Anthem Silver Pathway X Guided Access HMO 4950

Plan Type: HMO
Plan Tier: Silver
Individual Deductible $4,950
Family Deductible $9,900
Individual Out of Pocket Max $7,500
Family Out of Pocket Max $15,000
Primary Care Visit: $35
Specialist Visit: 35% Coinsurance after deductible
Emergency Room: $500 Copay after deductible and 35% Coinsurance after deductible
Hospital - Physician: 35% Coinsurance after deductible
Hospital - Facility: $500 Copay per Stay after deductible and 50% Coinsurance after deductible
Link to Full SBC: https://www.sbc.anthem.com/dps/ccd5K4S
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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