2027 CopayGo Expansion: Additional ASO Offerings and Fully Insured Products

Highmark's innovative health plan, CopayGo, is expanding in 2027. Debuting at the start of 2026, the plan was offered in all markets for administrative services only (ASO) large group accounts as a preferred provider organization (PPO) product.

What’s Changing

In 2027, ASO clients will also have access to an exclusive provider organization (EPO) product as well as a qualified high-deductible health plan (QHDHP) design, which will be available as either a PPO or an EPO.

In addition, EPO and PPO products will be available to fully insured clients in Delaware, New York, and Pennsylvania. The QHDHP is not available to fully insured clients.

Note: Non-qualified high-deductible health plans (HDHPs) are not available with CopayGo.

Background

CopayGo PPO and EPO operate as true, copay-only designs, with no deductible and no coinsurance for in-network care. While the QHDHP design does carry a deductible, once met, members transition to fixed copays for in-network care.

Providers are designated "enhanced" or "standard" based on rankings determined by the Blue Cross Blue Shield Axis^® Provider Insights, a national dataset that measures quality, appropriateness of care, and cost/efficiency at the individual provider level.

In order to promote higher-value care, members have a differentiated cost-share, which incentivizes the use of enhanced providers.

Verifying Eligibility and Benefits

Provider offices can verify a member's CopayGo plan through an eligibility and benefits inquiry in Availity Essentials^®. Out-of-area providers can check eligibility and benefits via their local portal using the member ID, making sure to include the prefix. Both Availity and a 270 inquiry will display the member's copay amounts for both "enhanced" and "standard" providers within your practice.

It's important to note that these tiered copays solely impact the member's out-of-pocket cost at the point of service and do not affect the total reimbursement providers receive for their services.

For detailed information on which individual providers within your practice are designated as "enhanced" or "standard," visit the CopayGo Health Plan page on the Provider Resource Center (PRC).