Anthem Heart Healthy Silver Pathway X Enhanced 4000/0% ($0 Virtual PCP + $0 Select Drugs)
Anthem BlueCross BlueShield
Plan overview
Medical deductible
Individual: $4000
Family: $8000
Per Person: $4000
Prescription drug deductible
Individual: $0
Family: $0
Per Person: $0
Combined medical and drug out of pocket maximum
Individual: $9000
Family: $18000
Per Person: $9000
Office visit
Primary Doctor
CoPay: $20.00
CoInsurance: Not Applicable
Covered: Covered
Benefit Explanation: Cardiologist office visits will follow this cost share. Cost share applies to both in-person and virtual services from in-network providers. Cost share does not apply to virtual PCP visits from designated virtual care-only providers. If this is an HSA plan, deductible applies.
Specialist
CoPay: $85.00
CoInsurance: Not Applicable
Covered: Covered
Benefit Explanation: Cardiologist office visits will follow the Primary Care Visit to Treat and Injury or Illness cost share. You have $0 virtual Primary Care Physician (PCP) visits using our virtual care-only providers.
Prescription drug information
Preferred brand drugs
CoPay: $45.00
CoInsurance: Not Applicable
Covered: Covered
Limit Quantity:
Limit Unit:
Benefit Explanation: Cost share is for a 30 day supply.90 day supply is available with additional cost shares.
Non preferred brand drugs
CoPay: Not Applicable
CoInsurance: 35.00% Coinsurance after deductible
Covered: Covered
Limit Quantity:
Limit Unit:
Benefit Explanation: Cost share is for a 30 day supply.90 day supply is available with additional cost shares.
Generic drugs
CoPay: $15.00
CoInsurance: Not Applicable
Covered: Covered
Limit Quantity:
Limit Unit:
Benefit Explanation: Cost share reflects a 30-day retail supply. $0 Select Drugs: We offer a $0 cost share for a select set of generic prescription drugs. These drugs are listed on Our Prescription Drug List (formulary).
Specialty drugs
CoPay: Not Applicable
CoInsurance: 40.00% Coinsurance after deductible
Covered: Covered
Limit Quantity:
Limit Unit:
Benefit Explanation: Cost share is for a 30 day supply.
Inpatient coverage
Hospital services
CoPay: $500.00 Copay per Stay after deductible
CoInsurance: Not Applicable
Covered: Covered
Inpatient services
CoPay: No Charge after deductible
CoInsurance: Not Applicable
Covered: Covered
Emergency and urgent care
Emergency room
CoPay: $500.00 Copay after deductible
CoInsurance: Not Applicable
Covered: Covered
Benefit Explanation: When directly admitted to the hospital, the Emergency Room copayment is not waived.
Urgent care facility
CoPay: $85.00
CoInsurance: Not Applicable
Covered: Covered
Benefit Explanation:
Maternity
Labor and delivery hospital stay
CoPay: $500.00 Copay after deductible
CoInsurance: Not Applicable
Covered: Covered
Pre and Postnatal office visit
CoPay: No Charge
CoInsurance: Not Applicable
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
Benefit Explanation: This Plan covers a complete eye exam and if needed, dilation.
Major dental care
Routine dental checkups for children
CoPay:
CoInsurance:
Covered: Not Covered
Limit Quantity:
Limit Unit:
Routine dental checkups for adults
CoPay:
CoInsurance:
Covered: Not Covered
Limit Quantity:
Limit Unit:
Benefit Explanation:
These policies have exclusions, limitations, reduction of benefits, terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, call or write your insurance agent or the company (whichever is applicable).