Benefits & Coverage

Insurance Type
Individual Health Insurance (Obamacare)
Insurance Provider
Anthem BCBS
Metal Level
Silver
Plan Type
PPO
Deductible
$2500
Out-of-Pocket Maximum
$6000
Plan Highlights

Cost & Coverage

Estimated Monthly Base Rate
Estimated monthly premium starts at $1329.56
Deductible
Individual: $2500
Family: $5000
In-Network Out-of-Pocket Limit
Individual: $6000
Family: $12000
What is included in the in-network out-of-pocket limit?
Deductible + Coinsurance + Co-pay
Is this plan Health Savings Account (HSA) eligible?
No
How can I find a doctor in this plan's network?
Plan Type
PPO

Health Services Options

Service
In Network
Out of Network
Primary care physician office visit
$30 Copay
40% Coinsurance after deductible
Specialist
10% Coinsurance after deductible
40% Coinsurance after deductible
Diagnostic Test (X-ray, blood work)
10% Coinsurance after deductible
40% Coinsurance after deductible
Outpatient Facility Fee
10% Coinsurance after deductible
40% Coinsurance after deductible
Outpatient Physician/Surgeon Fee
10% Coinsurance after deductible
40% Coinsurance after deductible
Hospital facility fee
10% Coinsurance after deductible
40% Coinsurance after deductible
Hospital physician/surgeon fee
10% Coinsurance after deductible
40% Coinsurance after deductible
Emergency Room
10% Coinsurance after deductible
10% Coinsurance after deductible

Drug Services

Generic Drugs
Coverage: $15 Copay
Preferred Brand Drugs
Coverage: $40 Copay
Specialty Drugs
Coverage: 10% Coinsurance after deductible
What drugs are covered in the formulary?

Mental Health or Substance Abuse Services

Service
In Network
Out of Network
Mental/behavioral health outpatient services
10% Coinsurance after deductible
40% Coinsurance after deductible
Mental/behavioral health inpatient services
10% Coinsurance after deductible
40% Coinsurance after deductible
Substance use disorder inpatient services
10% Coinsurance after deductible
40% Coinsurance after deductible
Substance use disorder outpatient services
10% Coinsurance after deductible
40% Coinsurance after deductible

Maternity Services

Service
In Network
Out of Network
Prenatal/postnatal care
10% Coinsurance after deductible
40% Coinsurance after deductible
Delivery and all inpatient services for maternity care
10% Coinsurance after deductible
40% Coinsurance after deductible

Coverage Options Summary

Included Benefits
  • Durable medical equipment
  • Emergency Transportation
  • Eye glasses children
  • Habilitation
  • Home health care
  • Hospice
  • Imaging (CT/PET scans, MRIs)
  • Inpatient rehabilitation
  • Non-preferred brand drugs
  • Skilled nursing care
  • Other practitioner office visit
  • Outpatient rehabilitation
  • Preventive care, screening, immunization
  • Routine eye exam children
  • Urgent Care
Excluded Benefits
  • Acupuncture
  • Bariatric surgery
  • Cosmetic surgery
  • Dental care adult
  • Dental check up children
  • Eye exam adult
  • Hearing Aid
  • Infertility treatment
  • Long Term Care
  • Routine foot care
  • Weight loss program
Limited Benefits
  • Chiropractic
  • Non-emergency care outside U.S.
  • Private duty nursing
  • Routine hearing tests

What To Know

  • This is an ACA (Obamacare) compliant health plan.
  • This plan is eligible for a tax credit subsidy

Physician Directory

List of doctors that accepts Anthem Silver DirectAccess - cbpa Obamacare Plan in Ohio

/
HEILMAN, ROBERT
4300 CLIME RD
COLUMBUS, OH 43228
KING, GRETZEL
104 N MURRAY HILL RD
COLUMBUS, OH 43228
ABOU-AMRO, AREF
5131 BEACON HILL RD
COLUMBUS, OH 43228
LOWE, ROBERT
5100 W BROAD ST
COLUMBUS, OH 43228
SMITH, MARK
750 MOUNT CARMEL MALL
COLUMBUS, OH 43222
LUKEN, THERESA
4300 CLIME RD
COLUMBUS, OH 43228
JOHNSTON, PETER
5131 BEACON HILL RD
COLUMBUS, OH 43228
HARD, WESLEY
100 N MURRAY HILL RD
COLUMBUS, OH 43228
RAPP, THOMAS
106 N MURRAY HILL RD
COLUMBUS, OH 43228
BIEDERMAN, BERNARD
17 NORTON RD
COLUMBUS, OH 43228
MORALES-YURIK, TERESITA
5100 W BROAD ST
COLUMBUS, OH 43228
RASHWAN, AHMED
5100 W BROAD ST
COLUMBUS, OH 43228
PEPONIS, NICHOLAS
3525 OLENTANGY RIVER RD
COLUMBUS, OH 43214
HAMILTON, DANA
111 INAH AVE
COLUMBUS, OH 43228
SCOTT, MARY
4488 WEST BROAD STREET
COLUMBUS, OH 43228
MCELDOWNEY, THOMAS
5100 W BROAD ST
COLUMBUS, OH 43228
BLAIS, FRANCIS
5109 WEST BROAD STREET
COLUMBUS, OH 43228
ASHTON, NICOLA
4821 ROBERTS ROAD
COLUMBUS, OH 43228
FOSS, PETER
5131 BEACON HILL RD
COLUMBUS, OH 43228
JOHNSEN, RONALD
5100 W BROAD ST
COLUMBUS, OH 43228
CHEEK, JOHN
4488 W BROAD ST
COLUMBUS, OH 43228
JONES, PAULA
5100 W BROAD ST
COLUMBUS, OH 43228
VINCENT, KAREN
5100 W BROAD ST
COLUMBUS, OH 43228
HINCKLEY, JOHN
5100 W BROAD ST
COLUMBUS, OH 43228
JONES, BRUCE
5100 W BROAD ST
COLUMBUS, OH 43228
Details
ROBERT HEILMAN, M.D.
Phone Number
(614) 308-9066
Office Locations
4300 CLIME RD
COLUMBUS, OH 43228
4300 CLIME RD COLUMBUS OH, 43228

Community Q&A

Do you have questions about this plan?

Get answers from the HealthPocket community.
1 question
getting a list of the doctors in network
Q:
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