Anthem Silver Pathway X 7050 ($0 Virtual PCP + $0 Select Drugs + Incentives) – EPO
Network type: EPO
Coverage tier: Silver
Primary care visit: No charge
Specialist visit: 30% coinsurance after deductible
Urgent care visit: $75 copay
Description
Health Care Plan Details
| Network type | EPO |
| Deductible | $7,050 per person $7,050 per person |
| Out-of-pocket max | $8,750 per person $17,500 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | No charge |
| Specialist visit | 30% coinsurance after deductible |
| 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) | 30% 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 | No charge |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | 30% coinsurance after deductible |
Pharmacy, Drugs, and Medication
| Generic | $5 copay |
| Brand | $40 copay |
| 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) | 30% 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 | 30% coinsurance after deductible |
Health Plan Provider Information
| Health Plan Benefits | https://sbc.anthem.com/dpsdeeplink/deepLink/AnthemSilverPathwayX70500VirtualPCP0SelectDrugsIncentives/English/DG166700590804.pdf |
| Drug and medication plan formulary | https://www.anthem.com/MOSelectdrugtier4 |
| Search doctor list | https://www.anthem.com/find-care/?alphaprefix=JXK |
