor":1}}}],"ded":{"ind":2000,"fam":4000,"embedded":true},"drugDed":null,"oop":{"ind":7900,"fam":15800},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245935642/SE_2245935642_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":457.68,"tobaccoFactor":1},"2":{"base21":522.62,"tobaccoFactor":1},"4":{"base21":522.62,"tobaccoFactor":1},"5":{"base21":529.94,"tobaccoFactor":1},"6":{"base21":560.9,"tobaccoFactor":1}}}},{"market":"group","id":"79279PA0200007-00","standardId":"79279PA0200007-00","variant":"standard","issuer":"Highmark Coverage Advantage","name":"PPO Blue $2000 90/70 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":463.1,"tobaccoFactor":1},"2":{"base21":550.59,"tobaccoFactor":1},"4":{"base21":534.55,"tobaccoFactor":1},"5":{"base21":558.34,"tobaccoFactor":1},"6":{"base21":566.5,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":472.55,"tobaccoFactor":1},"2":{"base21":561.83,"tobaccoFactor":1},"4":{"base21":545.47,"tobaccoFactor":1},"5":{"base21":569.74,"tobaccoFactor":1},"6":{"base21":578.07,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":482.22,"tobaccoFactor":1},"2":{"base21":573.32,"tobaccoFactor":1},"4":{"base21":556.62,"tobaccoFactor":1},"5":{"base21":581.39,"tobaccoFactor":1},"6":{"base21":589.89,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":492.09,"tobaccoFactor":1},"2":{"base21":585.05,"tobaccoFactor":1},"4":{"base21":568.01,"tobaccoFactor":1},"5":{"base21":593.29,"tobaccoFactor":1},"6":{"base21":601.97,"tobaccoFactor":1}}}],"ded":{"ind":2000,"fam":4000,"embedded":true},"drugDed":null,"oop":{"ind":7900,"fam":15800},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245889522/SE_2245889522_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":422.67,"tobaccoFactor":1},"2":{"base21":482.64,"tobaccoFactor":1},"4":{"base21":482.64,"tobaccoFactor":1},"5":{"base21":489.4,"tobaccoFactor":1},"6":{"base21":517.99,"tobaccoFactor":1}}}},{"market":"group","id":"79279PA0200008-00","standardId":"79279PA0200008-00","variant":"standard","issuer":"Highmark Coverage Advantage","name":"PPO Blue $2500 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":475.13,"tobaccoFactor":1},"2":{"base21":564.9,"tobaccoFactor":1},"4":{"base21":548.44,"tobaccoFactor":1},"5":{"base21":572.85,"tobaccoFactor":1},"6":{"base21":581.23,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":484.84,"tobaccoFactor":1},"2":{"base21":576.44,"tobaccoFactor":1},"4":{"base21":559.65,"tobaccoFactor":1},"5":{"base21":584.55,"tobaccoFactor":1},"6":{"base21":593.1,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":494.75,"tobaccoFactor":1},"2":{"base21":588.22,"tobaccoFactor":1},"4":{"base21":571.09,"tobaccoFactor":1},"5":{"base21":596.5,"tobaccoFactor":1},"6":{"base21":605.23,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":504.88,"tobaccoFactor":1},"2":{"base21":600.26,"tobaccoFactor":1},"4":{"base21":582.78,"tobaccoFactor":1},"5":{"base21":608.71,"tobaccoFactor":1},"6":{"base21":617.61,"tobaccoFactor":1}}}],"ded":{"ind":2500,"fam":5000,"embedded":true},"drugDed":null,"oop":{"ind":7900,"fam":15800},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245891452/SE_2245891452_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":428.9,"tobaccoFactor":1},"2":{"base21":489.76,"tobaccoFactor":1},"4":{"base21":489.76,"tobaccoFactor":1},"5":{"base21":496.61,"tobaccoFactor":1},"6":{"base21":525.62,"tobaccoFactor":1}}}},{"market":"group","id":"79279PA0200009-00","standardId":"79279PA0200009-00","variant":"standard","issuer":"Highmark Coverage Advantage","name":"PPO Blue $500 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":547.42,"tobaccoFactor":1},"2":{"base21":650.84,"tobaccoFactor":1},"4":{"base21":631.88,"tobaccoFactor":1},"5":{"base21":660,"tobaccoFactor":1},"6":{"base21":669.65,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":558.6,"tobaccoFactor":1},"2":{"base21":664.13,"tobaccoFactor":1},"4":{"base21":644.79,"tobaccoFactor":1},"5":{"base21":673.48,"tobaccoFactor":1},"6":{"base21":683.33,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":570.02,"tobaccoFactor":1},"2":{"base21":677.71,"tobaccoFactor":1},"4":{"base21":657.97,"tobaccoFactor":1},"5":{"base21":687.25,"tobaccoFactor":1},"6":{"base21":697.3,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":581.69,"tobaccoFactor":1},"2":{"base21":691.58,"tobaccoFactor":1},"4":{"base21":671.44,"tobaccoFactor":1},"5":{"base21":701.32,"tobaccoFactor":1},"6":{"base21":711.57,"tobaccoFactor":1}}}],"ded":{"ind":500,"fam":1000,"embedded":true},"drugDed":null,"oop":{"ind":8550,"fam":17100},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245891536/SE_2245891536_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":498.21,"tobaccoFactor":1},"2":{"base21":568.9,"tobaccoFactor":1},"4":{"base21":568.9,"tobaccoFactor":1},"5":{"base21":576.86,"tobaccoFactor":1},"6":{"base21":610.56,"tobaccoFactor":1}}}},{"market":"group","id":"79279PA0200010-00","standardId":"79279PA0200010-00","variant":"standard","issuer":"Highmark Coverage Advantage","name":"PPO Blue $0 100/80 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":491.71,"tobaccoFactor":1},"2":{"base21":584.6,"tobaccoFactor":1},"4":{"base21":567.58,"tobaccoFactor":1},"5":{"base21":592.83,"tobaccoFactor":1},"6":{"base21":601.5,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":501.75,"tobaccoFactor":1},"2":{"base21":596.54,"tobaccoFactor":1},"4":{"base21":579.17,"tobaccoFactor":1},"5":{"base21":604.94,"tobaccoFactor":1},"6":{"base21":613.79,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":512.01,"tobaccoFactor":1},"2":{"base21":608.74,"tobaccoFactor":1},"4":{"base21":591.01,"tobaccoFactor":1},"5":{"base21":617.31,"tobaccoFactor":1},"6":{"base21":626.34,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":522.49,"tobaccoFactor":1},"2":{"base21":621.2,"tobaccoFactor":1},"4":{"base21":603.11,"tobaccoFactor":1},"5":{"base21":629.94,"tobaccoFactor":1},"6":{"base21":639.16,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":650,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":750,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":1500,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $1,500 copay per admission, charged on the first day of each stay. The SBC prints \"$1,500 copay/visit\"; a hospital visit is read as one stay (Highmark's 2026 SBCs said \"per admission\").","Diagnostic tests: $200 copay for lab tests and $300 copay for x-rays.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","No network deductible: copays and coinsurance apply from the first visit.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245894315/SE_2245894315_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":472.59,"tobaccoFactor":1},"2":{"base21":539.65,"tobaccoFactor":1},"4":{"base21":539.65,"tobaccoFactor":1},"5":{"base21":547.21,"tobaccoFactor":1},"6":{"base21":579.17,"tobaccoFactor":1}}}},{"market":"group","id":"79279PA0210001-00","standardId":"79279PA0210001-00","variant":"standard","issuer":"Highmark Coverage Advantage","name":"PPO Blue Qualified $1800 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":486.71,"tobaccoFactor":1},"2":{"base21":578.66,"tobaccoFactor":1},"4":{"base21":561.8,"tobaccoFactor":1},"5":{"base21":586.8,"tobaccoFactor":1},"6":{"base21":595.39,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":496.65,"tobaccoFactor":1},"2":{"base21":590.48,"tobaccoFactor":1},"4":{"base21":573.28,"tobaccoFactor":1},"5":{"base21":598.79,"tobaccoFactor":1},"6":{"base21":607.55,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":506.8,"tobaccoFactor":1},"2":{"base21":602.55,"tobaccoFactor":1},"4":{"base21":585,"tobaccoFactor":1},"5":{"base21":611.03,"tobaccoFactor":1},"6":{"base21":619.97,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":517.18,"tobaccoFactor":1},"2":{"base21":614.88,"tobaccoFactor":1},"4":{"base21":596.97,"tobaccoFactor":1},"5":{"base21":623.54,"tobaccoFactor":1},"6":{"base21":632.66,"tobaccoFactor":1}}}],"ded":{"ind":1800,"fam":3600,"embedded":false},"drugDed":null,"oop":{"ind":4500,"fam":9000,"famPerPerson":9000},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","Family deductible: the SBC says the overall family deductible must be met before the plan begins to pay (an aggregate family deductible), and the estimate uses the aggregate family deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245912539/SE_2245912539_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":457.28,"tobaccoFactor":1},"2":{"base21":522.17,"tobaccoFactor":1},"4":{"base21":522.17,"tobaccoFactor":1},"5":{"base21":529.48,"tobaccoFactor":1},"6":{"base21":560.41,"tobaccoFactor":1}}}},{"market":"group","id":"79279PA0210002-00","standardId":"79279PA0210002-00","variant":"standard","issuer":"Highmark Coverage Advantage","name":"PPO Blue Qualified Embedded $4800 100/100 Silver","metal":"Silver","network":"PPO","hsaEligible":true,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":432.64,"tobaccoFactor":1},"2":{"base21":514.37,"tobaccoFactor":1},"4":{"base21":499.39,"tobaccoFactor":1},"5":{"base21":521.62,"tobaccoFactor":1},"6":{"base21":529.24,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":441.47,"tobaccoFactor":1},"2":{"base21":524.88,"tobaccoFactor":1},"4":{"base21":509.59,"tobaccoFactor":1},"5":{"base21":532.27,"tobaccoFactor":1},"6":{"base21":540.05,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":450.5,"tobaccoFactor":1},"2":{"base21":535.61,"tobaccoFactor":1},"4":{"base21":520.01,"tobaccoFactor":1},"5":{"base21":543.15,"tobaccoFactor":1},"6":{"base21":551.09,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":459.72,"tobaccoFactor":1},"2":{"base21":546.58,"tobaccoFactor":1},"4":{"base21":530.66,"tobaccoFactor":1},"5":{"base21":554.27,"tobaccoFactor":1},"6":{"base21":562.37,"tobaccoFactor":1}}}],"ded":{"ind":4800,"fam":9600,"embedded":true},"drugDed":null,"oop":{"ind":6100,"fam":12200},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"copay","amount":90,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","The SBC has no specialty drug row; every drug tier is priced the same, and specialty drugs are priced like them.","Generic drugs (used here): no charge (retail and mail order).","Formulary brand drugs (used here): no charge (retail and mail order).","Non-formulary brand drugs (used here): no charge (retail and mail order).