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Blue - BCBSHP Silver Pathway X Guided Access HMO 10 for HSA
Georgia, 2018
Plan Type
HMO
Metal Tier
Silver
Out of Pocket Maximum
$5,000
Deductible
$3,200
Emergency Room Care: $500 Copay after deductible + 10% 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) | $3,200 |
|---|---|
| Deductible (Family) | $6,400 |
| Coinsurance | Not applicable |
| Out of Pocket Maximum (Individual) | $5,000 |
| Out of Pocket Maximum (Family) | $10,000 |
Doctor Visits
| Primary Care Visit | 10% Coinsurance after deductible |
|---|---|
| Specialist Visit | 10% Coinsurance after deductible |
| Inpatient Facility | $500 Copay per stay after deductible + 50% Coinsurance after deductible |
| Inpatient Physician | 10% Coinsurance after deductible |
| Emergency Room Services | $500 Copay after deductible + 10% Coinsurance after deductible |
Tests and Imaging
| Imaging (CT/PET Scans, MRIs) | $300 Copay after deductible + 50% 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 + 50% 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 | 10% Coinsurance after deductible |
|---|---|
| Preferred Brand Rx | 10% Coinsurance after deductible |
| 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) | $2,700 |
|---|---|
| Deductible (Family) | $5,400 |
| Out of Pocket Maximum (Individual) | $3,850 |
| Out of Pocket Maximum (Family) | $7,700 |
Doctor Visits
| Primary Care Physician | 10% Coinsurance after deductible |
|---|---|
| Specialists | 10% Coinsurance after deductible |
| Emergency Room | $500 Copay after deductible + 10% Coinsurance after deductible |
| Inpatient Facility | $500 Copay per stay after deductible + 50% Coinsurance after deductible |
| Inpatient Physician | 10% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | 10% Coinsurance after deductible |
|---|---|
| Preferred Brand Rx | 10% Coinsurance after deductible |
| 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) | $1,150 |
|---|---|
| Deductible (Family) | $2,300 |
| Out of Pocket Maximum (Individual) | $1,350 |
| Out of Pocket Maximum (Family) | $2,700 |
Doctor Visits
| Primary Care Physician | No charge after deductible |
|---|---|
| Specialists | No charge after deductible |
| Emergency Room | $200 Copay after deductible |
| Inpatient Facility | No charge after deductible |
| Inpatient Physician | No charge after deductible |
Prescription Drugs
| Generic Rx | 0% Coinsurance after deductible |
|---|---|
| Preferred Brand Rx | 0% Coinsurance after deductible |
| 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) | $400 |
|---|---|
| Deductible (Family) | $800 |
| Out of Pocket Maximum (Individual) | $700 |
| Out of Pocket Maximum (Family) | $1,400 |
Doctor Visits
| Primary Care Physician | No charge after deductible |
|---|---|
| Specialists | No charge after deductible |
| Emergency Room | $200 Copay after deductible |
| Inpatient Facility | No charge after deductible |
| Inpatient Physician | No charge after deductible |
Prescription Drugs
| Generic Rx | 0% Coinsurance after deductible |
|---|---|
| Preferred Brand Rx | 0% Coinsurance after deductible |
| Non Preferred Brand Rx | 40% Coinsurance after deductible |
| Specialty Drugs | 40% Coinsurance after deductible |
Other Plans in Georgia
| Plan | Deductible | Coinsurance | Out of Pocket |
|---|---|---|---|
| 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 Guided Access HMO 5500 | Deductible $5,500 | 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 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 |