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Anthem BlueCross BlueShield

Bronze HMO Pathway Enhanced Tiered

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    Plan Overview

    Combined Medical and Drug Deductible
    • Individual: $7,900
    • Family: $15,800
    • Per Person: $7,900
    Combined Medical and Drug Out of Pocket Maximum
    • Individual: $8,700
    • Family: $17,400
    • Per Person: $8,700

    Office Visit

    Primary Doctor
    • CoPay: Not Applicable
    • CoInsurance: 50.00% Coinsurance after deductible
    • Covered: Covered
    • Benefit Explanation: Tier 1 beneifts are subject to a lower cost share after the in-network deductible is met.
    Specialist
    • CoPay: Not Applicable
    • CoInsurance: 50.00% Coinsurance after deductible
    • Covered: Covered
    • Benefit Explanation: Tier 1 beneifts are subject to a lower cost share after the in-network deductible is met.

    Prescription Drug Information

    Preferred Brand Drugs
    • CoPay: Not Applicable
    • CoInsurance: 50.00% Coinsurance after deductible
    • Covered: Covered
    • Benefit Explanation: 30 day supply for Retail or 90 day supply for Home Delivery. Retail Tier 3 and Tier 4 fill coinsurance is limited to a specific maximum per prescription, depending on your specific plan.
    Non Preferred Brand Drugs
    • CoPay: Not Applicable
    • CoInsurance: 50.00% Coinsurance after deductible
    • Covered: Covered
    • Benefit Explanation: 30 day supply for Retail or 90 day supply for Home Delivery. Retail Tier 3 and Tier 4 fill coinsurance is limited to a specific maximum per prescription, depending on your specific plan.
    Generic Drugs
    • CoPay: $25.00
    • CoInsurance: Not Applicable
    • Covered: Covered
    • Benefit Explanation: 30 day supply for Retail or 90 day supply for Home Delivery. Retail Tier 3 and Tier 4 fill coinsurance is limited to a specific maximum per prescription, depending on your specific plan.
    Specialty Drugs
    • CoPay: Not Applicable
    • CoInsurance: 50.00% Coinsurance after deductible
    • Covered: Covered
    • Benefit Explanation: 30 day supply for Retail or for Home Delivery. Retail Tier 3 and Tier 4 fill coinsurance is limited to a specific maximum per prescription, depending on your specific plan.

    Inpatient Coverage

    Hospital Services
    • CoPay: Not Applicable
    • CoInsurance: 50.00% Coinsurance after deductible
    • Covered: Covered
    • Benefit Explanation: Maximum of 2 daily copays per in network admission for a maximum of $1000. Tier 1 beneifts are subject to a lower cost share after the in-network deductible is met. Maximum of 2 daily copays per in network admission for a maximum of $1000. Copay applies after deductible has been met.
    Inpatient Services
    • CoPay: $0.00 Copay after deductible
    • CoInsurance: Not Applicable
    • Covered: Covered

    Emergency and Urgent Care

    Emergency Room
    • CoPay: Not Applicable
    • CoInsurance: 50.00% Coinsurance after deductible
    • Covered: Covered
    • Benefit Explanation: Emergency Room copay is waived if directly admitted to the hospital.
    Urgent Care Facility
    • CoPay: $75.00
    • CoInsurance: Not Applicable
    • Covered: Covered

    Maternity

    Labor and Delivery Hospital Stay
    • CoPay: Not Applicable
    • CoInsurance: 50.00% Coinsurance after deductible
    • Covered: Covered
    • Benefit Explanation: Maximum of 2 daily copays per in network admission for a maximum of $1000. Tier 1 beneifts are subject to a lower cost share after the in-network deductible is met. Maximum of 2 daily copays per in network admission for a maximum of $1000. Copay applies after deductible has been met.
    Pre and Postnatal Office Visit
    • CoPay: $0.00
    • CoInsurance: Not Applicable
    • Covered: Covered

    Vision

    Routine Eye Exams For Children
    • CoPay: $40.00
    • CoInsurance: Not Applicable
    • Covered: Covered
    • Limit Quantity: 1
    • Limit Unit : Visit(s) per Year

    Major Dental Care

    Routine Dental Checkups for Children
    • CoPay: Not Applicable
    • CoInsurance: 0.00%
    • 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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