Anthem Bronze Pathway X HMO 6700 ($0 Virtual PCP + $0 Select Drugs + Incentives) – HMO

Description

Health Care Plan Details

Network type	HMO
Deductible	$6,700 per person $6,700 per person
Out-of-pocket max	$8,750 per person $17,500 per family
Metal tier	Expanded Bronze

Visit Copay

Primary care visit	$35 copay
Specialist visit	$60 copay after deductible
Preventive care visit	No charge

Urgent, Emergency Care, and Hospital Care

Urgent care	$75 copay
Emergency room	$500 copay after deductible, 40% coinsurance after deductible
Ambulance	50% coinsurance after deductible
Hospital stay (facility)	$500 copay per Stay after deductible, 50% coinsurance after deductible
Hospital stay (physician)	40% coinsurance after deductible
Outpatient procedure (facility)	40% coinsurance after deductible
Outpatient procedure (physician)	40% coinsurance after deductible
Physical rehabilitation	$35 copay

Maternitowny and Pregnancy

Well baby care	No charge
Labor, delivery, hospital stay	$500 copay after deductible, 50% coinsurance after deductible

Pharmacy, Drugs, and Medication

Generic	40% coinsurance after deductible
Brand	40% coinsurance after deductible
Non-preferred Brand	40% coinsurance after deductible
Specialty	40% coinsurance after deductible

Lab Tests and Diagnostic Procedures

X-rays	40% coinsurance after deductible
Imaging (CT/PET/MRI)	$400 copay after deductible, 50% coinsurance after deductible
Blood work	40% coinsurance after deductible

Mental and Psychiatric Health Care

Mental Health outpatient services	$35 copay
Psychiatric hospital stay	$500 copay per Stay after deductible, 50% coinsurance after deductible

Health Plan Provider Information

Health Plan Benefits

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