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 Essential DirectAccess - cbpa Obamacare Plan in Ohio

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ABOU-AMRO, AREF
5131 BEACON HILL RD
COLUMBUS, OH 43228
AHMED, IMTIAZ
5131 BEACON HILL RD
COLUMBUS, OH 43228
HARRIS, PAUL
15 NORTON RD
COLUMBUS, OH 43228
KING, GRETZEL
104 N MURRAY HILL RD
COLUMBUS, OH 43228
ALEXIS, THOMAS
4310 CLIME RD
COLUMBUS, OH 43228
FINNIE, DOUGLAS
4310 CLIME ROAD
COLUMBUS, OH 43228
WANKO, THOMAS
104 N MURRAY HILL RD
COLUMBUS, OH 43228
KAUFMAN, JEFFREY
104 N MURRAY HILL RD
COLUMBUS, OH 43228
PALMA, ROBERT
104 N MURRAY HILL RD
COLUMBUS, OH 43228
AMIGO, ROGER
5131 BEACON HILL RD
COLUMBUS, OH 43228
MILLER, STEVEN
5131 BEACON HILL RD
COLUMBUS, OH 43228
LOWE, ROBERT
5100 W BROAD ST
COLUMBUS, OH 43228
LUKEN, THERESA
4300 CLIME RD
COLUMBUS, OH 43228
HEILMAN, ROBERT
4300 CLIME RD
COLUMBUS, OH 43228
HILTBRAND, JEFFERY
4300 CLIME RD
COLUMBUS, OH 43228
GUPTA, AKASH
4300 CLIME RD
COLUMBUS, OH 43228
NARVEL, FAOZAN
100 N MURRAY HILL RD
COLUMBUS, OH 43228
VU, KHAI
88 E MEMORIAL DR
POMEROY, OH 45769
PUE, CHARLES
5100 W BROAD ST
COLUMBUS, OH 43228
LADU, KEITH
165 N MURRAY HILL RD
COLUMBUS, OH 43228
DILLINGER, DAWN
111 INAH AVE
COLUMBUS, OH 43228
KUPER, ALICIA
4766 W BROAD ST
COLUMBUS, OH 43228
WHITE, MATTHEW
111 INAH AVE
COLUMBUS, OH 43228
HARD, WESLEY
100 N MURRAY HILL RD
COLUMBUS, OH 43228
BRIGHTWELL, ROBERT
5131 BEACON HILL RD
COLUMBUS, OH 43228
Details
AREF ABOU-AMRO, MD
Phone Number
(614) 486-2000
Office Locations
5131 BEACON HILL RD
COLUMBUS, OH 43228
5131 BEACON HILL RD COLUMBUS OH, 43228

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