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Rocky - Anthem Silver Pathway PPO 2250

Nevada, 2017

Plan Type

PPO

Metal Tier

Silver

Out of Pocket Maximum

$7,150

Deductible

$2,250

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Call (855) 782-0916 to speak with a licensed agent about a new health plan.

Emergency Room Care: $500 Copay after deductible + 20% Coinsurance after deductible

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) $2,250
Deductible (Family) $4,500
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,150
Out of Pocket Maximum (Family) $14,300

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit 20% Coinsurance after deductible
Inpatient Facility $500 Copay per stay after deductible + 40% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible
Emergency Room Services $500 Copay after deductible + 20% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) $500 Copay after deductible + 20% Coinsurance after deductible
Laboratory Outpatient and Professional Services 20% Coinsurance after deductible
X-Ray and Diagnostic Imaging 20% 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 after deductible + 40% Coinsurance after deductible
Mental / Behavioral Health Outpatient 20% Coinsurance after deductible
Rehabilitative Speech Therapy 20% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 20% Coinsurance after deductible
Outpatient Facility 20% Coinsurance after deductible
Outpatient Surgery 20% Coinsurance after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx Data Not Available
Non Preferred Brand Rx 40% Coinsurance after deductible
Specialty Drugs 40% Coinsurance after deductible

73% Cost Sharing Benefits

Households with incomes between 200% to 250% of FPL qualify for the following cost sharing benefits for this silver plan. To understand how cost sharing reductions work and how they work for you see our article about Obamacare Cost Sharing Reduction Discounts

Deductibles and Cost Sharing

Deductible (Individual) $2,150
Deductible (Family) $4,300
Out of Pocket Maximum (Individual) $5,700
Out of Pocket Maximum (Family) $11,400

Doctor Visits

Primary Care Physician
Specialists 20% Coinsurance after deductible
Emergency Room $500 Copay after deductible + 20% Coinsurance after deductible
Inpatient Facility $500 Copay per stay after deductible + 40% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx 40% Coinsurance after deductible
Specialty Drugs 40% Coinsurance after deductible

87% Cost Sharing Benefits

Households with incomes between 150% to 200% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $750
Deductible (Family) $1,500
Out of Pocket Maximum (Individual) $1,750
Out of Pocket Maximum (Family) $3,500

Doctor Visits

Primary Care Physician
Specialists 20% Coinsurance after deductible
Emergency Room $250 Copay after deductible + 20% Coinsurance after deductible
Inpatient Facility $250 Copay per stay after deductible + 40% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx 40% Coinsurance after deductible
Specialty Drugs 40% Coinsurance after deductible

94% Cost Sharing Benefits

Households with incomes between 138% to 150% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $250
Deductible (Family) $500
Out of Pocket Maximum (Individual) $700
Out of Pocket Maximum (Family) $1,400

Doctor Visits

Primary Care Physician
Specialists 20% Coinsurance after deductible
Emergency Room $150 Copay after deductible + 20% Coinsurance after deductible
Inpatient Facility $150 Copay per stay after deductible + 40% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx 40% Coinsurance after deductible
Specialty Drugs 40% Coinsurance after deductible

Other Plans in Nevada

Plan Deductible Coinsurance Out of Pocket
Plan Anthem Gold Pathway PPO 700 Deductible $700 Coinsurance Not applicable Out of Pocket $7,150
Plan Anthem Catastrophic Pathway PPO 7150 Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Anthem Bronze Pathway PPO 5150 for HSA Deductible $5,150 Coinsurance Not applicable Out of Pocket $6,550
Plan Anthem Silver Pathway PPO 4000 Deductible $4,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Anthem Silver Pathway PPO 2750 Deductible $2,750 Coinsurance Not applicable Out of Pocket $7,150
Plan Anthem Bronze Pathway PPO 6200 Deductible $6,200 Coinsurance Not applicable Out of Pocket $7,150
Plan Anthem Silver Pathway PPO 3500 Deductible $3,500 Coinsurance Not applicable Out of Pocket $5,000
Plan Anthem Bronze Pathway PPO 4600 Deductible $4,600 Coinsurance Not applicable Out of Pocket $7,150