Blue - BCBSHP Bronze Pathway X Guided Access HMO 5500

Georgia, 2018

  • Plan Type

    HMO

  • Metal Tier

    Bronze

  • Out of Pocket Maximum

    $7,350

  • Deductible

    $5,500

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) $5,500
Deductible (Family) $11,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,350
Out of Pocket Maximum (Family) $14,700

Doctor Visits

Primary Care Visit $50 Copay after deductible + 40% Coinsurance after deductible
Specialist Visit $75 Copay after deductible + 40% Coinsurance after deductible
Inpatient Facility $1000 Copay per stay after deductible + 50% Coinsurance after deductible
Inpatient Physician 40% Coinsurance after deductible
Emergency Room Services $500 Copay after deductible + 40% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) $400 Copay after deductible + 50% Coinsurance after deductible
Laboratory Outpatient and Professional Services 40% Coinsurance after deductible
X-Ray and Diagnostic Imaging 40% 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 $1000 Copay per stay after deductible + 50% Coinsurance after deductible
Mental / Behavioral Health Outpatient 40% Coinsurance after deductible
Rehabilitative Speech Therapy 40% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 40% Coinsurance after deductible
Outpatient Facility 40% Coinsurance after deductible
Outpatient Surgery 40% Coinsurance after deductible

Prescription Drugs

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

Other Plans in Georgia

Plan BCBSHP Silver Pathway X Guided Access HMO 2000 Deductible $2,000 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Silver Pathway X HMO 2900 Deductible $2,900 Coinsurance Not applicable Out of Pocket $4,850
Plan BCBSHP Silver Pathway X Guided Access HMO 3000 Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Bronze Pathway X HMO 6750 Deductible $6,750 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Catastrophic Pathway X Guided Access HMO 7350 Deductible $7,350 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Silver Pathway X Guided Access HMO 10 for HSA Deductible $3,200 Coinsurance Not applicable Out of Pocket $5,000
Plan BCBSHP Silver Pathway X Guided Access HMO 6000 Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Silver Pathway X HMO 4950 Deductible $4,950 Coinsurance Not applicable Out of Pocket $6,500
Plan BCBSHP Bronze Pathway X Guided Access HMO 5500 Deductible $5,500 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Bronze Pathway X HMO 5500 Deductible $5,500 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Bronze Pathway X HMO 5200 Deductible $5,200 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Silver Pathway X HMO 2000 Deductible $2,000 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Silver Pathway X Guided Access HMO 5300 Deductible $5,300 Coinsurance Not applicable Out of Pocket $6,500
Plan BCBSHP Bronze Pathway X Guided Access HMO 6750 Deductible $6,750 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Silver Pathway X HMO 5300 Deductible $5,300 Coinsurance Not applicable Out of Pocket $6,500
Plan BCBSHP Bronze Pathway X HMO 5850 Deductible $5,850 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Gold Pathway X Guided Access HMO 1300 Deductible $1,300 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Bronze Pathway X Guided Access HMO 5850 Deductible $5,850 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Catastrophic Pathway X Guided Access HMO 7350 Deductible $7,350 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Silver Pathway X Guided Access HMO 3150 Deductible $3,150 Coinsurance Not applicable Out of Pocket $5,750
Plan BCBSHP Gold Pathway X Guided Access HMO 1300 Deductible $1,300 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Bronze Pathway X Guided Access HMO 5200 Deductible $5,200 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Silver Pathway X HMO 6000 Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Silver Pathway X Guided Access HMO 4950 Deductible $4,950 Coinsurance Not applicable Out of Pocket $6,500
Plan BCBSHP Silver Pathway X Guided Access HMO 3150 Deductible $3,150 Coinsurance Not applicable Out of Pocket $5,750
Plan BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA Deductible $6,650 Coinsurance Not applicable Out of Pocket $6,650
Plan BCBSHP Silver Pathway X HMO 10 for HSA Deductible $3,200 Coinsurance Not applicable Out of Pocket $5,000
Plan BCBSHP Silver Pathway X Guided Access HMO 4950 Deductible $4,950 Coinsurance Not applicable Out of Pocket $6,500
Plan BCBSHP Bronze Pathway Guided Access HMO 6750 Deductible $6,750 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Bronze Pathway X Guided Access HMO 5850 Deductible $5,850 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Gold Pathway X HMO 1300 Deductible $1,300 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA Deductible $6,650 Coinsurance Not applicable Out of Pocket $6,650
Plan BCBSHP Silver Pathway X Guided Access HMO 6000 Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Bronze Pathway X Guided Access HMO 5200 Deductible $5,200 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Bronze Pathway X HMO 0 for HSA Deductible $6,650 Coinsurance Not applicable Out of Pocket $6,650
Plan BCBSHP Silver Pathway X Guided Access HMO 10 for HSA Deductible $3,200 Coinsurance Not applicable Out of Pocket $5,000
Plan BCBSHP Silver Pathway X Guided Access HMO 2000 Deductible $2,000 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Catastrophic Pathway X HMO 7350 Deductible $7,350 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Silver Pathway X HMO 3000 Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Silver Pathway X Guided Access HMO 3000 Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Silver Pathway X Guided Access HMO 5300 Deductible $5,300 Coinsurance Not applicable Out of Pocket $6,500
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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) $5,500
Deductible (Family) $11,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,350
Out of Pocket Maximum (Family) $14,700

