Anthem Bronze Pathway Essentials 5500 Plan Details for 2021- HealthPocket

Anthem Bronze Pathway Essentials 5500

$355.03/mo

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Zip Code46227
Applicant6/27/1987 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameAnthem Bronze Pathway Essentials 5500
Plan IDhhs-17575IN0700053
Plan Year2021
Insurance ProviderAnthem BCBS
Metal LevelExpanded Bronze
Plan TypeHMO
Deductible$5,500
Out-of-Pocket Maximum$8,700
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$30 Copay with deductible, 50.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Specialist Visit$60 Copay with deductible, 50.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Laboratory Outpatient and Professional Services50.00% Coinsurance after deductible
X-rays and Diagnostic Imaging50.00% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans50.00% Coinsurance after deductible
Deductible - Family$11000 per group
Out-of-Pocket Maximum - Family$17400 per group

Prescription drug coverage

Generic Drugs40.00% Coinsurance after deductible
Preferred Brand Drugs40.00% Coinsurance after deductible
Non-Preferred Brand Drugs50.00% Coinsurance after deductible
Specialty Drugs50.00% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttp://www.anthem.com/health-insurance/provider-directory/searchcriteria?branding=ABCBS&state=IN
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$500 Copay after deductible, 50.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Inpatient Hospital Services (e.g., Hospital Stay)$1500 Copay per Stay after deductible, 50.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Inpatient Physician and Surgical Services50.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service50.00% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care50.00% Coinsurance after deductible
Delivery and all inpatient services for maternity care$1500 Copay after deductible, 50.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.

Mental Health

Mental/Behavioral Health Outpatient Services50.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services$1500 Copay per Stay after deductible, 50.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Substance use disorder outpatient services50.00% Coinsurance after deductible
Substance use disorder inpatient services$1500 Copay per Stay after deductible, 50.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.

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 ChildrenIncluded
Eye Glasses for ChildrenIncluded
Routine Eye Exam for AdultsNot Covered

Child Dental Coverage

Child Dental Coverage - Routine Dental CareIncluded
Child Dental Coverage - Basic Dental CareIncluded
Child Dental Coverage - OrthodontiaIncluded
Child Dental Coverage - Major Dental CareIncluded

Adult Dental Coverage

Adult Dental Coverage - Routine Dental CareNot Covered
Adult Dental Coverage - Basic Dental CareNot Covered
Adult Dental Coverage - OrthodontiaNot Covered
Adult Dental Coverage - Major Dental CareNot Covered

Exclusions and Limitations

More Included BenefitsOther Practitioner Office Visit (Nurse, Physician Assistant)
Preventive Care/Screening/Immunization
Imaging (CT/PET Scans, MRIs)
Outpatient Surgery Physician/Surgical Services
Urgent Care Centers or Facilities
Inpatient Physician and Surgical Services
Durable Medical Equipment
Hospice Services
Dental Anesthesia
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 BenefitsSkilled Nursing Facility
Private-Duty Nursing
Home Health Care Services
Outpatient Rehabilitation Services
Habilitation Services
Dental Check-Up for Children
Chiropractic Care
Accidental Dental
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
More Excluded Benefits[object Object]
PremiumPlan NameDeductible
from $355CareSource Marketplace HSA Eligible Bronze$5,400.00Select
from $408Ambetter Balanced Care 31$5,450.00Select
from $421Anthem Silver Pathway Essentials 5500$5,500.00Select
from $427Ambetter Balanced Care 31 + Vision + Adult Dental$5,450.00Select
from $427Ambetter Balanced Care 26 (2021)$5,450.00Select
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Jane, Wilson
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Carol, Johnson
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Kevin, Julian
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Karamchand, Paul
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Bipinchandra, Patel
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Wynter, Vik
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Candelaria, Cordova
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Amanda, Smith
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Susan, Tanney
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Mary, Driskell
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Anna, Lynch
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Alyssa, Emata
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Dylan, Wirick
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Mariesa, Mclean
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Elise, Birch
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Zachry, Skinner
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Katrina, Morgan
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Lauren, Ferendo
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Miranda, Mazza
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Marisa, Kitt
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Emma, Engdahl
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Jane Wilson, MD
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  • Phone Number
    (317) 780-4080
  • Office Locations
    5550 S East St
    Indianapolis, IN 46227
5550 S East St Indianapolis IN, 46227

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HealthPocket.com is a free information source. 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. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. While on our site, if you click on a plan or link, you may be directed to one of our partners who offers health insurance products. HealthPocket, Inc. is part of the Benefytt Technologies, Inc. family of companies.