Anthem Bronze 6000 $0 Virtual PCP $0 Select Drugs – HMO
Network type: HMO
Coverage tier: Expanded Bronze
Primary care visit: $40 copay
Specialist visit: $100 copay
Urgent care visit: $50 copay
Description
Health Care Plan Details
| Network type | HMO |
| Deductible | $6,000 per person $6,000 per person |
| Out-of-pocket max | $9,450 per person $18,900 per family |
| Metal tier | Expanded Bronze |
Visit Copay
| Primary care visit | $40 copay |
| Specialist visit | $100 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $50 copay |
| Emergency room | $500 plus 30% after deductible copay, $500 plus 30% after deductible |
| Ambulance | 30% after deductible |
| Hospital stay (facility) | $500 plus 40% after deductible copay, $500 plus 40% after deductible |
| Hospital stay (physician) | 30% after deductible |
| Outpatient procedure (facility) | 30% after deductible |
| Outpatient procedure (physician) | 30% after deductible |
| Physical rehabilitation | 30% after deductible |
Maternitowny and Pregnancy
| Labor, delivery, hospital stay | $500 plus 40% after deductible copay, $500 plus 40% after deductible |
Pharmacy, Drugs, and Medication
| Generic | $30 copay |
| Brand | 30% after deductible |
| Non-preferred Brand | 30% after deductible |
| Specialty | 30% after deductible |
Lab Tests and Diagnostic Procedures
| X-rays | 30% after deductible |
| Imaging (CT/PET/MRI) | $500 plus 30% after deductible copay, $500 plus 30% after deductible |
| Blood work | 30% after deductible |
Mental and Psychiatric Health Care
| Mental Health outpatient services | 30% after deductible |
| Psychiatric hospital stay | $500 plus 40% after deductible copay, $500 plus 40% after deductible |
Health Plan Provider Information
| Health Plan Benefits | https://d2ed110nmrd591.cloudfront.net/blobs/5TzsJ2KkiQ7jSR6YjMApmagU.pdf |
