Anthem Silver Pathway X HMO 10 for HSA

Plan Type: HMO
Plan Tier: Silver
Medical Deductible - Individual: $3,200
Medical Deductible - Family: $6,400
Drug Deductible - Individual: Included in Medical
Drug Deductible - Family: Included in Medical
Out of Pocket Max - Individual: $5,000
Out of Pocket Max - Family: $10,000
Primary Care Visit: 10% Coinsurance after deductible
Specialist Visit: 10% Coinsurance after deductible
Emergency Room: $500 Copay after deductible and 10% Coinsurance after deductible
Hospital - Physician: 10% 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/ccd379U
Plan Brochure: http://editiondigital.net/view/IU65/2019/ON_HIX_OH_KIT_2019

Other Coverage:

Child Dental: Yes
Adult Dental No

Prescription Drug Pricing:

Generic Drugs: 10% Coinsurance after deductible
Non-Preferred Brand Drugs: 40% Coinsurance after deductible
Preferred Brand Drugs: 10% Coinsurance after deductible
Specialty Drugs: 40% Coinsurance after deductible
Link to Full Policy Formulary: https://www.anthem.com/OHSelectdrugtier4

About The Carrier

Anthem BCBS offers one of the larger provider networks in Ohio. A wide range of choices in plans, coverage and price levels. Innovative cost-of-care products and programs that improve health and reduce expenses. Let Anthem help you customize medical benefits that work best for your employees and your budget.

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