SimpliveraCoverage Companion

Anthem Silver Pathway X 2700 S04 $0 Select Drugs

HMO Colorado, Inc. · 2027 plan year

Silver
Ind. deductible
$2,700
Family deductible
$5,400
Ind. OOP max
$8,200
Family OOP max
$16,400

Other cost-sharing reduction variants for this plan:

87% AV Level Silver Plan94% AV Level Silver PlanLimited Cost Sharing Plan VariationStandard Silver Off Exchange PlanStandard Silver On Exchange PlanZero Cost Sharing Plan Variation

More HMO Colorado, Inc. plans in CO

Anthem Bronze Mountain Enhanced X 10800 HSA $0 Select DrugsAnthem Bronze Pathway Essentials X 5650 Rx Copay $0 Select DrugsAnthem Bronze Pathway X 5650 Rx Copay $0 Select DrugsAnthem Bronze Pathway X 6000 HSA $0 Select DrugsAnthem Bronze Pathway X 8300 for HSA

Live premium estimate

$

Benefits & cost sharing

Primary Care

BenefitIn-network
Preventive Care/Screening/ImmunizationNo charge
Primary Care Visit to Treat an Injury or Illness$20.00

Specialist

BenefitIn-network
Specialist Visit25.00% Coinsurance after deductible

Hospital

BenefitIn-network
Emergency Room Services25.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)25.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services25.00% Coinsurance after deductible
Urgent Care Centers or Facilities$50.00

Pharmacy

BenefitIn-network
Generic Drugs25.00% Coinsurance after deductible
Medical Service Drugs25.00% Coinsurance after deductible
Non-Preferred Brand Drugs25.00% Coinsurance after deductible
Non-Preferred Generic Drugs25.00% Coinsurance after deductible
Preferred Brand Drugs25.00% Coinsurance after deductible
Preventive DrugsNo charge
Specialty Drugs25.00% Coinsurance after deductible

Mental Health

BenefitIn-network
Intensive Outpatient for Mental/Behavioral Health25.00% Coinsurance after deductible
Intensive Outpatient for Substance Use Disorder25.00% Coinsurance after deductible
Mental Health Wellness VisitNo charge
Mental/Behavioral Health Inpatient Services25.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services25.00% Coinsurance after deductible
Mental/Behavioral Health Prenatal Care25.00% Coinsurance after deductible
Office Visit - Mental/Behavioral Health25.00% Coinsurance after deductible
Office Visit - Substance Use Disorder25.00% Coinsurance after deductible
Partial Hospitalization for Mental/Behavioral Health25.00% Coinsurance after deductible
Partial Hospitalization for Substance Use Disorder25.00% Coinsurance after deductible
Postpartum Mental/Behavioral Health25.00% Coinsurance after deductible
Postpartum Substance Use Disorder25.00% Coinsurance after deductible
Residential Day Treatment for Mental/Behavioral Health25.00% Coinsurance after deductible
Residential Day Treatment for Substance Use Disorder25.00% Coinsurance after deductible
Substance Use Disorder Prenatal Care25.00% Coinsurance after deductible
Telehealth Mental/Behavioral Health25.00% Coinsurance after deductible
Telehealth Substance Use Disorder25.00% Coinsurance after deductible

Other

BenefitIn-network
Abortion for Which Public Funding is ProhibitedNo charge
Acupuncture25.00% Coinsurance after deductible
Allergy Testing25.00% Coinsurance after deductible
Applied Behavior Analysis Based Therapies25.00% Coinsurance after deductible
Autism Spectrum Disorders - Assessment and Evaluation Services25.00% Coinsurance after deductible
Bariatric Surgery25.00% Coinsurance after deductible
Basic Dental Care - Child50.00% Coinsurance after deductible
Chemotherapy25.00% Coinsurance after deductible
Chiropractic Care$20.00
Delivery and All Inpatient Services for Maternity Care25.00% Coinsurance after deductible
Dental Check-Up for ChildrenNo Charge after deductible
Diabetes Education25.00% Coinsurance after deductible
Diabetic Supplies25.00% Coinsurance after deductible
Dialysis25.00% Coinsurance after deductible
Durable Medical Equipment25.00% Coinsurance after deductible
Emergency Transportation/Ambulance25.00% Coinsurance after deductible
Eye Glasses for ChildrenNo charge
Gender Affirming Care25.00% Coinsurance after deductible
Habilitation Services$20.00
Hearing Aids25.00% Coinsurance after deductible
Home Health Care Services25.00% Coinsurance after deductible
Hospice Services25.00% Coinsurance after deductible
Imaging (CT/PET Scans, MRIs)25.00% Coinsurance after deductible
Infertility Treatment25.00% Coinsurance after deductible
Infusion Therapy25.00% Coinsurance after deductible
Inpatient Physician and Surgical Services25.00% Coinsurance after deductible
Inpatient Rehabilitation25.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services25.00% Coinsurance after deductible
Major Dental Care - Child50.00% Coinsurance after deductible
Nutritional Counseling25.00% Coinsurance after deductible
Other Practitioner Office Visit (Nurse, Physician Assistant)$20.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)25.00% Coinsurance after deductible
Outpatient Rehabilitation Services$20.00
Prenatal and Postnatal CareNo charge
Private-Duty Nursing25.00% Coinsurance after deductible
Prosthetic Devices25.00% Coinsurance after deductible
Prosthetics: Legs and Arms20.00%
Prosthetics: Recreational20.00%
Radiation25.00% Coinsurance after deductible
Reconstructive Surgery25.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy$20.00
Rehabilitative Occupational Therapy$20.00
Rehabilitative Physical Therapy$20.00
Rehabilitative Speech Therapy$20.00
Routine Eye Exam for ChildrenNo charge
Skilled Nursing Facility25.00% Coinsurance after deductible
Standalone Laboratory25.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services25.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services25.00% Coinsurance after deductible
Telehealth PCP$20.00
Telehealth Specialist25.00% Coinsurance after deductible
Transplant25.00% Coinsurance after deductible
Treatment for Temporomandibular Joint Disorders25.00% Coinsurance after deductible
Well Baby Visits and CareNo charge
X-rays and Diagnostic Imaging25.00% Coinsurance after deductible

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