Anthem Heart Healthy Silver Pathway X Enhanced 4000/0% ($0 Virtual PCP + $0 Select Drugs)

Anthem Blue Cross and Blue Shield

Silver

Ind. deductible: $4,000
Family deductible: $4,000
Ind. OOP max: $9,000
Family OOP max: $9,000

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	$374	—
30	$424	—
40	$478	—
50	$668	—
60	$1,014	—

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	$20.00

Specialist

Benefit	In-network
Specialist Visit	$30.00

Hospital

Benefit	In-network
Emergency Room Services	$0.00
Inpatient Hospital Services (e.g., Hospital Stay)	$0.00
Outpatient Surgery Physician/Surgical Services	$0.00
Urgent Care Centers or Facilities	$0.00

Pharmacy

Benefit	In-network
Generic Drugs	$15.00
Non-Preferred Brand Drugs	35.00% Coinsurance after deductible
Preferred Brand Drugs	$45.00
Specialty Drugs	40.00% Coinsurance after deductible

Mental Health

Benefit	In-network
Mental/Behavioral Health Inpatient Services	$100.00 Copay per Stay after deductible
Mental/Behavioral Health Outpatient Services	$10.00

Other

Benefit	In-network
Abortion for Which Public Funding is Prohibited	Not covered
Accidental Dental	$0.00
Acupuncture	Not covered
Allergy Testing	No Charge after deductible
Bariatric Surgery	$500.00 Copay after deductible
Basic Dental Care - Adult	Not covered
Basic Dental Care - Child	Not covered
Chemotherapy	No Charge after deductible
Chiropractic Care	$20.00
Cosmetic Surgery	Not covered
Delivery and All Inpatient Services for Maternity Care	$0.00
Dental Check-Up for Children	Not covered
Diabetes Education	$85.00
Dialysis	No Charge after deductible
Durable Medical Equipment	$0.00
Emergency Transportation/Ambulance	No Charge after deductible
Eye Glasses for Children	No charge
Habilitation Services	No Charge after deductible
Hearing Aids	$0.00
Home Health Care Services	No Charge after deductible
Hospice Services	No Charge after deductible
Imaging (CT/PET Scans, MRIs)	No Charge after deductible
Infertility Treatment	$250.00 Copay after deductible
Infusion Therapy	$0.00
Inpatient Physician and Surgical Services	No Charge 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	$20.00
Orthodontia - Adult	Not covered
Orthodontia - Child	Not covered
Other Practitioner Office Visit (Nurse, Physician Assistant)	$20.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)	$250.00 Copay after deductible
Outpatient Rehabilitation Services	No Charge after deductible
Prenatal and Postnatal Care	No charge
Private-Duty Nursing	Not covered
Prosthetic Devices	No Charge after deductible
Radiation	$0.00
Reconstructive Surgery	$100.00 Copay after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy	No Charge after deductible
Rehabilitative Speech Therapy	No Charge after deductible
Routine Dental Services (Adult)	Not covered
Routine Eye Exam (Adult)	Not covered
Routine Eye Exam for Children	$0.00
Routine Foot Care	$85.00
Skilled Nursing Facility	No Charge after deductible
Substance Abuse Disorder Inpatient Services	$500.00 Copay per Stay after deductible
Substance Abuse Disorder Outpatient Services	$10.00
Transplant	$500.00 Copay after deductible
Treatment for Temporomandibular Joint Disorders	$250.00 Copay after deductible
Weight Loss Programs	Not covered
Well Baby Visits and Care	No charge
X-rays and Diagnostic Imaging	No Charge after deductible

Plan rules

Service area

This plan covers 1 geographic area.