Anthem Silver Pathway X Enhanced 5500/20% ($0 Preferred Virtual Care + $0 Select Drugs) – HMO

Description

Health Care Plan Details

Network type	HMO
Deductible	$5,500 per person $5,500 per person
Out-of-pocket max	$9,200 per person $18,400 per family
Metal tier	Silver

Visit Copay

Primary care visit	$30 copay
Specialist visit	$50 copay
Preventive care visit	No charge

Urgent, Emergency Care, and Hospital Care

Urgent care	$50 copay
Emergency room	20% coinsurance after deductible
Ambulance	20% coinsurance after deductible
Hospital stay (facility)	20% coinsurance after deductible
Hospital stay (physician)	20% coinsurance after deductible
Outpatient procedure (facility)	20% coinsurance after deductible
Outpatient procedure (physician)	20% coinsurance after deductible
Physical rehabilitation	20% coinsurance after deductible

Maternitowny and Pregnancy

Well baby care	No charge
Labor, delivery, hospital stay	20% coinsurance after deductible

Pharmacy, Drugs, and Medication

Generic	$20 copay
Brand	$55 copay
Non-preferred Brand	40% coinsurance after deductible
Specialty	40% coinsurance after deductible

Lab Tests and Diagnostic Procedures

X-rays	20% coinsurance after deductible
Imaging (CT/PET/MRI)	20% coinsurance after deductible
Blood work	20% coinsurance after deductible

Mental and Psychiatric Health Care

Mental Health outpatient services	$30 copay
Psychiatric hospital stay	20% coinsurance after deductible

Health Plan Provider Information

Health Plan Benefits	https://sbc.anthem.com/dpsdeeplink/deepLink/AnthemSilverPathwayXEnhanced5500200PreferredVirtualCare0SelectDrugs/English/DG166700590630.pdf
Drug and medication plan formulary	https://www.anthem.com/NHSelectdrugtier4
Search doctor list	https://www.anthem.com/find-care/?alphaprefix=YGQ