Anthem HMO Catastrophic Pathway Enhanced 8550 0 Plan Details for 2021- HealthPocket

Insurance Type	ACA (Obamacare)
Plan Name	Anthem HMO Catastrophic Pathway Enhanced 8550 0
Plan ID	hhs-86545CT1310033
Plan Year	2021
Insurance Provider	Anthem BCBS
Metal Level	Catastrophic
Plan Type	HMO
Deductible	$8,550
Out-of-Pocket Maximum	$8,550
Plan Highlights

Costs for Medical Care
Primary Care Visit to Treat an Injury or Illness	$40 Copay with deductible, 0.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Specialist Visit	$0 Copay after deductible
Laboratory Outpatient and Professional Services	$0 Copay after deductible
X-rays and Diagnostic Imaging	$0 Copay after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans	$0 Copay after deductible
Deductible - Family	$17100 per group
Out-of-Pocket Maximum - Family	$17100 per group

Prescription drug coverage
Generic Drugs	No Charge after deductible
Preferred Brand Drugs	No Charge after deductible
Non-Preferred Brand Drugs	No Charge after deductible
Specialty Drugs	No Charge after deductible

Access to doctors and hospitals
Provider directory URL	http://www.anthem.com/health-insurance/provider-directory/searchcriteria?branding=ABCBS&state=CT
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	$0 Copay after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	$0 Copay per Day after deductible
Inpatient Physician and Surgical Services	$0 Copay after deductible
Emergency Transportation or Ambulance Service	$0 Copay after deductible

Maternity
Prenatal and Postnatal Care	$0 Copay
Delivery and all inpatient services for maternity care	$0 Copay after deductible

Mental Health
Mental/Behavioral Health Outpatient Services	$0 Copay after deductible
Mental/Behavioral Health Inpatient Services	$0 Copay per Day after deductible
Substance use disorder outpatient services	$0 Copay after deductible
Substance use disorder inpatient services	$0 Copay 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 Acupuncture 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 Durable Medical Equipment Hospice Services Diabetes Care Management Inherited Metabolic Disorder - PKU Abortion for Which Public Funding is Prohibited Accidental Dental Chemotherapy Dialysis Infusion Therapy Laboratory Outpatient and Professional Services Prosthetic Devices Radiation Reconstructive Surgery Transplant Treatment for Temporomandibular Joint Disorders Well Baby Visits and Care Accidental Ingestion of a Controlled Drug Bone Marrow Testing Bones/Joints Clinical Trials Developmental Needs of Children & Youth with Cancer Early Intervention Services Network Retail Pharmacy (60-90 Day Supply) Covered Off Label Prescription Drugs Post-Mastectomy Care Prescription Drugs Other Treatment of Medical Complications of Alcoholism Wound Care for Individuals with Epidermolysis Bullosa Outpatient Facility Fee (e.g., Ambulatory Surgery Center) Mammography Ultrasound
More Limited Benefits	Skilled Nursing Facility Hearing Aids Home Health Care Services Outpatient Rehabilitation Services Habilitation Services Dental Check-Up for Children Chiropractic Care Allergy Testing Diabetes Education Nutritional Counseling Rehabilitative Occupational and Rehabilitative Physical Therapy Rehabilitative Speech Therapy Rehabilitative Occupational Therapy
More Excluded Benefits	Bariatric Surgery Cosmetic Surgery Long Term Care Private-Duty Nursing Weight Loss Programs Routine Foot Care Dental Care - Adult Long-Term/Custodial Nursing Home Care

+ See All Coverage Details

Premium	Plan Name	Deductible
from $197	Choice Catastrophic POS with Dental	$8,550.00	Select
from $385	Anthem Bronze HMO BlueCare Prime 8500 50	$8,500.00	Select

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Phone Number
(203) 371-0406
Office Locations
3715 Main St
Bridgeport, CT 06606

What is the Catastrophic Plan?
Catastrophic health insurance is a type of medical coverage under the Affordable Care Act. This is a type of high-deductible health plan for people under 30 or those who qualify for a "hardship exemption."
How are Catastrophic Plans different than other Obamacare health plans?
The fundamental difference among the new Obamacare health plans is the percentage of covered medical costs paid by the health plan. There is no actuarial value associated with catastrophic plans but other Obamacare metal plans pay a higher percentage of these costs.
How much does a Catastrophic Plan cost?
The monthly premium for a Catastrophic Plan depends on the insurer from whom you purchase the plan, the number of people to be insured by the plan, your age, whether you smoke, and the region in which you live. You can use HealthPocket’s comparison tool to compare Catastrophic Plan premiums in your area.

Zip Code	06606 (edit)
Applicant	3/2/1986 Male (edit)

Zip Code	06606 (edit)
Applicant	3/2/1986 Male (edit)

Anthem HMO Catastrophic Pathway Enhanced 8550 0

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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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