Anthem Gold Pathway X HMO 1850
Plan Type: | HMO |
Plan Tier: | Gold |
Individual Deductible | $1,850 |
Family Deductible | $3,700 |
Individual Out of Pocket Max | $8,550 |
Family Out of Pocket Max | $17,100 |
Primary Care Visit: | $30 |
Specialist Visit: | $60 |
Emergency Room: | $500 Copay after deductible and 10% Coinsurance after deductible |
Hospital - Physician: | 10% Coinsurance after deductible |
Hospital - Facility: | $500 Copay per Stay after deductible and 45% Coinsurance after deductible |
Link to Full SBC: | https://www.sbc.anthem.com/dps/ccd5K4B |
Plan Brochure: | http://editiondigital.net/view/IU65/2021/ON_HIX_GA_KIT_2021 |
Other Coverage:
Child Dental: | Yes |
Adult Dental | No |
Prescription Drug Pricing:
Generic Drugs: | $10 |
Non-Preferred Brand Drugs: | 40% Coinsurance after deductible |
Preferred Brand Drugs: | $40 |
Specialty Drugs: | 40% Coinsurance after deductible |
Summary of Benefits | https://www.anthem.com/GASelectdrugtier4 |
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