Anthem BlueCross BlueShield of Georgia

Anthem Silver Pathway X HMO 5500

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    Plan Overview

    Combined Medical and Drug Deductible
    • Individual: $5,500
    • Family: $11,000
    • Per Person: $5,500
    Combined Medical and Drug Out of Pocket Maximum
    • Individual: $8,700
    • Family: $17,400
    • Per Person: $8,700

    Office Visit

    Primary Doctor
    • CoPay: $30.00
    • 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: 35.00% 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: $40.00
    • CoInsurance: Not Applicable
    • 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: $15.00
    • CoInsurance: Not Applicable
    • 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: Not Applicable
    • 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: 35.00% 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: Not Applicable
    • 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: 35.00% 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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    We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.

    Attention: This website is operated by HealthMarkets Insurance Agency, Inc. and is not the Health Insurance Marketplace® website. HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency nationwide except in MA. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in an insurance plan. No obligation to enroll. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.

    HealthMarkets Insurance Agency offers the opportunity to enroll in either QHPs or off-Marketplace coverage. Please visit HealthCare.gov for information on the benefits of enrolling in a QHP. Off-Marketplace coverage is not eligible for the cost savings offered for coverage through the Marketplaces.

    This information is not a complete description of benefits. Call the Plan’s customer service phone number for more information.

    HMPLAN49046GA0410032ACA1

    © 2024 HealthMarkets Insurance Agency. All rights reserved.

    We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.

    Attention: This website is operated by HealthMarkets Insurance Agency, Inc. and is not the Health Insurance Marketplace® website. HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency nationwide except in MA. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in an insurance plan. No obligation to enroll. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.

    HealthMarkets Insurance Agency offers the opportunity to enroll in either QHPs or off-Marketplace coverage. Please visit HealthCare.gov for information on the benefits of enrolling in a QHP. Off-Marketplace coverage is not eligible for the cost savings offered for coverage through the Marketplaces.

    This information is not a complete description of benefits. Call the Plan’s customer service phone number for more information.

    HMPLAN49046GA0410032ACA1

    © 2024 HealthMarkets Insurance Agency. All rights reserved.

    We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.

    Attention: This website is operated by HealthMarkets Insurance Agency, Inc. and is not the Health Insurance Marketplace® website. HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency nationwide except in MA. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in an insurance plan. No obligation to enroll. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.

    HealthMarkets Insurance Agency offers the opportunity to enroll in either QHPs or off-Marketplace coverage. Please visit HealthCare.gov for information on the benefits of enrolling in a QHP. Off-Marketplace coverage is not eligible for the cost savings offered for coverage through the Marketplaces.

    This information is not a complete description of benefits. Call the Plan’s customer service phone number for more information.

    HMPLAN49046GA0410032ACA1