Anthem Anthem Bronze DirectAccess w/HSA - cabp (Wisconsin)

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Company Anthem Blue Cross and Blue Shield
Plan Year 2014
State Wisconsin
Metal Tier Bronze
Plan Type POS
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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) $4,000
Deductible (Family) $8,000
Coinsurance Data Not Available
Out of Pocket Maximum (Individual) $6,350
Out of Pocket Maximum (Family) $12,700

Doctors Visits

Primary Care Visit 20% Coinsurance after deductible
Specialist Visit 20% Coinsurance after deductible
In Patient Hospital Services $500 Copay per Stay and 20% Coin
Emergency Room Services $200 Copay before deductible and

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 20% coinsurance
Laboratory Outpatient and Professional Services 20% coinsurance
X-ray and Diagnostic Imaging 20% coinsurance

Other

Mental / Behavioral Health Data Not Available
Rehabilitative Speech Therapy Data Not Available
Rehabilitative Occupational & Physical Therapy Data Not Available
Outpatient Facility 20% coinsurance
Outpatient Surgery 20% coinsurance

Prescription Drugs

Generic Rx 20% Coinsurance after deductible
Preferred Brand Rx 20% Coinsurance after deductible
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
Anthem Catastrophic Blue Priority X WI 6600 0
Anthem Bronze Blue Priority X WI 5750 20
Anthem Bronze Blue Priority X WI 6050 25
Anthem Bronze Blue Priority X WI 0 for HSA
Anthem Bronze Blue Priority X WI 20 for HSA
Anthem Bronze Blue Priority X WI 4300 20
Anthem Silver Blue Priority X WI 3500 0
Anthem Silver Blue Priority X WI 2500 10
Anthem Silver Blue Priority X WI 10 for HSA
Anthem Silver Blue Priority X WI 1850 20
Anthem Gold Blue Priority X WI 1100 10
Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan
Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan

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