Changes to Highmark Insurance Programs in 2026

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Affordable Care Act (ACA)

Individual Markets Only

• OOA and OON Changes – Preferred Provider Organization (PPO) members in Delaware, Pennsylvania, and West Virginia will see changes in coverage for out-of-area (OOA) and out-of-network (OON) providers.
  • DE and WV – Providers outside the BlueCard Network — less than 3% of all providers — will no longer be covered in Delaware and West Virginia (except for urgent or emergent care).
  • PA – Using OON providers will result in a higher member cost-share.

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• New Name – Delaware’s product will be renamed “My Blue Access Select PPO” due to the change in coverage for out-of-state, out-of-network providers.

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Individual and Small Group Markets

• Pilot Program Ending in Western PA – The TytoCare pilot will be discontinued for Together Blue products.​

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Medicare Advantage

Highmark is launching a new product Complete Blue HMO in Western Pennsylvania, while also expanding the reach of two existing products:

• Complete Blue PPO – currently offered across Pennsylvania will be available in Delaware and West Virginia.
• Community Blue Medicare HMO – offered in select counties in Pennsylvania’s Western, Central, and Northeastern regions will be available in Western New York.

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There are two related National Association of Insurance Commissioners (NAIC) code changes for Pennsylvania and West Virginia when filing claims for these new offerings:

• PA – For Complete Blue HMO, use NAIC Code 54771 with prefix BMW.
• WV – For Complete Blue PPO, use NAIC Code 15459 with prefix WBH.