Anthem Silver Pathway X HMO 4950 Plan Details for 2020- HealthPocket

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Zip Code30044
Applicant10/26/1985 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameAnthem Silver Pathway X HMO 4950
Plan IDqhp-49046GA0410085
Plan Year2020
Insurance ProviderBlue Cross Blue Shield of Georgia
Metal LevelSilver
Plan TypeHMO
Deductible$4,950
Out-of-Pocket Maximum$6,500
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$35 Copay
Specialist Visit35% Coinsurance after deductible
Laboratory Outpatient and Professional Services35.00% Coinsurance after deductible
X-rays and Diagnostic Imaging35.00% Coinsurance after deductible
Deductible - Family$9900
Out-of-Pocket Maximum - Family$13000

Prescription drug coverage

Generic Drugs$10 Copay
Preferred Brand Drugs$40 Copay
Non-Preferred Brand Drugs40% Coinsurance after deductible
Specialty Drugs40% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttps://www.anthem.com/health-insurance/provider-directory/searchcriteria/?alphaprefix=1620

Hospital services

Emergency Room Services35% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)35% Coinsurance after deductible
Inpatient Physician and Surgical Services50% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care35.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services35.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services50.00% Coinsurance after deductible

Vision Coverage

Routine Eye Exam for ChildrenNot Applicable
Eye Glasses for ChildrenNot Applicable

Exclusions and Limitations

More Included BenefitsOutpatient Surgery Physician/Surgical Services
Hospice Services
Urgent Care Centers or Facilities
Home Health Care Services
Inpatient Physician and Surgical Services
Cosmetic Surgery
Diabetes Care Management
Off Label Prescription Drugs
Well Child Care
Bone Marrow Transplant
Heart Transplant
Other Practitioner Office Visit (Nurse, Physician Assistant)
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Skilled Nursing Facility
Outpatient Rehabilitation Services
Habilitation Services
Chiropractic Care
Durable Medical Equipment
Imaging (CT/PET Scans, MRIs)
Preventive Care/Screening/Immunization
Weight Loss Programs
Dental Check-Up for Children
Rehabilitative Speech Therapy
Rehabilitative Occupational and Rehabilitative Physical Therapy
Well Baby Visits and Care
Transplant
Accidental Dental
Dialysis
Allergy Testing
Chemotherapy
Radiation
Diabetes Education
Prosthetic Devices
Infusion Therapy
Treatment for Temporomandibular Joint Disorders
Nutritional Counseling
Reconstructive Surgery
Clinical Trials
More Excluded BenefitsInfertility Treatment
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Bariatric Surgery
Hearing Aids
Routine Foot Care
Acupuncture
Abortion for Which Public Funding is Prohibited
PremiumPlan NameDeductible
from $302
Anthem Bronze Pathway X Guided Access HMO 4800
$4,800.00Select
from $337
KP GA Signature Bronze 5000/50
$5,000.00Select
from $365
Anthem Silver Pathway X Guided Access HMO 4950
$4,950.00Select
from $369
CareSource Marketplace Low Deductible Silver
$5,100.00Select
from $369
Anthem Bronze Pathway Guided Access HMO 4800
$4,800.00Select
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  • Phone Number
    (678) 344-8700
  • Office Locations
    2878 Five Forks Trickum Rd
    Lawrenceville, GA 30044
2878 Five Forks Trickum Rd Lawrenceville GA, 30044
  • What Is the Silver Plan?

    ObamaCare’s Silver Plan is a type of Metal Plan on the Health Insurance Marketplace. Silver Plans qualify for both Tax Credits and Cost Sharing subsidies.Silver Plans have lower out-of-pocket costs than Bronze Plans but higher out- of-pocket costs than both Gold and Platinum Plans. All Silver Plans share the same minimum health benefits, but the way they charge out-of-pocket costs can differ significantly.

  • How are Silver Plans different than other Obamacare health plans?

    The fundamental difference among the new Obamacare health plans is the percentage of covered medical costs paid by the health plan. The Silver Plan pays 70% of covered medical costs for a typical enrollee. Silver Plans are also the only metal plans which offer cost-sharing reduction (CSR) versions to consumers that require financial assistance for out-of-pocket costs.

  • How much does a Silver Plan cost?

    The monthly premium for a Silver Plan depends on the insurer from whom you purchase the plan, the number of people to be insured by the plan, your age, whether you smoke, and the region in which you live. You can use HealthPocket’s comparison tool to compare Silver Plan premiums in your area.

  • When Can I Enroll in a Silver Plan?

    The Open Enrollment period for the 2018 Affordable Care Act health plans begins November 1, 2017 and ends December 15, 2017. See our Open Enrollment article for more information.

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is part of the Benefytt Technologies, Inc. family of companies.

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is part of the Benefytt Technologies, Inc. family of companies.