Anthem Silver Pathway/Lean 4100 ($0 Virtual PCP + $0 Select Drugs + Incentives) – HMO

Network type: HMO
Coverage tier: Silver
Primary care visit: $35 copay
Specialist visit: 25% coinsurance after deductible
Urgent care visit: $75 copay

Description

Health Care Plan Details

Network type HMO
Deductible $4,100 per person $4,100 per person
Out-of-pocket max $7,700 per person $15,400 per family
Metal tier Silver

Visit Copay

Primary care visit $35 copay
Specialist visit 25% coinsurance after deductible
Preventive care visit No charge

Urgent, Emergency Care, and Hospital Care

Urgent care $75 copay
Emergency room $500 copay after deductible, 25% coinsurance after deductible
Ambulance 40% coinsurance after deductible
Hospital stay (facility) $1000 copay per Stay after deductible, 40% coinsurance after deductible
Hospital stay (physician) 25% coinsurance after deductible
Outpatient procedure (facility) 25% coinsurance after deductible
Outpatient procedure (physician) 25% coinsurance after deductible
Physical rehabilitation 25% 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 $5 copay
Brand 25% coinsurance after deductible
Non-preferred Brand 45% coinsurance after deductible
Specialty 50% coinsurance after deductible

Lab Tests and Diagnostic Procedures

X-rays 25% coinsurance after deductible
Imaging (CT/PET/MRI) $500 copay after deductible, 40% coinsurance after deductible
Blood work 25% coinsurance after deductible

Mental and Psychiatric Health Care

Mental Health outpatient services 25% 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/AnthemSilverPathwayLean41000VirtualPCP0SelectDrugsIncentives/English/DG166700589817.pdf
Drug and medication plan formulary https://www.anthem.com/WISelectdrugtier4
Search doctor list https://www.anthem.com/find-care/?alphaprefix=X9P