Anthem Anthem HealthKeepers Gold DirectAccess - ccam VA

Plan Information
Company Anthem Blue Cross and Blue Shield
State VA
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) $750 $0
Deductible (Family) $1,500 $0
Coinsurance 20% $0
Out of Pocket Maximum (Individual) $3,500 $0
Out of Pocket Maximum (Family) $7,000 $0
Services In Network Out of Network
Primary Care Visit $30 $0
Specialist Visit 20% Coinsurance after deductible $0
In Patient Hospital Services 20% Coinsurance after deductible $0
Emergency Room Services 30% Coinsurance after deductible 30% coinsurance
Mental / Behavioral Health 20% coinsurance $0
Imaging (CT/PET Scans, MRIs) 20% coinsurance $0
Rehabilitative Speech Therapy 20% coinsurance $0
Rehabilitative Occupational & Physical Therapy 20% coinsurance $0
Preventative Care $0 $0
Laboratory Outpatient and Professional Services 20% coinsurance $0
X-ray and Diagnostic Imaging 20% coinsurance $0
Outpatient Facility 20% coinsurance $0
Outpatient Surgery 20% coinsurance $0
Prescription Drugs In Network Out of Network
Generic Rx $15
Preferred Brand Rx $40
Non Preferred Brand Rx 20% Coinsurance after deductible
Specialty Drugs 20% Coinsurance after deductible

Other Plans

Other plans that are available in the state.

Plan Name
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