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Anthem BlueCross BlueShield

Anthem Silver Pathway X Enhanced HMO 4000 0

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    Plan Overview

    Combined Medical and Drug Deductible
    • Individual: $4,000
    • Family: $8,000
    • Per Person: $4,000
    Combined Medical and Drug Out of Pocket Maximum
    • Individual: $8,700
    • Family: $17,400
    • Per Person: $8,700

    Office Visit

    Primary Doctor
    • CoPay: $40.00 Copay with deductible
    • CoInsurance: No Charge after deductible
    • Covered: Covered
    • Benefit Explanation: Copay applies for the first 3 visits for Primary care, Retail Health Clinic and Chiropractic office visits combined. Additional office visits are subject to the deductible. 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 Sydney application.
    Specialist
    • CoPay: $60.00 Copay after deductible
    • 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 Sydney application.

    Prescription Drug Information

    Preferred Brand Drugs
    • CoPay: $45.00
    • CoInsurance: Not Applicable
    • Covered: Covered
    • 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: 40.00% Coinsurance after deductible
    • Covered: Covered
    • Benefit Explanation: Cost share is for a 30 day supply.  90 day supply is available with additional cost shares.
    Generic Drugs
    • CoPay: $20.00
    • CoInsurance: Not Applicable
    • Covered: Covered
    • Benefit Explanation: Cost share is for a 30 day supply.  90 day supply is available with additional cost shares.
    Specialty Drugs
    • CoPay: Not Applicable
    • CoInsurance: 40.00% Coinsurance after deductible
    • Covered: Covered
    • 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: If applicable, copay waived if admitted.
    Urgent Care Facility
    • CoPay: $50.00 Copay after deductible
    • CoInsurance: Not Applicable
    • Covered: Covered

    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
    • Covered: Not Covered
    Routine Dental Checkups for Adults
    • Covered: Not Covered
    Basic Dental Care - Adult
    • Covered: Not Covered
    Basic Dental Care - Child
    • Covered: Not Covered
    Major Dental Care - Adult
    • Covered: Not Covered
    Major Dental Care - Child
    • Covered: Not Covered
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