Anthem Catastrophic Pathway X HMO 9450
49046GA0410014
Catastrophic
HMO
Anthem Catastrophic Pathway X HMO 9450 is a Catastrophic HMO plan by Anthem Blue Cross and Blue Shield.
IMPORTANT: You are viewing the 2024 version of Anthem Catastrophic Pathway X HMO 9450 49046GA0410014. 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 HMO 9450 is offered in the following counties.
Plan Overview
This is a plan overview for 2024 version of Anthem Catastrophic Pathway X HMO 9450 49046GA0410014.
| Insurer: | Anthem Blue Cross and Blue Shield |
| Network Type: | HMO |
| Metal Type: | Catastrophic |
| HSA Eligible?: | No |
| Plan ID: | 49046GA0410014 |
Cost-Sharing Overview
Anthem Catastrophic Pathway X HMO 9450 offers the following cost-sharing.
Cost-Sharing
Out-of-Network Cost-Sharing
Cost-Sharing Examples
Cost-Sharing
Cost-sharing for Anthem Catastrophic Pathway X HMO 9450 includes your out-of-pocket maximum, your annual deductible, and coinsurance under this plan.
| Cost Sharing Type | Individual | Family |
|---|---|---|
| Out-of-Pocket Maximum: | $9450 per person | $18900 per group |
| Deductible: | $9450 per person | $18900 per group |
| Coinsurance: | 0.00% | |
Out-of-Network Cost-Sharing
Some plans have different cost-sharing out-of-network. The out-of-network cost-sharing for Anthem Catastrophic Pathway X HMO 9450 will be shown below if applicable.
| Cost Sharing Type | Individual | Family |
|---|---|---|
| Out-of-Network Maximum: | per person not applicable | per group not applicable |
| Out-of-Network Deductible: | per person not applicable | per group not applicable |
Cost-Sharing Examples
The cost-sharing for the sample Summary of Benefits & Coverage (SBC) scenarios of having a baby, having diabetes, and having a simple fracture.
| Deductible: | $9,450.00 |
| Copayment: | $0.00 |
| Coinsurance: | $0.00 |
| Limit: | $60.00 |
| Deductible: | $5,200.00 |
| Copayment: | $100.00 |
| Coinsurance: | $0.00 |
| Limit: | $20.00 |
| Deductible: | $2,800.00 |
| Copayment: | $0.00 |
| Coinsurance: | $0.00 |
| Limit: | $0.00 |
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 HMO 9450?
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 HMO 9450 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 HMO 9450 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 HMO 9450 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 deductible | Not Applicable 100.00% | Primary Care Office visits, Other Practitioners Office visits, and Virtual Office visits have a combined shared limit of 3 copays before deductible/coinsurance applies. 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 mobile app or website. |
| Specialist Visit Covered | No Charge after deductible Not Applicable | Not 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 mobile app or website. |
| Other Practitioner Office Visit (Nurse, Physician Assistant) Covered | $40.00 No Charge after deductible | Not 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 mobile app or website. |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | |
| Outpatient Surgery Physician/Surgical Services Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | |
| Hospice Services Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | |
| Routine Dental Services (Adult) Not Covered | |||
| Infertility Treatment Not Covered | |||
| 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 Applicable | No Charge after deductible Not Applicable | Additional Cost Share determined based on service received |
| Home Health Care Services Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | 120.0 Visit(s) per Year Limit also applies to Physical, Occupational or Speech Therapy when performed as part of Home Health Care Services. |
| Emergency Room Services Covered | No Charge after deductible Not Applicable | No Charge after deductible Not Applicable | Copayment (if applicable) is waived if admitted. |
| Emergency Transportation/Ambulance Covered | No Charge after deductible Not Applicable | No Charge after deductible Not Applicable | NON-emergency ambulance/transportation out of network is NOT covered, unless prior authorization is obtained. If authorized out of network, limited to $50,000 per occurrence. |
| Inpatient Hospital Services (e.g., Hospital Stay) Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Combined 60 days per year for Inpatient Rehabilitation and Skilled Nursing Facility services. |
| Inpatient Physician and Surgical Services Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | |
| Bariatric Surgery Not Covered | |||
| Cosmetic Surgery Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Reconstructive surgery is covered. Reconstructive surgery is performed to correct deformities caused by congenital or developmental abnormalities, illness, injury, or previous therapeutic process, for the purpose of improving bodily function or symptomatology or to create a normal appearance, including surgery performed to restore symmetry following mastectomy. Reconstructive services required due to prior therapeutic process are covered only if the original procedure would have been a covered service under the plan. |
