Anthem BlueCross BlueShield

Anthem Bronze Pathway Essentials X 8000 for HSA

Prescription Drug Information

Inpatient Coverage

Emergency and Urgent Care

Links

Summary Of Benefits

Plan Overview

Medical Deductible	Individual: $8,000 Family: $16,000 Per Person: $8,000
Prescription Drug Deductible	Individual: Included in Medical Family: Included in Medical Per Person: Included in Medical
Medical Out-of-Pocket Maximum	Individual: $8,000 Family: $16,000 Per Person: $8,000
Drug Out-of-Pocket Maximum	Individual: Included in Medical Family: Included in Medical Per Person: Included in Medical

Office Visit

Primary Doctor	Standard: Copay: No Charge after deductible \| Coinsurance: Not Applicable
Specialist	Standard: Copay: No Charge after deductible \| Coinsurance: Not Applicable

Prescription Drug Information

Preferred Brand Drugs	Standard: Copay: Not Applicable \| Coinsurance: 0.00% Coinsurance after deductible
Non Preferred Brand Drugs	Standard: Copay: Not Applicable \| Coinsurance: 0.00% Coinsurance after deductible
Generic Drugs	Standard: Copay: Not Applicable \| Coinsurance: 0.00% Coinsurance after deductible
Specialty Drugs	Standard: Copay: Not Applicable \| Coinsurance: 0.00% Coinsurance after deductible

Inpatient Coverage

Hospital Services	Standard: Copay: No Charge after deductible \| Coinsurance: Not Applicable
Inpatient Services	Standard: Copay: No Charge after deductible \| Coinsurance: Not Applicable

Emergency and Urgent Care

Emergency Room

Standard: Copay: No Charge after deductible | Coinsurance: Not Applicable