Insurance Type | ACA (Obamacare) |
Plan Name | Anthem Bronze Pathway Transition HMO 7300 |
Plan ID | hhs-36239KY1140038 |
Plan Year | 2021 |
Insurance Provider | Anthem BCBS |
Metal Level | Expanded Bronze |
Plan Type | HMO |
Deductible | $7,300 |
Out-of-Pocket Maximum | $8,550 |
Plan Highlights |
Costs for Medical Care | |
---|---|
Primary Care Visit to Treat an Injury or Illness | $40 Copay |
Specialist Visit | $60 Copay 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 | 40.00% Coinsurance after deductible |
Deductible - Family | $14600 per group |
Out-of-Pocket Maximum - Family | $17100 per group |
Prescription drug coverage | |
---|---|
Generic Drugs | $15 Copay |
Preferred Brand Drugs | 35.00% Coinsurance after deductible |
Non-Preferred Brand Drugs | 45.00% Coinsurance after deductible |
Specialty Drugs | 45.00% 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 | 40.00% Coinsurance after deductible |
Inpatient Hospital Services (e.g., Hospital Stay) | 40.00% Coinsurance after deductible |
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 | 40.00% Coinsurance after deductible |
Mental Health | |
---|---|
Mental/Behavioral Health Outpatient Services | $40 Copay |
Mental/Behavioral Health Inpatient Services | 40.00% Coinsurance after deductible |
Substance use disorder outpatient services | $40 Copay |
Substance use disorder inpatient services | 40.00% Coinsurance after deductible |
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 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 Cochlear Implants Dental Anesthesia Diabetes Care Management Inherited Metabolic Disorder - PKU Second Opinion Accidental Dental 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 Hearing Aids Private-Duty Nursing 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 |
More Excluded Benefits | Acupuncture Bariatric Surgery Cosmetic Surgery Infertility Treatment 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 |
Premium | Plan Name | Deductible | |
---|---|---|---|
from $409 | Anthem Bronze Pathway Transition HMO 7300 | $7,300.00 | Select |
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