Anthem Bronze Pathway Essentials 6850 HSA

17575IN0700058
Expanded Bronze
HMO

Anthem Bronze Pathway Essentials 6850 HSA is an Expanded Bronze HMO plan by Anthem Blue Cross and Blue Shield.

IMPORTANT: You are viewing the 2023 version of Anthem Bronze Pathway Essentials 6850 HSA 17575IN0700058. You can enroll in this plan if you qualify for special enrollment until the end of 2023.

Locations

Anthem Bronze Pathway Essentials 6850 HSA is offered in the following counties.

Plan Overview

This is a plan overview for 2023 version of Anthem Bronze Pathway Essentials 6850 HSA 17575IN0700058.
Insurer: Anthem Blue Cross and Blue Shield
Network Type: HMO
Metal Type: Expanded Bronze
HSA Eligible?: Yes
Plan ID: 17575IN0700058

Cost-Sharing Overview

Anthem Bronze Pathway Essentials 6850 HSA offers the following cost-sharing.

Notes:

  • Some plans have separate cost-sharing for medical and drugs, while other plans offer combined cost-sharing. The cost-sharing amounts above are combined medical and drug costs unless otherwise noted.
  • You are viewing the standard version of this plan. Your costs may be lower depending on your income. Use the “get a quote” button below to see your estimated premium and out-of-pocket costs after assistance.
Ready to sign up for Anthem Bronze Pathway Essentials 6850 HSA?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

Plan Features

Anthem Bronze Pathway Essentials 6850 HSA offers the following features and referral requirements.

Wellness Program: No
Disease Program: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management
Notice Pregnancy: No
Referral Specialist: No
Specialist Requiring Referral:
Plan Exclusions:
Child Only Option?: Allows Adult and Child-Only

Network Details

The following network details will help you understand what Anthem Bronze Pathway Essentials 6850 HSA covers when you are out of the service area or out of the country.

Out of Country Coverage: No
Out of Country Coverage Description: Urgent/Emergency Coverage Only
Out of Service Area Coverage: No
Out of Service Area Coverage Description: TRAD/PAR network
National Network: No

Additional Benefits and Cost-Sharing

Anthem Bronze Pathway Essentials 6850 HSA includes the following benefits at the cost sharing rates listed below.

