Anthem Bronze Blue Priority/Lean 0 ($0 Virtual PCP + $0 Select Drugs + Incentives) – HMO
Network type: HMO
Coverage tier: Expanded Bronze
Primary care visit: $30 copay
Specialist visit: $200 copay
Urgent care visit: $100 copay
Description
Health Care Plan Details
| Network type | HMO |
| Deductible | $0 per person $0 per person |
| Out-of-pocket max | $9,450 per person $18,900 per family |
| Metal tier | Expanded Bronze |
Visit Copay
| Primary care visit | $30 copay |
| Specialist visit | $200 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $100 copay |
| Emergency room | $3,000 copay |
| Ambulance | 50% coinsurance |
| Hospital stay (facility) | $3200 copay per Stay |
| Hospital stay (physician) | 50% coinsurance |
| Outpatient procedure (facility) | 50% coinsurance |
| Outpatient procedure (physician) | 50% coinsurance |
| Physical rehabilitation | $200 copay |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | $3,200 copay |
Pharmacy, Drugs, and Medication
| Generic | $25 copay |
| Brand | $175 copay after deductible |
| Non-preferred Brand | 45% coinsurance after deductible |
| Specialty | 50% coinsurance after deductible |
Lab Tests and Diagnostic Procedures
| X-rays | $150 copay |
| Imaging (CT/PET/MRI) | $2,100 copay |
| Blood work | $75 copay |
Mental and Psychiatric Health Care
| Mental Health outpatient services | 50% coinsurance |
| Psychiatric hospital stay | $3200 copay per Stay |
Health Plan Provider Information
| Health Plan Benefits | https://sbc.anthem.com/dpsdeeplink/deepLink/AnthemBronzeBluePriorityLean00VirtualPCP0SelectDrugsIncentives/English/DG166700590377.pdf |
| Drug and medication plan formulary | https://www.anthem.com/WISelectdrugtier4 |
| Search doctor list | https://www.anthem.com/find-care/?alphaprefix=DHS |
