Anthem Silver Pathway Guided Access HMO 6450($0 Virtual PCP+$0 Select Drugs)

Health Insurance Plan Details (2024 Plan)

by Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.

Monthly Premium

HMO
$ubsidy
Silver
Deductible
$6,450 /yr
Max Out-of-Pocket
$9,450 /yr

Details

Deductible (per individual) $6,450 /yr
Deductible (per family) $12,900 /yr
Max Out-of-Pocket (per individual) $9,450 /yr
Max Out-of-Pocket (per family) $18,900 /yr
Drug Deductible (per individual) Included in Medical
Drug Deductible (per family) Included in Medical
Drug Max Out-of-Pocket (per individual) Included in Medical
Drug Max Out-of-Pocket (per family) Included in Medical
Plan Type HMO
Includes Child Dental? Yes
Includes Adult Dental? No
Medical Services
Preventive Care No Charge
Primary Care Visit $25 Copay
Specialist Visit $75 Copay
Emergency Room $750 Copay after deductible and 20% Coinsurance after deductible
Inpatient Facility $500 Copay per Stay after deductible and 50% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible
Drug Costs
Generic Drugs $3 Copay
Preferred Brand Drugs $40 Copay
Non-preferred Brand Drugs 40% Coinsurance after deductible
Specialty Drugs 50% Coinsurance after deductible

Plan Documents

Summary of Benefits and Coverage SBC doc
Provider Directory Doctor lookup
Drug Formulary List drug list

* Figures shown are only for in-network medical costs

** Please check with insurance company if Copay and Coinsurance rates are before or after the deductible


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