2018 Anthem Bronze Pathway Transition HMO 6750 Plan Details - HealthPocket

Anthem Bronze Pathway Transition HMO 6750

$514.10/mo

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Zip Code40214
Applicant8/16/1983 Male
Coverage Start8/17/2018
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameAnthem Bronze Pathway Transition HMO 6750
Plan IDhhs-36239KY1140038
Insurance ProviderAnthem BCBS
Metal LevelExpanded Bronze
Plan TypeHMO
Deductible$6,750
Out-of-Pocket Maximum$7,350
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$25 Copay
Specialist Visit40.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services40.00% Coinsurance after deductible
X-rays and Diagnostic Imaging40.00% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans40.00% Coinsurance after deductible
Deductible - Family$13500 per group
Out-of-Pocket Maximum - Family$14700 per group

Prescription drug coverage

Generic Drugs$5 Copay
Preferred Brand Drugs35.00% Coinsurance after deductible
Non-Preferred Brand Drugs45.00% Coinsurance after deductible
Specialty Drugs45.00% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttps://www.anthem.com/health-insurance/provider-directory/searchcriteria
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 - Emergency Coverage Only. Urgent Care is covered only if rendered by a BlueCard Provider.
Does this plan cover services outside the country?No - Emergency Coverage Only

Hospital services

Emergency Room Services40.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)40.00% Coinsurance after deductible
Inpatient Physician and Surgical Services40.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service40.00% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care40.00% Coinsurance after deductible
Delivery and all inpatient services for maternity care40.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services40.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services40.00% Coinsurance after deductible
Substance use disorder outpatient services40.00% Coinsurance after deductible
Substance use disorder inpatient services40.00% 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 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
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
Applied Behavior Analysis Based Therapies
Cochlear Implants
Dental Anesthesia
Diabetes Care Management
Inherited Metabolic Disorder - PKU
Second Opinion
Accidental Dental
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Nutritional Counseling
Prosthetic Devices
Radiation
Reconstructive Surgery
Transplant
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
More Limited BenefitsSkilled Nursing Facility
Hearing Aids
Private-Duty Nursing
Home Health Care Services
Outpatient Rehabilitation Services
Habilitation Services
Dental Check-Up for Children
Chiropractic Care
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
More Excluded BenefitsAcupuncture
Bariatric Surgery
Cosmetic Surgery
Infertility Treatment
Long-Term/Custodial Nursing Home Care
Weight Loss Programs
Routine Foot Care
Abortion for Which Public Funding is Prohibited
PremiumPlan NameDeductible
from $230
Anthem Bronze Pathway X Transition HMO 6750
$6,750.00Select
from $255
CareSource Federal Simple Choice Bronze
$6,650.00Select
from $271
CareSource Federal Simple Choice Bronze Dental and Vision
$6,650.00Select
from $303
Anthem Bronze Pathway X HMO 6650 for HSA
$6,650.00Select
from $312
CareSource Federal Simple Choice Bronze
$6,650.00Select

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