Anthem Bronze Pathway X Enhanced 5500/35% ($0 Preferred Virtual Care + $0 Select Drugs) – HMO
Network type: HMO
Coverage tier: Expanded Bronze
Primary care visit: $40 copay
Specialist visit: $50 copay after deductible, 35% coinsurance after deductible
Urgent care visit: $50 copay after deductible, 35% coinsurance after deductible
Description
Health Care Plan Details
| Network type | HMO |
| Deductible | $5,500 per person $5,500 per person |
| Out-of-pocket max | $9,400 per person $18,800 per family |
| Metal tier | Expanded Bronze |
Visit Copay
| Primary care visit | $40 copay |
| Specialist visit | $50 copay after deductible, 35% coinsurance after deductible |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $50 copay after deductible, 35% coinsurance after deductible |
| Emergency room | $500 copay after deductible, 35% coinsurance after deductible |
| Ambulance | 35% coinsurance after deductible |
| Hospital stay (facility) | $500 copay per Stay after deductible, 35% coinsurance after deductible |
| Hospital stay (physician) | 35% coinsurance after deductible |
| Outpatient procedure (facility) | 35% coinsurance after deductible |
| Outpatient procedure (physician) | 35% coinsurance after deductible |
| Physical rehabilitation | 35% coinsurance after deductible |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | $500 copay after deductible, 35% coinsurance after deductible |
Pharmacy, Drugs, and Medication
| Generic | 35% coinsurance after deductible |
| Brand | 35% coinsurance after deductible |
| Non-preferred Brand | 40% coinsurance after deductible |
| Specialty | 40% coinsurance after deductible |
Lab Tests and Diagnostic Procedures
| X-rays | 35% coinsurance after deductible |
| Imaging (CT/PET/MRI) | 35% coinsurance after deductible |
| Blood work | 35% coinsurance after deductible |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $40 copay |
| Psychiatric hospital stay | $500 copay per Stay after deductible, 35% coinsurance after deductible |
Health Plan Provider Information
| Health Plan Benefits | https://sbc.anthem.com/dpsdeeplink/deepLink/AnthemBronzePathwayXEnhanced5500350PreferredVirtualCare0SelectDrugs/English/DG166700596596.pdf |
| Drug and medication plan formulary | https://www.anthem.com/NHSelectdrugtier4 |
| Search doctor list | https://www.anthem.com/find-care/?alphaprefix=YGQ |
