We’ve put together some important information to help you manage your care — and it’s all available on the member website.
Easily manage your health care and coverage.
Easily manage your health care and coverage.
We’ve put together some important information to help you manage your care — and it’s all available on the member website.
Your medical benefits
To review your member benefits booklet, select the Coverage tab from the member website homepage. From there, you can read important information about:
- Coverage for certain medical and prescription benefits.
- Your cost sharing.
- Out-of-network and out-of-area coverage and restrictions.
- How to obtain primary, specialist, and behavioral health care, as well as emergency and after-hours services.
- How to submit a claim, complaint, or appeal.
- The availability of an independent external review.
- How we evaluate new technology.
- Language assistance and TTY/TDD services.
Find out which of your prescriptions are covered.
Find out which of your prescriptions are covered.
You can look up drug information, coverage, pricing, and in-network pharmacies convenient to you. You will also find links for both your pharmacy benefits and drug formulary.
You can look up drug information, coverage, pricing, and in-network pharmacies convenient to you. You will also find links for both your pharmacy benefits and drug formulary.
In-network care
Before you book an appointment with a doctor or specialist, be sure that the provider is in your plan network. Choosing in-network providers helps you avoid paying higher out-of-pocket costs or being denied coverage for the service.
To find out if a doctor or specialist is in network, go to your member website homepage and select the Find Care tab, then the Search Doctors link. From there, type in the name of the person you’d like to see to get the following information:
- Name, address, and telephone numbers.
- Professional qualifications.
- Specialty and board certification status.
- Medical school attended and residency completion.
- Hospital affiliations.
Annual Women’s Health and Cancer Rights Act (WHCRA) notification
WHCRA is a federal law that provides certain rights and protections to patients after a mastectomy. This law requires most health insurance plans that cover mastectomies to also cover (after any applicable deductible and coinsurance):
- All stages of reconstruction and surgery of the breast on which the mastectomy was performed.
- Surgery and reconstruction of the other breast to produce a symmetrical appearance.
- Prostheses.
- Treatment of physical complications of a mastectomy, including lymphedema.
Plus, you’ll also find information on:
Our online privacy policy
For details about the information we collect, use, and disclose, as well as how we maintain your privacy, select the Legal tab at the bottom of the Coverage page to review:
• The Notice of Privacy Practices.
• Member Rights and Responsibilities.
• Mental Health Parity.
• Our Quality and Member Satisfaction.
Our rewards policy
Highmark does not reward employees, doctors, health care providers, or anyone else for denying coverage.
Need more information?
Both you and your doctor have the right to know the criteria and guidelines we use to make decisions about what’s covered and what’s not.
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Member Service
You can request this information by calling the number on on the back of your member ID card.
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Doctor request
Call 1-800-452-8507 for medical or surgical decisions, and 1-800-258-9808 for behavioral health decisions.
