Anthem Bronze Pathway X Enhanced HMO 25 for HSA Plan Details for 2020- HealthPocket

Anthem Bronze Pathway X Enhanced HMO 25 for HSA

$254.41/mo

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Zip Code03103
Applicant1/22/1985 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameAnthem Bronze Pathway X Enhanced HMO 25 for HSA
Plan IDqhp-96751NH0150015
Plan Year2020
Insurance ProviderAnthem BCBS
Metal LevelExpanded Bronze
Plan TypeHMO
Deductible$5,150
Out-of-Pocket Maximum$6,850
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness25% Coinsurance after deductible
Specialist Visit25% Coinsurance after deductible
Laboratory Outpatient and Professional Services25.00% Coinsurance after deductible
X-rays and Diagnostic Imaging25.00% Coinsurance after deductible
Deductible - Family$10300
Out-of-Pocket Maximum - Family$13700

Prescription drug coverage

Generic Drugs25% Coinsurance after deductible
Preferred Brand Drugs25% Coinsurance after deductible
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=1318

Hospital services

Emergency Room Services25% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)25% Coinsurance after deductible
Inpatient Physician and Surgical Services25% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care0.00%

Mental Health

Mental/Behavioral Health Outpatient Services0.00%
Mental/Behavioral Health Inpatient Services0.00%

Vision Coverage

Routine Eye Exam for ChildrenNot Applicable
Eye Glasses for ChildrenNot Applicable

Exclusions and Limitations

More Included BenefitsAbortion for Which Public Funding is Prohibited
Transplant
Accidental Dental
Dialysis
Allergy Testing
Chemotherapy
Radiation
Diabetes Education
Prosthetic Devices
Infusion Therapy
Treatment for Temporomandibular Joint Disorders
Nutritional Counseling
Reconstructive Surgery
Other Practitioner Office Visit (Nurse, Physician Assistant)
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Outpatient Surgery Physician/Surgical Services
Hospice Services
Infertility Treatment
Urgent Care Centers or Facilities
Home Health Care Services
Inpatient Physician and Surgical Services
Bariatric Surgery
Skilled Nursing Facility
Outpatient Rehabilitation Services
Habilitation Services
Chiropractic Care
Durable Medical Equipment
Hearing Aids
Imaging (CT/PET Scans, MRIs)
Preventive Care/Screening/Immunization
Routine Foot Care
Rehabilitative Speech Therapy
Rehabilitative Occupational and Rehabilitative Physical Therapy
Well Baby Visits and Care
More Excluded BenefitsLong-Term/Custodial Nursing Home Care
Private-Duty Nursing
Cosmetic Surgery
Acupuncture
Weight Loss Programs
Dental Check-Up for Children
PremiumPlan NameDeductible
from $268
ElevateHealth HMO HSA Bronze 5000
$5,000.00Select
from $324
ElevateHealth HMO Silver 5000
$5,000.00Select
from $329
ElevateHealth HMO HSA Bronze 5000
$5,000.00Select
from $398
ElevateHealth HMO Silver 5000
$5,000.00Select
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  • Phone Number
    (603) 625-1864
  • Office Locations
    700 Lake Ave
    Manchester, NH 03103
700 Lake Ave Manchester NH, 03103

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 Health Insurance Innovations, Inc. family of companies (NASDAQ: HIIQ).

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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 Health Insurance Innovations, Inc. family of companies (NASDAQ: HIIQ).