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Anthem Catastrophic Pathway X Enhanced 9450/0%

96751NH0150024
Catastrophic
HMO

Anthem Catastrophic Pathway X Enhanced 9450/0% is a Catastrophic HMO plan by Anthem Blue Cross and Blue Shield.

IMPORTANT: You are viewing the 2024 version of Anthem Catastrophic Pathway X Enhanced 9450/0% 96751NH0150024. You can enroll in this plan during open enrollment 2024, which starts November 1st and ends January 15th, 2023, in most states.

Locations

Anthem Catastrophic Pathway X Enhanced 9450/0% is offered in the following counties.

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Plan Overview

This is a plan overview for 2024 version of Anthem Catastrophic Pathway X Enhanced 9450/0% 96751NH0150024.
Insurer: Anthem Blue Cross and Blue Shield
Network Type: HMO
Metal Type: Catastrophic
HSA Eligible?: No
Plan ID: 96751NH0150024

Cost-Sharing Overview

Anthem Catastrophic Pathway X Enhanced 9450/0% 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 Catastrophic Pathway X Enhanced 9450/0%?

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 Catastrophic Pathway X Enhanced 9450/0% 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 Catastrophic Pathway X Enhanced 9450/0% 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 Catastrophic Pathway X Enhanced 9450/0% 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
$40.00 No Charge after deductibleNot Applicable 100.00% Copay applies for the first 3 visits for Primary care and Retail Health Clinic combined. 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 Not ApplicableNot Applicable 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
$40.00 No Charge after deductibleNot Applicable 100.00% Copay applies for the first 3 visits for Primary care and Retail Health Clinic combined. 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 Not ApplicableNot Applicable 100.00%
Outpatient Surgery Physician/Surgical Services
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Hospice Services
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00% Hospice Beareavement is not covered.
Routine Dental Services (Adult)
Not Covered
Infertility Treatment
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00% The benefits do not include artificial insemination (AI) services or assisted reproductive technologies (ART) services or the diagnostic tests and Drugs to support AI or ART services. Examples of ART include in-vitro fertilization, zygote intrafallopian transfer (ZIFT), or gamete intrafallopian transfer (GIFT). Covered Services include diagnostic tests to find the cause of infertility, such as diagnostic laparoscopy, endometrial biopsy, and semen analysis. Benefits also include services to treat the underlying medical conditions that cause infertility (e.g., endometriosis, obstructed fallopian tubes, and hormone deficiency).
Long-Term/Custodial Nursing Home Care
Not Covered
Private-Duty Nursing
Not Covered
Routine Eye Exam (Adult)
Not Covered
Urgent Care Centers or Facilities
Covered
No Charge after deductible Not ApplicableNo Charge after deductible Not Applicable
Home Health Care Services
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Emergency Room Services
Covered
No Charge after deductible Not ApplicableNo Charge after deductible Not Applicable If applicable, copay waived if admitted.
Emergency Transportation/Ambulance
Covered
No Charge after deductible Not ApplicableNo Charge after deductible Not Applicable 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 Not ApplicableNot Applicable 100.00%
Inpatient Physician and Surgical Services
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Bariatric Surgery
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00% Benefits are available for bariatric surgery that is Medically Necessary for the treatment of diseases and ailments caused by or resulting from obesity or morbid obesity.
Cosmetic Surgery
Not Covered
Skilled Nursing Facility
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%100.0 Days per Year Custodial Care is not a Covered Service. When you require Inpatient skilled nursing and related services for convalescent and rehabilitative care, Covered Services are available if the Facility is licensed or certified under state law as a Skilled Nursing Facility.
Prenatal and Postnatal Care
Covered
No Charge No ChargeNot Applicable 100.00%
Delivery and All Inpatient Services for Maternity Care
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Mental/Behavioral Health Outpatient Services
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00% Member coinsurance will not exceed the Primary Care Provider copay.
Mental/Behavioral Health Inpatient Services
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Substance Abuse Disorder Outpatient Services
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00% Member coinsurance will not exceed the Primary Care Provider copay.
Substance Abuse Disorder Inpatient Services
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Generic Drugs
Covered