Service In-Network
Copay / Coinsurance
Out-of-Network
Copay / Coinsurance
Limits and Explanation
Primary Care Visit to Treat an Injury or Illness
Covered
No Charge after deductible 100.00% Deductible then Covered in Full applies to office visits. Copays do not apply to these services. You may also be able to access care with lower cost shares using our online virtual doctor visits and medical chat with a doctor. These can be accessed via our Sydney application.
Specialist Visit
Covered
No Charge after deductible 100.00% Deductible then Covered in Full applies to office visits. Copays do not apply to these services. You may also be able to access care with lower cost shares using our online virtual doctor visits and medical chat with a doctor. These can be accessed via our Sydney application.
Other Practitioner Office Visit (Nurse, Physician Assistant)
Covered
No Charge after deductible 100.00% Deductible then Covered in Full applies to office visits. Copays do not apply to these services. You may also be able to access care with lower cost shares using our online virtual doctor visits and medical chat with a doctor. These can be accessed via our Sydney application.
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Covered
No Charge after deductible 100.00%
Outpatient Surgery Physician/Surgical Services
Covered
No Charge after deductible 100.00%
Hospice Services
Covered
No Charge after deductible 100.00%
Routine Dental Services (Adult)
Not Covered
Infertility Treatment
Not Covered
Long-Term/Custodial Nursing Home Care
Not Covered
Private-Duty Nursing
Covered
No Charge after deductible 100.00%82 Visit(s) per Year Private Duty Nursing care provided in home setting is limited to a maximum of 82 visits per Member, per Calendar Year and a maximum of 164 visits per Member, per lifetime.
Routine Eye Exam (Adult)
Not Covered
Urgent Care Centers or Facilities
Covered
No Charge after deductible No Charge after deductible
Home Health Care Services
Covered
No Charge after deductible 100.00%100 Visit(s) per Year
Emergency Room Services
Covered
No Charge after deductible No Charge after deductible
Emergency Transportation/Ambulance
Covered
No Charge after deductible No Charge after deductible Non-emergency ambulance/transportation out of network is not covered unless authorized. Authorized out of network is limited to $50,000 per occurrence.
Inpatient Hospital Services (e.g., Hospital Stay)
Covered
No Charge after deductible 100.00% Maximum 60 days per Benefit Period for Physical Medicine and Rehabilitation (includes Day Rehabilitation Therapy services on an Outpatient basis).
Inpatient Physician and Surgical Services
Covered
No Charge after deductible 100.00%
Bariatric Surgery
Not Covered
Cosmetic Surgery
Not Covered
Skilled Nursing Facility
Covered
No Charge after deductible 100.00%90 Days per Year
Prenatal and Postnatal Care
Covered
No Charge after deductible 100.00%
Delivery and All Inpatient Services for Maternity Care
Covered
No Charge after deductible 100.00%
Mental/Behavioral Health Outpatient Services
Covered
No Charge after deductible 100.00% Cost share determined by services rendered.
Mental/Behavioral Health Inpatient Services
Covered
No Charge after deductible 100.00%
Substance Abuse Disorder Outpatient Services
Covered
No Charge after deductible 100.00% Cost share determined by services rendered.
Substance Abuse Disorder Inpatient Services
Covered
No Charge after deductible 100.00%
Generic Drugs
Covered
0.00% Coinsurance after deductible 100.00% Cost share shown is for a 30 day supply.
Preferred Brand Drugs
Covered
0.00% Coinsurance after deductible 100.00% Cost share shown is for a 30 day supply.
Non-Preferred Brand Drugs
Covered
0.00% Coinsurance after deductible 100.00% Cost share shown is for a 30 day supply.
Specialty Drugs
Covered
0.00% Coinsurance after deductible 100.00% Cost share shown is for a 30 day supply.
Outpatient Rehabilitation Services
Covered
No Charge after deductible 100.00%60 Visit(s) per Year Limited to 20 visits each for Rehabilitative Physical, Occupational and Speech Therapy. Limited to 36 visits for Cardiac Rehabilitation. Cost share determined by service rendered.
Habilitation Services
Covered
No Charge after deductible 100.00%60 Visit(s) per Year Limited to 20 visits each for Habilitative Physical, Occupational and Speech Therapy. Cost share determined by services rendered.
Chiropractic Care
Covered
No Charge after deductible 100.00%12 Visit(s) per Year
Durable Medical Equipment
Covered
No Charge after deductible 100.00% Wigs limited to the first one following cancer treatment.
Hearing Aids
Not Covered
Imaging (CT/PET Scans, MRIs)
Covered
No Charge after deductible 100.00%
Preventive Care/Screening/Immunization
Covered
No Charge 100.00% You may have to pay for services that aren’t preventive. Ask your provider if the services needed are preventive. Then check what your plan will pay for.
Routine Foot Care
Not Covered
Acupuncture
Not Covered
Weight Loss Programs
Not Covered
Routine Eye Exam for Children
Covered
No Charge 100.00%1 Visit(s) per Benefit Period Eye exams are covered once per benefit period for In Network Services.
Eye Glasses for Children
Covered
No Charge 100.00%1 Item(s) per Year Eye glasses are covered once per benefit period for In Network Services.
Dental Check-Up for Children
Covered
No Charge after deductible 100.00%2 Visit(s) per Year
Rehabilitative Speech Therapy
Covered
No Charge after deductible 100.00%20 Visit(s) per Year Cost share determined by services rendered.
Rehabilitative Occupational and Rehabilitative Physical Therapy
Covered
No Charge after deductible 100.00%40 Visit(s) per Year Limited to 20 visits each for Rehabilitative Physical, and Occupational Therapy. Cost share determined by service rendered.
Well Baby Visits and Care
Covered
No Charge 100.00% You may have to pay for services that aren’t preventive. Ask your provider if the services needed are preventive. Then check what your plan will pay for.
Laboratory Outpatient and Professional Services
Covered
No Charge after deductible 100.00%
X-rays and Diagnostic Imaging
Covered
No Charge after deductible 100.00%
Basic Dental Care – Child
Covered
40.00% Coinsurance after deductible 100.00%
Orthodontia – Child
Covered
50.00% Coinsurance after deductible 100.00%
Major Dental Care – Child
Covered
50.00% Coinsurance after deductible 100.00%
Basic Dental Care – Adult
Not Covered
Orthodontia – Adult
Not Covered
Major Dental Care – Adult
Not Covered
Abortion for Which Public Funding is Prohibited
Not Covered
Covered only in the case of rape or incest, or for a pregnancy which, as certified by a doctor, places the woman in danger of death unless an abortion is performed (i.e., abortions for which federal funding is allowed).
Transplant
Covered
No Charge after deductible 100.00% $10,000 limit per transplant for transportation and lodging. Unrelated Donor Search is Limited to a maximum of the 10 best matched donors, identified by an authorized registry.
Accidental Dental
Covered
No Charge after deductible 100.00%3000 Dollars per Episode Limit is combined in network and out of network.
Dialysis
Covered
No Charge after deductible 100.00%
Allergy Testing
Covered
No Charge after deductible 100.00%
Chemotherapy
Covered
No Charge after deductible 100.00%
Radiation
Covered
No Charge after deductible 100.00%
Diabetes Education
Covered
No Charge after deductible 100.00%
Prosthetic Devices
Covered
No Charge after deductible 100.00%
Infusion Therapy
Covered
No Charge after deductible 100.00%
Treatment for Temporomandibular Joint Disorders
Covered
No Charge after deductible 100.00% Services do not include fixed or removable appliances that involve movement or repositioning of the teeth, repair of teeth (fillings), or prosthetics (crowns, bridges, dentures).
Nutritional Counseling
Covered
No Charge after deductible 100.00% Covered under preventive guidelines and for diabetes. Cost share is driven by provider/setting.
Reconstructive Surgery
Covered
No Charge after deductible 100.00% Reconstruction is covered when required following a mastectomy and certain other deformities caused by disease, trauma, congenital anomalies and previous therapeutic process.
Gender Affirming Care
Dental Anesthesia
Covered
No Charge after deductible 100.00% Limited to Accidental Dental or a Member less than 19 years of age or a Member with intellectual or physical disability, are covered if the Member requires dental treatment to be given in a Hospital or Outpatient Ambulatory Surgical Facility.

Free Preventive Services

There is no copayment or coinsurance for any of the following Anthem Bronze Pathway Essentials 6850 HSA preventive services. This is true even if you haven’t met your yearly deductible.

Please note, these services are free only when delivered by a doctor or other provider in your plan’s network.

Additional Resources

Below are additional resources for Anthem Bronze Pathway Essentials 6850 HSA including the Summary of Benefits & Coverage (SBC), plan brochure, formulary link, and a link to the website to pay your monthly premium after you enroll.

Summary of Benefits: Summary of Benefits Link
Plan Brochure: Plan Brochure Link
Formulary: Formulary Link
Premium Payment Website: Premium Payment Link
Ready to sign up for Anthem Bronze Pathway Essentials 6850 HSA?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

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