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 |
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."
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.
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.
HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. 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. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. 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 is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. 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. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is part of the Benefytt Technologies, Inc. family of companies.