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, emergency room care, lab tests, x-rays, imaging, therapy, outpatient mental health, generic drugs, formulary brand drugs, non-formulary brand drugs, specialty drugs, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245891804/SE_2245891804_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":394.87,"tobaccoFactor":1},"2":{"base21":450.9,"tobaccoFactor":1},"4":{"base21":450.9,"tobaccoFactor":1},"5":{"base21":457.22,"tobaccoFactor":1},"6":{"base21":483.92,"tobaccoFactor":1}}}},{"market":"group","id":"79279PA0210003-00","standardId":"79279PA0210003-00","variant":"standard","issuer":"Highmark Coverage Advantage","name":"PPO Blue Qualified Embedded $3500 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":461,"tobaccoFactor":1},"2":{"base21":548.09,"tobaccoFactor":1},"4":{"base21":532.13,"tobaccoFactor":1},"5":{"base21":555.81,"tobaccoFactor":1},"6":{"base21":563.93,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":470.41,"tobaccoFactor":1},"2":{"base21":559.28,"tobaccoFactor":1},"4":{"base21":542.99,"tobaccoFactor":1},"5":{"base21":567.16,"tobaccoFactor":1},"6":{"base21":575.45,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":480.03,"tobaccoFactor":1},"2":{"base21":570.72,"tobaccoFactor":1},"4":{"base21":554.1,"tobaccoFactor":1},"5":{"base21":578.75,"tobaccoFactor":1},"6":{"base21":587.22,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":489.86,"tobaccoFactor":1},"2":{"base21":582.4,"tobaccoFactor":1},"4":{"base21":565.44,"tobaccoFactor":1},"5":{"base21":590.6,"tobaccoFactor":1},"6":{"base21":599.24,"tobaccoFactor":1}}}],"ded":{"ind":3500,"fam":7000,"embedded":true},"drugDed":null,"oop":{"ind":4500,"fam":9000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded","max":350}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, emergency room care, lab tests, x-rays, imaging, therapy, outpatient mental health, outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245895630/SE_2245895630_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":414.91,"tobaccoFactor":1},"2":{"base21":473.78,"tobaccoFactor":1},"4":{"base21":473.78,"tobaccoFactor":1},"5":{"base21":480.41,"tobaccoFactor":1},"6":{"base21":508.48,"tobaccoFactor":1}}}},{"market":"group","id":"79279PA0210004-00","standardId":"79279PA0210004-00","variant":"standard","issuer":"Highmark Coverage Advantage","name":"PPO Blue Qualified $2750 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Allegheny","Armstrong","Beaver","Bedford","Blair","Butler","Cambria","Cameron","Centre","Clarion","Clearfield","Crawford","Elk","Erie","Fayette","Forest","Greene","Huntingdon","Indiana","Jefferson","Lawrence","McKean","Mercer","Potter","Somerset","Venango","Warren","Washington","Westmoreland"],"rates":{"1":{"base21":446.25,"tobaccoFactor":1},"2":{"base21":530.56,"tobaccoFactor":1},"4":{"base21":515.1,"tobaccoFactor":1},"5":{"base21":538.03,"tobaccoFactor":1},"6":{"base21":545.89,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"1":{"base21":455.36,"tobaccoFactor":1},"2":{"base21":541.39,"tobaccoFactor":1},"4":{"base21":525.62,"tobaccoFactor":1},"5":{"base21":549.01,"tobaccoFactor":1},"6":{"base21":557.04,"tobaccoFactor":1}}},{"from":7,"rates":{"1":{"base21":464.67,"tobaccoFactor":1},"2":{"base21":552.46,"tobaccoFactor":1},"4":{"base21":536.37,"tobaccoFactor":1},"5":{"base21":560.24,"tobaccoFactor":1},"6":{"base21":568.43,"tobaccoFactor":1}}},{"from":10,"rates":{"1":{"base21":474.18,"tobaccoFactor":1},"2":{"base21":563.77,"tobaccoFactor":1},"4":{"base21":547.35,"tobaccoFactor":1},"5":{"base21":571.71,"tobaccoFactor":1},"6":{"base21":580.07,"tobaccoFactor":1}}}],"ded":{"ind":2750,"fam":5500,"embedded":false},"drugDed":null,"oop":{"ind":4800,"fam":9600,"famPerPerson":9600},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":30,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded","max":350}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","Family deductible: the SBC says the overall family deductible must be met before the plan begins to pay (an aggregate family deductible), and the estimate uses the aggregate family deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245895874/SE_2245895874_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"1":{"base21":405.99,"tobaccoFactor":1},"2":{"base21":463.59,"tobaccoFactor":1},"4":{"base21":463.59,"tobaccoFactor":1},"5":{"base21":470.08,"tobaccoFactor":1},"6":{"base21":497.54,"tobaccoFactor":1}}}},{"market":"group","id":"79962PA0140003-00","standardId":"79962PA0140003-00","variant":"standard","issuer":"Highmark Benefits Group","name":"Lehigh Valley Flex Blue PPO 500 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Northampton","Schuylkill"],"rates":{"6":{"base21":635.73,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":652.76,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":667.05,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":683.72,"tobaccoFactor":1}}}],"ded":{"ind":500,"fam":1000,"embedded":true},"drugDed":null,"oop":{"ind":9100,"fam":18200},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":225,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: primary care $65 copay; specialist $100 copay; lab and x-ray $90 copay (blood work lab) $90 copay (x-ray); imaging $375 copay; outpatient surgery facility fee 30% coinsurance; outpatient surgeon fees 30% coinsurance; urgent care $100 copay; hospital facility fee 30% coinsurance; hospital physician fees 30% coinsurance; prenatal office visits 30% coinsurance; delivery professional fees 30% coinsurance; delivery facility fee 30% coinsurance; rehabilitation $100 copay.","Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $20 copay for a 31-day retail supply ($40 for 60 days, $60 for 90 days); $20 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245780350/SE_2245780350_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":540.75,"tobaccoFactor":1}}}},{"market":"group","id":"79962PA0140004-00","standardId":"79962PA0140004-00","variant":"standard","issuer":"Highmark Benefits Group","name":"Lehigh Valley Flex Blue PPO 1250 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Northampton","Schuylkill"],"rates":{"6":{"base21":620.62,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":637.25,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":651.19,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":667.47,"tobaccoFactor":1}}}],"ded":{"ind":1250,"fam":2500,"embedded":true},"drugDed":null,"oop":{"ind":9100,"fam":18200},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: primary care $60 copay; specialist $80 copay; lab and x-ray $70 copay (blood work lab) $70 copay (x-ray); imaging $300 copay; outpatient surgery facility fee 30% coinsurance; outpatient surgeon fees 30% coinsurance; urgent care $100 copay; hospital facility fee 30% coinsurance; hospital physician fees 30% coinsurance; prenatal office visits 30% coinsurance; delivery professional fees 30% coinsurance; delivery facility fee 30% coinsurance; rehabilitation $80 copay.","Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245780490/SE_2245780490_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":526.92,"tobaccoFactor":1}}}},{"market":"group","id":"79962PA0250001-00","standardId":"79962PA0250001-00","variant":"standard","issuer":"Highmark Benefits Group","name":"PPO Blue $0 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":708.76,"tobaccoFactor":1},"7":{"base21":764.26,"tobaccoFactor":1},"9":{"base21":753.14,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":727.75,"tobaccoFactor":1},"7":{"base21":784.73,"tobaccoFactor":1},"9":{"base21":773.31,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":743.68,"tobaccoFactor":1},"7":{"base21":801.91,"tobaccoFactor":1},"9":{"base21":790.24,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":762.27,"tobaccoFactor":1},"7":{"base21":821.96,"tobaccoFactor":1},"9":{"base21":809.99,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":350,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":75,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":300,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $300 copay per admission, charged on the first day of each stay. The SBC prints \"$300 copay/visit\"; a hospital visit is read as one stay (Highmark's 2026 SBCs said \"per admission\").","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","No network deductible: copays and coinsurance apply from the first visit.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245781460/SE_2245781460_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":627.8,"tobaccoFactor":1},"7":{"base21":676.96,"tobaccoFactor":1},"9":{"base21":667.11,"tobaccoFactor":1}}}},{"market":"group","id":"79962PA0250002-00","standardId":"79962PA0250002-00","variant":"standard","issuer":"Highmark Benefits Group","name":"PPO Blue $0 100/80 Platinum","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":751.46,"tobaccoFactor":1},"7":{"base21":810.3,"tobaccoFactor":1},"9":{"base21":798.51,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":771.59,"tobaccoFactor":1},"7":{"base21":832.01,"tobaccoFactor":1},"9":{"base21":819.9,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":788.48,"tobaccoFactor":1},"7":{"base21":850.22,"tobaccoFactor":1},"9":{"base21":837.85,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":808.19,"tobaccoFactor":1},"7":{"base21":871.48,"tobaccoFactor":1},"9":{"base21":858.79,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":6000,"fam":12000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":35,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","No network deductible: copays and coinsurance apply from the first visit.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245781531/SE_2245781531_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":665.09,"tobaccoFactor":1},"7":{"base21":717.17,"tobaccoFactor":1},"9":{"base21":706.73,"tobaccoFactor":1}}}},{"market":"group","id":"79962PA0250003-00","standardId":"79962PA0250003-00","variant":"standard","issuer":"Highmark Benefits Group","name":"PPO Blue $1000 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":676.33,"tobaccoFactor":1},"7":{"base21":729.29,"tobaccoFactor":1},"9":{"base21":718.67,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":694.44,"tobaccoFactor":1},"7":{"base21":748.82,"tobaccoFactor":1},"9":{"base21":737.92,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":709.64,"tobaccoFactor":1},"7":{"base21":765.21,"tobaccoFactor":1},"9":{"base21":754.08,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":727.38,"tobaccoFactor":1},"7":{"base21":784.34,"tobaccoFactor":1},"9":{"base21":772.93,"tobaccoFactor":1}}}],"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245782404/SE_2245782404_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":596.1,"tobaccoFactor":1},"7":{"base21":642.77,"tobaccoFactor":1},"9":{"base21":633.42,"tobaccoFactor":1}}}},{"market":"group","id":"79962PA0250004-00","standardId":"79962PA0250004-00","variant":"standard","issuer":"Highmark Benefits Group","name":"PPO Blue $1000 80/60 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":599.27,"tobaccoFactor":1},"7":{"base21":646.2,"tobaccoFactor":1},"9":{"base21":636.79,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":615.33,"tobaccoFactor":1},"7":{"base21":663.51,"tobaccoFactor":1},"9":{"base21":653.85,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":628.8,"tobaccoFactor":1},"7":{"base21":678.03,"tobaccoFactor":1},"9":{"base21":668.17,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":644.52,"tobaccoFactor":1},"7":{"base21":694.98,"tobaccoFactor":1},"9":{"base21":684.87,"tobaccoFactor":1}}}],"ded":{"ind":1000,"fam":2000,"embedded":true},"drugDed":null,"oop":{"ind":8000,"fam":16000},"rules":{"pcp":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":90,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":90,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Hospital physician fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245782470/SE_2245782470_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":538.35,"tobaccoFactor":1},"7":{"base21":580.51,"tobaccoFactor":1},"9":{"base21":572.06,"tobaccoFactor":1}}}},{"market":"group","id":"79962PA0250005-00","standardId":"79962PA0250005-00","variant":"standard","issuer":"Highmark Benefits Group","name":"PPO Blue $1250 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":673.74,"tobaccoFactor":1},"7":{"base21":726.49,"tobaccoFactor":1},"9":{"base21":715.92,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":691.79,"tobaccoFactor":1},"7":{"base21":745.96,"tobaccoFactor":1},"9":{"base21":735.1,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":706.93,"tobaccoFactor":1},"7":{"base21":762.28,"tobaccoFactor":1},"9":{"base21":751.19,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":724.6,"tobaccoFactor":1},"7":{"base21":781.34,"tobaccoFactor":1},"9":{"base21":769.97,"tobaccoFactor":1}}}],"ded":{"ind":1250,"fam":2500,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":325,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245782566/SE_2245782566_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":592.84,"tobaccoFactor":1},"7":{"base21":639.26,"tobaccoFactor":1},"9":{"base21":629.95,"tobaccoFactor":1}}}},{"market":"group","id":"79962PA0250006-00","standardId":"79962PA0250006-00","variant":"standard","issuer":"Highmark