Anthem Silver Pathway X Guided Access HMO 4950 S06($0 Virtual PCP+$0 Select Drugs) – HMO
94% cost sharing reduction [Popular Plan]
Network type: HMO
Coverage tier: Silver
Primary care visit: $5 copay
Specialist visit: $80 copay
Urgent care visit: $75 copay
Description
This plan has 94% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | HMO |
| 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 | $5 copay |
| Specialist visit | $80 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $75 copay |
| Emergency room | $350 copay, 20% coinsurance |
| Ambulance | 20% coinsurance |
| Hospital stay (facility) | $50 copay per Stay, 20% coinsurance |
| Hospital stay (physician) | 20% coinsurance |
| Outpatient procedure (facility) | 20% coinsurance |
| Outpatient procedure (physician) | 20% coinsurance |
| Physical rehabilitation | 20% coinsurance |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | $50 copay, 20% coinsurance |
Pharmacy, Drugs, and Medication
| Generic | $3 copay |
| Brand | $15 copay |
| Non-preferred Brand | 35% coinsurance |
| Specialty | 40% coinsurance |
Lab Tests and Diagnostic Procedures
| X-rays | 20% coinsurance |
| Imaging (CT/PET/MRI) | $50 copay, 20% coinsurance |
| Blood work | 20% coinsurance |
Mental and Psychiatric Health Care
| Mental Health outpatient services | 20% coinsurance |
| Psychiatric hospital stay | $50 copay per Stay, 20% coinsurance |
Health Plan Provider Information
| Health Plan Benefits | https://sbc.anthem.com/dpsdeeplink/deepLink/AnthemSilverPathwayXGuidedAccessHMO4950S060VirtualPCP0SelectDrugs/English/DG166700542951.pdf |
| Drug and medication plan formulary | https://www.anthem.com/GASelectdrugtier4 |
| Search doctor list | https://www.anthem.com/find-care/?alphaprefix=GAP |
