Insurance Type | ACA (Obamacare) |
Plan Name | Anthem Bronze Pathway HMO 5500 Online Plus |
Plan ID | hhs-29276OH0920429 |
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 |
Specialist Visit | 30.00% Coinsurance after deductible |
Laboratory Outpatient and Professional Services | 30.00% Coinsurance after deductible |
X-rays and Diagnostic Imaging | 30.00% 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 | $20 Copay |
Preferred Brand Drugs | $80 Copay 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 | |
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Emergency Room Services | $500 Copay after deductible, 30.00% 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 | 30.00% Coinsurance after deductible |
Emergency Transportation or Ambulance Service | 30.00% Coinsurance after deductible |
Maternity | |
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Prenatal and Postnatal Care | 30.00% 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 | |
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Mental/Behavioral Health Outpatient Services | 30.00% 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 | 30.00% 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 | |
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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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