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

$238.75/mo
View BrochureSummary of BenefitsProvider Directory

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Zip Code06606
Applicant7/28/1986 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameAnthem HMO Catastrophic Pathway Enhanced 8550 0
Plan IDhhs-86545CT1310033
Plan Year2021
Insurance ProviderAnthem BCBS
Metal LevelCatastrophic
Plan TypeHMO
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 DrugsNo Charge after deductible
Preferred Brand DrugsNo Charge after deductible
Non-Preferred Brand DrugsNo Charge after deductible
Specialty DrugsNo Charge after deductible

Access to doctors and hospitals

Provider directory URLhttp://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 ChildrenIncluded
Eye Glasses for ChildrenIncluded
Routine Eye Exam for AdultsNot Covered

Child Dental Coverage

Child Dental Coverage - Routine Dental CareIncluded
Child Dental Coverage - Basic Dental CareIncluded
Child Dental Coverage - OrthodontiaIncluded
Child Dental Coverage - Major Dental CareIncluded

Adult Dental Coverage

Adult Dental Coverage - Routine Dental CareNot Covered
Adult Dental Coverage - Basic Dental CareNot Covered
Adult Dental Coverage - OrthodontiaNot Covered
Adult Dental Coverage - Major Dental CareNot Covered

Exclusions and Limitations

More Included BenefitsOther 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 BenefitsSkilled 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 BenefitsBariatric Surgery
Cosmetic Surgery
Long Term Care
Private-Duty Nursing
Weight Loss Programs
Routine Foot Care
Dental Care - Adult
Long-Term/Custodial Nursing Home Care
PremiumPlan NameDeductible
from $197Choice Catastrophic POS with Dental$8,550.00Select
from $385Anthem Bronze HMO BlueCare Prime 8500 50$8,500.00Select
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  • Phone Number
    (203) 371-0406
  • Office Locations
    3715 Main St
    Bridgeport, CT 06606
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.

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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.

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