Anthem Bronze Pathway X HMO 9100/0% Standard

29276OH0920431
Bronze
HMO

Anthem Bronze Pathway X HMO 9100/0% Standard is a Bronze HMO plan by Anthem Blue Cross and Blue Shield.

IMPORTANT: You are viewing the 2023 version of Anthem Bronze Pathway X HMO 9100/0% Standard 29276OH0920431. You can enroll in this plan during open enrollment 2023, which started November 1st and ends January 15th, 2023, in most states.

Locations

Anthem Bronze Pathway X HMO 9100/0% Standard is offered in the following counties.

Plan Overview

This is a plan overview for 2023 version of Anthem Bronze Pathway X HMO 9100/0% Standard 29276OH0920431.
Insurer: Anthem Blue Cross and Blue Shield
Network Type: HMO
Metal Type: Bronze
HSA Eligible?: No
Plan ID: 29276OH0920431

Cost-Sharing Overview

Anthem Bronze Pathway X HMO 9100/0% Standard 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 X HMO 9100/0% Standard?

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 X HMO 9100/0% Standard 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 X HMO 9100/0% Standard 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 X HMO 9100/0% Standard 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% 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% 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% 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
Covered
No Charge after deductible 100.00% Includes services to diagnose and treat MEDICAL conditions resulting in infertility. Excludes: Artificial insemination, in vitro fertilization, other types of artificial or surgical means of conception including drugs administered in connection with these procedures.
Long-Term/Custodial Nursing Home Care
Not Covered
Private-Duty Nursing
Covered
No Charge after deductible 100.00%90 Visit(s) per Year Private Duty Nursing is only covered through Home Health Care Services and is limited to 90 visits per calendar year.
Routine Eye Exam (Adult)
Not Covered
Urgent Care Centers or Facilities
Covered
No Charge after deductible 100.00% Urgent Care center services received outside of the service area are not covered, unless the service is rendered at a BlueCard facility. If out of area Urgent Care services are rendered at a BlueCard facility, the cost share is the same as In Network.
Home Health Care Services
Covered
No Charge after deductible 100.00%100 Visit(s) per Year Benefit limit does not apply to Home Infusion Therapy or Home Dialysis.? Private Duty Nursing is only covered through Home Health Care Services and is limited to 90 visits per calendar year, which is separate from the 100 visits a year limit for “other” Home Health Care services. Benefit limit does not apply to Physical, Occupational or Speech Therapy when performed as part of Home Health.
Emergency Room Services
Covered
No Charge after deductible No Charge after deductible Copay waived if admitted.
Emergency Transportation/Ambulance
Covered
No Charge after deductible No Charge after deductible Nonemergency Ambulance Services must be Preauthorized by Us.
Inpatient Hospital Services (e.g., Hospital Stay)
Covered
No Charge after deductible 100.00% Inpatient Physical Medicine and Rehabilitation (includes Day Rehabilitation Therapy services on an Outpatient basis) is limited to a maximum of 60 days per member, per calendar year. Coverage includes inpatient maternity care in a hospital for the mother, and inpatient newborn care in a hospital for the infant, for at least 48 hours following a normal delivery and at least 96 hours following a caesarean section delivery, regardless of whether such care is medically necessary.
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 Custodial or residential care in a skilled nursing facility or any other facility is not covered except when rendered as part of hospice care.
Prenatal and Postnatal Care
Covered
No Charge after deductible 100.00% Services related to surrogacy are excluded if the member is not the surrogate.
Delivery and All Inpatient Services for Maternity Care
Covered
No Charge after deductible 100.00% Coverage includes inpatient maternity care in a Hospital for the mother, and inpatient newborn care in a Hospital for the infant, for at least 48 hours following a normal delivery and at least 96 hours following a caesarean section delivery, regardless of whether such care is Medically Necessary. Covered services include at-home post delivery care visits at your residence by a Physician or Nurse performed no later than 72 hours following you and your newborn child?s discharge from the hospital.
Mental/Behavioral Health Outpatient Services
Covered
No Charge after deductible 100.00%
Mental/Behavioral Health Inpatient Services
Covered
No Charge after deductible 100.00%
Substance Abuse Disorder Outpatient Services
Covered
No Charge after deductible 100.00%
Substance Abuse Disorder Inpatient Services
Covered
No Charge after deductible 100.00%
Generic Drugs
Covered
No Charge after deductible 100.00% Cost share reflects a 30 day retail supply.
Preferred Brand Drugs
Covered
No Charge after deductible 100.00% Cost share reflects a 30 day retail supply
Non-Preferred Brand Drugs
Covered
No Charge after deductible 100.00% Cost share reflects a 30 day retail supply
