Introducing CopayGo: Highmark's New Tiered Copay Plan for ASO Large Group Accounts

Effective Jan. 1, 2026, Highmark is launching CopayGo, an innovative alternative health product designed for our Administrative Services Only (ASO) large group accounts. CopayGo simplifies healthcare costs with a national two-tiered network of "Enhanced" and "Standard" providers.

Understanding CopayGo's Structure

CopayGo is a unique copay-only plan. This means members will not face deductibles or coinsurance for covered services. Instead, they will have differentiated copay amounts based on whether they choose an "Enhanced" or "Standard" provider. 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.

How Providers are Tiered

CopayGo leverages the most current Blue Cross Blue Shield Axis^® Provider Insights national dataset to tier selected providers across the nation. This tiering applies to providers in 20 specialties, including essential services like primary care, pediatrics, and OB/GYN.

The analysis for each individual provider is based on three key measures: Quality, Appropriateness of Care, and Cost. To ensure ongoing accuracy, this dataset will be refreshed annually, which may lead to changes in a provider's "Enhanced" or "Standard" designation based on their performance.

Information for Provider Offices

Provider offices can verify a member's CopayGo plan through an eligibility and benefits inquiry in Availity Essentials^®. Both Availity and a 270 inquiry will display the member's copay amounts for both "Enhanced" and "Standard" providers within your practice. In addition, member ID cards will clearly indicate enhanced and standard copays for primary care providers (PCPs), specialists, emergency room (ER) visits, and Urgent Care.

For detailed information on which individual providers within your practice are designated as "Enhanced" or "Standard," visit the CopayGo page on the Provider Resource Center, which is located under the Provider Network tab.

Empowering Members with Simplicity

CopayGo's streamlined design aims to alleviate common member pain points by offering clear, upfront cost and quality information. Through the digital tools available on the MyHighmark member portal, members can easily reference individual provider designations and check copay amounts before their visit.