Anthem Silver Pathway HMO 2000

Individual Health Insurance (Obamacare)

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Anthem Silver Pathway HMO 2000

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Benefits & Coverage

Plan Name
Anthem Silver Pathway HMO 2000
Plan Year
2018
Insurance Type
Individual Health Insurance (Obamacare)
Insurance Provider
Metal Level
Silver
Out-of-Pocket Maximum
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness
$35 Copay
Specialist Visit
25.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services
25.00% Coinsurance after deductible
X-rays and Diagnostic Imaging
25.00% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans
$250 Copay after deductible, 25.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Deductible - Family
$4000 per group
Out-of-Pocket Maximum - Family
$12700 per group

Prescription drug coverage

Generic Drugs
25.00% Coinsurance after deductible
Preferred Brand Drugs
25.00% Coinsurance after deductible
Non-Preferred Brand Drugs
25.00% Coinsurance after deductible
Specialty Drugs
25.00% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URL
http://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
$200 Copay after deductible, 25.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Inpatient Hospital Services (e.g., Hospital Stay)
$500 Copay per Stay after deductible, 30.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Inpatient Physician and Surgical Services
25.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service
25.00% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care
25.00% Coinsurance after deductible
Delivery and all inpatient services for maternity care
$500 Copay after deductible, 30.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.

Mental Health

Mental/Behavioral Health Outpatient Services
25.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services
$500 Copay per Stay after deductible, 30.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Substance use disorder outpatient services
25.00% Coinsurance after deductible
Substance use disorder inpatient services
$500 Copay per Stay after deductible, 30.00% Coinsurance after deductible. See plan brochure for when Copay is 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
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
Dental Anesthesia
Diabetes Care Management
Inherited Metabolic Disorder - PKU
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
Clinical Trials
Congenital Anomaly, including Cleft Lip/Palate
Off Label Prescription Drugs
Prescription Drugs Other
Non-Preferred Generic
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 Benefits
Skilled Nursing Facility
Home Health Care Services
Habilitation Services
Dental Check-Up for Children
Chiropractic Care
Rehabilitative Speech Therapy
Early Intervention Services
Rehabilitative Occupational Therapy
Rehabilitative Physical Therapy
More Excluded Benefits
Acupuncture
Cosmetic Surgery
Long-Term/Custodial Nursing Home Care
Weight Loss Programs
Outpatient Rehabilitation Services
Routine Foot Care
Non-Emergency Care When Traveling Outside the U.S.
Abortion for Which Public Funding is Prohibited
Accidental Dental
Rehabilitative Occupational and Rehabilitative Physical Therapy
Spinal Manipulations

What To Know

  • This is an ACA (Obamacare) compliant health plan.

Physician Directory

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Silver plan frequently asked questions (FAQ)

  • What Is the Silver Plan?

    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.

  • How are Silver 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 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.

  • How much does a Silver Plan cost?

    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.

  • When Can I Enroll in a Silver 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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