Anthem Silver Pathway X 4950 S06 ($0 Virtual PCP + $0 Select Drugs + Incentives) – EPO
94% cost sharing reduction [Popular Plan]
Network type: EPO
Coverage tier: Silver
Primary care visit: $3 copay
Specialist visit: 25% coinsurance
Urgent care visit: $30 copay
Description
This plan has 94% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | EPO |
| Deductible | $0 per person $0 per person |
| Out-of-pocket max | $800 per person $1,600 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $3 copay |
| Specialist visit | 25% coinsurance |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $30 copay |
| Emergency room | 25% coinsurance |
| Ambulance | 25% coinsurance |
| Hospital stay (facility) | $100 copay per Stay, 40% coinsurance |
| Hospital stay (physician) | 25% coinsurance |
| Outpatient procedure (facility) | 25% coinsurance |
| Outpatient procedure (physician) | 25% coinsurance |
| Physical rehabilitation | $3 copay |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | $100 copay, 40% coinsurance |
Pharmacy, Drugs, and Medication
| Generic | $3 copay |
| Brand | $30 copay |
| Non-preferred Brand | 35% coinsurance |
| Specialty | 40% coinsurance |
Lab Tests and Diagnostic Procedures
| X-rays | 25% coinsurance |
| Imaging (CT/PET/MRI) | $100 copay, 40% coinsurance |
| Blood work | 25% coinsurance |
Mental and Psychiatric Health Care
| Mental Health outpatient services | 25% coinsurance |
| Psychiatric hospital stay | $100 copay per Stay, 40% coinsurance |
Health Plan Provider Information
| Health Plan Benefits | https://sbc.anthem.com/dpsdeeplink/deepLink/AnthemSilverPathwayX4950S060VirtualPCP0SelectDrugsIncentives/English/DG166700590808.pdf |
| Drug and medication plan formulary | https://www.anthem.com/MOSelectdrugtier4 |
| Search doctor list | https://www.anthem.com/find-care/?alphaprefix=JXK |
