2018 BCBSHP Silver Pathway Guided Access HMO 3000 Plan Details - HealthPocket

BCBSHP Silver Pathway Guided Access HMO 3000

$491.71/mo

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Zip Code30044
Applicant8/20/1983 Male
Coverage Start8/21/2018
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameBCBSHP Silver Pathway Guided Access HMO 3000
Plan IDhhs-49046GA0410055
Insurance ProviderBlue Cross Blue Shield of Georgia
Metal LevelSilver
Plan TypeHMO
Deductible$3,000
Out-of-Pocket Maximum$7,350
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$40 Copay with deductible, 10.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Specialist Visit$75 Copay with deductible, 10.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Laboratory Outpatient and Professional Services10.00% Coinsurance after deductible
X-rays and Diagnostic Imaging10.00% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans$300 Copay after deductible, 50.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Deductible - Family$6000 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 Drugs40.00% Coinsurance after deductible
Specialty Drugs40.00% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttp://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?Yes - All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists
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, 10.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Inpatient Hospital Services (e.g., Hospital Stay)$500 Copay per Stay after deductible, 50.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Inpatient Physician and Surgical Services10.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service10.00% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care10.00% Coinsurance after deductible
Delivery and all inpatient services for maternity care$500 Copay after deductible, 50.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.

Mental Health

Mental/Behavioral Health Outpatient Services10.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services$500 Copay per Stay after deductible, 50.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Substance use disorder outpatient services10.00% Coinsurance after deductible
Substance use disorder inpatient services$500 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 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
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 BenefitsSkilled 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 BenefitsAcupuncture
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
PremiumPlan NameDeductible
from $378
KP GA Signature Silver 3000/30
$3,000.00Select
from $416
KP GA Silver 3000/30
$3,000.00Select
from $464
KP GA Signature Silver 3000/30
$3,000.00Select
from $476
BCBSHP Silver Pathway X Guided Access HMO 3000
$3,000.00Select
from $482
BCBSHP Silver Pathway X Guided Access HMO 3150
$3,150.00Select
  • 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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