Specialty Drugs
Covered
No Charge after deductible 100.00% Cost share reflects a 30 day retail supply
Outpatient Rehabilitation Services
Covered
No Charge after deductible 100.00%116 Visit(s) per Year 20 visits each Physical Therapy, Occupational Therapy, Speech Therapy, Pulmonary Rehabilitation. 36 visits for Cardiac Rehabilitation. Limit is combined across professional visits and outpatient facilities.
Habilitation Services
Covered
No Charge after deductible 100.00% Benefits include treatment of Autism Spectrum disorder for children ages 0-21. Applied Behavioral Analysis is limited to 20 hours per week. Limit is combined across professional visits and outpatient facilities.
Chiropractic Care
Covered
No Charge after deductible 100.00%12 Visit(s) per Year Limit is combined across professional visits and outpatient facilities for Osteopathic/Chiropractic Manipulation Therapy. These services are not covered in the home.
Durable Medical Equipment
Covered
No Charge after deductible 100.00% Wigs are limited to 1 wig per Member, per Benefit Period after cancer treatment. Coverage includes 4 surgical bras per benefit period.
Hearing Aids
Not Covered
Cochlear implants are covered as durable medical equipment (DME).
Imaging (CT/PET Scans, MRIs)
Covered
No Charge after deductible 100.00%
Preventive Care/Screening/Immunization
Covered
0.00% 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 Exam(s) per Year
Eye Glasses for Children
Covered
No Charge 100.00%1 Item(s) per Year
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 Autism limits are separate from Rehabilitation limits for Physical and Speech Therapy. Limit is combined across professional visits and outpatient facilities.
Rehabilitative Occupational and Rehabilitative Physical Therapy
Covered
No Charge after deductible 100.00%40 Visit(s) per Year 20 visits per person per year for Physical Therapy and a separate 20 visits for Occupational Therapies. Autism limits are separate from Rehabilitation limits for Physical and Speech Therapy. Limit is combined across professional visits and outpatient facilities.
Well Baby Visits and Care
Covered
No Charge 100.00%
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
no coverage except limited to therapeutic coverage (only in case of rape, incest or health of mother)
Transplant
Covered
No Charge after deductible 100.00% Transportation and lodging limited to $10000/transplant per benefit paid. The Plan will provide assistance with reasonable and necessary travel expenses when patient is required to travel more than 75 miles from residence to reach the facility where the Covered Transplant Procedure will be performed. If the Member receiving treatment is a minor, then reasonable and necessary expenses for transportation and lodging may be allowed for two companions. 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 Damage to teeth due to chewing or biting is not deemed an accidental injury and is not covered. Cost share will vary by the specific service rendered. Accident must have occurred on or after your effective date and treatment within 12 months of an accidental injury.
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% Cost share will vary by the specific service rendered.
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% Benefits for artificial substitutes for body parts and tissues and materials inserted into tissue for functional or therapeutic purposes. Covered Services include purchase, fitting, needed adjustment, repairs, and replacements of prosthetic devices and supplies that 1) Replace all or part of a missing body part and its adjoining tissues; or 2) Replace all or part of the function of a permanently useless or malfunctioning body part.
Infusion Therapy
Covered
No Charge after deductible 100.00% Home IV therapy includes but is not limited to: injections (intra-muscular, subcutaneous, continuous subcutaneous), Total Parenteral Nutrition (TPN), Enteral nutrition therapy, antibiotic therapy, pain management and chemotherapy. Home Infusion Therapy is not included in the Home Health Care visit maximum
Treatment for Temporomandibular Joint Disorders
Covered
No Charge after deductible 100.00%
Nutritional Counseling
Covered
No Charge after deductible 100.00% Covered benefit under Home Health Services or covered as US Preventive Services Task Force (USPSTF) A or B recommendation under preventive health services, which includes diet counseling for adults at higher risk for chronic disease, obesity screening and counseling for all adults, and healthy diet counseling for adults with cardiovascular risk factors.
Reconstructive Surgery
Covered
No Charge after deductible 100.00% Cost shares may vary based on the setting in which Covered Services are received.
Gender Affirming Care

Free Preventive Services

There is no copayment or coinsurance for any of the following Anthem Bronze Pathway X HMO 9100/0% Standard 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 X HMO 9100/0% Standard 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 X HMO 9100/0% Standard?

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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