Delaware health plan · 2025

my Blue Access PPO Gold 1700 HSA · 76168DE0710003

Highmark BCBSD Inc. offers this marketplace health insurance plan (Plan ID 76168DE0710003) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Gold Plan type: PPO CSR: Standard Gold On Exchange Plan Issuer: Highmark BCBSD Inc.
Telehealth Data pending HSA eligible Yes Dental Child Vision Adult/Child
Pay / Manage Plan View issuer site

CMS AV Calculator output: 78.97% (21.03% member share on average). Learn about AV methodology.

2025 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$361 – $1415

Before subsidies

Estimate after subsidies

Deductible

$1,700

$3400 per group

See deductible details

Max out-of-pocket

$5,700

$11400 per group

Review MOOP rules

Office visits

Primary care $20.00 Copay after deductible
Specialist $20.00 Copay after deductible
HSA Eligible

Drug tiers

Generic No Charge after deductible
Preferred brand $30.00 Copay after deductible

View formulary tiers

$494 / mo before subsidies

≈ $5933 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$1567 / mo before subsidies

≈ $18800 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$1897 / mo before subsidies

≈ $22769 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$1206 / mo before subsidies

≈ $14470 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

$175.00 Copay after deductible

Durable Medical Equipment

20.00% Coinsurance after deductible

Advertisement

Enrollment guidance

Stay on top of 2025 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2025 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Delaware). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • Standard Gold On Exchange Plan plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

$175.00 Copay after deductible

Durable Medical Equipment

20.00% Coinsurance after deductible

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 76168DE0710003
Coverage year 2025
State Delaware
Issuer Highmark BCBSD Inc.
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 76168DE0710003-01
Available variants

Standard Off Exchange Plan · 76168DE0710003-00

Standard On Exchange Plan · 76168DE0710003-01

Open to Indians below 300% FPL · 76168DE0710003-02

Open to Indians above 300% FPL · 76168DE0710003-03
Last plan update Wed, 14 Aug 2024 00:00 GMT
Last HealthPorta import Tue, 02 Dec 2025 06:13 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in Delaware 148
PCPs in Delaware N/A
Telehealth support Data pending
Nationwide providers 570
148 doctors statewide

Provider network(s)

Providers Delaware All US states
All 148 570
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists 106 131

Drug coverage overview

3,432 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
GENERIC 3,175
PREVENTIVE-DRUGS 257
Prior authorization Drugs
Required 794
Not Required 2,638
Step therapy Drugs
Required 509
Not Required 2,923
Quantity limits Drugs
Has Limit 1,089
No Limit 2,343

Customer highlights

What stands out for members

  • Issuer: Highmark BCBSD Inc. · Plan ID 76168DE0710003 · 2025 filing.
  • Disease management programs available: Asthma, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 76168DE0710003-01 (Standard On Exchange Plan) currently displayed.
Advertisement

Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 25.00% Coinsurance after deductible

Limit: 30.0 Visit(s) per Benefit Period

nan

Exclusions: nan

Diabetes Care Management

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Diabetes Education

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

nan

Exclusions: nan

Home Health Care Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Limit: 100.0 Visit(s) per Benefit Period

Aggregate with Visiting Nurse

Exclusions: nan

Laboratory Outpatient and Professional Services

$20.00 Copay after deductible
Tier 1 in-network $20.00 Copay after deductible
Out-of-network 50.00% Coinsurance after deductible

Copayments, if any, do not apply to diagnostic services prescribed for the treatment of mental illness or substance abuse.

Exclusions: nan

Other Practitioner Office Visit (Nurse, Physician Assistant)

$20.00 Copay after deductible
Tier 1 in-network $20.00 Copay after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Preventive Care/Screening/Immunization

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

nan

Exclusions: nan

Primary Care Visit to Treat an Injury or Illness

$20.00 Copay after deductible
Tier 1 in-network $20.00 Copay after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Rehabilitative Occupational and Rehabilitative Physical Therapy

$20.00 Copay after deductible
Tier 1 in-network $20.00 Copay after deductible
Out-of-network 25.00% Coinsurance after deductible

Limit: 30.0 Visit(s) per Benefit Period

Limited to a combined total of thirty (30) Outpatient Visits for rehabilitative purposes per Benefit Period and a combined total of thirty (30) Outpatient Visits for habilitative purposes per Benefit Period. This limit does not apply when therapy services are prescribed for the treatment of Mental Illness or Substance Abuse.

Exclusions: nan

Rehabilitative Speech Therapy

$20.00 Copay after deductible
Tier 1 in-network $20.00 Copay after deductible
Out-of-network 25.00% Coinsurance after deductible

Limit: 30.0 Visit(s) per Benefit Period

Limited to thirty (30) Outpatient Visits for rehabilitative purposes per Benefit Period and thirty (30) Outpatient Visits for habilitative purposes per Benefit Period. This limit does not apply when therapy services are prescribed for the treatment of Mental Illness or Substance Abuse.

