Anthem Silver Pathway X 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/ccd5K50 |
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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