Benefits Group","name":"PPO Blue $1400 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":652.26,"tobaccoFactor":1},"7":{"base21":703.33,"tobaccoFactor":1},"9":{"base21":693.09,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":669.73,"tobaccoFactor":1},"7":{"base21":722.17,"tobaccoFactor":1},"9":{"base21":711.66,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":684.39,"tobaccoFactor":1},"7":{"base21":737.98,"tobaccoFactor":1},"9":{"base21":727.24,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":701.5,"tobaccoFactor":1},"7":{"base21":756.43,"tobaccoFactor":1},"9":{"base21":745.42,"tobaccoFactor":1}}}],"ded":{"ind":1400,"fam":2800,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":325,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":75,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245784580/SE_2245784580_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":575.64,"tobaccoFactor":1},"7":{"base21":620.71,"tobaccoFactor":1},"9":{"base21":611.68,"tobaccoFactor":1}}}},{"market":"group","id":"79962PA0250007-00","standardId":"79962PA0250007-00","variant":"standard","issuer":"Highmark Benefits Group","name":"PPO Blue $1500 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":666.46,"tobaccoFactor":1},"7":{"base21":718.65,"tobaccoFactor":1},"9":{"base21":708.19,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":684.32,"tobaccoFactor":1},"7":{"base21":737.9,"tobaccoFactor":1},"9":{"base21":727.16,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":699.29,"tobaccoFactor":1},"7":{"base21":754.05,"tobaccoFactor":1},"9":{"base21":743.08,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":716.78,"tobaccoFactor":1},"7":{"base21":772.9,"tobaccoFactor":1},"9":{"base21":761.65,"tobaccoFactor":1}}}],"ded":{"ind":1500,"fam":3000,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":145,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245784667/SE_2245784667_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":587.75,"tobaccoFactor":1},"7":{"base21":633.77,"tobaccoFactor":1},"9":{"base21":624.55,"tobaccoFactor":1}}}},{"market":"group","id":"79962PA0250008-00","standardId":"79962PA0250008-00","variant":"standard","issuer":"Highmark Benefits Group","name":"PPO Blue $1550 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":660.46,"tobaccoFactor":1},"7":{"base21":712.17,"tobaccoFactor":1},"9":{"base21":701.81,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":678.15,"tobaccoFactor":1},"7":{"base21":731.25,"tobaccoFactor":1},"9":{"base21":720.61,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":692.99,"tobaccoFactor":1},"7":{"base21":747.26,"tobaccoFactor":1},"9":{"base21":736.38,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":710.32,"tobaccoFactor":1},"7":{"base21":765.94,"tobaccoFactor":1},"9":{"base21":754.79,"tobaccoFactor":1}}}],"ded":{"ind":1550,"fam":3100,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":325,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":170,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":300,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $300 copay per admission, charged on the first day of each stay. The other days count toward the deductible until it is met, then cost nothing more. The SBC prints \"$300 copay/visit\"; a hospital visit is read as one stay (Highmark's 2026 SBCs said \"per admission\").","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245784907/SE_2245784907_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":578.26,"tobaccoFactor":1},"7":{"base21":623.54,"tobaccoFactor":1},"9":{"base21":614.47,"tobaccoFactor":1}}}},{"market":"group","id":"79962PA0250009-00","standardId":"79962PA0250009-00","variant":"standard","issuer":"Highmark Benefits Group","name":"PPO Blue $1750 90/70 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":618.35,"tobaccoFactor":1},"7":{"base21":666.77,"tobaccoFactor":1},"9":{"base21":657.07,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":634.92,"tobaccoFactor":1},"7":{"base21":684.63,"tobaccoFactor":1},"9":{"base21":674.67,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":648.82,"tobaccoFactor":1},"7":{"base21":699.62,"tobaccoFactor":1},"9":{"base21":689.44,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":665.04,"tobaccoFactor":1},"7":{"base21":717.11,"tobaccoFactor":1},"9":{"base21":706.67,"tobaccoFactor":1}}}],"ded":{"ind":1750,"fam":3500,"embedded":true},"drugDed":null,"oop":{"ind":9100,"fam":18200},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Hospital physician fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245785294/SE_2245785294_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":546.98,"tobaccoFactor":1},"7":{"base21":589.81,"tobaccoFactor":1},"9":{"base21":581.23,"tobaccoFactor":1}}}},{"market":"group","id":"79962PA0250010-00","standardId":"79962PA0250010-00","variant":"standard","issuer":"Highmark Benefits Group","name":"PPO Blue $2000 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":652.92,"tobaccoFactor":1},"7":{"base21":704.04,"tobaccoFactor":1},"9":{"base21":693.8,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":670.41,"tobaccoFactor":1},"7":{"base21":722.9,"tobaccoFactor":1},"9":{"base21":712.38,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":685.08,"tobaccoFactor":1},"7":{"base21":738.73,"tobaccoFactor":1},"9":{"base21":727.98,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":702.21,"tobaccoFactor":1},"7":{"base21":757.19,"tobaccoFactor":1},"9":{"base21":746.17,"tobaccoFactor":1}}}],"ded":{"ind":2000,"fam":4000,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":60,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":125,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245783428/SE_2245783428_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":575.48,"tobaccoFactor":1},"7":{"base21":620.54,"tobaccoFactor":1},"9":{"base21":611.51,"tobaccoFactor":1}}}},{"market":"group","id":"79962PA0250011-00","standardId":"79962PA0250011-00","variant":"standard","issuer":"Highmark Benefits Group","name":"PPO Blue $2000 90/70 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":608.17,"tobaccoFactor":1},"7":{"base21":655.79,"tobaccoFactor":1},"9":{"base21":646.25,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":624.46,"tobaccoFactor":1},"7":{"base21":673.36,"tobaccoFactor":1},"9":{"base21":663.56,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":638.13,"tobaccoFactor":1},"7":{"base21":688.1,"tobaccoFactor":1},"9":{"base21":678.08,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":654.08,"tobaccoFactor":1},"7":{"base21":705.3,"tobaccoFactor":1},"9":{"base21":695.03,"tobaccoFactor":1}}}],"ded":{"ind":2000,"fam":4000,"embedded":true},"drugDed":null,"oop":{"ind":9100,"fam":18200},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Hospital physician fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245783361/SE_2245783361_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":544.14,"tobaccoFactor":1},"7":{"base21":586.75,"tobaccoFactor":1},"9":{"base21":578.21,"tobaccoFactor":1}}}},{"market":"group","id":"79962PA0250012-00","standardId":"79962PA0250012-00","variant":"standard","issuer":"Highmark Benefits Group","name":"PPO Blue $2000 70/50 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":541.61,"tobaccoFactor":1},"7":{"base21":584.02,"tobaccoFactor":1},"9":{"base21":575.52,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":556.12,"tobaccoFactor":1},"7":{"base21":599.66,"tobaccoFactor":1},"9":{"base21":590.93,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":568.29,"tobaccoFactor":1},"7":{"base21":612.79,"tobaccoFactor":1},"9":{"base21":603.87,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":582.49,"tobaccoFactor":1},"7":{"base21":628.11,"tobaccoFactor":1},"9":{"base21":618.97,"tobaccoFactor":1}}}],"ded":{"ind":2000,"fam":4000,"embedded":true},"drugDed":null,"oop":{"ind":11250,"fam":22500},"rules":{"pcp":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":550,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":95,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $95 copay for a 31-day retail supply ($190 for 60 days, $285 for 90 days); $190 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $150 copay for a 31-day retail supply ($300 for 60 days, $450 for 90 days); $300 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245783295/SE_2245783295_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":486.89,"tobaccoFactor":1},"7":{"base21":525.02,"tobaccoFactor":1},"9":{"base21":517.38,"tobaccoFactor":1}}}},{"market":"group","id":"79962PA0250013-00","standardId":"79962PA0250013-00","variant":"standard","issuer":"Highmark Benefits Group","name":"PPO Blue $250 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":697.48,"tobaccoFactor":1},"7":{"base21":752.09,"tobaccoFactor":1},"9":{"base21":741.15,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":716.16,"tobaccoFactor":1},"7":{"base21":772.24,"tobaccoFactor":1},"9":{"base21":761,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":731.84,"tobaccoFactor":1},"7":{"base21":789.15,"tobaccoFactor":1},"9":{"base21":777.66,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":750.13,"tobaccoFactor":1},"7":{"base21":808.87,"tobaccoFactor":1},"9":{"base21":797.1,"tobaccoFactor":1}}}],"ded":{"ind":250,"fam":500,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":360,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":70,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":125,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245783225/SE_2245783225_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":617.36,"tobaccoFactor":1},"7":{"base21":665.7,"tobaccoFactor":1},"9":{"base21":656.01,"tobaccoFactor":1}}}},{"market":"group","id":"79962PA0250014-00","standardId":"79962PA0250014-00","variant":"standard","issuer":"Highmark Benefits Group","name":"PPO Blue $250 100/80 Platinum","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":752.23,"tobaccoFactor":1},"7":{"base21":811.14,"tobaccoFactor":1},"9":{"base21":799.33,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":772.39,"tobaccoFactor":1},"7":{"base21":832.87,"tobaccoFactor":1},"9":{"base21":820.74,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":789.29,"tobaccoFactor":1},"7":{"base21":851.1,"tobaccoFactor":1},"9":{"base21":838.71,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":809.02,"tobaccoFactor":1},"7":{"base21":872.37,"tobaccoFactor":1},"9":{"base21":859.68,"tobaccoFactor":1}}}],"ded":{"ind":250,"fam":500,"embedded":true},"drugDed":null,"oop":{"ind":6000,"fam":12000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":35,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Outpatient surgery facility fee: the chart marks it \"Deductible does not apply\"; page 1 does not list it among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245125349/SE_2245125349_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":664.11,"tobaccoFactor":1},"7":{"base21":716.12,"tobaccoFactor":1},"9":{"base21":705.69,"tobaccoFactor":1}}}},{"market":"group","id":"79962PA0250015-00","standardId":"79962PA0250015-00","variant":"standard","issuer":"Highmark Benefits Group","name":"PPO Blue $2500 