Anthem Gold Pathway Essentials 2700 ($0 Virtual PCP + $0 Virtual Chat + $0 Select Drugs) – HMO

Description

Health Care Plan Details

Network type	HMO
Deductible	$2,700 per person $2,700 per person
Out-of-pocket max	$4,700 per person $9,400 per family
Metal tier	Gold

Visit Copay

Primary care visit	$25 copay
Specialist visit	20% coinsurance after deductible
Preventive care visit	No charge

Urgent, Emergency Care, and Hospital Care

Urgent care	$75 copay after deductible, 20% coinsurance after deductible
Emergency room	$500 copay after deductible, 20% coinsurance after deductible
Ambulance	20% coinsurance after deductible
Hospital stay (facility)	$1000 copay per Stay after deductible, 40% coinsurance after deductible
Hospital stay (physician)	20% coinsurance after deductible
Outpatient procedure (facility)	20% coinsurance after deductible
Outpatient procedure (physician)	20% coinsurance after deductible
Physical rehabilitation	20% coinsurance after deductible

Maternitowny and Pregnancy

Well baby care	No charge
Labor, delivery, hospital stay	$1000 copay after deductible, 40% coinsurance after deductible

Pharmacy, Drugs, and Medication

Generic	$20 copay
Brand	$40 copay
Non-preferred Brand	35% coinsurance after deductible
Specialty	40% coinsurance after deductible

Lab Tests and Diagnostic Procedures

X-rays	20% coinsurance after deductible
Imaging (CT/PET/MRI)	$500 copay after deductible, 40% coinsurance after deductible
Blood work	20% coinsurance after deductible

Mental and Psychiatric Health Care

Mental Health outpatient services	20% coinsurance after deductible
Psychiatric hospital stay	$1000 copay per Stay after deductible, 40% coinsurance after deductible

Health Plan Provider Information

Health Plan Benefits	https://sbc.anthem.com/dpsdeeplink/deepLink/AnthemGoldPathwayEssentials27000VirtualPCP0VirtualChat0SelectDrugs/English/DG166700590555.pdf
Drug and medication plan formulary	https://www.anthem.com/INSelectdrugtier4
Search doctor list	https://www.anthem.com/find-care/?alphaprefix=E7E