| Skilled Nursing Facility Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | 60.0 Days per Year Combined days for Inpatient Rehabilitation and Skilled Nursing Facility services. 60 Days per year. |
| Prenatal and Postnatal Care Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | |
| Delivery and All Inpatient Services for Maternity Care Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Hospital stay is 48 hours for vaginal delivery and 96 hours for c-section |
| Mental/Behavioral Health Outpatient Services Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Cost share is driven by provider/setting. |
| Mental/Behavioral Health Inpatient Services Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | |
| Substance Abuse Disorder Outpatient Services Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Cost share is driven by provider/setting. |
| Substance Abuse Disorder Inpatient Services Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | |
| Generic Drugs Covered | Not Applicable 0.00% Coinsurance after deductible | Not Applicable 100.00% | 30 day retail supply |
| Preferred Brand Drugs Covered | Not Applicable 0.00% Coinsurance after deductible | Not Applicable 100.00% | 30 day retail supply |
| Non-Preferred Brand Drugs Covered | Not Applicable 0.00% Coinsurance after deductible | Not Applicable 100.00% | 30 day retail supply |
| Specialty Drugs Covered | Not Applicable 0.00% Coinsurance after deductible | Not Applicable 100.00% | 30 day supply |
| Outpatient Rehabilitation Services Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | 20.0 Visit(s) per Year 20 visits for Rehabilitation Speech Therapy and 20 visits combined for Rehabilitation Physical Therapy and Rehabilitation Occupational Therapy. |
| Habilitation Services Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | 20.0 Visit(s) per Year 20 visits for Rehabilitation Speech Therapy and 20 visits combined for Rehabilitation Physical Therapy and Rehabilitation Occupational Therapy. Applied Behavioral Analysis services are subject to medical necessity and will require an authorization. |
| Chiropractic Care Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | 20.0 Visit(s) per Year Visit limit is combined both across outpatient and other professional visits. Cost share is driven by provider/setting. 20 Visits per year. |
| Durable Medical Equipment Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Hearing Aids covered In-Network only for ages 1- 18 only. Limit 1 per ear every 48 months with a $3000 cap per ear every 48 months. |
| Hearing Aids Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Limited to a maximum of $3,000 for each hearing impaired ear through age 18 and for the replacement of one hearing aid per hearing impaired ear every 48 months |
| Imaging (CT/PET Scans, MRIs) Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Cost share is driven by provider/setting. |
| Preventive Care/Screening/Immunization Covered | No Charge Not Applicable | Not Applicable 100.00% | |
| Routine Foot Care Not Covered | |||
| Acupuncture Not Covered | |||
| Weight Loss Programs Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | 4.0 Visit(s) per Year Covered only for treatment of morbid obesity. Excluded Nutritional supplements; services, supplies and/or nutritional sustenance products. Limited to 4 visits per year. |
| Routine Eye Exam for Children Covered | $0.00 Copay after deductible Not Applicable | Not Applicable 100.00% | 1.0 Visit(s) per Year 1 Visit(s) per Year |
| Eye Glasses for Children Covered | $0.00 Copay after deductible Not Applicable | Not Applicable 100.00% | 1.0 Item(s) per Year 1 Item(s) per Year |
| Dental Check-Up for Children Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | 2.0 Visit(s) per Year 2 Visit(s) per Year |
| Rehabilitative Speech Therapy Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | 20.0 Visit(s) per Year 20 visits for Rehabilitation Speech Therapy.? |
| Rehabilitative Occupational and Rehabilitative Physical Therapy Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | 20.0 Visit(s) per Year 20 visits combined for Rehabilitation Physical Therapy and Rehabilitation Occupational Therapy. |
| Well Baby Visits and Care Covered | No Charge Not Applicable | Not Applicable 100.00% | Care provided for birth through age 5. |
| Laboratory Outpatient and Professional Services Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Cost share is driven by provider/setting. |
| X-rays and Diagnostic Imaging Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Cost share is driven by provider/setting. |
