Anthem Clear Choice Silver Tiered 3000, Off Marketplace Twin

Health Insurance Plan Details (2024 Plan)

by Anthem Blue Cross and Blue Shield

Monthly Premium

HMO
$ubsidy
Silver
Deductible
$3,000 /yr
Max Out-of-Pocket
$9,100 /yr

Details

Deductible (per individual) $3,000 /yr
Deductible (per family) $6,000 /yr
Max Out-of-Pocket (per individual) $9,100 /yr
Max Out-of-Pocket (per family) $18,200 /yr
Drug Deductible (per individual)
Drug Deductible (per family)
Drug Max Out-of-Pocket (per individual)
Drug Max Out-of-Pocket (per family)
Plan Type HMO
Includes Child Dental? No
Includes Adult Dental? No
Medical Services
Preventive Care No Charge
Primary Care Visit $40 Copay
Specialist Visit $80 Copay
Emergency Room 40.00% Coinsurance after deductible
Inpatient Facility 40.00% Coinsurance after deductible
Inpatient Physician 40.00% Coinsurance after deductible
Drug Costs
Generic Drugs $25 Copay
Preferred Brand Drugs $50 Copay
Non-preferred Brand Drugs 30.00% Coinsurance after deductible
Specialty Drugs 50.00% Coinsurance after deductible

Plan Documents

Summary of Benefits and Coverage SBC doc
Provider Directory Doctor lookup
Drug Formulary List n/a

* 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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