Doctor Visits

Primary Care Visit $50 Copay after deductible + 40% Coinsurance after deductible
Specialist Visit $75 Copay after deductible + 40% Coinsurance after deductible
Inpatient Facility $1000 Copay per stay after deductible + 50% Coinsurance after deductible
Inpatient Physician 40% Coinsurance after deductible
Emergency Room Services $500 Copay after deductible + 40% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) $400 Copay after deductible + 50% Coinsurance after deductible
Laboratory Outpatient and Professional Services 40% Coinsurance after deductible
X-Ray and Diagnostic Imaging 40% 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 $1000 Copay per stay after deductible + 50% Coinsurance after deductible
Mental / Behavioral Health Outpatient 40% Coinsurance after deductible
Rehabilitative Speech Therapy 40% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 40% Coinsurance after deductible
Outpatient Facility 40% Coinsurance after deductible
Outpatient Surgery 40% Coinsurance after deductible

Prescription Drugs

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

Other Plans in Georgia

Plan BCBSHP Silver Pathway X Guided Access HMO 2000 Deductible $2,000 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Silver Pathway X HMO 2900 Deductible $2,900 Coinsurance Not applicable Out of Pocket $4,850
Plan BCBSHP Silver Pathway X Guided Access HMO 3000 Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Bronze Pathway X HMO 6750 Deductible $6,750 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Catastrophic Pathway X Guided Access HMO 7350 Deductible $7,350 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Silver Pathway X Guided Access HMO 10 for HSA Deductible $3,200 Coinsurance Not applicable Out of Pocket $5,000
Plan BCBSHP Silver Pathway X Guided Access HMO 6000 Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Silver Pathway X HMO 4950 Deductible $4,950 Coinsurance Not applicable Out of Pocket $6,500
Plan BCBSHP Bronze Pathway X Guided Access HMO 5500 Deductible $5,500 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Bronze Pathway X HMO 5500 Deductible $5,500 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Bronze Pathway X HMO 5200 Deductible $5,200 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Silver Pathway X HMO 2000 Deductible $2,000 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Silver Pathway X Guided Access HMO 5300 Deductible $5,300 Coinsurance Not applicable Out of Pocket $6,500
Plan BCBSHP Bronze Pathway X Guided Access HMO 6750 Deductible $6,750 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Silver Pathway X HMO 5300 Deductible $5,300 Coinsurance Not applicable Out of Pocket $6,500
Plan BCBSHP Bronze Pathway X HMO 5850 Deductible $5,850 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Gold Pathway X Guided Access HMO 1300 Deductible $1,300 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Bronze Pathway X Guided Access HMO 5850 Deductible $5,850 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Catastrophic Pathway X Guided Access HMO 7350 Deductible $7,350 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Silver Pathway X Guided Access HMO 3150 Deductible $3,150 Coinsurance Not applicable Out of Pocket $5,750
Plan BCBSHP Gold Pathway X Guided Access HMO 1300 Deductible $1,300 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Bronze Pathway X Guided Access HMO 5200 Deductible $5,200 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Silver Pathway X HMO 6000 Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Silver Pathway X Guided Access HMO 4950 Deductible $4,950 Coinsurance Not applicable Out of Pocket $6,500
Plan BCBSHP Silver Pathway X Guided Access HMO 3150 Deductible $3,150 Coinsurance Not applicable Out of Pocket $5,750
Plan BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA Deductible $6,650 Coinsurance Not applicable Out of Pocket $6,650
Plan BCBSHP Silver Pathway X HMO 10 for HSA Deductible $3,200 Coinsurance Not applicable Out of Pocket $5,000
Plan BCBSHP Silver Pathway X Guided Access HMO 4950 Deductible $4,950 Coinsurance Not applicable Out of Pocket $6,500
Plan BCBSHP Bronze Pathway Guided Access HMO 6750 Deductible $6,750 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Bronze Pathway X Guided Access HMO 5850 Deductible $5,850 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Gold Pathway X HMO 1300 Deductible $1,300 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA Deductible $6,650 Coinsurance Not applicable Out of Pocket $6,650
Plan BCBSHP Silver Pathway X Guided Access HMO 6000 Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Bronze Pathway X Guided Access HMO 5200 Deductible $5,200 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Bronze Pathway X HMO 0 for HSA Deductible $6,650 Coinsurance Not applicable Out of Pocket $6,650
Plan BCBSHP Silver Pathway X Guided Access HMO 10 for HSA Deductible $3,200 Coinsurance Not applicable Out of Pocket $5,000
Plan BCBSHP Silver Pathway X Guided Access HMO 2000 Deductible $2,000 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Catastrophic Pathway X HMO 7350 Deductible $7,350 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Silver Pathway X HMO 3000 Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Silver Pathway X Guided Access HMO 3000 Deductible $3,000 Coinsurance Not applicable Out of Pocket $7,350
Plan BCBSHP Silver Pathway X Guided Access HMO 5300 Deductible $5,300 Coinsurance Not applicable Out of Pocket $6,500