Anthem Gold 1100 ($0 Preferred Virtual PCP $0 Select Drugs + Incentives)

Health Insurance Plan Details (2025 Plan)

SBC doc

doctor lookup

HMO

Gold

Deductible (per individual)	$1,100 /yr
Deductible (per family)	$2,200 /yr
Max Out-of-Pocket (per individual)	$6,800 /yr
Max Out-of-Pocket (per family)	$13,600 /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	25.00% Coinsurance after deductible
Specialist Visit	25.00% Coinsurance after deductible
Emergency Room	25.00% Coinsurance after deductible
Inpatient Facility	25.00% Coinsurance after deductible
Inpatient Physician	25.00% Coinsurance after deductible

Drug Costs
Generic Drugs	$10 Copay
Preferred Brand Drugs	$40 Copay
Non-preferred Brand Drugs	30.00% Coinsurance after deductible
Specialty Drugs	30.00% Coinsurance after deductible

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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