Anthem Heart Healthy Silver Pathway Essentials 3100 ($0 Virtual PCP + $0 Select Drugs)

Anthem Blue Cross and Blue Shield

Silver

Ind. deductible: $3,100
Family deductible: $3,100
Ind. OOP max: $10,150
Family OOP max: $10,150

Other cost-sharing reduction variants for this plan:

73% AV Level Silver Plan 87% AV Level Silver Plan 94% AV Level Silver Plan Limited Cost Sharing Plan Variation Standard Silver Off Exchange Plan Zero Cost Sharing Plan Variation

Monthly premiums by age

Age	Individual	Individual + tobacco
21	$517	—
30	$587	—
40	$661	—
50	$923	—
60	$1,403	—

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	$25.00

Specialist

Benefit	In-network
Specialist Visit	$0.00

Hospital

Benefit	In-network
Inpatient Hospital Services (e.g., Hospital Stay)	40.00% Coinsurance after deductible
Emergency Room Services	30.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services	30.00%
Urgent Care Centers or Facilities	$75.00

Pharmacy

Benefit	In-network
Generic Drugs	$3.00
Non-Preferred Brand Drugs	35.00% Coinsurance after deductible
Preferred Brand Drugs	25.00%
Specialty Drugs	40.00% Coinsurance after deductible

Mental Health

Benefit	In-network
Mental/Behavioral Health Inpatient Services	40.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services	30.00% Coinsurance after deductible

Other

Benefit	In-network
Acupuncture	Not covered
Allergy Testing	30.00% Coinsurance after deductible
Applied Behavior Analysis Based Therapies	30.00% Coinsurance after deductible
Bariatric Surgery	Not covered
Basic Dental Care - Adult	Not covered
Basic Dental Care - Child	50.00% Coinsurance after deductible
Infusion Therapy	30.00% Coinsurance after deductible
Inherited Metabolic Disorder - PKU	0.00%
Inpatient Physician and Surgical Services	0.00%
Abortion for Which Public Funding is Prohibited	Not covered
Accidental Dental	$0.00
Bone Marrow Testing	0.00%
Chemotherapy	30.00% Coinsurance after deductible
Chiropractic Care	$3.00
Clinical Trials	40.00% Coinsurance after deductible
Cosmetic Surgery	Not covered
Delivery and All Inpatient Services for Maternity Care	0.00%
Dental Anesthesia	0.00%
Dental Check-Up for Children	No Charge after deductible
Diabetes Education	$75.00
Dialysis	30.00% Coinsurance after deductible
Durable Medical Equipment	30.00% Coinsurance after deductible
Emergency Transportation/Ambulance	30.00% Coinsurance after deductible
Eye Glasses for Children	No charge
Habilitation Services	30.00% Coinsurance after deductible
Hearing Aids	0.00%
Home Health Care Services	30.00% Coinsurance after deductible
Hospice Services	30.00% Coinsurance after deductible
Imaging (CT/PET Scans, MRIs)	40.00% Coinsurance after deductible
Infertility Treatment	Not covered
Laboratory Outpatient and Professional Services	30.00% Coinsurance after deductible
Long-Term/Custodial Nursing Home Care	Not covered
Major Dental Care - Adult	Not covered
Major Dental Care - Child	50.00% Coinsurance after deductible
Newborn Hearing Screening	40.00% Coinsurance after deductible
Nutritional Counseling	30.00% Coinsurance after deductible
Orthodontia - Adult	Not covered
Orthodontia - Child	50.00% Coinsurance after deductible
Other Practitioner Office Visit (Nurse, Physician Assistant)	$3.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)	30.00% Coinsurance after deductible
Outpatient Rehabilitation Services	30.00% Coinsurance after deductible
Prenatal and Postnatal Care	0.00%
Private-Duty Nursing	0.00%
Prosthetic Devices	30.00% Coinsurance after deductible
Radiation	30.00% Coinsurance after deductible
Reconstructive Surgery	0.00%
Rehabilitative Occupational and Rehabilitative Physical Therapy	$25.00
Rehabilitative Speech Therapy	30.00% 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	$20.00
Skilled Nursing Facility	30.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services	0.00%
Substance Abuse Disorder Outpatient Services	0.00%
Transplant	40.00% Coinsurance after deductible
Treatment for Temporomandibular Joint Disorders	30.00% Coinsurance after deductible
Weight Loss Programs	Not covered
Well Baby Visits and Care	No charge
X-rays and Diagnostic Imaging	0.00%

Plan rules

Service area

This plan covers 4 geographic areas.