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":635.47,"tobaccoFactor":1},"7":{"base21":685.23,"tobaccoFactor":1},"9":{"base21":675.26,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":652.49,"tobaccoFactor":1},"7":{"base21":703.59,"tobaccoFactor":1},"9":{"base21":693.35,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":666.77,"tobaccoFactor":1},"7":{"base21":718.99,"tobaccoFactor":1},"9":{"base21":708.52,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":683.44,"tobaccoFactor":1},"7":{"base21":736.96,"tobaccoFactor":1},"9":{"base21":726.23,"tobaccoFactor":1}}}],"ded":{"ind":2500,"fam":5000,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":50,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245782176/SE_2245782176_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":562.09,"tobaccoFactor":1},"7":{"base21":606.1,"tobaccoFactor":1},"9":{"base21":597.28,"tobaccoFactor":1}}}},{"market":"group","id":"79962PA0250016-00","standardId":"79962PA0250016-00","variant":"standard","issuer":"Highmark Benefits Group","name":"PPO Blue $2500 100/80 Gold 1x","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":662.36,"tobaccoFactor":1},"7":{"base21":714.23,"tobaccoFactor":1},"9":{"base21":703.84,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":680.11,"tobaccoFactor":1},"7":{"base21":733.36,"tobaccoFactor":1},"9":{"base21":722.69,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":695,"tobaccoFactor":1},"7":{"base21":749.42,"tobaccoFactor":1},"9":{"base21":738.51,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":712.37,"tobaccoFactor":1},"7":{"base21":768.15,"tobaccoFactor":1},"9":{"base21":756.97,"tobaccoFactor":1}}}],"ded":{"ind":2500,"fam":2500,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":10600},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":35,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":35,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":35,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":300,"ded":"after_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $300 copay per admission, charged on the first day of each stay. The other days count toward the deductible until it is met, then cost nothing more. The SBC prints \"$300 copay/visit\"; a hospital visit is read as one stay (Highmark's 2026 SBCs said \"per admission\").","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $20 copay for a 31-day retail supply ($40 for 60 days, $60 for 90 days); $20 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245782242/SE_2245782242_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":579.33,"tobaccoFactor":1},"7":{"base21":624.7,"tobaccoFactor":1},"9":{"base21":615.61,"tobaccoFactor":1}}}},{"market":"group","id":"79962PA0250017-00","standardId":"79962PA0250017-00","variant":"standard","issuer":"Highmark Benefits Group","name":"PPO Blue $2600 70/50 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":536.34,"tobaccoFactor":1},"7":{"base21":578.34,"tobaccoFactor":1},"9":{"base21":569.93,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":550.71,"tobaccoFactor":1},"7":{"base21":593.84,"tobaccoFactor":1},"9":{"base21":585.19,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":562.77,"tobaccoFactor":1},"7":{"base21":606.83,"tobaccoFactor":1},"9":{"base21":598,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":576.84,"tobaccoFactor":1},"7":{"base21":622,"tobaccoFactor":1},"9":{"base21":612.95,"tobaccoFactor":1}}}],"ded":{"ind":2600,"fam":5200,"embedded":true},"drugDed":null,"oop":{"ind":11250,"fam":22500},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":95,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $95 copay for a 31-day retail supply ($190 for 60 days, $285 for 90 days); $190 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $150 copay for a 31-day retail supply ($300 for 60 days, $450 for 90 days); $300 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245782035/SE_2245782035_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":480.56,"tobaccoFactor":1},"7":{"base21":518.19,"tobaccoFactor":1},"9":{"base21":510.65,"tobaccoFactor":1}}}},{"market":"group","id":"79962PA0250018-00","standardId":"79962PA0250018-00","variant":"standard","issuer":"Highmark Benefits Group","name":"PPO Blue $3000 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":635.89,"tobaccoFactor":1},"7":{"base21":685.69,"tobaccoFactor":1},"9":{"base21":675.71,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":652.93,"tobaccoFactor":1},"7":{"base21":704.05,"tobaccoFactor":1},"9":{"base21":693.81,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":667.22,"tobaccoFactor":1},"7":{"base21":719.47,"tobaccoFactor":1},"9":{"base21":708.99,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":683.9,"tobaccoFactor":1},"7":{"base21":737.45,"tobaccoFactor":1},"9":{"base21":726.72,"tobaccoFactor":1}}}],"ded":{"ind":3000,"fam":6000,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":175,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":30,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":175,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245782110/SE_2245782110_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":561.24,"tobaccoFactor":1},"7":{"base21":605.19,"tobaccoFactor":1},"9":{"base21":596.38,"tobaccoFactor":1}}}},{"market":"group","id":"79962PA0250019-00","standardId":"79962PA0250019-00","variant":"standard","issuer":"Highmark Benefits Group","name":"PPO Blue $3500 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":608.41,"tobaccoFactor":1},"7":{"base21":656.05,"tobaccoFactor":1},"9":{"base21":646.5,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":624.7,"tobaccoFactor":1},"7":{"base21":673.62,"tobaccoFactor":1},"9":{"base21":663.82,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":638.38,"tobaccoFactor":1},"7":{"base21":688.37,"tobaccoFactor":1},"9":{"base21":678.35,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":654.34,"tobaccoFactor":1},"7":{"base21":705.57,"tobaccoFactor":1},"9":{"base21":695.3,"tobaccoFactor":1}}}],"ded":{"ind":3500,"fam":7000,"embedded":true},"drugDed":null,"oop":{"ind":9500,"fam":19000},"rules":{"pcp":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $15 copay for a 31-day retail supply ($30 for 60 days, $45 for 90 days); $15 for a 90-day mail-order supply.","Formulary brand drugs (used here): $60 copay for a 31-day retail supply ($120 for 60 days, $180 for 90 days); $120 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245781969/SE_2245781969_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":545,"tobaccoFactor":1},"7":{"base21":587.68,"tobaccoFactor":1},"9":{"base21":579.13,"tobaccoFactor":1}}}},{"market":"group","id":"79962PA0250020-00","standardId":"79962PA0250020-00","variant":"standard","issuer":"Highmark Benefits Group","name":"PPO Blue $4000 100/80 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":569.3,"tobaccoFactor":1},"7":{"base21":613.88,"tobaccoFactor":1},"9":{"base21":604.94,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":584.55,"tobaccoFactor":1},"7":{"base21":630.32,"tobaccoFactor":1},"9":{"base21":621.15,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":597.35,"tobaccoFactor":1},"7":{"base21":644.12,"tobaccoFactor":1},"9":{"base21":634.75,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":612.28,"tobaccoFactor":1},"7":{"base21":660.22,"tobaccoFactor":1},"9":{"base21":650.61,"tobaccoFactor":1}}}],"ded":{"ind":4000,"fam":8000,"embedded":true},"drugDed":null,"oop":{"ind":11500,"fam":23000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":70,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245781819/SE_2245781819_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":507.78,"tobaccoFactor":1},"7":{"base21":547.54,"tobaccoFactor":1},"9":{"base21":539.57,"tobaccoFactor":1}}}},{"market":"group","id":"79962PA0250021-00","standardId":"79962PA0250021-00","variant":"standard","issuer":"Highmark Benefits Group","name":"PPO Blue $500 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":691.86,"tobaccoFactor":1},"7":{"base21":746.03,"tobaccoFactor":1},"9":{"base21":735.18,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":710.39,"tobaccoFactor":1},"7":{"base21":766.02,"tobaccoFactor":1},"9":{"base21":754.87,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":725.94,"tobaccoFactor":1},"7":{"base21":782.79,"tobaccoFactor":1},"9":{"base21":771.39,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":744.09,"tobaccoFactor":1},"7":{"base21":802.36,"tobaccoFactor":1},"9":{"base21":790.68,"tobaccoFactor":1}}}],"ded":{"ind":500,"fam":1000,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":405,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":375,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":70,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":125,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $20 copay for a 31-day retail supply ($40 for 60 days, $60 for 90 days); $20 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245781899/SE_2245781899_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":610.72,"tobaccoFactor":1},"7":{"base21":658.54,"tobaccoFactor":1},"9":{"base21":648.96,"tobaccoFactor":1}}}},{"market":"group","id":"79962PA0250022-00","standardId":"79962PA0250022-00","variant":"standard","issuer":"Highmark Benefits Group","name":"PPO Blue $5000 100/80 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":555.57,"tobaccoFactor":1},"7":{"base21":599.07,"tobaccoFactor":1},"9":{"base21":590.35,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":570.45,"tobaccoFactor":1},"7":{"base21":615.12,"tobaccoFactor":1},"9":{"base21":606.17,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":582.94,"tobaccoFactor":1},"7":{"base21":628.59,"tobaccoFactor":1},"9":{"base21":619.44,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":597.51,"tobaccoFactor":1},"7":{"base21":644.3,"tobaccoFactor":1},"9":{"base21":634.92,"tobaccoFactor":1}}}],"ded":{"ind":5000,"fam":10000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":325,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":75,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $95 copay for a 31-day retail supply ($190 for 60 days, $285 for 90 days); $190 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $150 copay for a 31-day retail supply ($300 for 60 days, $450 for 90 days); $300 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245781741/SE_2245781741_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":494.95,"tobaccoFactor":1},"7":{"base21":533.7,"tobaccoFactor":1},"9":{"base21":525.93,"tobaccoFactor":1}}}},{"market":"group","id":"79962PA0250023-00","standardId":"79962PA0250023-00","variant":"standard","issuer":"Highmark Benefits Group","name":"PPO Blue $750 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":683.89,"tobaccoFactor":1},"7":{"base21":737.44,"tobaccoFactor":1},"9":{"base21":726.71,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":702.21,"tobaccoFactor":1},"7":{"base21":757.2,"tobaccoFactor":1},"9":{"base21":746.18,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":717.58,"tobaccoFactor":1},"7":{"base21":773.77,"tobaccoFactor":1},"9":{"base21":762.51,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":735.52,"tobaccoFactor":1},"7":{"base21":793.12,"tobaccoFactor":1},"9":{"base21":781.57,"tobaccoFactor":1}}}],"ded":{"ind":750,"fam":1500,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":65,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":125,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["This is a small-business (small-group) plan. Highmark has no SBC for it: it is not in Highmark's small-group SBC search, and its form filing with the Pennsylvania Insurance Department, SERFF HGHM-134875116 (certificate CERT-HBG-PPO-SM-2027), holds only another plan's sample SBC. This record is built from that filing's benefit matrix (\"BPM-HBG-PPO-SM-2027.xlsx\", sheet \"Grids\", column D, \"PPO Blue $750 100/80 Gold\", Standard Network); each rule cites its cell, and its \"page\" is the sheet row.","Checked against the 2027 rate decision's Rate Pages (hbg-rate-change-decision-sm-grp-mkt.pdf p. 45): deductible $750, out-of-pocket maximum $10,600, plan coinsurance 100% and the primary care copay agree (the Rate Pages print no drug amounts). The matrix's other columns (79962PA0250002-00, 79962PA0250020-00) give exactly the records built from those plans' 2027 SBCs.","Emergency room and advanced imaging: the matrix prints no deductible word in these rows for any plan; this plan's 2026 SBC, with the same amounts, charged the emergency room after the deductible (\"$300 copay/visit\") and imaging before it (\"$300 copay/visit Deductible does not apply.