Blue - BCBSHP Silver Pathway X HMO 3000

Georgia, 2018

  • Plan Type

    HMO

  • Metal Tier

    Silver

  • Out of Pocket Maximum

    $7,350

  • Deductible

    $3,000

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) $3,000
Deductible (Family) $6,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,350
Out of Pocket Maximum (Family) $14,700

Doctor Visits

Primary Care Visit $40 Copay after deductible + 10% Coinsurance after deductible
Specialist Visit $75 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
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 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) $2,500
Deductible (Family) $5,000
Out of Pocket Maximum (Individual) $5,100
Out of Pocket Maximum (Family) $10,200

Doctor Visits

Primary Care Physician $30 Copay after deductible + 10% Coinsurance after deductible
Specialists $75 Copay after deductible + 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
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) $700
Deductible (Family) $1,400
Out of Pocket Maximum (Individual) $1,600
Out of Pocket Maximum (Family) $3,200

Doctor Visits

Primary Care Physician $10 Copay after deductible + 10% Coinsurance after deductible
Specialists $30 Copay after deductible + 10% Coinsurance after deductible
Emergency Room $500 Copay after deductible + 10% Coinsurance after deductible
Inpatient Facility $250 Copay per stay after deductible + 50% Coinsurance after deductible
Inpatient Physician 10% 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) $650
Out of Pocket Maximum (Family) $1,300

Doctor Visits

Primary Care Physician $10 Copay after deductible + 10% Coinsurance after deductible
Specialists $30 Copay after deductible + 10% Coinsurance after deductible
Emergency Room $300 Copay after deductible + 10% Coinsurance after deductible
Inpatient Facility $100 Copay per stay after deductible + 50% Coinsurance after deductible
Inpatient Physician 10% 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 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 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 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 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) $3,000
Deductible (Family) $6,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,350
Out of Pocket Maximum (Family) $14,700

Doctor Visits

Primary Care Visit $40 Copay after deductible + 10% Coinsurance after deductible
Specialist Visit $75 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
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 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) $2,500
Deductible (Family) $5,000
Out of Pocket Maximum (Individual) $5,100
Out of Pocket Maximum (Family) $10,200

Doctor Visits

Primary Care Physician $30 Copay after deductible + 10% Coinsurance after deductible
Specialists $75 Copay after deductible + 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
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) $700
Deductible (Family) $1,400
Out of Pocket Maximum (Individual) $1,600
Out of Pocket Maximum (Family) $3,200

Doctor Visits

Primary Care Physician $10 Copay after deductible + 10% Coinsurance after deductible
Specialists $30 Copay after deductible + 10% Coinsurance after deductible
Emergency Room $500 Copay after deductible + 10% Coinsurance after deductible
Inpatient Facility $250 Copay per stay after deductible + 50% Coinsurance after deductible
Inpatient Physician 10% 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) $650
Out of Pocket Maximum (Family) $1,300

Doctor Visits

Primary Care Physician $10 Copay after deductible + 10% Coinsurance after deductible
Specialists $30 Copay after deductible + 10% Coinsurance after deductible
Emergency Room $300 Copay after deductible + 10% Coinsurance after deductible
Inpatient Facility $100 Copay per stay after deductible + 50% Coinsurance after deductible
Inpatient Physician 10% 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 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 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 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 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