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Anthem BlueCross BlueShield of Georgia

Anthem Silver Pathway X Guided Access HMO 3000

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    Plan Overview

    Combined Medical and Drug Deductible
    • Individual: $3,000
    • Family: $6,000
    • Per Person: $3,000
    Combined Medical and Drug Out of Pocket Maximum
    • Individual: $7,700
    • Family: $15,400
    • Per Person: $7,700

    Office Visit

    Primary Doctor
    • CoPay: $35.00
    • CoInsurance: Not Applicable
    • Covered: Covered
    • Benefit Explanation: You may also be able to access care with lower cost shares using our online virtual doctor visits and medical chat with a doctor. These can be accessed via our mobile app, website, or Anthem-enabled devices
    Specialist
    • CoPay: Not Applicable
    • CoInsurance: 25.00% Coinsurance after deductible
    • Covered: Covered
    • Benefit Explanation: You may also be able to access care with lower cost shares using our online virtual doctor visits and medical chat with a doctor. These can be accessed via our mobile app, website, or Anthem-enabled devices

    Prescription Drug Information

    Preferred Brand Drugs
    • CoPay: Not Applicable
    • CoInsurance: 25.00% Coinsurance after deductible
    • Covered: Covered
    • Benefit Explanation: Cost share shown is for a 30 day retail supply
    Non Preferred Brand Drugs
    • CoPay: Not Applicable
    • CoInsurance: 40.00% Coinsurance after deductible
    • Covered: Covered
    • Benefit Explanation: Cost share shown is for a 30 day retail supply
    Generic Drugs
    • CoPay: Not Applicable
    • CoInsurance: 25.00% Coinsurance after deductible
    • Covered: Covered
    • Benefit Explanation: Cost share shown is for a 30 day retail supply
    Specialty Drugs
    • CoPay: Not Applicable
    • CoInsurance: 40.00% Coinsurance after deductible
    • Covered: Covered
    • Benefit Explanation: Limited to a 30 day supply

    Inpatient Coverage

    Hospital Services
    • CoPay: $500.00 Copay per Stay after deductible
    • CoInsurance: 50.00% Coinsurance after deductible
    • Covered: Covered
    • Benefit Explanation: Combined 60 days per year for Inpatient Rehabilitation and Skilled Nursing Facility services.
    Inpatient Services
    • CoPay: Not Applicable
    • CoInsurance: 25.00% Coinsurance after deductible
    • Covered: Covered

    Emergency and Urgent Care

    Emergency Room
    • CoPay: $500.00 Copay after deductible
    • CoInsurance: 25.00% Coinsurance after deductible
    • Covered: Covered
    • Benefit Explanation: Copayment (if applicable) is waived if admitted.
    Urgent Care Facility
    • CoPay: $50.00
    • CoInsurance: Not Applicable
    • Covered: Covered
    • Benefit Explanation: Cost share is driven by provider/setting.

    Maternity

    Labor and Delivery Hospital Stay
    • CoPay: $500.00 Copay after deductible
    • CoInsurance: 50.00% Coinsurance after deductible
    • Covered: Covered
    • Benefit Explanation: Hospital stay is 48 hours for vaginal delivery and 96 hours for c-section
    Pre and Postnatal Office Visit
    • CoPay: Not Applicable
    • CoInsurance: 25.00% Coinsurance after deductible
    • Covered: Covered

    Vision

    Routine Eye Exams For Children
    • CoPay: No Charge
    • CoInsurance: Not Applicable
    • Covered: Covered
    • Limit Quantity: 1
    • Limit Unit : Visit(s) per Year

    Major Dental Care

    Routine Dental Checkups for Children
    • CoPay: No Charge after deductible
    • CoInsurance: Not Applicable
    • Covered: Covered
    • Limit Quantity: 2
    • Limit Unit : Visit(s) per Year
    Routine Dental Checkups for Adults
    • Covered: Not Covered
    Basic Dental Care - Adult
    • Covered: Not Covered
    Basic Dental Care - Child
    • CoPay: Not Applicable
    • CoInsurance: 40.00% Coinsurance after deductible
    • Covered: Covered
    Major Dental Care - Adult
    • Covered: Not Covered
    Major Dental Care - Child
    • CoPay: Not Applicable
    • CoInsurance: 50.00% Coinsurance after deductible
    • Covered: Covered
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