Anthem Silver Pathway X 2950 ($0 Virtual PCP + $0 Select Drugs + Incentives) – EPO
Network type: EPO
Coverage tier: Silver
Primary care visit: $25 copay
Specialist visit: $75 copay
Urgent care visit: $75 copay
Description
Health Care Plan Details
Network type | EPO |
Deductible | $2,950 per person $2,950 per person |
Out-of-pocket max | $9,450 per person $18,900 per family |
Metal tier | Silver |
Visit Copay
Primary care visit | $25 copay |
Specialist visit | $75 copay |
Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
Urgent care | $75 copay |
Emergency room | $500 copay after deductible, 30% coinsurance after deductible |
Ambulance | 30% coinsurance after deductible |
Hospital stay (facility) | $500 copay per Stay after deductible, 40% coinsurance after deductible |
Hospital stay (physician) | 30% coinsurance after deductible |
Outpatient procedure (facility) | 30% coinsurance after deductible |
Outpatient procedure (physician) | 30% coinsurance after deductible |
Physical rehabilitation | $25 copay |
Maternitowny and Pregnancy
Well baby care | No charge |
Labor, delivery, hospital stay | $500 copay after deductible, 40% coinsurance after deductible |
Pharmacy, Drugs, and Medication
Generic | $3 copay |
Brand | 30% coinsurance after deductible |
Non-preferred Brand | 35% coinsurance after deductible |
Specialty | 40% coinsurance after deductible |
Lab Tests and Diagnostic Procedures
X-rays | 30% coinsurance after deductible |
Imaging (CT/PET/MRI) | $500 copay after deductible, 40% coinsurance after deductible |
Blood work | 30% coinsurance after deductible |
Mental and Psychiatric Health Care
Mental Health outpatient services | 30% coinsurance after deductible |
Psychiatric hospital stay | $500 copay per Stay after deductible, 40% coinsurance after deductible |
Health Plan Provider Information
Health Plan Benefits | https://sbc.anthem.com/dpsdeeplink/deepLink/AnthemSilverPathwayX29500VirtualPCP0SelectDrugsIncentives/English/DG166700590802.pdf |
Drug and medication plan formulary | https://www.anthem.com/MOSelectdrugtier4 |
Search doctor list | https://www.anthem.com/find-care/?alphaprefix=JXK |