Insurance Type | ACA (Obamacare) |
Plan Name | Anthem Catastrophic Pathway Guided Access HMO 8550 |
Plan ID | hhs-49046GA0410037 |
Plan Year | 2021 |
Insurance Provider | Blue Cross Blue Shield of Georgia |
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 |
Specialist Visit | Not Applicable |
Laboratory Outpatient and Professional Services | Not Applicable |
X-rays and Diagnostic Imaging | Not Applicable |
Diagnostic Imaging such as MRIs, CT, and PET scans | Not Applicable |
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 | 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? | Yes - You do not need a Referral or approval from Your PCP to see an Obstetrician/Gynecologist (OB/GYN), Dermatologist, or eye care professionals including Optometrists and Ophthalmologists. |
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 | Not Applicable |
Inpatient Hospital Services (e.g., Hospital Stay) | Not Applicable |
Inpatient Physician and Surgical Services | Not Applicable |
Emergency Transportation or Ambulance Service | Not Applicable |
Maternity | |
---|---|
Prenatal and Postnatal Care | Not Applicable |
Delivery and all inpatient services for maternity care | Not Applicable |
Mental Health | |
---|---|
Mental/Behavioral Health Outpatient Services | Not Applicable |
Mental/Behavioral Health Inpatient Services | Not Applicable |
Substance use disorder outpatient services | Not Applicable |
Substance use disorder inpatient services | Not Applicable |
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 Cosmetic Surgery 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 Accidental Dental Allergy Testing Chemotherapy Diabetes Education Dialysis Infusion Therapy Laboratory Outpatient and Professional Services Prosthetic Devices Radiation Reconstructive Surgery Treatment for Temporomandibular Joint Disorders Well Baby Visits and Care Clinical Trials Off Label Prescription Drugs Well Child Care Outpatient Facility Fee (e.g., Ambulatory Surgery Center) |
More Limited Benefits | Skilled Nursing Facility Weight Loss Programs Home Health Care Services Outpatient Rehabilitation Services Habilitation Services Dental Check-Up for Children Chiropractic Care Nutritional Counseling Rehabilitative Occupational and Rehabilitative Physical Therapy Rehabilitative Speech Therapy Transplant Bone Marrow Transplant Heart Transplant |
More Excluded Benefits | Acupuncture Bariatric Surgery Hearing Aids Infertility Treatment Long Term Care Private-Duty Nursing Routine Foot Care Dental Care - Adult Abortion for Which Public Funding is Prohibited Long-Term/Custodial Nursing Home Care |
Premium | Plan Name | Deductible | |
---|---|---|---|
from $289 | KP GA Signature Catastrophic 8550/0 | $8,550.00 | Select |
from $318 | KP GA Catastrophic 8550/0 | $8,550.00 | Select |
from $333 | SoloCare Bronze PPO 40021 Area 12 | $8,550.00 | Select |
from $333 | SoloCare Bronze PPO 40021 Area 16 | $8,550.00 | Select |
from $339 | SoloCare Bronze PPO 40021 Area 1 | $8,550.00 | Select |
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.