Anthem Silver Pathway X Transition HMO 6500 S05 ($0 Virtual PCP + $0 Select Drugs + Incentives) – HMO

Description

This plan has 87% cost sharing reduction [Popular Plan]

Health Care Plan Details

Network type	HMO
Deductible	$1,400 per person $1,400 per person
Out-of-pocket max	$1,900 per person $3,800 per family
Metal tier	Silver

Visit Copay

Primary care visit	$10 copay
Specialist visit	$25 copay after deductible
Preventive care visit	No charge

Urgent, Emergency Care, and Hospital Care

Urgent care	$50 copay
Emergency room	$350 copay after deductible, 25% coinsurance after deductible
Ambulance	50% coinsurance after deductible
Hospital stay (facility)	$250 copay per Stay after deductible, 50% coinsurance after deductible
Hospital stay (physician)	25% coinsurance after deductible
Outpatient procedure (facility)	25% coinsurance after deductible
Outpatient procedure (physician)	25% coinsurance after deductible
Physical rehabilitation	$10 copay

Maternitowny and Pregnancy

Well baby care	No charge
Labor, delivery, hospital stay	$250 copay after deductible, 50% coinsurance after deductible

Pharmacy, Drugs, and Medication

Generic	$5 copay
Brand	$35 copay
Non-preferred Brand	40% coinsurance after deductible
Specialty	40% coinsurance after deductible

Lab Tests and Diagnostic Procedures

X-rays	25% coinsurance after deductible
Imaging (CT/PET/MRI)	$250 copay after deductible, 50% coinsurance after deductible
Blood work	25% coinsurance after deductible

Mental and Psychiatric Health Care

Mental Health outpatient services	$10 copay
Psychiatric hospital stay	$250 copay per Stay after deductible, 50% coinsurance after deductible

Health Plan Provider Information

Health Plan Benefits

https://d2ed110nmrd591.cloudfront.net/blobs/PZV25LtQXUk5GmrCCmsDnqEX.pdf