Anthem Bronze Pathway X HMO 6000 ($0 Virtual PCP + $0 Select Drugs) – HMO
Network type: HMO
Coverage tier: Bronze
Primary care visit: $50 copay, 35% coinsurance after deductible
Specialist visit: 35% coinsurance after deductible
Urgent care visit: 35% coinsurance after deductible
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 | Bronze |
Visit Copay
| Primary care visit | $50 copay, 35% coinsurance after deductible |
| Specialist visit | 35% coinsurance after deductible |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | 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) | $400 copay after deductible, 50% coinsurance after deductible |
| Blood work | 35% coinsurance after deductible |
Mental and Psychiatric Health Care
| Mental Health outpatient services | 35% coinsurance after deductible |
| 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/AnthemBronzePathwayXHMO60000VirtualPCP0SelectDrugs/English/DG166700589649.pdf |
| Drug and medication plan formulary | https://www.anthem.com/OHSelectdrugtier4 |
| Search doctor list | https://www.anthem.com/find-care/?alphaprefix=JWV |