Exclusions: nan

Specialist Visit

$20.00 Copay after deductible
Tier 1 in-network $20.00 Copay after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Urgent Care Centers or Facilities

$40.00 Copay after deductible
Tier 1 in-network $40.00 Copay after deductible
Out-of-network $40.00 Copay after deductible

The copayment, if any, does not apply to urgent care services prescribed for the treatment of mental illness or substance abuse.

Exclusions: nan

X-rays and Diagnostic Imaging

$20.00 Copay after deductible
Tier 1 in-network $20.00 Copay after deductible
Out-of-network 50.00% Coinsurance after deductible

Copayments, if any, do not apply to diagnostic services prescribed for the treatment of mental illness or substance abuse.

Exclusions: nan

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Delivery and All Inpatient Services for Maternity Care

$450.00 Copay after deductible
Tier 1 in-network $450.00 Copay after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Dialysis

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Durable Medical Equipment

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Emergency Room Services

$175.00 Copay after deductible
Tier 1 in-network $175.00 Copay after deductible
Out-of-network $175.00 Copay after deductible

nan

Exclusions: nan

Emergency Transportation/Ambulance

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 20.00% Coinsurance after deductible

nan

Exclusions: nan

Hospice Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Inpatient Hospital Services (e.g., Hospital Stay)

$450.00 Copay per Stay after deductible
Tier 1 in-network $450.00 Copay per Stay after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Inpatient Physician and Surgical Services

No Charge
Tier 1 in-network No Charge
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Mental/Behavioral Health Inpatient Services

$450.00 Copay per Stay after deductible
Tier 1 in-network $450.00 Copay per Stay after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Mental/Behavioral Health Outpatient Services

$20.00 Copay after deductible
Tier 1 in-network $20.00 Copay after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

$130.00 Copay after deductible
Tier 1 in-network $130.00 Copay after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Outpatient Rehabilitation Services

$20.00 Copay after deductible
Tier 1 in-network $20.00 Copay after deductible
Out-of-network 25.00% Coinsurance after deductible

Limit: 30.0 Visit(s) per Benefit Period

nan

Exclusions: nan

Outpatient Surgery Physician/Surgical Services

$130.00 Copay after deductible
Tier 1 in-network $130.00 Copay after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Radiation

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Skilled Nursing Facility

$450.00 Copay per Stay after deductible
Tier 1 in-network $450.00 Copay per Stay after deductible
Out-of-network 50.00% Coinsurance after deductible

Limit: 120.0 Days per Benefit Period

nan

Exclusions: nan

Substance Abuse Disorder Inpatient Services

$450.00 Copay per Stay after deductible
Tier 1 in-network $450.00 Copay per Stay after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Substance Abuse Disorder Outpatient Services

$20.00 Copay after deductible
Tier 1 in-network $20.00 Copay after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Transplant

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Hearing Aids

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Limit: 1.0 Item(s) per 3 Years

Limited to one hearing aid, per person, per ear, every three years

Exclusions: nan

Major Dental Care - Child

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Prenatal and Postnatal Care

No Charge
Tier 1 in-network No Charge
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Routine Eye Exam for Children

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Limit: 1.0 Exam(s) per Year

nan

Exclusions: nan

Well Baby Visits and Care

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

nan

Exclusions: nan

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

No Charge after deductible
Tier 1 in-network No Charge after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Non-Preferred Brand Drugs

$150.00 Copay after deductible
Tier 1 in-network $150.00 Copay after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Preferred Brand Drugs

$30.00 Copay after deductible
Tier 1 in-network $30.00 Copay after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Specialty Drugs

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Basic Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Dental Check-Up for Children

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Limit: 1.0 Exam(s) per 6 Months

nan

Exclusions: nan

Infusion Therapy

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Major Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Nutritional Counseling

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

nan

Exclusions: nan

Orthodontia - Adult

Coverage details pending

nan

Exclusions: nan

Orthodontia - Child

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Prosthetic Devices

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Routine Dental Services (Adult)

Coverage details pending

nan

Exclusions: nan

Weight Loss Programs

Coverage details pending

nan

Exclusions: nan

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

nan

Exclusions: nan

Acupuncture

Coverage details pending

nan

Exclusions: nan

Allergy Testing

$20.00 Copay after deductible
Tier 1 in-network $20.00 Copay after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Bariatric Surgery

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Clinical Trials

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Cosmetic Surgery

Coverage details pending

nan

Exclusions: nan

Eye Glasses for Children

No Charge after deductible
Tier 1 in-network No Charge after deductible
Out-of-network 100.00%

Limit: 1.0 Item(s) per Year

nan

Exclusions: nan

Gender Affirming Care

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Habilitation Services

$20.00 Copay after deductible
Tier 1 in-network $20.00 Copay after deductible
Out-of-network 25.00% Coinsurance after deductible

Limit: 30.0 Visit(s) per Benefit Period

In parity with and comparable to outpatient rehabilitation services; 30 visits combined PT/OT and 30 visits speech therapy.