| Basic Dental Care – Child Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | |
| Orthodontia – Child Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Medically Necessary Orthodontia only |
| Major Dental Care – Child Covered | No Charge after deductible Not Applicable | Not Applicable 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 | |||
| Transplant Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | 10000.0 Dollars per Procedure In-Network Transplant Transportation and Lodging $10,000 Maximum benefit limit per Transplant Unrelated Donor Search $30,000 Maximum benefit limit per Transplant. |
| Accidental Dental Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Cost share is driven by provider/setting. |
| Dialysis Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Cost share is driven by provider/setting. |
| Allergy Testing Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Cost share is driven by provider/setting. |
| Chemotherapy Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Cost share is driven by provider/setting. |
| Radiation Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Cost share is driven by provider/setting. |
| Diabetes Education Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Cost share is driven by provider/setting. |
| Prosthetic Devices Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Wigs are limited to 1 (one) per year as needed after cancer treatment.? |
| Infusion Therapy Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Cost share is driven by provider/setting. |
| Treatment for Temporomandibular Joint Disorders Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | |
| Nutritional Counseling Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | 4.0 Visit(s) per Year Covered only for treatment of morbid obesity. Excluded Nutritional supplements; services, supplies and/or nutritional sustenance products. Limited to 4 visits per year. |
| Reconstructive Surgery Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | Reconstructive surgery is covered. Reconstructive surgery is performed to correct deformities caused by congenital or developmental abnormalities, illness, injury, or previous therapeutic process, for the purpose of improving bodily function or symptomatology or to create a normal appearance, including surgery performed to restore symmetry following mastectomy. Reconstructive services required due to prior therapeutic process are covered only if the original procedure would have been a covered service under the plan. |
| Gender Affirming Care | |||
| Clinical Trials Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | |
| Diabetes Care Management Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | |
| Off Label Prescription Drugs Covered | Not Applicable 0.00% Coinsurance after deductible | Not Applicable 100.00% | |
| Well Child Care Covered | No Charge Not Applicable | Not Applicable 100.00% | |
| Bone Marrow Testing Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | 10000.0 Dollars per Procedure In-Network Transplant Transportation and Lodging $10,000 Maximum benefit limit per Transplant Unrelated Donor Search $30,000 Maximum benefit limit per Transplant. |
| Heart Transplant Covered | No Charge after deductible Not Applicable | Not Applicable 100.00% | 10000.0 Dollars per Procedure In-Network Transplant Transportation and Lodging $10,000 Maximum benefit limit per Transplant Unrelated Donor Search $30,000 Maximum benefit limit per Transplant. |
Free Preventive Services
There is no copayment or coinsurance for any of the following Anthem Catastrophic Pathway X HMO 9450 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.
Preventive Care Benefits for All Adults
Preventive Care Benefits for Women
Preventive Care Benefits for Children
Preventive Care Benefits for All Adults
Preventive care benefits for adults
- Abdominal aortic aneurysm one-time screening for men of specified ages who have ever smoked
- Alcohol misuse screening and counseling
- Aspirin use to prevent cardiovascular disease and colorectal cancer for adults 50 to 59 years with a high cardiovascular risk
- Blood pressure screening
- Cholesterol screening for adults of certain ages or at higher risk
- Colorectal cancer screening for adults 45 to 75
- Depression screening
- Diabetes (Type 2) screening for adults 40 to 70 years who are overweight or obese
- Diet counseling for adults at higher risk for chronic disease
- Falls prevention (with exercise or physical therapy and vitamin D use) for adults 65 years and over, living in a community setting
- Hepatitis B screening for people at high risk, including people from countries with 2% or more Hepatitis B prevalence, and U.S.-born people not vaccinated as infants and with at least one parent born in a region with 8% or more Hepatitis B prevalence.
