Anthem Silver Pathway X HMO 3000

Plan Type: HMO
Plan Tier: Silver
Individual Deductible $3,000
Family Deductible $6,000
Individual Out of Pocket Max $7,700
Family Out of Pocket Max $15,400
Primary Care Visit: $35
Specialist Visit: 25% Coinsurance after deductible
Emergency Room: $500 Copay after deductible and 25% Coinsurance after deductible
Hospital - Physician: 25% 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/ccd5K43
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: 25% Coinsurance after deductible
Non-Preferred Brand Drugs: 40% Coinsurance after deductible
Preferred Brand Drugs: 25% Coinsurance after deductible
Specialty Drugs: 40% Coinsurance after deductible
Summary of Benefits https://www.anthem.com/GASelectdrugtier4

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