Exclusions: nan

Imaging (CT/PET Scans, MRIs)

$175.00 Copay after deductible
Tier 1 in-network $175.00 Copay after deductible
Out-of-network 50.00% Coinsurance after deductible

Copayments, if any, do not apply to diagnostic services prescribed for the treatment of mental illness or substance abuse.

Exclusions: nan

Infertility Treatment

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Inherited Metabolic Disorder - PKU

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Long-Term/Custodial Nursing Home Care

Coverage details pending

nan

Exclusions: nan

Private-Duty Nursing

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Limit: 240.0 Hours per Benefit Period

nan

Exclusions: Outpatient not covered

Reconstructive Surgery

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Routine Eye Exam (Adult)

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Limit: 1.0 Exam(s) per Year

nan

Exclusions: nan

Routine Foot Care

Coverage details pending

nan

Exclusions: nan

Treatment for Temporomandibular Joint Disorders

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: Limited to Services to Determine Initial Diagnosis. Exclude Treatment Coverage when TMJ or Related Diagnosis Is only Reason for Treatment

Variant attributes

my Blue Access PPO Gold 1700 HSA · Variant 76168DE0710003-01

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

Standard Gold On Exchange Plan

HIOS Product ID

76168DE071

Metal Level

Gold

Plan ID (Standard Component ID with Variant)

76168DE0710003-01

Plan Marketing Name

my Blue Access PPO Gold 1700 HSA

Plan Variant Marketing Name

my Blue Access PPO Gold 1700 HSA

Issuer & service area

Issuer-provided metadata for this variant.

Issuer ID

76168

Issuer Marketplace Marketing Name

Highmark Blue Cross Blue Shield Delaware

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

Yes

Network ID

DEN001

Out of Country Coverage

Yes

Out of Country Coverage Description

Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.

Out of Service Area Coverage

Yes

Out of Service Area Coverage Description

If a member receives non-emergency medically necessary and appropriate care from an out-of-area Blue Card provider, benefits will be paid in accordance with the contract. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member will be financially responsible for the difference between the plan's payment and the full amount of the out-of-area provider's charge.

Service Area ID

DES001

State Code

DE

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

0.789739948502277

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

Yes

Medical Drug Maximum Out of Pocket Integrated

Yes

SBC Scenario, Having a Baby, Coinsurance

$0

SBC Scenario, Having a Baby, Copayment

$700

SBC Scenario, Having a Baby, Deductible

$1,700

SBC Scenario, Having Diabetes, Coinsurance

$100

SBC Scenario, Having Diabetes, Copayment

$500

SBC Scenario, Having Diabetes, Deductible

$1,700

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$60

SBC Scenario, Treatment of a Simple Fracture, Copayment

$200

SBC Scenario, Treatment of a Simple Fracture, Deductible

$1,700

Specialty Drug Maximum Coinsurance

$1,000

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual

Not Applicable

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

20.00%

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group

$11400 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person

$5700 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$5,700

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group

$22800 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person

$11400 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

$11,400

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

DEF004

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$60

SBC Scenario, Having Diabetes, Limit

$20

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

0

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Dental Only Plan

No

Design Type

Not Applicable

Disease Management Programs Offered

Asthma, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs

EHB Percent of Total Premium

0.9988

First Tier Utilization

100%

Import Date

2024-08-14 20:01:41

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

Yes

New/Existing Plan

Existing

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

No

Plan Effective Date

2025-01-01

Plan Type

PPO

QHP/Non QHP

Both

Source Name

SERFF

Plan ID

76168DE0710003

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group

per group not applicable

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person

per person not applicable

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group

$3400 per group

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person

$3400 per person

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual

$1,700

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group

$6800 per group

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person

$6800 per person

Combined Medical and Drug EHB Deductible, Out of Network, Individual

$3,400

Unique Plan Design

No

Wellness Program Offered

Yes

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in Delaware?

my Blue Access PPO Gold 1700 HSA (76168DE0710003) is a Gold PPO from Highmark BCBSD Inc. in Delaware for the 2025 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does my Blue Access PPO Gold 1700 HSA support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is my Blue Access PPO Gold 1700 HSA HSA-eligible and does it include dental or vision coverage?

It is HSA-eligible, so you can pair it with a Health Savings Account to lower taxes.

Dental add-ons: Child.

Vision add-ons: Adult, Child.

Does my Blue Access PPO Gold 1700 HSA support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with my Blue Access PPO Gold 1700 HSA?

The issuer lists disease management resources for: Asthma, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs.

Is there out-of-country coverage for my Blue Access PPO Gold 1700 HSA?

Yes, limited out-of-country coverage is available. Review the Summary of Benefits for reimbursement steps. Details: Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.

Does my Blue Access PPO Gold 1700 HSA cover care outside the service area?

Yes, you have limited out-of-area coverage. See the plan documents for referral and prior authorization rules. Details: If a member receives non-emergency medically necessary and appropriate care from an out-of-area Blue Card provider, benefits will be paid in accordance with the contract. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member will be financially responsible for the difference between the plan's payment and the full amount of the out-of-area provider's charge.

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
Issuer profile More plans
Open comparison tray

Add at least two plans to launch side-by-side comparisons.