Anthem Anthem Bronze DirectAccess - cabu (Ohio)

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Company Anthem Blue Cross and Blue Shield
Plan Year 2014
State Ohio
Metal Tier Bronze
Plan Type PPO
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Cost Sharing Benefits (In Network)

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.

Deductible (Individual) $5,000
Deductible (Family) $10,000
Coinsurance 30%
Out of Pocket Maximum (Individual) $6,350
Out of Pocket Maximum (Family) $12,700

Doctors Visits

Primary Care Visit $45 Copay before deductible and
Specialist Visit 30% Coinsurance after deductible
In Patient Hospital Services $500 Copay per Stay and 30% Coin
Emergency Room Services $200 Copay before deductible and

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 30% coinsurance
Laboratory Outpatient and Professional Services 30% coinsurance
X-ray and Diagnostic Imaging 30% coinsurance


Mental / Behavioral Health 30% coinsurance
Rehabilitative Speech Therapy 30% coinsurance
Rehabilitative Occupational & Physical Therapy 30% coinsurance
Outpatient Facility 30% coinsurance
Outpatient Surgery 30% coinsurance

Prescription Drugs

Generic Rx 30% Coinsurance after deductible
Preferred Brand Rx 30% Coinsurance after deductible
Non Preferred Brand Rx 30% Coinsurance after deductible
Specialty Drugs 30% Coinsurance after deductible

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