\"), and that is followed.","Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered. The matrix does not print the limit; it is this plan's 2026 SBC's and every 2027 SBC's of this certificate checked here.","Low-cost generic drugs (used here): $3 / $6 / $9 low cost generic copay retail. Generic drugs: $30 / $60 / $90 standard generic copay retail. Formulary brand drugs (used here): $65 / $130 / $195 formulary brand copay. Non-formulary brand drugs (used here): $90 / $180 / $270 non-formulary copay. Formulary specialty drugs (used here): 20% formulary specialty coinsurance -- $350 Maximum (31-day supply-Retail). Non-formulary specialty drugs: 20% formulary specialty coinsurance -- $350 Maximum (31-day supply-Retail). Drug deductible: None.","Hospital, surgeon, prenatal and delivery costs: the matrix says \"$0 after deductible\", free once the deductible is met.","Outpatient surgeon fees: the 2026 SBC printed the facility copay ($125) in the surgeon-fee row too; the matrix says \"$0 after deductible\" for Surgical Services - Surgery, as the 2027 SBCs of this certificate print \"No charge\" in that row where their 2026 SBCs printed the copay (79962PA0250003, 0250020)."],"sbcUrl":"https://serff-sfa.naic.org/serff/sfa/home/PA#HGHM-134875116/BPM-HBG-PPO-SM-2027.xlsx","prev":{"planYear":2026,"rates":{"6":{"base21":603.49,"tobaccoFactor":1},"7":{"base21":650.75,"tobaccoFactor":1},"9":{"base21":641.28,"tobaccoFactor":1}}}},{"market":"group","id":"79962PA0250024-00","standardId":"79962PA0250024-00","variant":"standard","issuer":"Highmark Benefits Group","name":"PPO Blue $0 100/80 Silver","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":665.03,"tobaccoFactor":1},"7":{"base21":717.1,"tobaccoFactor":1},"9":{"base21":706.67,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":682.84,"tobaccoFactor":1},"7":{"base21":736.31,"tobaccoFactor":1},"9":{"base21":725.6,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":697.79,"tobaccoFactor":1},"7":{"base21":752.43,"tobaccoFactor":1},"9":{"base21":741.48,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":715.23,"tobaccoFactor":1},"7":{"base21":771.24,"tobaccoFactor":1},"9":{"base21":760.02,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":80,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":650,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":200,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":80,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":600,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"},"firstN":{"n":1,"rule":{"kind":"copay","amount":1500,"ded":"no_ded"}}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Hospital stay: $1,500 copay per admission, charged on the first day of each stay. The SBC prints \"$1,500 copay/visit\"; a hospital visit is read as one stay (Highmark's 2026 SBCs said \"per admission\").","Diagnostic tests: $85 copay for lab tests and $200 copay for x-rays.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","No network deductible: copays and coinsurance apply from the first visit.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245782324/SE_2245782324_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":602,"tobaccoFactor":1},"7":{"base21":649.14,"tobaccoFactor":1},"9":{"base21":639.69,"tobaccoFactor":1}}}},{"market":"group","id":"79962PA0250026-00","standardId":"79962PA0250026-00","variant":"standard","issuer":"Highmark Benefits Group","name":"PPO Blue $7000 100/80","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":528.27,"tobaccoFactor":1},"7":{"base21":569.64,"tobaccoFactor":1},"9":{"base21":561.35,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":542.42,"tobaccoFactor":1},"7":{"base21":584.9,"tobaccoFactor":1},"9":{"base21":576.39,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":554.3,"tobaccoFactor":1},"7":{"base21":597.7,"tobaccoFactor":1},"9":{"base21":589,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":568.15,"tobaccoFactor":1},"7":{"base21":612.64,"tobaccoFactor":1},"9":{"base21":603.73,"tobaccoFactor":1}}}],"ded":{"ind":7000,"fam":14000,"embedded":true},"drugDed":null,"oop":{"ind":11500,"fam":23000},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":350,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":75,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":95,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":150,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":300,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $95 copay for a 31-day retail supply ($190 for 60 days, $285 for 90 days); $190 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $150 copay for a 31-day retail supply ($300 for 60 days, $450 for 90 days); $300 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Imaging, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245781669/SE_2245781669_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":474.97,"tobaccoFactor":1},"7":{"base21":512.16,"tobaccoFactor":1},"9":{"base21":504.71,"tobaccoFactor":1}}}},{"market":"group","id":"79962PA0260001-00","standardId":"79962PA0260001-00","variant":"standard","issuer":"Highmark Benefits Group","name":"PPO Blue Qualified $1750 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":644.04,"tobaccoFactor":1},"7":{"base21":694.48,"tobaccoFactor":1},"9":{"base21":684.37,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":661.3,"tobaccoFactor":1},"7":{"base21":713.08,"tobaccoFactor":1},"9":{"base21":702.7,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":675.77,"tobaccoFactor":1},"7":{"base21":728.69,"tobaccoFactor":1},"9":{"base21":718.08,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":692.67,"tobaccoFactor":1},"7":{"base21":746.9,"tobaccoFactor":1},"9":{"base21":736.03,"tobaccoFactor":1}}}],"ded":{"ind":1750,"fam":3500,"embedded":false},"drugDed":null,"oop":{"ind":6250,"fam":12500,"famPerPerson":12000},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":200,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":40,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":150,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","Family deductible: the SBC says the overall family deductible must be met before the plan begins to pay (an aggregate family deductible), and the estimate uses the aggregate family deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245781299/SE_2245781299_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":568.78,"tobaccoFactor":1},"7":{"base21":613.32,"tobaccoFactor":1},"9":{"base21":604.39,"tobaccoFactor":1}}}},{"market":"group","id":"79962PA0260002-00","standardId":"79962PA0260002-00","variant":"standard","issuer":"Highmark Benefits Group","name":"PPO Blue Qualified Embedded $3500 100/80 Silver","metal":"Silver","network":"PPO","hsaEligible":true,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":583.93,"tobaccoFactor":1},"7":{"base21":629.65,"tobaccoFactor":1},"9":{"base21":620.49,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":599.57,"tobaccoFactor":1},"7":{"base21":646.52,"tobaccoFactor":1},"9":{"base21":637.11,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":612.69,"tobaccoFactor":1},"7":{"base21":660.67,"tobaccoFactor":1},"9":{"base21":651.05,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":628.01,"tobaccoFactor":1},"7":{"base21":677.19,"tobaccoFactor":1},"9":{"base21":667.33,"tobaccoFactor":1}}}],"ded":{"ind":3500,"fam":7000,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"copay","amount":20,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":35,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":70,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":70,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":35,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":35,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":65,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":90,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $30 copay for a 31-day retail supply ($60 for 60 days, $90 for 90 days); $30 for a 90-day mail-order supply.","Formulary brand drugs (used here): $65 copay for a 31-day retail supply ($130 for 60 days, $195 for 90 days); $130 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $90 copay for a 31-day retail supply ($180 for 60 days, $270 for 90 days); $180 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245781394/SE_2245781394_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":512.24,"tobaccoFactor":1},"7":{"base21":552.35,"tobaccoFactor":1},"9":{"base21":544.31,"tobaccoFactor":1}}}},{"market":"group","id":"79962PA0260003-00","standardId":"79962PA0260003-00","variant":"standard","issuer":"Highmark Benefits Group","name":"PPO Blue Qualified Embedded $3550 100/60 Silver","metal":"Silver","network":"PPO","hsaEligible":true,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":607.89,"tobaccoFactor":1},"7":{"base21":655.49,"tobaccoFactor":1},"9":{"base21":645.95,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":624.17,"tobaccoFactor":1},"7":{"base21":673.05,"tobaccoFactor":1},"9":{"base21":663.25,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":637.84,"tobaccoFactor":1},"7":{"base21":687.78,"tobaccoFactor":1},"9":{"base21":677.77,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":653.78,"tobaccoFactor":1},"7":{"base21":704.98,"tobaccoFactor":1},"9":{"base21":694.72,"tobaccoFactor":1}}}],"ded":{"ind":3550,"fam":7100,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, emergency room care, lab tests, x-rays, imaging, therapy, outpatient mental health, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245781011/SE_2245781011_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":527.39,"tobaccoFactor":1},"7":{"base21":568.69,"tobaccoFactor":1},"9":{"base21":560.41,"tobaccoFactor":1}}}},{"market":"group","id":"79962PA0260004-00","standardId":"79962PA0260004-00","variant":"standard","issuer":"Highmark Benefits Group","name":"PPO Blue Qualified Embedded $4250 100/100 Silver","metal":"Silver","network":"PPO","hsaEligible":true,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":588.33,"tobaccoFactor":1},"7":{"base21":634.39,"tobaccoFactor":1},"9":{"base21":625.16,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":604.09,"tobaccoFactor":1},"7":{"base21":651.39,"tobaccoFactor":1},"9":{"base21":641.91,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":617.31,"tobaccoFactor":1},"7":{"base21":665.65,"tobaccoFactor":1},"9":{"base21":655.96,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":632.74,"tobaccoFactor":1},"7":{"base21":682.29,"tobaccoFactor":1},"9":{"base21":672.36,"tobaccoFactor":1}}}],"ded":{"ind":4250,"fam":8500,"embedded":true},"drugDed":null,"oop":{"ind":7500,"fam":15000},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":400,"ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, lab