Anthem Heart Healthy Bronze Essential 4500 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Anthem Blue Cross and Blue Shield

Expanded BronzeHSA eligible

Ind. deductible: $4,500
Family deductible: $4,500
Ind. OOP max: $10,150
Family OOP max: $10,150

Other cost-sharing reduction variants for this plan:

Limited Cost Sharing Plan Variation Standard Bronze Off Exchange Plan Zero Cost Sharing Plan Variation

Monthly premiums by age

Age	Individual	Individual + tobacco
21	$352	—
30	$400	—
40	$450	—
50	$629	—
60	$956	—

Live premium estimate

Benefits & cost sharing

Primary Care

Benefit	In-network
Preventive Care/Screening/Immunization	No charge
Primary Care Visit to Treat an Injury or Illness	$0.00

Specialist

Benefit	In-network
Specialist Visit	$100.00

Hospital

Benefit	In-network
Emergency Room Services	$500.00 Copay after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	$1500.00 Copay per Stay after deductible
Outpatient Surgery Physician/Surgical Services	0.00%
Urgent Care Centers or Facilities	$75.00

Pharmacy

Benefit	In-network
Generic Drugs	40.00% Coinsurance after deductible
Non-Preferred Brand Drugs	45.00% Coinsurance after deductible
Preferred Brand Drugs	0.00%
Specialty Drugs	50.00% Coinsurance after deductible

Mental Health

Benefit	In-network
Mental/Behavioral Health Inpatient Services	$1500.00 Copay per Stay after deductible
Mental/Behavioral Health Outpatient Services	50.00% Coinsurance after deductible

Other

Benefit	In-network
Abortion for Which Public Funding is Prohibited	Not covered
Accidental Dental	$100.00
Acupuncture	Not covered
Allergy Testing	0.00%
Bariatric Surgery	Not covered
Basic Dental Care - Adult	Not covered
Basic Dental Care - Child	Not covered
Chemotherapy	0.00%
Chiropractic Care	50.00% Coinsurance after deductible
Cosmetic Surgery	Not covered
Delivery and All Inpatient Services for Maternity Care	$1500.00 Copay after deductible
Dental Anesthesia	50.00% Coinsurance after deductible
Dental Check-Up for Children	Not covered
Diabetes Education	$100.00
Dialysis	0.00%
Durable Medical Equipment	0.00%
Emergency Transportation/Ambulance	50.00% Coinsurance after deductible
Eye Glasses for Children	No charge
Habilitation Services	50.00% Coinsurance after deductible
Hearing Aids	Not covered
Home Health Care Services	50.00% Coinsurance after deductible
Hospice Services	0.00%
Imaging (CT/PET Scans, MRIs)	$500.00 Copay after deductible
Infertility Treatment	Not covered
Infusion Therapy	50.00% Coinsurance after deductible
Inpatient Physician and Surgical Services	50.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services	0.00%
Long-Term/Custodial Nursing Home Care	Not covered
Major Dental Care - Adult	Not covered
Major Dental Care - Child	Not covered
Nutritional Counseling	50.00% Coinsurance after deductible
Orthodontia - Adult	Not covered
Orthodontia - Child	Not covered
Other Practitioner Office Visit (Nurse, Physician Assistant)	$0.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)	0.00%
Outpatient Rehabilitation Services	50.00% Coinsurance after deductible
Prenatal and Postnatal Care	0.00%
Private-Duty Nursing	0.00%
Prosthetic Devices	50.00% Coinsurance after deductible
Radiation	0.00%
Reconstructive Surgery	$1500.00 Copay after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy	50.00% Coinsurance after deductible
Rehabilitative Speech Therapy	50.00% Coinsurance after deductible
Routine Dental Services (Adult)	Not covered
Routine Eye Exam (Adult)	Not covered
Routine Eye Exam for Children	No charge
Routine Foot Care	Not covered
Skilled Nursing Facility	50.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services	$0.00
Substance Abuse Disorder Outpatient Services	50.00% Coinsurance after deductible
Transplant	$1500.00 Copay after deductible
Treatment for Temporomandibular Joint Disorders	50.00% Coinsurance after deductible
Weight Loss Programs	Not covered
Well Baby Visits and Care	No charge
X-rays and Diagnostic Imaging	50.00% Coinsurance after deductible

Plan rules

Service area

This plan covers 85 geographic areas.