Anthem Bronze Pathway HMO 5000 Plan Details for 2021- HealthPocket

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

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Zip Code	43228 (edit)
Applicant	1/22/1986 Male (edit)

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Insurance Type	ACA (Obamacare)
Plan Name	Anthem Bronze Pathway HMO 5000
Plan ID	hhs-29276OH0920413
Plan Year	2021
Insurance Provider	Anthem BCBS
Metal Level	Expanded Bronze
Plan Type	HMO
Deductible	$0
Out-of-Pocket Maximum	$0
Plan Highlights

Costs for Medical Care
Primary Care Visit to Treat an Injury or Illness	$50 Copay with deductible, 40.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
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	$400 Copay after deductible, 50.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.

Prescription drug coverage
Generic Drugs	40.00% Coinsurance after deductible
Preferred Brand Drugs	40.00% Coinsurance after deductible
Non-Preferred Brand Drugs	40.00% Coinsurance after deductible
Specialty Drugs	40.00% Coinsurance after deductible

Access to doctors and hospitals
Provider directory URL	https://www.anthem.com/health-insurance/provider-directory/searchcriteria
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, 40.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Inpatient Hospital Services (e.g., Hospital Stay)	$500 Copay per Stay after deductible, 50.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
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	$500 Copay after deductible, 50.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.

Mental Health
Mental/Behavioral Health Outpatient Services	40.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services	$500 Copay per Stay after deductible, 50.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Substance use disorder outpatient services	40.00% Coinsurance after deductible
Substance use disorder inpatient services	$500 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 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 Infertility Treatment 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 Habilitation Services Durable Medical Equipment Hospice Services 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 Private-Duty Nursing Home Health Care Services Outpatient Rehabilitation Services Dental Check-Up for Children Chiropractic Care Accidental Dental Rehabilitative Occupational and Rehabilitative Physical Therapy Rehabilitative Speech Therapy
More Excluded Benefits	Acupuncture Bariatric Surgery Cosmetic Surgery Hearing Aids Long Term Care Weight Loss Programs Routine Foot Care Dental Care - Adult Abortion for Which Public Funding is Prohibited Long-Term/Custodial Nursing Home Care

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Last Name

Location/Distance

Please select the correct zip

Mark, Barnhart

Patrick, Callender

Steven, Miller

Douglas, Finnie

Thomas, Baker

Kevin, Klauer

Andrea, Caito

Caitlin, Brown

Christopher, Smith

Comprehensive Wound Care Consultants Llc

Muhammad, Baig

Paige, Houghtaling

Hayleigh, Tomek

Emma, Folk

Cassondra, Righter

Kirstan, Law

Megan, Sugden

Tiffany, Pfeil

Nina, Henry

Fabian, Soto

Abigail, Wills

Adam, Dennison

Mark Barnhart, DPM

Phone Number
(614) 870-0000
Office Locations
5212 W Broad St
Columbus, OH 43228

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

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Anthem Bronze Pathway HMO 5000

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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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