tests, x-rays, imaging, therapy, outpatient mental health, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245780938/SE_2245780938_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":518.63,"tobaccoFactor":1},"7":{"base21":559.25,"tobaccoFactor":1},"9":{"base21":551.11,"tobaccoFactor":1}}}},{"market":"group","id":"79962PA0260006-00","standardId":"79962PA0260006-00","variant":"standard","issuer":"Highmark Benefits Group","name":"PPO Blue Qualified Embedded $7800 100/100 Bronze","metal":"Bronze","network":"PPO","hsaEligible":true,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":521.27,"tobaccoFactor":1},"7":{"base21":562.09,"tobaccoFactor":1},"9":{"base21":553.91,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":535.23,"tobaccoFactor":1},"7":{"base21":577.14,"tobaccoFactor":1},"9":{"base21":568.74,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":546.95,"tobaccoFactor":1},"7":{"base21":589.78,"tobaccoFactor":1},"9":{"base21":581.19,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":560.62,"tobaccoFactor":1},"7":{"base21":604.52,"tobaccoFactor":1},"9":{"base21":595.72,"tobaccoFactor":1}}}],"ded":{"ind":7800,"fam":15600,"embedded":true},"drugDed":null,"oop":{"ind":7800,"fam":15600},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","The SBC has no specialty drug row; every drug tier is priced the same, and specialty drugs are priced like them.","Generic drugs (used here): no charge (retail and mail order).","Formulary brand drugs (used here): no charge (retail and mail order).","Non-formulary brand drugs (used here): no charge (retail and mail order).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, emergency room care, lab tests, x-rays, imaging, therapy, outpatient mental health, generic drugs, formulary brand drugs, non-formulary brand drugs, specialty drugs, outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","Out-of-pocket limit: this SBC says $7,800 for one person; the Rate Pages of the approved rate filing say $15,600 (hbg-rate-change-decision-sm-grp-mkt.pdf, page 47). They agree on the deductible, coinsurance and primary care copay; the SBC, Highmark's January 2027 document, is followed. The Rate Pages amount is the SBC's family limit ($15,600), twice its $7,800 limit for one person, which equals the deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245125935/SE_2245125935_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":478.67,"tobaccoFactor":1},"7":{"base21":516.15,"tobaccoFactor":1},"9":{"base21":508.64,"tobaccoFactor":1}}}},{"market":"group","id":"79962PA0260008-00","standardId":"79962PA0260008-00","variant":"standard","issuer":"Highmark Benefits Group","name":"PPO Blue Qualified Embedded $6100 100/80 Silver","metal":"Silver","network":"PPO","hsaEligible":true,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":580.82,"tobaccoFactor":1},"7":{"base21":626.3,"tobaccoFactor":1},"9":{"base21":617.18,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":596.37,"tobaccoFactor":1},"7":{"base21":643.07,"tobaccoFactor":1},"9":{"base21":633.71,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":609.43,"tobaccoFactor":1},"7":{"base21":657.15,"tobaccoFactor":1},"9":{"base21":647.59,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":624.66,"tobaccoFactor":1},"7":{"base21":673.58,"tobaccoFactor":1},"9":{"base21":663.77,"tobaccoFactor":1}}}],"ded":{"ind":6100,"fam":12200,"embedded":true},"drugDed":null,"oop":{"ind":6100,"fam":12200},"rules":{"pcp":{"base":{"kind":"free","ded":"after_ded"}},"specialist":{"base":{"kind":"free","ded":"after_ded"}},"urgentCare":{"base":{"kind":"free","ded":"after_ded"}},"er":{"base":{"kind":"free","ded":"after_ded"}},"lab":{"base":{"kind":"free","ded":"after_ded"}},"xray":{"base":{"kind":"free","ded":"after_ded"}},"imaging":{"base":{"kind":"free","ded":"after_ded"}},"pt":{"base":{"kind":"free","ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"free","ded":"after_ded"}},"rxGeneric":{"base":{"kind":"free","ded":"after_ded"}},"rxPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"free","ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"free","ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","The SBC has no specialty drug row; every drug tier is priced the same, and specialty drugs are priced like them.","Generic drugs (used here): no charge (retail and mail order).","Formulary brand drugs (used here): no charge (retail and mail order).","Non-formulary brand drugs (used here): no charge (retail and mail order).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Primary care visits, specialist visits, urgent care, emergency room care, lab tests, x-rays, imaging, therapy, outpatient mental health, generic drugs, formulary brand drugs, non-formulary brand drugs, specialty drugs, outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245780872/SE_2245780872_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":497.75,"tobaccoFactor":1},"7":{"base21":536.72,"tobaccoFactor":1},"9":{"base21":528.91,"tobaccoFactor":1}}}},{"market":"group","id":"79962PA0260009-00","standardId":"79962PA0260009-00","variant":"standard","issuer":"Highmark Benefits Group","name":"PPO Blue Qualified $2750 100/80 Gold","metal":"Gold","network":"PPO","hsaEligible":true,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":603.38,"tobaccoFactor":1},"7":{"base21":650.63,"tobaccoFactor":1},"9":{"base21":641.16,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":619.54,"tobaccoFactor":1},"7":{"base21":668.06,"tobaccoFactor":1},"9":{"base21":658.33,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":633.11,"tobaccoFactor":1},"7":{"base21":682.68,"tobaccoFactor":1},"9":{"base21":672.74,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":648.93,"tobaccoFactor":1},"7":{"base21":699.75,"tobaccoFactor":1},"9":{"base21":689.56,"tobaccoFactor":1}}}],"ded":{"ind":2750,"fam":5500,"embedded":false},"drugDed":null,"oop":{"ind":5800,"fam":11600,"famPerPerson":11600},"rules":{"pcp":{"base":{"kind":"copay","amount":15,"ded":"after_ded"}},"specialist":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"er":{"base":{"kind":"copay","amount":250,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"xray":{"base":{"kind":"copay","amount":40,"ded":"after_ded"}},"imaging":{"base":{"kind":"copay","amount":100,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":30,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":30,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":55,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":85,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"after_ded","max":350}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $10 copay for a 31-day retail supply ($20 for 60 days, $30 for 90 days); $10 for a 90-day mail-order supply.","Formulary brand drugs (used here): $55 copay for a 31-day retail supply ($110 for 60 days, $165 for 90 days); $110 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","Family deductible: the SBC says the overall family deductible must be met before the plan begins to pay (an aggregate family deductible), and the estimate uses the aggregate family deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245781144/SE_2245781144_20270101_SBC.pdf","prev":{"planYear":2026,"rates":{"6":{"base21":535.74,"tobaccoFactor":1},"7":{"base21":577.69,"tobaccoFactor":1},"9":{"base21":569.28,"tobaccoFactor":1}}}},{"market":"group","id":"79962PA0390001-00","standardId":"79962PA0390001-00","variant":"standard","issuer":"Highmark Benefits Group","name":"Performance Flex Blue PPO $6000","metal":"Bronze","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":433.42,"tobaccoFactor":1},"7":{"base21":467.36,"tobaccoFactor":1},"9":{"base21":460.56,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":445.03,"tobaccoFactor":1},"7":{"base21":479.88,"tobaccoFactor":1},"9":{"base21":472.89,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":454.77,"tobaccoFactor":1},"7":{"base21":490.38,"tobaccoFactor":1},"9":{"base21":483.25,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":466.14,"tobaccoFactor":1},"7":{"base21":502.64,"tobaccoFactor":1},"9":{"base21":495.33,"tobaccoFactor":1}}}],"ded":{"ind":6000,"fam":12000,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.5,"ded":"after_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: primary care no charge; specialist no charge; lab and x-ray no charge (blood work lab) no charge (x-ray); imaging no charge; outpatient surgery facility fee no charge; outpatient surgeon fees no charge; urgent care no charge; hospital facility fee no charge; hospital physician fees no charge; prenatal office visits no charge; delivery professional fees no charge; delivery facility fee no charge; rehabilitation no charge.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","The SBC has no specialty drug row; every drug tier is priced the same, and specialty drugs are priced like them.","Generic drugs (used here): 50% coinsurance (retail and mail order).","Formulary brand drugs (used here): 50% coinsurance (retail and mail order).","Non-formulary brand drugs (used here): 50% coinsurance (retail and mail order).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision services, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245779037/SE_2245779037_20270101_SBC.pdf"},{"market":"group","id":"79962PA0390002-00","standardId":"79962PA0390002-00","variant":"standard","issuer":"Highmark Benefits Group","name":"Performance Flex Blue PPO $2800","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":507.41,"tobaccoFactor":1},"7":{"base21":547.14,"tobaccoFactor":1},"9":{"base21":539.18,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":521,"tobaccoFactor":1},"7":{"base21":561.8,"tobaccoFactor":1},"9":{"base21":553.62,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":532.4,"tobaccoFactor":1},"7":{"base21":574.09,"tobaccoFactor":1},"9":{"base21":565.74,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":545.71,"tobaccoFactor":1},"7":{"base21":588.45,"tobaccoFactor":1},"9":{"base21":579.88,"tobaccoFactor":1}}}],"ded":{"ind":2800,"fam":5600,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":40,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"er":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"lab":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"pt":{"base":{"kind":"copay","amount":85,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.3,"ded":"after_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: primary care 40% coinsurance; specialist 40% coinsurance; lab and x-ray 40% coinsurance (blood work lab) 40% coinsurance (x-ray); imaging 40% coinsurance; outpatient surgery facility fee 40% coinsurance; outpatient surgeon fees 40% coinsurance; urgent care 40% coinsurance; hospital facility fee 40% coinsurance; hospital physician fees 40% coinsurance; prenatal office visits 40% coinsurance; delivery professional fees 40% coinsurance; delivery facility fee 40% coinsurance; rehabilitation 40% coinsurance.