Anthem Colorado Option Gold Mountain Enhanced Std – HMO
Network type: HMO
Coverage tier: Gold
Primary care visit: No charge
Specialist visit: $50 copay
Urgent care visit: $50 copay
Description
Health Care Plan Details
Network type | HMO |
Deductible | $1,700 per person $1,700 per person |
Out-of-pocket max | $8,700 per person $17,400 per family |
Metal tier | Gold |
Visit Copay
Primary care visit | No charge |
Specialist visit | $50 copay |
Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
Urgent care | $50 copay |
Emergency room | 30% after deductible |
Ambulance | 30% after deductible |
Hospital stay (facility) | 30% 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 | 30% after deductible |
Pharmacy, Drugs, and Medication
Generic | $10 copay |
Brand | $50 copay |
Non-preferred Brand | $200 copay |
Specialty | $600 copay |
Lab Tests and Diagnostic Procedures
X-rays | 30% after deductible |
Imaging (CT/PET/MRI) | 30% after deductible |
Blood work | 30% after deductible |
Mental and Psychiatric Health Care
Mental Health outpatient services | 30% after deductible |
Psychiatric hospital stay | 30% after deductible |