Anthem Silver Pathway/Lean 4100 S05 ($0 Virtual PCP + $0 Select Drugs + Incentives) – HMO
87% cost sharing reduction [Popular Plan]
Network type: HMO
Coverage tier: Silver
Primary care visit: $15 copay
Specialist visit: 20% coinsurance after deductible
Urgent care visit: $75 copay
Description
This plan has 87% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | HMO |
| Deductible | $1,050 per person $1,050 per person |
| Out-of-pocket max | $2,100 per person $4,200 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $15 copay |
| Specialist visit | 20% coinsurance after deductible |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $75 copay |
| Emergency room | $250 copay after deductible, 20% coinsurance after deductible |
| Ambulance | 30% coinsurance after deductible |
| Hospital stay (facility) | $250 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 | $250 copay after deductible, 40% coinsurance after deductible |
Pharmacy, Drugs, and Medication
| Generic | $3 copay |
| Brand | 25% coinsurance after deductible |
| 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) | $250 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 | $250 copay per Stay after deductible, 40% coinsurance after deductible |
Health Plan Provider Information
| Health Plan Benefits | https://sbc.anthem.com/dpsdeeplink/deepLink/AnthemSilverPathwayLean4100S050VirtualPCP0SelectDrugsIncentives/English/DG166700589843.pdf |
| Drug and medication plan formulary | https://www.anthem.com/WISelectdrugtier4 |
| Search doctor list | https://www.anthem.com/find-care/?alphaprefix=X9P |