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245779606/SE_2245779606_20270101_SBC.pdf"},{"market":"group","id":"79962PA0390003-00","standardId":"79962PA0390003-00","variant":"standard","issuer":"Highmark Benefits Group","name":"Performance Flex Blue PPO $4250","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":532.12,"tobaccoFactor":1},"7":{"base21":573.79,"tobaccoFactor":1},"9":{"base21":565.44,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":546.38,"tobaccoFactor":1},"7":{"base21":589.16,"tobaccoFactor":1},"9":{"base21":580.58,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":558.34,"tobaccoFactor":1},"7":{"base21":602.06,"tobaccoFactor":1},"9":{"base21":593.29,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":572.29,"tobaccoFactor":1},"7":{"base21":617.11,"tobaccoFactor":1},"9":{"base21":608.12,"tobaccoFactor":1}}}],"ded":{"ind":4250,"fam":8500,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":60,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":90,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":600,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":400,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":85,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":185,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: primary care 50% coinsurance; specialist 50% coinsurance; lab and x-ray 50% coinsurance (blood work lab) 50% coinsurance (x-ray); imaging 50% coinsurance; outpatient surgery facility fee 50% coinsurance; outpatient surgeon fees 50% coinsurance; urgent care 50% coinsurance; hospital facility fee 50% coinsurance; hospital physician fees 50% coinsurance; prenatal office visits 50% coinsurance; delivery professional fees 50% coinsurance; delivery facility fee 50% coinsurance; rehabilitation 50% coinsurance.","Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","Outpatient surgeon fees: the chart marks it \"Deductible does not apply\"; page 1 does not list it among the services covered before the deductible. The chart is followed.","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245779832/SE_2245779832_20270101_SBC.pdf"},{"market":"group","id":"79962PA0390004-00","standardId":"79962PA0390004-00","variant":"standard","issuer":"Highmark Benefits Group","name":"Performance Flex Blue PPO $5000","metal":"Silver","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":492.87,"tobaccoFactor":1},"7":{"base21":531.47,"tobaccoFactor":1},"9":{"base21":523.73,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":506.08,"tobaccoFactor":1},"7":{"base21":545.7,"tobaccoFactor":1},"9":{"base21":537.76,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":517.15,"tobaccoFactor":1},"7":{"base21":557.65,"tobaccoFactor":1},"9":{"base21":549.53,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":530.08,"tobaccoFactor":1},"7":{"base21":571.59,"tobaccoFactor":1},"9":{"base21":563.27,"tobaccoFactor":1}}}],"ded":{"ind":5000,"fam":10000,"embedded":true},"drugDed":null,"oop":{"ind":7000,"fam":14000},"rules":{"pcp":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"imaging":{"base":{"kind":"coins","rate":0.15,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.15,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":70,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"coins","rate":0.15,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.15,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.15,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.15,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.15,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.15,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.15,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.15,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.15,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.15,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.15,"ded":"after_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: primary care 50% coinsurance; specialist 50% coinsurance; lab and x-ray 50% coinsurance (blood work lab) 50% coinsurance (x-ray); imaging 50% coinsurance; outpatient surgery facility fee 50% coinsurance; outpatient surgeon fees 50% coinsurance; urgent care 50% coinsurance; hospital facility fee 50% coinsurance; hospital physician fees 50% coinsurance; prenatal office visits 50% coinsurance; delivery professional fees 50% coinsurance; delivery facility fee 50% coinsurance; rehabilitation 50% coinsurance.","Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","The SBC has no specialty drug row; every drug tier is priced the same, and specialty drugs are priced like them.","Generic drugs (used here): 15% coinsurance (retail and mail order).","Formulary brand drugs (used here): 15% coinsurance (retail and mail order).","Non-formulary brand drugs (used here): 15% coinsurance (retail and mail order).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, pediatric vision services, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245779968/SE_2245779968_20270101_SBC.pdf"},{"market":"group","id":"79962PA0390005-00","standardId":"79962PA0390005-00","variant":"standard","issuer":"Highmark Benefits Group","name":"Performance Flex Blue PPO $250","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":653.67,"tobaccoFactor":1},"7":{"base21":704.85,"tobaccoFactor":1},"9":{"base21":694.6,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":671.18,"tobaccoFactor":1},"7":{"base21":723.74,"tobaccoFactor":1},"9":{"base21":713.2,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":685.87,"tobaccoFactor":1},"7":{"base21":739.58,"tobaccoFactor":1},"9":{"base21":728.81,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":703.02,"tobaccoFactor":1},"7":{"base21":758.07,"tobaccoFactor":1},"9":{"base21":747.03,"tobaccoFactor":1}}}],"ded":{"ind":250,"fam":500,"embedded":true},"drugDed":null,"oop":{"ind":12000,"fam":24000},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":45,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: primary care $60 copay; specialist $100 copay; lab and x-ray $100 copay (blood work lab) $100 copay (x-ray); imaging $400 copay; outpatient surgery facility fee 30% coinsurance; outpatient surgeon fees 30% coinsurance; urgent care $100 copay; hospital facility fee 30% coinsurance; hospital physician fees 30% coinsurance; prenatal office visits 30% coinsurance; delivery professional fees 30% coinsurance; delivery facility fee 30% coinsurance; rehabilitation $100 copay.","Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245779204/SE_2245779204_20270101_SBC.pdf"},{"market":"group","id":"79962PA0390006-00","standardId":"79962PA0390006-00","variant":"standard","issuer":"Highmark Benefits Group","name":"Performance Flex Blue PPO $500","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":640.41,"tobaccoFactor":1},"7":{"base21":690.56,"tobaccoFactor":1},"9":{"base21":680.51,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":657.56,"tobaccoFactor":1},"7":{"base21":709.05,"tobaccoFactor":1},"9":{"base21":698.74,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":671.96,"tobaccoFactor":1},"7":{"base21":724.58,"tobaccoFactor":1},"9":{"base21":714.03,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":688.76,"tobaccoFactor":1},"7":{"base21":742.69,"tobaccoFactor":1},"9":{"base21":731.88,"tobaccoFactor":1}}}],"ded":{"ind":500,"fam":1000,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":30,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":325,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: primary care $65 copay; specialist $100 copay; lab and x-ray $100 copay (blood work lab) $100 copay (x-ray); imaging $400 copay; outpatient surgery facility fee 30% coinsurance; outpatient surgeon fees 30% coinsurance; urgent care $100 copay; hospital facility fee 30% coinsurance; hospital physician fees 30% coinsurance; prenatal office visits 30% coinsurance; delivery professional fees 30% coinsurance; delivery facility fee 30% coinsurance; rehabilitation $100 copay.","Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245779899/SE_2245779899_20270101_SBC.pdf"},{"market":"group","id":"79962PA0390007-00","standardId":"79962PA0390007-00","variant":"standard","issuer":"Highmark Benefits Group","name":"Performance Flex Blue PPO $1250","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":620.99,"tobaccoFactor":1},"7":{"base21":669.62,"tobaccoFactor":1},"9":{"base21":659.87,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":637.62,"tobaccoFactor":1},"7":{"base21":687.55,"tobaccoFactor":1},"9":{"base21":677.55,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":651.58,"tobaccoFactor":1},"7":{"base21":702.6,"tobaccoFactor":1},"9":{"base21":692.38,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":667.87,"tobaccoFactor":1},"7":{"base21":720.17,"tobaccoFactor":1},"9":{"base21":709.69,"tobaccoFactor":1}}}],"ded":{"ind":1250,"fam":2500,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":25,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":300,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":45,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":45,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: primary care $60 copay; specialist $85 copay; lab and x-ray $85 copay (blood work lab) $85 copay (x-ray); imaging $400 copay; outpatient surgery facility fee 30% coinsurance; outpatient surgeon fees 30% coinsurance; urgent care $100 copay; hospital facility fee 30% coinsurance; hospital physician fees 30% coinsurance; prenatal office visits 30% coinsurance; delivery professional fees 30% coinsurance; delivery facility fee 30% coinsurance; rehabilitation $85 copay.","Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245779363/SE_2245779363_20270101_SBC.pdf"},{"market":"group","id":"79962PA0390008-00","standardId":"79962PA0390008-00","variant":"standard","issuer":"Highmark Benefits Group","name":"Performance Flex Blue PPO $2500","metal":"Gold","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":596.05,"tobaccoFactor":1},"7":{"base21":642.73,"tobaccoFactor":1},"9":{"base21":633.37,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":612.02,"tobaccoFactor":1},"7":{"base21":659.95,"tobaccoFactor":1},"9":{"base21":650.34,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":625.42,"tobaccoFactor":1},"7":{"base21":674.39,"tobaccoFactor":1},"9":{"base21":664.58,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":641.05,"tobaccoFactor":1},"7":{"base21":691.25,"tobaccoFactor":1},"9":{"base21":681.19,"tobaccoFactor":1}}}],"ded":{"ind":2500,"fam":5000,"embedded":true},"drugDed":null,"oop":{"ind":10600,"fam":21200},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":500,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":250,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":50,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":50,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"after_ded"}},"prenatal":{"base":{"kind":"free","ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"after_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: primary care $40 copay; specialist $85 copay; lab and x-ray $85 copay (blood work lab) $85 copay (x-ray); imaging 30% coinsurance; outpatient surgery facility fee 30% coinsurance; outpatient surgeon fees 30% coinsurance; urgent care $100 copay; hospital facility fee 30% coinsurance; hospital physician fees 30% coinsurance; prenatal office visits 30% coinsurance; delivery professional fees 30% coinsurance; delivery facility fee 30% coinsurance; rehabilitation $85 copay.","Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","SBC page 1 lists these as covered before the deductible: Office visits, preventive care services, standard diagnostic services, imaging tests, emergency room care, urgent care, outpatient mental health, outpatient substance abuse, rehabilitation services, habilitation services, pediatric vision services, pediatric dental exams, and prescription drug benefits. