Medical

Medical Plans - Highmark

Sila is committed to helping you and your dependents maintain health and wellness by providing you with access to the highest levels of care. We offer you the following three medical plan choices for 2026 through Highmark: two PPO plans and one High Deductible Health Plan (HDHP). If you enroll in the White plan, Sila will automatically open a Health Savings Account (HSA) for you. More information on HSAs can be found here.
How to Find a Provider
  1. Visit highmark.com/member/blueshield or download the My Highmark app (Apple App Store | Google Play).
  2. Then either login/register or under Find Care, select Find a Doctor.
  3. Then select Choose a Plan.
  4. Then enter your City and Zip code.
  5. Then if you don’t have an ID card to enter your three-digit prefix number, then select Browse a List of Plans and then select PPOBlue.
  6. You can then filter your provider search by name, location, specialty or type.
Highmark Online Account Access
To access your account for the first time, be sure to have your ID card handy and follow the steps below:

  1. Go to highmark.com.
  2. Click Member Login on the right side of the page.
  3. Select “Register”.
  4. Enter the following information: first name, last name,
    member ID/SSN, and date of birth.
  5. Enter your email address.
  6. Create a username and password.
Highmark Mobile App — Download Today!
With just a tap you can:

  • Access your digital ID card when you need it.
  • Look up in-network healthcare providers.
  • Keep up to date with information about your healthcare balances.
  • See how much you have paid toward your deductible.
  • Find out if there is a copay for upcoming appointments.
  • View your medical claims.
  • Chat, call or message the Highmark member support team.

Download the Highmark mobile app (Apple App Store | Google Play) for on-the-go access.

 

Care Cost Estimator
Members can use the Care Cost Estimator to search for estimates on:

  • Physicals, including adult and well-child checkups.
  • Women’s health, including mammograms, breast biopsies, ultrasounds, vaginal and C-section deliveries.
  • MRIs and other imaging.
  • Colonoscopies, weight loss surgery, physical therapy, and more.

These are just the most common searches. If you don’t see what you’re looking for, you can click All Procedures (A-Z) to compare costs on more than 1,600 common health care services so you can choose the options that give you the best value and quality.

 

Medical Plan Documents

Medical Plan Quick Comparison

Calendar Year Deductible
Individual
Family
Out-of-Pocket Maximum
Individual
Family
Coinsurance (plan pays)
Preventative Care (plan pays)
Physician Office Visits
Primary Care Visit
Specialist Visit
Urgent Care
Telemedicine
Hospital Services
Inpatient
Outpatient
Emergency Room
Orange Plan
Embedded
$2,000
$4,000
Embedded
$5,500
$11,000
80%
100%
$30
$50
$50
$25
80% after deductible
80% after deductible
$300
White Plan
Non-Embedded
$2,500
$5,500
Embedded
$7,000
$10,000
70%
100%
$40 after deductible
$70 after deductible
$100 after deductible
70% after deductible
70% after deductible
70% after deductible
$200 copay and 70% after deductible
Blue Plan
Embedded
$5,000
$10,000
Embedded
$7,000
$14,000
70%
100%
$40
$80
$80
$40
70% after deductible
70% after deductible
70% after deductible

Weekly Medical Contributions


Employee
Employee + Spouse
Employee + Child(ren)
Family
Orange Plan
$50.06
$123.70
$93.64
$132.94
White Plan
$41.21
$103.53
$75.57
$112.31
Blue Plan
$22.95
$63.44
$37.39
$65.18

Medical Terms

COINSURANCE: Your share of the costs of a covered healthcare service, calculated as a percentage (for example, 20%) of the allowed amount for the service. Your coinsurance will begin after you have met your deductible. For example, if your medical plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your coinsurance payment of 20% would be $20. The medical plan pays the rest of the allowed amount.

COPAY: A fixed dollar amount you pay for a healthcare service. The amount can vary by the type of service. Your copays will not count toward your deductible, but will count toward your out-of-pocket maximum.

DEDUCTIBLE: The amount you owe for covered healthcare services before your plan begins to pay benefits. For example, if your deductible is $2,800, your plan won’t pay anything until you’ve met your $2,800 deductible for covered healthcare services that are subject to the deductible. In network preventive care is not subject to the deductible, as it is covered 100% by the medical plan options.

EMBEDDED DEDUCTIBLE: If your family medical coverage has an embedded deductible, that means if one family member reaches the individual deductible, they will begin to share in the cost of care through coinsurance—they do not need to reach the family deductible before coinsurance begins. Once the expenses for all other family members reach the family deductible, coinsurance will begin.

EXPLANATION OF BENEFITS (EOB): A statement from the insurance company showing how claims were processed. The EOB tells you what portion of the claim was paid to the healthcare provider and what portion of the payment, if any, you are responsible for.

EVIDENCE OF INSURABILITY (EOI): EOI is a short health questionnaire that some insurance may require you to apply for certain types or amounts of coverage—like life or disability insurance—outside of your initial eligibility period or above a guaranteed amount. It helps the insurer understand your health status before approving the coverage.

IN-NETWORK VS. OUT-OF-NETWORK: A network is composed of all contracted providers. Networks request providers to participate in their network, and in return, providers agree to offer discounted services to their patients. If you pick an out-of-network provider, your costs will be higher because you will not receive the discounts the in network providers offer.

OUT-OF-POCKET MAXIMUM: The out-of-pocket maximum is designed to protect you if you have a catastrophic illness or injury. Your out-of-pocket maximum includes your deductible, coinsurance and copays that come out of your pocket. After you have reached the annual out of-pocket maximum, the plan pays the remaining covered services at 100%.

PREVENTIVE CARE: Routine healthcare services can minimize the risk of certain illnesses or chronic conditions. Examples of preventive care services include physical exams, mammograms, flu vaccines, prostate tests and smoking cessation.

REASONABLE AND CUSTOMARY: The amount of money a medical plan determines is the normal or acceptable range of charges for a specific health-related service or medical procedure. If your healthcare provider submits higher charges than what the health plan considers reasonable and customary, you may have to pay the difference.