Highmark Essential Plan benefits

As a Highmark Essential Plan member, you get many benefits with little to no costs or copays.

Who's eligible for Essential Plan?

 

The Essential Plan is a health insurance plan in New York for people who have limited income, but don’t qualify for Medicaid. You may be eligible for the Essential Plan through Highmark Blue Cross and Blue Shield if you:

 

 Are between the ages of 19 and 64

 

 Live in Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, or Wyoming County

 

 Are not eligible for Medicaid or Child Health Plus

 

 Are not eligible for minimum essential coverage

 

You do not have to be a citizen or legal resident to qualify for the Essential Plan. Participation in this program will not affect any future immigration status.

What you get with Highmark

Visits to the Doctor

Hospital stays

Prescriptions

Specialty pharmacy: extra care to manage your condition

Specialty pharmacy: extra care to manage your condition 

A specialty pharmacy does more than just fill prescriptions. These pharmacies serve members with complex or chronic conditions. Specialty medications are used to treat these conditions and often require special storage or extra support. Specialty pharmacies have highly trained pharmacists and nurses to provide personal care and guidance to help you manage your condition. 

 

If you have a specialty condition, you have the option to use BioPlus Specialty Pharmacy for your medications. These medications are delivered to your home or shipped to a local pharmacy for pickup. 

 

 Specialty Drug List - English

 

 Specialty Drug List - Spanish

 

With BioPlus specialty pharmacy, you get: 

Free shipping with confidential, on-time delivery 

 

Order your medicine online at any time. You can choose to have your prescription mailed to you or shipped to a school, business, doctor’s office, or retail pharmacy where you can pick it up. And, you can track your order until it arrives. 

Member resources

 

Log in to your account to manage your specialty prescriptions. You can:

 

   Order a refill

 

  Check your order status

 

  View your prescriptions

Your Care Team support

Call Specialty Pharmacy Member Services at 833-549-2115 (TTY 711) anytime day or night to speak with your Care Team.

There are five versions of the Essential Plan

Some of the benefits listed below will vary based on the plan you’re in.

Frequently asked questions

How to Get Your Prescriptions

 

Simply take your written prescription to a plan pharmacy or ask your doctor to call it in. Be sure to show the pharmacy your member ID card.

 

It’s good to use the same pharmacy each time you fill a prescription. This way, your pharmacist will know about problems that may happen when you’re taking more than one prescription. If you use another pharmacy, you should tell the pharmacist about any medicines you’re taking.

 

Our new Medication Synchronization program (Med Sync) makes getting all your medicines easier – at no extra cost to you. Med Sync helps align your refill schedules so you can pick up most of your medicines on just one day each month.

 

Our Med Sync program can help you:

 

 Cut down on trips to the pharmacy.

 

 Make sure you have your medicines when you need them.

 

 Work with your pharmacist so you can stick to a medicine routine.

Get started with Med Sync today!

Talk to your pharmacist about coordinating your prescriptions to get started. Have more questions about Med Sync? Call 833-232-1713 (TTY 711).

 

 

Log in to your account 

Pharmacy Forms

Prescription Drug Reimbursement Form

 

 CarelonRx Reimbursement Form (English)

 

 CarelonRx Reimbursement Form (Spanish)

 

 

Get your specialty medications

 

If you have a specialty condition, you’re covered. We partner with CarelonRx Specialty Pharmacy to meet all your specialty medication needs.

Already a member? We’re glad you chose Highmark.

We want you to understand your benefits and receive the best possible care. Here are some resources to help.

Member services

If you have any questions, call Member Services at 866-231-0847 (TTY 711). Our team is available Monday through Friday from 8 a.m. to 8 p.m. and Saturday from 8:30 a.m. to 6 p.m.

 

You can also log in to your account to send us a message at any time.

 

Send us a message  

24/7 NurseLine

Whether it’s 3 a.m. or a Sunday afternoon, health issues come up.

 

That’s why you can always call our 24/7 NurseLine and speak directly to a nurse.

 

Call 866-231-0847 (TTY 711) anytime, day or night.

Member handbooks

Complete benefit information can be found in your member handbook.

Essential Plan 3 and 4