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Outpatient surgery facility fees, outpatient surgeon fees, hospital facility fees, hospital physician fees, prenatal visits, delivery facility fees and delivery professional fees show \"No charge\" with no deductible waiver. Highmark marks every cell that is paid before the deductible \"Deductible does not apply\" (and page 1 lists those services), and the chart says its costs are after the deductible \"if a deductible applies\", so this \"No charge\" is read as free only after the deductible is met. This is a reading, not something the SBC states.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245779286/SE_2245779286_20270101_SBC.pdf"},{"market":"group","id":"79962PA0390009-00","standardId":"79962PA0390009-00","variant":"standard","issuer":"Highmark Benefits Group","name":"Performance Flex Blue PPO $0","metal":"Platinum","network":"PPO","hsaEligible":false,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":709.73,"tobaccoFactor":1},"7":{"base21":765.3,"tobaccoFactor":1},"9":{"base21":754.16,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":728.74,"tobaccoFactor":1},"7":{"base21":785.8,"tobaccoFactor":1},"9":{"base21":774.37,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":744.69,"tobaccoFactor":1},"7":{"base21":803,"tobaccoFactor":1},"9":{"base21":791.32,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":763.31,"tobaccoFactor":1},"7":{"base21":823.08,"tobaccoFactor":1},"9":{"base21":811.1,"tobaccoFactor":1}}}],"ded":{"ind":0,"fam":0,"embedded":true},"drugDed":null,"oop":{"ind":8000,"fam":16000},"rules":{"pcp":{"base":{"kind":"copay","amount":10,"ded":"no_ded"}},"specialist":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"urgentCare":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"er":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"lab":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"xray":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"imaging":{"base":{"kind":"copay","amount":75,"ded":"no_ded"}},"pt":{"base":{"kind":"copay","amount":20,"ded":"no_ded"},"limit":30},"mentalHealth":{"base":{"kind":"copay","amount":20,"ded":"no_ded"}},"rxGeneric":{"base":{"kind":"copay","amount":3,"ded":"no_ded"}},"rxPreferred":{"base":{"kind":"copay","amount":85,"ded":"no_ded"}},"rxNonPreferred":{"base":{"kind":"copay","amount":125,"ded":"no_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.2,"ded":"no_ded","max":350}},"outpatientFacility":{"base":{"kind":"copay","amount":100,"ded":"no_ded"}},"outpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"inpatientFacility":{"base":{"kind":"free","ded":"no_ded"}},"inpatientProfessional":{"base":{"kind":"free","ded":"no_ded"}},"prenatal":{"base":{"kind":"free","ded":"no_ded"}},"deliveryFacility":{"base":{"kind":"free","ded":"no_ded"}},"deliveryProfessional":{"base":{"kind":"free","ded":"no_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: primary care 15% coinsurance; specialist 15% coinsurance; lab and x-ray 15% coinsurance (blood work lab) 15% coinsurance (x-ray); imaging 15% coinsurance; outpatient surgery facility fee 15% coinsurance; outpatient surgeon fees 15% coinsurance; urgent care 15% coinsurance; hospital facility fee 15% coinsurance; hospital physician fees 15% coinsurance; prenatal office visits 15% coinsurance; delivery professional fees 15% coinsurance; delivery facility fee 15% coinsurance; rehabilitation 15% coinsurance.","Emergency room: the copay is waived if you are admitted as an inpatient.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","Low-cost generic drugs (used here): $3 copay for a 31-day retail supply ($6 for 60 days, $9 for 90 days); $3 for a 90-day mail-order supply.","Generic drugs: $40 copay for a 31-day retail supply ($80 for 60 days, $120 for 90 days); $40 for a 90-day mail-order supply.","Formulary brand drugs (used here): $85 copay for a 31-day retail supply ($170 for 60 days, $255 for 90 days); $170 for a 90-day mail-order supply.","Non-formulary brand drugs (used here): $125 copay for a 31-day retail supply ($250 for 60 days, $375 for 90 days); $250 for a 90-day mail-order supply.","Formulary specialty drugs (used here): 20% coinsurance, at most $350 per retail prescription (at most $700 per mail-order prescription).","Non-formulary specialty drugs: 30% coinsurance, at most $500 per retail prescription (at most $1,000 per mail-order prescription).","No network deductible: copays and coinsurance apply from the first visit.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245778895/SE_2245778895_20270101_SBC.pdf"},{"market":"group","id":"79962PA0400001-00","standardId":"79962PA0400001-00","variant":"standard","issuer":"Highmark Benefits Group","name":"Performance Flex Blue PPO Qualified Embedded $7500","metal":"Bronze","network":"PPO","hsaEligible":true,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":473.42,"tobaccoFactor":1},"7":{"base21":510.49,"tobaccoFactor":1},"9":{"base21":503.06,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":486.1,"tobaccoFactor":1},"7":{"base21":524.16,"tobaccoFactor":1},"9":{"base21":516.53,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":496.74,"tobaccoFactor":1},"7":{"base21":535.64,"tobaccoFactor":1},"9":{"base21":527.84,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":509.16,"tobaccoFactor":1},"7":{"base21":549.03,"tobaccoFactor":1},"9":{"base21":541.04,"tobaccoFactor":1}}}],"ded":{"ind":7500,"fam":15000,"embedded":true},"drugDed":null,"oop":{"ind":8500,"fam":17000},"rules":{"pcp":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: primary care 50% coinsurance; specialist 50% coinsurance; lab and x-ray 50% coinsurance (blood work lab) 50% coinsurance (x-ray); imaging 50% coinsurance; outpatient surgery facility fee 50% coinsurance; outpatient surgeon fees 50% coinsurance; urgent care 50% coinsurance; hospital facility fee 50% coinsurance; hospital physician fees 50% coinsurance; prenatal office visits 50% coinsurance; delivery professional fees 50% coinsurance; delivery facility fee 50% coinsurance; rehabilitation 50% coinsurance.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","The SBC has no specialty drug row; every drug tier is priced the same, and specialty drugs are priced like them.","Generic drugs (used here): 10% coinsurance (retail and mail order).","Formulary brand drugs (used here): 10% coinsurance (retail and mail order).","Non-formulary brand drugs (used here): 10% coinsurance (retail and mail order).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245780279/SE_2245780279_20270101_SBC.pdf"},{"market":"group","id":"79962PA0400002-00","standardId":"79962PA0400002-00","variant":"standard","issuer":"Highmark Benefits Group","name":"Performance Flex Blue PPO Qualified Embedded $3500","metal":"Silver","network":"PPO","hsaEligible":true,"counties":["Adams","Berks","Centre","Columbia","Cumberland","Dauphin","Franklin","Fulton","Juniata","Lancaster","Lebanon","Montour","Northampton","Northumberland","Perry","Schuylkill","Snyder","York"],"rates":{"6":{"base21":543.68,"tobaccoFactor":1},"7":{"base21":586.25,"tobaccoFactor":1},"9":{"base21":577.72,"tobaccoFactor":1}},"sheets":[{"from":4,"rates":{"6":{"base21":558.25,"tobaccoFactor":1},"7":{"base21":601.96,"tobaccoFactor":1},"9":{"base21":593.2,"tobaccoFactor":1}}},{"from":7,"rates":{"6":{"base21":570.47,"tobaccoFactor":1},"7":{"base21":615.14,"tobaccoFactor":1},"9":{"base21":606.18,"tobaccoFactor":1}}},{"from":10,"rates":{"6":{"base21":584.73,"tobaccoFactor":1},"7":{"base21":630.51,"tobaccoFactor":1},"9":{"base21":621.34,"tobaccoFactor":1}}}],"ded":{"ind":3500,"fam":7000,"embedded":true},"drugDed":null,"oop":{"ind":8700,"fam":17400},"rules":{"pcp":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"specialist":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"urgentCare":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"er":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"lab":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"xray":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"imaging":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"pt":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"},"limit":30},"mentalHealth":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"rxGeneric":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"rxPreferred":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"rxNonPreferred":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"rxSpecialty":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"outpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded","min":200}},"outpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"inpatientProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"prenatal":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryFacility":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}},"deliveryProfessional":{"base":{"kind":"coins","rate":0.1,"ded":"after_ded"}}},"notes":["This plan has two in-network tiers: the Enhanced value network (lowest cost, used for every amount here) and the Standard value network. Standard value network costs that differ: primary care 30% coinsurance; specialist 30% coinsurance; lab and x-ray 30% coinsurance (blood work lab) 30% coinsurance (x-ray); imaging 30% coinsurance; outpatient surgery facility fee 30% coinsurance; outpatient surgeon fees 30% coinsurance; urgent care 30% coinsurance; hospital facility fee 30% coinsurance; hospital physician fees 30% coinsurance; prenatal office visits 30% coinsurance; delivery professional fees 30% coinsurance; delivery facility fee 30% coinsurance; rehabilitation 30% coinsurance.","Outpatient surgery facility fee: the SBC says \"$200 copay/visit then 10% coinsurance\", a $200 copay plus 10% coinsurance on the rest, which the estimate cannot express; it is estimated as 10% coinsurance with a $200 minimum, up to $180 less per surgery than the SBC's amount.","Physical and occupational therapy: limited to 30 combined visits per benefit period (speech therapy has its own 30-visit limit, not modelled); visits above the limit are not covered.","The SBC has no specialty drug row; every drug tier is priced the same, and specialty drugs are priced like them.","Generic drugs (used here): 10% coinsurance (retail and mail order).","Formulary brand drugs (used here): 10% coinsurance (retail and mail order).","Non-formulary brand drugs (used here): 10% coinsurance (retail and mail order).","SBC page 1 lists these as covered before the deductible: Preventive care services, pediatric vision exams, and pediatric dental exams. Services the chart marks \"Deductible does not apply\" are charged from the first visit; every other service below, including those the SBC prices at \"No charge\", is treated as after the deductible.","Out-of-pocket limit: this SBC says $8,700 for one person; the Rate Pages of the approved rate filing say $12,000 (hbg-rate-change-decision-sm-grp-mkt.pdf, page 48). They agree on the deductible, coinsurance and primary care copay; the SBC, Highmark's January 2027 document, is followed. The Rate Pages amount is far above the federal out-of-pocket limit for an HSA-qualified high deductible plan (2026: $8,500 for one person), which this plan is; the SBC's amount is within it.","This is a small-business (small-group) plan. Highmark's SBC prints no plan ID; it was matched to the filed plan by company, counties, deductible and HSA eligibility (highmark-sg-map.csv)."],"sbcUrl":"https://shop.highmark.com/cmcrst/x-services/sbc/file/product/2245780037/SE_2245780037_20270101_SBC.pdf"}],"excluded":[{"id":"61389PA0010003-00","market":"group","issuer":"Highmark Senior Health Company","name":"PPO Blue Qualified Embedded $3500 1x 100/80 Gold","counties":["Bucks"],"reason":"no SBC"}]}