Anthem Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan NH

Plan Information
Company Anthem Blue Cross and Blue Shield
State NH
Metal Tier Gold
Plan Type HMO

Cost Sharing Benefits

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $1,000 Data Not Available
Deductible (Family) $2,000 Data Not Available
Coinsurance 10% Data Not Available
Out of Pocket Maximum (Individual) $3,500 Data Not Available
Out of Pocket Maximum (Family) $7,000 Data Not Available
Services In Network Out of Network
Primary Care Visit $30 Data Not Available
Specialist Visit 10% Coinsurance after deductible Data Not Available
In Patient Hospital Services $500 Copay per Stay and 10% Coin Data Not Available
Emergency Room Services $200 Copay before deductible and $200 and 10% coinsurance
Mental / Behavioral Health 10% coinsurance Data Not Available
Imaging (CT/PET Scans, MRIs) 10% coinsurance Data Not Available
Rehabilitative Speech Therapy 10% coinsurance Data Not Available
Rehabilitative Occupational & Physical Therapy 10% coinsurance Data Not Available
Preventative Care $0 Data Not Available
Laboratory Outpatient and Professional Services 10% coinsurance Data Not Available
X-ray and Diagnostic Imaging 10% coinsurance Data Not Available
Outpatient Facility 10% coinsurance Data Not Available
Outpatient Surgery 10% coinsurance Data Not Available
Prescription Drugs In Network Out of Network
Generic Rx $15
Preferred Brand Rx $40
Non Preferred Brand Rx 10% Coinsurance after deductible
Specialty Drugs 10% Coinsurance after deductible

Other Plans

Other plans that are available in the state.

Plan Name
Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan
Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan
Anthem Bronze DirectAccess - caaa
Anthem Bronze DirectAccess - cabr
Anthem Bronze DirectAccess w/Child Dental - cdaa
Anthem Bronze DirectAccess w/HSA - caax
Anthem Bronze DirectAccess w/HSA - cacc
Anthem Catastrophic DirectAccess
Anthem Gold DirectAccess - ccaf
Anthem Silver DirectAccess - cbcm
Anthem Silver DirectAccess w/HSA - cbdo
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