Matthew - Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan

New Hampshire, 2017

  • Plan Type

    HMO

  • Metal Tier

    Gold

  • Out of Pocket Maximum

    $5,000

  • Deductible

    $1,000

Enroll Now
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Call (855) 866-5590 to speak with a licensed agent about a new health plan.

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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) $1,000
Deductible (Family) $3,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $5,000
Out of Pocket Maximum (Family) $10,000

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit 10% Coinsurance after deductible
Inpatient Facility $500 Copay per stay after deductible + 10% Coinsurance after deductible
Inpatient Physician 10% Coinsurance after deductible
Emergency Room Services $200 Copay after deductible + 10% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 10% Coinsurance after deductible
Laboratory Outpatient and Professional Services 10% Coinsurance after deductible
X-Ray and Diagnostic Imaging 10% 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 $500 Copay per stay after deductible + 10% Coinsurance after deductible
Mental / Behavioral Health Outpatient 10% Coinsurance after deductible
Rehabilitative Speech Therapy 10% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 10% Coinsurance after deductible
Outpatient Facility 10% Coinsurance after deductible
Outpatient Surgery 10% Coinsurance after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx Data Not Available
Non Preferred Brand Rx 30% Coinsurance after deductible
Specialty Drugs 30% Coinsurance after deductible

Other Plans in New Hampshire

Plan Anthem Bronze Pathway X Enhanced HMO 0 for HSA Deductible $6,050 Coinsurance Not applicable Out of Pocket $6,550
Plan Anthem Silver Pathway X Enhanced HMO 4000 0 Deductible $4,000 Coinsurance Not applicable Out of Pocket $5,700
Plan Anthem Catastrophic Pathway X Enhanced HMO 7150 0 Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Anthem Silver Pathway X Enhanced HMO 4200 0 Deductible $4,200 Coinsurance Not applicable Out of Pocket $5,900
Plan Anthem Bronze Pathway X Enhanced HMO 5400 30 Deductible $5,400 Coinsurance Not applicable Out of Pocket $7,150
Plan Anthem Gold Pathway X Enhanced HMO 1000 10 Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,000
Plan Anthem Bronze Pathway X Enhanced HMO 25 for HSA Deductible $5,150 Coinsurance Not applicable Out of Pocket $6,550
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 Enhanced HMO 5300 25 Deductible $5,300 Coinsurance Not applicable Out of Pocket $6,750
Plan Anthem Bronze Pathway X Enhanced HMO 6350 40 Deductible $6,350 Coinsurance Not applicable Out of Pocket $7,150
Plan Anthem Silver Pathway X Enhanced HMO 10 for HSA Deductible $3,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Anthem Bronze Pathway X Enhanced HMO 5750 10 Deductible $5,750 Coinsurance Not applicable Out of Pocket $7,150
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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) $1,000
Deductible (Family) $3,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $5,000
Out of Pocket Maximum (Family) $10,000

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit 10% Coinsurance after deductible
Inpatient Facility $500 Copay per stay after deductible + 10% Coinsurance after deductible
Inpatient Physician 10% Coinsurance after deductible
Emergency Room Services $200 Copay after deductible + 10% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 10% Coinsurance after deductible
Laboratory Outpatient and Professional Services 10% Coinsurance after deductible
X-Ray and Diagnostic Imaging 10% 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 $500 Copay per stay after deductible + 10% Coinsurance after deductible
Mental / Behavioral Health Outpatient 10% Coinsurance after deductible
Rehabilitative Speech Therapy 10% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 10% Coinsurance after deductible
Outpatient Facility 10% Coinsurance after deductible
Outpatient Surgery 10% Coinsurance after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx Data Not Available
Non Preferred Brand Rx 30% Coinsurance after deductible
Specialty Drugs 30% Coinsurance after deductible

Other Plans in New Hampshire

Plan Anthem Bronze Pathway X Enhanced HMO 0 for HSA Deductible $6,050 Coinsurance Not applicable Out of Pocket $6,550
Plan Anthem Silver Pathway X Enhanced HMO 4000 0 Deductible $4,000 Coinsurance Not applicable Out of Pocket $5,700
Plan Anthem Catastrophic Pathway X Enhanced HMO 7150 0 Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Anthem Silver Pathway X Enhanced HMO 4200 0 Deductible $4,200 Coinsurance Not applicable Out of Pocket $5,900
Plan Anthem Bronze Pathway X Enhanced HMO 5400 30 Deductible $5,400 Coinsurance Not applicable Out of Pocket $7,150
Plan Anthem Gold Pathway X Enhanced HMO 1000 10 Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,000
Plan Anthem Bronze Pathway X Enhanced HMO 25 for HSA Deductible $5,150 Coinsurance Not applicable Out of Pocket $6,550
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 Enhanced HMO 5300 25 Deductible $5,300 Coinsurance Not applicable Out of Pocket $6,750
Plan Anthem Bronze Pathway X Enhanced HMO 6350 40 Deductible $6,350 Coinsurance Not applicable Out of Pocket $7,150
Plan Anthem Silver Pathway X Enhanced HMO 10 for HSA Deductible $3,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Anthem Bronze Pathway X Enhanced HMO 5750 10 Deductible $5,750 Coinsurance Not applicable Out of Pocket $7,150