Insurance Type | ACA (Obamacare) |
Plan Name | Anthem Bronze Pathway HMO 6000 |
Plan ID | hhs-76680CO0220021 |
Plan Year | 2021 |
Insurance Provider | Anthem BCBS |
Metal Level | Expanded Bronze |
Plan Type | HMO |
Deductible | $6,000 |
Out-of-Pocket Maximum | $8,550 |
Plan Highlights |
Costs for Medical Care | |
---|---|
Primary Care Visit to Treat an Injury or Illness | $45 Copay with deductible, 30.00% Coinsurance after deductible. See plan brochure for when Copay is applicable. |
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 | $500 Copay after deductible, 30.00% Coinsurance after deductible. See plan brochure for when Copay is applicable. |
Deductible - Family | $12000 per group |
Out-of-Pocket Maximum - Family | $17100 per group |
Prescription drug coverage | |
---|---|
Generic Drugs | 30.00% Coinsurance after deductible |
Preferred Brand Drugs | 30.00% Coinsurance after deductible |
Non-Preferred Brand Drugs | 30.00% Coinsurance after deductible |
Specialty Drugs | 30.00% Coinsurance after deductible |
Access to doctors and hospitals | |
---|---|
Provider directory URL | https://www.anthem.com/health-insurance/provider-directory/searchcriteria?brand=abcbs |
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 | $200 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, 40.00% 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 | |
---|---|
Prenatal and Postnatal Care | 30.00% Coinsurance after deductible |
Delivery and all inpatient services for maternity care | $500 Copay after deductible, 40.00% Coinsurance after deductible. See plan brochure for when Copay is applicable. |
Mental Health | |
---|---|
Mental/Behavioral Health Outpatient Services | 30.00% Coinsurance after deductible |
Mental/Behavioral Health Inpatient Services | $500 Copay per Stay after deductible, 40.00% 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, 40.00% 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 Bariatric Surgery Hearing Aids Infertility Treatment Private-Duty Nursing 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 Durable Medical Equipment Hospice Services Applied Behavior Analysis Based Therapies Dental Anesthesia Diabetes Care Management Inherited Metabolic Disorder - PKU 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 Autism Spectrum Disorders Clinical Trials Congenital Anomaly, including Cleft Lip/Palate Off Label Prescription Drugs Prescription Drugs Other Non-Preferred Generic Outpatient Facility Fee (e.g., Ambulatory Surgery Center) Intensive Outpatient for Mental Health/ Substance Abuse Partial Hospitalization for Mental Health/ Substance Abuse Prosthetics: Legs and Arms Residential Day Treatment for Mental Health/ Substance Abuse Telehealth PCP Telehealth Specialist Partial Hospitalization for Mental Health/Substance Abuse Intensive Outpatient for Mental Health/Substance Abuse Residential Day Treatment for Mental Health/Substance Abuse Intensive Outpatient for Substance Use Disorder Mental/Behavioral Health Prenatal Care Partial Hospitalization for Mental/Behavioral Health Partial Hospitalization for Substance Use Disorder Postpartum Mental/Behavioral Health Postpartum Substance Use Disorder Residential Day Treatment for Mental/Behavioral Health Residential Day Treatment for Substance Use Disorder Substance Use Disorder Prenatal Care Telehealth Mental/Behavioral Health Telehealth Substance Use Disorder Autism Spectrum Disorders - Assessment and Evaluation Services Intensive Outpatient for Mental/Behavioral Health |
More Limited Benefits | Skilled Nursing Facility Home Health Care Services Outpatient Rehabilitation Services Habilitation Services Dental Check-Up for Children Chiropractic Care Rehabilitative Occupational and Rehabilitative Physical Therapy Rehabilitative Speech Therapy Early Intervention Services Rehabilitative Occupational Therapy Rehabilitative Physical Therapy |
More Excluded Benefits | Acupuncture Cosmetic Surgery Long Term Care Weight Loss Programs Routine Foot Care Non-Emergency Care When Traveling Outside the U.S. Dental Care - Adult Abortion for Which Public Funding is Prohibited Accidental Dental Spinal Manipulations Long-Term/Custodial Nursing Home Care |
Premium | Plan Name | Deductible | |
---|---|---|---|
from $265 | Anthem Bronze Pathway Essentials HMO 6000 | $6,000.00 | Select |
from $266 | Oscar Bronze Classic PCP Copay ($3 Prescription List + Free 24/ | $6,000.00 | Select |
from $291 | Oscar Silver Saver 2 Off-Ex | $6,200.00 | Select |
from $302 | KP Select CO Silver 6000/45 X | $6,000.00 | Select |
from $312 | Anthem Bronze Mountain Enhanced HMO 6000 | $6,000.00 | Select |
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.
HealthPocket.com provides information on insurance products. If you choose to obtain a quote or apply for an insurance plan, you may be transferred to a partner website to complete your request. Always review the privacy and terms of use of the partner website.
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.
Quotes are provided by our partner. You are now leaving our site.