Anthem Bronze Pathway Transition HMO 7150 Plan Details for 2021- HealthPocket

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Applicant Info
Applicant
Date of birth
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Gender
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female
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Zip Code	40214 (edit)
Applicant	1/15/1986 Male (edit)

Insurance Type	ACA (Obamacare)
Plan Name	Anthem Bronze Pathway Transition HMO 7150
Plan ID	hhs-36239KY1140038
Plan Year	2020
Insurance Provider	Anthem BCBS
Metal Level	Expanded Bronze
Plan Type	HMO
Deductible	$7,150
Out-of-Pocket Maximum	$8,150
Plan Highlights

Costs for Medical Care
Primary Care Visit to Treat an Injury or Illness	$25 Copay
Specialist Visit	40.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services	40.00% Coinsurance after deductible
X-rays and Diagnostic Imaging	40.00% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans	40.00% Coinsurance after deductible
Deductible - Family	$14300 per group
Out-of-Pocket Maximum - Family	$16300 per group

Prescription drug coverage
Generic Drugs	$5 Copay
Preferred Brand Drugs	35.00% Coinsurance after deductible
Non-Preferred Brand Drugs	45.00% Coinsurance after deductible
Specialty Drugs	45.00% Coinsurance after deductible

Access to doctors and hospitals
Provider directory URL	https://www.anthem.com/health-insurance/provider-directory/searchcriteria?brand=abcbs
Does this plan have access to a national provider network?	No
Is a referral required to see a Specialist?	Not Covered
Does this plan cover services outside plan service area?	No - TRAD/PAR network
Does this plan cover services outside the country?	No - Urgent/Emergency Coverage Only

Hospital services
Emergency Room Services	40.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	40.00% Coinsurance after deductible
Inpatient Physician and Surgical Services	40.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service	40.00% Coinsurance after deductible

Maternity
Prenatal and Postnatal Care	40.00% Coinsurance after deductible
Delivery and all inpatient services for maternity care	40.00% Coinsurance after deductible

Mental Health
Mental/Behavioral Health Outpatient Services	40.00% Coinsurance
Mental/Behavioral Health Inpatient Services	40.00% Coinsurance after deductible
Substance use disorder outpatient services	40.00% Coinsurance
Substance use disorder inpatient services	40.00% Coinsurance after deductible

Medical Management Programs
Does this plan offer disease managment programs?	Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management
Does this plan offer a wellness program?	Not Covered

Vision Coverage
Routine Eye Exam for Children	Included
Eye Glasses for Children	Included
Routine Eye Exam for Adults	Not Covered

Child Dental Coverage
Child Dental Coverage - Routine Dental Care	Included
Child Dental Coverage - Basic Dental Care	Included
Child Dental Coverage - Orthodontia	Included
Child Dental Coverage - Major Dental Care	Included

Adult Dental Coverage
Adult Dental Coverage - Routine Dental Care	Not Covered
Adult Dental Coverage - Basic Dental Care	Not Covered
Adult Dental Coverage - Orthodontia	Not Covered
Adult Dental Coverage - Major Dental Care	Not Covered

Exclusions and Limitations
More Included Benefits	Other Practitioner Office Visit (Nurse, Physician Assistant) Preventive Care/Screening/Immunization Imaging (CT/PET Scans, MRIs) Outpatient Facility Fee (e.g., Ambulatory Surgery Center) Outpatient Surgery Physician/Surgical Services Urgent Care Centers or Facilities Inpatient Physician and Surgical Services Durable Medical Equipment Hospice Services Applied Behavior Analysis Based Therapies Cochlear Implants Dental Anesthesia Diabetes Care Management Inherited Metabolic Disorder - PKU Second Opinion Accidental Dental Allergy Testing Chemotherapy Diabetes Education Dialysis Infusion Therapy Laboratory Outpatient and Professional Services Nutritional Counseling Prosthetic Devices Radiation Reconstructive Surgery Transplant Treatment for Temporomandibular Joint Disorders Well Baby Visits and Care Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
More Limited Benefits	Skilled Nursing Facility Hearing Aids Private-Duty Nursing Home Health Care Services Outpatient Rehabilitation Services Habilitation Services Dental Check-Up for Children Chiropractic Care Rehabilitative Occupational and Rehabilitative Physical Therapy Rehabilitative Speech Therapy
More Excluded Benefits	Acupuncture Bariatric Surgery Cosmetic Surgery Infertility Treatment Long-Term/Custodial Nursing Home Care Weight Loss Programs Routine Foot Care Abortion for Which Public Funding is Prohibited

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Premium	Plan Name	Deductible
from $409	Anthem Bronze Pathway Transition HMO 7300	$7,300.00	Select

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Phone Number
(502) 367-2288
Office Locations
5334 S 3rd St
Louisville, KY 40214

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ZIP Code
County
Applicant Info
Applicant
Date of birth
//
Gender
male
female
Income
$

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Anthem Bronze Pathway Transition HMO 7150

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Benefits & Coverage

Costs for Medical Care

Prescription drug coverage

Access to doctors and hospitals

Hospital services

Maternity

Mental Health

Medical Management Programs

Vision Coverage

Child Dental Coverage

Adult Dental Coverage

Exclusions and Limitations

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