Not Applicable 0.00% Coinsurance after deductibleNot Applicable 100.00% Cost share is for a 30 day supply.? 90 day supply is available with additional cost shares.
Preferred Brand Drugs
Covered
Not Applicable 0.00% Coinsurance after deductibleNot Applicable 100.00% Cost share is for a 30 day supply.? 90 day supply is available with additional cost shares.
Non-Preferred Brand Drugs
Covered
Not Applicable 0.00% Coinsurance after deductibleNot Applicable 100.00% Cost share is for a 30 day supply.? 90 day supply is available with additional cost shares.
Specialty Drugs
Covered
Not Applicable 0.00% Coinsurance after deductibleNot Applicable 100.00% Cost share is for a 30 day supply.
Outpatient Rehabilitation Services
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%20.0 Visit(s) per Year Limit is combined across professional visits and outpatient facilities. Benefit limit does not apply when related to Autism.
Habilitation Services
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%20.0 Visit(s) per Year Limit is combined across professional visits and outpatient facilities. Benefit limit does not apply when related to Autism.
Chiropractic Care
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%12.0 Visit(s) per Year
Durable Medical Equipment
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00% Coverage for external breast prostheses is limited to 2 prostheses per breast, per Calendar Year. Coverage for post-mastectomy bras is limited to 3 bras per Member, per Calendar Year
Hearing Aids
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Imaging (CT/PET Scans, MRIs)
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Preventive Care/Screening/Immunization
Covered
No Charge No ChargeNot Applicable 100.00%
Routine Foot Care
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00% Covered if medically necessary for illness or injury.
Acupuncture
Not Covered
Weight Loss Programs
Not Covered
Routine Eye Exam for Children
Covered
$0.00 Copay after deductible Not ApplicableNot Applicable 100.00%1.0 Visit(s) per Year This Plan covers a complete eye exam and if needed, dilation.
Eye Glasses for Children
Covered
$0.00 Copay after deductible Not ApplicableNot Applicable 100.00%1.0 Item(s) per Year
Dental Check-Up for Children
Not Covered
Rehabilitative Speech Therapy
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%20.0 Visit(s) per Year Limit is combined across professional visits and outpatient facilities. Benefit limit does not apply when related to Autism.
Rehabilitative Occupational and Rehabilitative Physical Therapy
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%20.0 Visit(s) per Year Occupational therapy does not include recreational or vocational therapies, such as hobbies, arts and crafts. Limit is combined across professional visits and outpatient facilities. Benefit limit does not apply when related to Autism.
Well Baby Visits and Care
Covered
No Charge No ChargeNot Applicable 100.00% Benefits are covered under preventive care.
Laboratory Outpatient and Professional Services
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
X-rays and Diagnostic Imaging
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Basic Dental Care – Child
Not Covered
Orthodontia – Child
Not Covered
Major Dental Care – Child
Not Covered
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 Not ApplicableNot Applicable 100.00% Limited to a maximum of the 10 best matched donors, identified by an authorized registry.
Accidental Dental
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00% Benefits are available for dental work that is Medically Necessary due to an accidental injury to sound natural teeth and gums when the course of treatment for the accidental injury is received or authorized within 3 months of the date of the injury.
Dialysis
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Allergy Testing
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Chemotherapy
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Radiation
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Diabetes Education
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Prosthetic Devices
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Infusion Therapy
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Treatment for Temporomandibular Joint Disorders
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00% Covered Services include removable appliances for TMJ repositioning and related surgery, medical care, and diagnostic services.
Nutritional Counseling
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Reconstructive Surgery
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Gender Affirming Care

Free Preventive Services

There is no copayment or coinsurance for any of the following Anthem Catastrophic Pathway X Enhanced 9450/0% 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 Catastrophic Pathway X Enhanced 9450/0% 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 Catastrophic Pathway X Enhanced 9450/0%?

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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