Insurance Type | ACA (Obamacare) |
Plan Name | Anthem Silver HMO Pathway Enhanced Tiered 2800 3800 10 40 for H |
Plan ID | hhs-86545CT1310051 |
Plan Year | 2021 |
Insurance Provider | Anthem BCBS |
Metal Level | Silver |
Plan Type | HMO |
Deductible | $2,800 |
Out-of-Pocket Maximum | $7,000 |
Plan Highlights |
Costs for Medical Care | |
---|---|
Primary Care Visit to Treat an Injury or Illness | 40.00% Coinsurance after deductible |
Specialist Visit | 40.00% Coinsurance after deductible |
Laboratory Outpatient and Professional Services | 10.00% Coinsurance after deductible |
X-rays and Diagnostic Imaging | 10.00% Coinsurance after deductible |
Diagnostic Imaging such as MRIs, CT, and PET scans | 40.00% Coinsurance after deductible |
Deductible - Family | $5600 per group |
Out-of-Pocket Maximum - Family | $14000 per group |
Prescription drug coverage | |
---|---|
Generic Drugs | 10.00% Coinsurance after deductible |
Preferred Brand Drugs | 15.00% Coinsurance after deductible |
Non-Preferred Brand Drugs | 25.00% Coinsurance after deductible |
Specialty Drugs | 30.00% Coinsurance 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 | 40.00% Coinsurance after deductible |
Inpatient Hospital Services (e.g., Hospital Stay) | 40.00% Coinsurance after deductible |
Inpatient Physician and Surgical Services | 10.00% Coinsurance 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 | 40.00% Coinsurance after deductible |
Mental Health | |
---|---|
Mental/Behavioral Health Outpatient Services | 10.00% Coinsurance after deductible |
Mental/Behavioral Health Inpatient Services | 10.00% Coinsurance after deductible |
Substance use disorder outpatient services | 10.00% Coinsurance after deductible |
Substance use disorder inpatient services | 10.00% 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 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 Developmental Needs of Children & Youth with Cancer Early Intervention Services Post-Mastectomy Care 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 |
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 |
Premium | Plan Name | Deductible | |
---|---|---|---|
from $488 | Anthem Silver HMO Pathway Enhanced Tiered 2600 6500 10 40 | $2,600.00 | Select |
ObamaCare’s Silver Plan is a type of Metal Plan on the Health Insurance Marketplace. Silver Plans qualify for both Tax Credits and Cost Sharing subsidies.Silver Plans have lower out-of-pocket costs than Bronze Plans but higher out- of-pocket costs than both Gold and Platinum Plans. All Silver Plans share the same minimum health benefits, but the way they charge out-of-pocket costs can differ significantly.
The fundamental difference among the new Obamacare health plans is the percentage of covered medical costs paid by the health plan. The Silver Plan pays 70% of covered medical costs for a typical enrollee. Silver Plans are also the only metal plans which offer cost-sharing reduction (CSR) versions to consumers that require financial assistance for out-of-pocket costs.
The monthly premium for a Silver 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 Silver Plan premiums in your area.
The Open Enrollment period for the 2018 Affordable Care Act health plans begins November 1, 2017 and ends December 15, 2017. See our Open Enrollment article for more information.
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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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