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Health Plan - Highmark Delaware

Announcement

All bariatric surgeries are required to be completed under your SurgeryPlus benefit with a surgeon in the SurgeryPlus network. Bariatric surgery is not covered under your Aetna or Highmark Delaware non-Medicare health plan and will not be eligible for a financial incentive.

Outpatient Surgery

Save time and money by having your outpatient surgery services completed at in-network non-hospital affiliated Ambulatory Surgery Centers (ASCs). These facilities provide similar quality as hospital affiliated locations and are often more convenient.

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Freestanding Ambulatory Surgery Center Locations

Highmark Delaware Comprehensive PPO Plan

Site of Care	Average Cost Per Visit	Your Cost Per Visit
Note: Prior authorization is required for certain outpatient surgical procedures.
In-network non-hospital affiliated Ambulatory Surgery Center (ASC)	$1,799	$50 copay
In-network hospital affiliated facility	$4,836	$150 copay

Highmark Delaware First State Basic Plan

Site of Care	Average Cost Per Visit	Your Cost Per Visit
Note: Prior authorization is required for certain outpatient surgical procedures.
In-network non-hospital affiliated Ambulatory Surgery Center (ASC)	$1,799	10% coinsurance after deductible is met
In-network hospital affiliated facility	$4,836	10% coinsurance after deductible is met