2018 Anthem Gold Pathway HMO 1100 Plan Details - HealthPocket

Anthem Gold Pathway HMO 1100

$661.53/mo

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Zip Code80219
Applicant8/14/1983 Male
Coverage Start8/15/2018
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameAnthem Gold Pathway HMO 1100
Plan IDhhs-76680CO0220048
Insurance ProviderAnthem BCBS
Metal LevelGold
Plan TypeHMO
Deductible$1,100
Out-of-Pocket Maximum$7,350
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$30 Copay
Specialist Visit$60 Copay
Laboratory Outpatient and Professional Services30.00% Coinsurance after deductible
X-rays and Diagnostic Imaging30.00% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans$250 Copay after deductible, 30.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Deductible - Family$2200 per group
Out-of-Pocket Maximum - Family$14700 per group

Prescription drug coverage

Generic Drugs$10 Copay
Preferred Brand Drugs$40 Copay
Non-Preferred Brand Drugs$80 Copay
Specialty Drugs$500 Copay

Access to doctors and hospitals

Provider directory URLhttp://www.anthem.com/health-insurance/provider-directory/searchcriteria?branding=ABCBS&state=CO
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?Yes - TRAD/PAR network
Does this plan cover services outside the country?Yes - Urgent/Emergency Coverage Only

Hospital services

Emergency Room Services$500 Copay after deductible
Inpatient Hospital Services (e.g., Hospital Stay)$1000 Copay per Stay after deductible
Inpatient Physician and Surgical Services30.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service30.00% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care30.00% Coinsurance after deductible
Delivery and all inpatient services for maternity care$1000 Copay after deductible

Mental Health

Mental/Behavioral Health Outpatient Services30.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services$1000 Copay per Stay after deductible
Substance use disorder outpatient services30.00% Coinsurance after deductible
Substance use disorder inpatient services$1000 Copay per Stay 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
Bariatric Surgery
Hearing Aids
Infertility Treatment
Private-Duty Nursing
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
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
Intensive Outpatient for Mental Health/ Substance Abuse
Partial Hospitalization for Mental Health/ Substance Abuse
Prosthetics: Legs and Arms
Residential Day Treatment for Mental Health/ Substance Abuse
Telehealth PCP
Telehealth Specialist
More Limited BenefitsSkilled Nursing Facility
Home Health Care Services
Habilitation Services
Dental Check-Up for Children
Chiropractic Care
Rehabilitative Speech Therapy
Rehabilitative Occupational Therapy
Rehabilitative Physical Therapy
More Excluded BenefitsAcupuncture
Cosmetic Surgery
Long-Term/Custodial Nursing Home Care
Weight Loss Programs
Outpatient Rehabilitation Services
Routine Foot Care
Abortion for Which Public Funding is Prohibited
Accidental Dental
Rehabilitative Occupational and Rehabilitative Physical Therapy
PremiumPlan NameDeductible
from $54
Everest 1000/20/5000/250000
$1,000.00Select
from $55
Everest 1000/20/4000/250000
$1,000.00Select
from $57
Everest 1000/20/3000/250000
$1,000.00Select
from $60
LifeShield Flex 1000/20/5000/750000
$1,000.00Select
from $62
LifeShield Flex 1000/20/4000/750000
$1,000.00Select
  • What is the Gold Plan?

    ObamaCare’s Gold Plan is a type of Metal Plan on the Health Insurance Marketplace. Gold Plans qualify for Tax Credits, have high premiums, and good cost sharing. Gold plans mean higher premiums, less Tax Credits, but much better cost sharing on average than Silver or Bronze.

  • How are Gold 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. The Gold Plan typically pays 80% of covered medical costs.

  • How much does a Gold Plan cost?

    The monthly premium for a Gold 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 your geographic region. You can use HealthPocket’s comparison tool to compare Gold Plan premiums in your area.

  • When Can I Enroll in a Gold Plan?

    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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