Anthem Silver Mountain Enhanced X 0 S06 $0 Select Drugs
HMO Colorado, Inc. · 2027 plan year
Silver
- Ind. deductible
- $0
- Family deductible
- $0
- Ind. OOP max
- $2,000
- Family OOP max
- $4,000
Other cost-sharing reduction variants for this plan:
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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 | $10.00 |
Specialist
| Benefit | In-network |
|---|---|
| Specialist Visit | 25.00% |
Hospital
| Benefit | In-network |
|---|---|
| Emergency Room Services | 25.00% |
| Inpatient Hospital Services (e.g., Hospital Stay) | 25.00% |
| Outpatient Surgery Physician/Surgical Services | 25.00% |
| Urgent Care Centers or Facilities | $50.00 |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | $3.00 |
| Medical Service Drugs | 25.00% |
| Non-Preferred Brand Drugs | 35.00% |
| Non-Preferred Generic Drugs | 35.00% |
| Preferred Brand Drugs | $40.00 |
| Preventive Drugs | No charge |
| Specialty Drugs | 50.00% |
Mental Health
| Benefit | In-network |
|---|---|
| Intensive Outpatient for Mental/Behavioral Health | 10.00% |
| Intensive Outpatient for Substance Use Disorder | 10.00% |
| Mental Health Wellness Visit | No charge |
| Mental/Behavioral Health Inpatient Services | 25.00% |
| Mental/Behavioral Health Outpatient Services | 10.00% |
| Mental/Behavioral Health Prenatal Care | 10.00% |
| Office Visit - Mental/Behavioral Health | 10.00% |
| Office Visit - Substance Use Disorder | 10.00% |
| Partial Hospitalization for Mental/Behavioral Health | 10.00% |
| Partial Hospitalization for Substance Use Disorder | 10.00% |
| Postpartum Mental/Behavioral Health | 10.00% |
| Postpartum Substance Use Disorder | 10.00% |
| Residential Day Treatment for Mental/Behavioral Health | 25.00% |
| Residential Day Treatment for Substance Use Disorder | 25.00% |
| Substance Use Disorder Prenatal Care | 10.00% |
| Telehealth Mental/Behavioral Health | 10.00% |
| Telehealth Substance Use Disorder | 10.00% |
Other
| Benefit | In-network |
|---|---|
| Abortion for Which Public Funding is Prohibited | No charge |
| Acupuncture | 25.00% |
| Allergy Testing | 25.00% |
| Applied Behavior Analysis Based Therapies | 25.00% |
| Autism Spectrum Disorders - Assessment and Evaluation Services | 25.00% |
| Bariatric Surgery | 25.00% |
| Basic Dental Care - Child | 50.00% Coinsurance after deductible |
| Chemotherapy | 25.00% |
| Chiropractic Care | $10.00 |
| Delivery and All Inpatient Services for Maternity Care | 25.00% |
| Dental Check-Up for Children | No Charge after deductible |
| Diabetes Education | 25.00% |
| Diabetic Supplies | 25.00% |
| Dialysis | 25.00% |
| Durable Medical Equipment | 25.00% |
| Emergency Transportation/Ambulance | 25.00% |
| Eye Glasses for Children | No charge |
| Gender Affirming Care | 25.00% |
| Habilitation Services | $10.00 |
| Hearing Aids | 25.00% |
| Home Health Care Services | 25.00% |
| Hospice Services | 25.00% |
| Imaging (CT/PET Scans, MRIs) | 25.00% |
| Infertility Treatment | 25.00% |
| Infusion Therapy | 25.00% |
| Inpatient Physician and Surgical Services | 25.00% |
| Inpatient Rehabilitation | 25.00% |
| Laboratory Outpatient and Professional Services | 25.00% |
| Major Dental Care - Child | 50.00% Coinsurance after deductible |
| Nutritional Counseling | 10.00% |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $10.00 |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | 25.00% |
| Outpatient Rehabilitation Services | $10.00 |
| Prenatal and Postnatal Care | No charge |
| Private-Duty Nursing | 25.00% |
| Prosthetic Devices | 25.00% |
| Prosthetics: Legs and Arms | 20.00% |
| Prosthetics: Recreational | 20.00% |
| Radiation | 25.00% |
| Reconstructive Surgery | 25.00% |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | $10.00 |
| Rehabilitative Occupational Therapy | $10.00 |
| Rehabilitative Physical Therapy | $10.00 |
| Rehabilitative Speech Therapy | $10.00 |
| Routine Eye Exam for Children | No charge |
| Skilled Nursing Facility | 25.00% |
| Standalone Laboratory | 25.00% |
| Substance Abuse Disorder Inpatient Services | 25.00% |
| Substance Abuse Disorder Outpatient Services | 10.00% |
| Telehealth PCP | $10.00 |
| Telehealth Specialist | 25.00% |
| Transplant | 25.00% |
| Treatment for Temporomandibular Joint Disorders | 25.00% |
| Well Baby Visits and Care | No charge |
| X-rays and Diagnostic Imaging | 25.00% |
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