Anthem Anthem Gold DirectAccess - ccac OH

Plan Information
Company Anthem Blue Cross and Blue Shield
State OH
Metal Tier Gold
Plan Type PPO

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) $1,250 $5,000
Deductible (Family) $2,500 $10,000
Coinsurance $0 $10,000
Out of Pocket Maximum (Individual) $5,000 $20,000
Out of Pocket Maximum (Family) $10,000 $0
Services In Network Out of Network
Primary Care Visit $30 $10,000 copay
Specialist Visit No Charge $10,000 copay
In Patient Hospital Services $500 Copay per Stay and 10% Coin $10,000 copay
Emergency Room Services $200 Copay before deductible $200 copay
Mental / Behavioral Health $0 $10,000 copay
Imaging (CT/PET Scans, MRIs) $0 $10,000 copay
Rehabilitative Speech Therapy $0 $10,000 copay
Rehabilitative Occupational & Physical Therapy $0 $10,000 copay
Preventative Care $0 $10,000 copay
Laboratory Outpatient and Professional Services $0 $10,000 copay
X-ray and Diagnostic Imaging $0 $10,000 copay
Outpatient Facility $0 $10,000 copay
Outpatient Surgery $0 $10,000 copay
Prescription Drugs In Network Out of Network
Generic Rx $15
Preferred Brand Rx $40
Non Preferred Brand Rx No Charge
Specialty Drugs No Charge

Other Plans

Other plans that are available in the state.

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