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) |
$4,950 |
Deductible (Family) |
$9,900 |
Coinsurance |
Not applicable |
Out of Pocket Maximum (Individual) |
$7,150 |
Out of Pocket Maximum (Family) |
$14,300 |
Doctor Visits
Primary Care Visit |
50% Coinsurance after deductible |
Specialist Visit |
50% Coinsurance after deductible |
Inpatient Facility |
$1500 Copay per stay after deductible + 50% Coinsurance after deductible |
Inpatient Physician |
50% Coinsurance after deductible |
Emergency Room Services |
$500 Copay after deductible + 50% Coinsurance after deductible |
Tests and Imaging
Imaging (CT/PET Scans, MRIs) |
$300 Copay after deductible + 50% Coinsurance after deductible |
Laboratory Outpatient and Professional Services |
50% Coinsurance after deductible |
X-Ray and Diagnostic Imaging |
50% Coinsurance after deductible |
Health Management Programs
Asthma |
Available |
Depression |
Available |
Diabetes |
Available |
Heart Disease |
Available |
High Blood Pressure / High Cholesterol |
Available |
Lower Back Pain |
Available |
Pain Management |
Available |
Pregnancy |
Not available |
Weight Loss |
Not available |
Other
Mental / Behavioral Health Inpatient |
$1500 Copay after deductible + 50% Coinsurance after deductible |
Mental / Behavioral Health Outpatient |
50% Coinsurance after deductible |
Rehabilitative Speech Therapy |
50% Coinsurance after deductible |
Rehabilitative Occupational & Physical Therapy |
50% Coinsurance after deductible |
Outpatient Facility |
50% Coinsurance after deductible |
Outpatient Surgery |
50% Coinsurance after deductible |
Prescription Drugs
Generic Rx |
40% Coinsurance after deductible |
Preferred Brand Rx |
50% Coinsurance after deductible |
Non Preferred Brand Rx |
50% Coinsurance after deductible |
Specialty Drugs
| 50% Coinsurance after deductible |
Other Plans in Indiana
Plan
Anthem Bronze Pathway X 5300
|
Deductible
$5,300 |
Coinsurance Not applicable |
Out of Pocket
$7,150 |
Plan
Anthem Bronze Pathway X POS 5000
|
Deductible
$5,000 |
Coinsurance Not applicable |
Out of Pocket
$7,150 |
Plan
Anthem Silver Pathway X 2500
|
Deductible
$2,500 |
Coinsurance Not applicable |
Out of Pocket
$7,150 |
Plan
Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan
|
Deductible
$1,000 |
Coinsurance Not applicable |
Out of Pocket
$7,150 |
Plan
Anthem Bronze Pathway X 5850
|
Deductible
$5,850 |
Coinsurance Not applicable |
Out of Pocket
$7,150 |
Plan
Anthem Silver Pathway X 3500
|
Deductible
$3,500 |
Coinsurance Not applicable |
Out of Pocket
$6,150 |
Plan
Anthem Bronze Pathway X 0 for HSA
|
Deductible
$6,550 |
Coinsurance Not applicable |
Out of Pocket
$6,550 |
Plan
Anthem Silver Pathway X for HSA
|
Deductible
$3,000 |
Coinsurance Not applicable |
Out of Pocket
$4,500 |
Plan
Anthem Bronze Pathway X 7150
|
Deductible
$7,150 |
Coinsurance Not applicable |
Out of Pocket
$7,150 |
Plan
Anthem Silver Core Pathway X 5300
|
Deductible
$5,300 |
Coinsurance Not applicable |
Out of Pocket
$6,600 |
Plan
Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan
|
Deductible
$2,000 |
Coinsurance Not applicable |
Out of Pocket
$7,150 |
Plan
Anthem Silver Pathway X 4350
|
Deductible
$4,350 |
Coinsurance Not applicable |
Out of Pocket
$5,700 |
Plan
Anthem Catastrophic Pathway X 7150
|
Deductible
$7,150 |
Coinsurance Not applicable |
Out of Pocket
$7,150 |
Plan
Anthem Bronze Pathway X 20 for HSA
|
Deductible
$5,200 |
Coinsurance Not applicable |
Out of Pocket
$6,550 |
Plan
Anthem Bronze Pathway X 6500
|
Deductible
$6,500 |
Coinsurance Not applicable |
Out of Pocket
$7,150 |