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Zip Code	30044 (edit)
Applicant	2/19/1984 Male (edit)
Coverage Start	2/20/2019 (edit)

Insurance Type	ACA (Obamacare)
Plan Name	BCBSHP Bronze Pathway HMO 5850
Plan ID	hhs-49046GA0410029
Plan Year	2018
Insurance Provider	Blue Cross Blue Shield of Georgia
Metal Level	Bronze
Plan Type	HMO
Deductible	$5,850
Out-of-Pocket Maximum	$7,350
Personal Score
Plan Highlights

Costs for Medical Care
Primary Care Visit to Treat an Injury or Illness	35.00% Coinsurance after deductible
Specialist Visit	35.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services	35.00% Coinsurance after deductible
X-rays and Diagnostic Imaging	35.00% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans	$400 Copay after deductible, 50.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Deductible - Family	$11700 per group
Out-of-Pocket Maximum - Family	$14700 per group

Prescription drug coverage
Generic Drugs	35.00% Coinsurance after deductible
Preferred Brand Drugs	35.00% Coinsurance after deductible
Non-Preferred Brand Drugs	40.00% Coinsurance after deductible
Specialty Drugs	40.00% Coinsurance after deductible

Access to doctors and hospitals
Provider directory URL	http://www.anthem.com/health-insurance/provider-directory/searchcriteria?branding=ABCBS&state=GA
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 - Urgent/Emergency Coverage Only
Does this plan cover services outside the country?	No - Urgent/Emergency Coverage Only

Hospital services
Emergency Room Services	$500 Copay after deductible, 35.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Inpatient Hospital Services (e.g., Hospital Stay)	$1000 Copay per Stay after deductible, 50.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Inpatient Physician and Surgical Services	35.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service	35.00% Coinsurance after deductible

Maternity
Prenatal and Postnatal Care	35.00% Coinsurance after deductible
Delivery and all inpatient services for maternity care	$1000 Copay after deductible, 50.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.

Mental Health
Mental/Behavioral Health Outpatient Services	35.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services	$1000 Copay per Stay after deductible, 50.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Substance use disorder outpatient services	35.00% Coinsurance after deductible
Substance use disorder inpatient services	$1000 Copay per Stay after deductible, 50.00% 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 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
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/Custodial Nursing Home Care Private-Duty Nursing Routine Foot Care Abortion for Which Public Funding is Prohibited

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Premium

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$6,000.00

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from $344

Ambetter Balanced Care 11 (2019)

$6,000.00

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Anthem Silver Pathway X Guided Access HMO 6000

$6,000.00

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from $383

Anthem Silver Pathway X HMO 6000

$6,000.00

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from $419

Anthem Silver Pathway Guided Access HMO 6000 30

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Location/Distance

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Phone Number
(678) 344-8700
Office Locations
2878 Five Forks Trickum Rd
Lawrenceville, GA 30044

2878 Five Forks Trickum Rd Lawrenceville GA, 30044

What is a bronze plan?
Bronze Plan is a type of Metal Plan on the Health Insurance Marketplace. Bronze Plans qualify for Tax Credits and have low premiums. Generally speaking, a Bronze Plan is intended to have the lowest premium of the 4 new categories of health plans under the Affordable Care Act but charge the highest out-of-pocket costs for healthcare services.
How are Bronze 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 Bronze Plan pays 60% of the covered medical costs among its enrollees while the other Obamacare health plans pay a higher percentage of these costs.
How much does a Bronze Plan cost?
The monthly premium for a Bronze 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 Bronze Plan premiums in your area. Another important factor to remember is Advanced Premium Tax Credits which can subsidize bronze plan premiums if an individual meets eligibility criteria.
When Can I Enroll in a Bronze Plan?
The annual enrollment period for the 2018 plan year will begin on November 1, 2017 and continue through December 15, 2017.
In 2015 there had been a Special Enrollment Period for many facing the uninsured penalty on their 2014 tax return. There is no guarantee that a similar Special Enrollment Period will be granted in 2017. See our Open Enrollment article for more information.

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual 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.

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BCBSHP Bronze Pathway HMO 5850

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Prescription drug coverage

Access to doctors and hospitals

Hospital services

Maternity

Mental Health

Medical Management Programs

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