- Hepatitis C screening for adults age 18 to 79 years
- HIV screening for everyone age 15 to 65, and other ages at increased risk
- PrEP (pre-exposure prophylaxis) HIV prevention medication for HIV-negative adults at high risk for getting HIV through sex or injection drug use
- Immunizations for adults — doses, recommended ages, and recommended populations vary:
- Chickenpox (Varicella)
- Diphtheria
- Flu (influenza)
- Hepatitis A
- Hepatitis B
- Human Papillomavirus (HPV)
- Measles
- Meningococcal
- Mumps
- Whooping Cough (Pertussis)
- Pneumococcal
- Rubella
- Shingles
- Tetanus
- Lung cancer screening for adults 50 to 80 at high risk for lung cancer because they’re heavy smokers or have quit in the past 15 years
- Obesity screening and counseling
- Sexually transmitted infection (STI) prevention counseling for adults at higher risk
- Statin preventive medication for adults 40 to 75 at high risk
- Syphilis screening for adults at higher risk
- Tobacco use screening for all adults and cessation interventions for tobacco users
- Tuberculosis screening for certain adults without symptoms at high risk
Preventive Care Benefits for Women
Services for pregnant women or women who may become pregnant
- Breastfeeding support and counseling from trained providers, and access to breastfeeding supplies, for pregnant and nursing women
- Birth control: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, as prescribed by a health care provider for women with reproductive capacity (not including abortifacient drugs). This does not apply to health plans sponsored by certain exempt “religious employers.”
- Folic acid supplements for women who may become pregnant
- Gestational diabetes screening for women 24 weeks pregnant (or later) and those at high risk of developing gestational diabetes
- Gonorrhea screening for all women at higher risk
- Hepatitis B screening for pregnant women at their first prenatal visit
- Maternal depression screening for mothers at well-baby visits
- Preeclampsia prevention and screening for pregnant women with high blood pressure
- Rh incompatibility screening for all pregnant women and follow-up testing for women at higher risk
- Syphilis screening
- Expanded tobacco intervention and counseling for pregnant tobacco users
- Urinary tract or other infection screening
Other covered preventive services for women
- Bone density screening for all women over age 65 or women age 64 and younger that have gone through menopause
- Breast cancer genetic test counseling (BRCA) for women at higher risk
- Breast cancer mammography screenings
- Every 2 years for women 50 and over
- As recommended by a provider for women 40 to 49 or women at higher risk for breast cancer
- Breast cancer chemoprevention counseling for women at higher risk
- Cervical cancer screening
- Pap test (also called a Pap smear) for women age 21 to 65
- Chlamydia infection screening for younger women and other women at higher risk
- Diabetes screening for women with a history of gestational diabetes who aren’t currently pregnant and who haven’t been diagnosed with type 2 diabetes before
- Domestic and interpersonal violence screening and counseling for all women
- Gonorrhea screening for all women at higher risk
- HIV screening and counseling for everyone age 15 to 65, and other ages at increased risk
- PrEP (pre-exposure prophylaxis) HIV prevention medication for HIV-negative women at high risk for getting HIV through sex or injection drug use
- Sexually transmitted infections counseling for sexually active women
- Tobacco use screening and interventions
- Urinary incontinence screening for women yearly
- Well-woman visits to get recommended services for all women
Preventive Care Benefits for Children
Coverage for children’s preventive health services
- Alcohol, tobacco, and drug use assessments for adolescents
- Autism screening for children at 18 and 24 months
- Behavioral assessments for children: Age 0 to 17 years
- Bilirubin concentration screening for newborns
- Blood pressure screening for children: Age 0 to 17
- Blood screening for newborns
- Depression screening for adolescents beginning routinely at age 12
- Developmental screening for children under age 3
- Dyslipidemia screening for all children once between 9 and 11 years and once between 17 and 21 years, and for children at higher risk of lipid disorders
- Fluoride supplements for children without fluoride in their water source
- Fluoride varnish for all infants and children as soon as teeth are present
- Gonorrhea preventive medication for the eyes of all newborns
- Hearing screening for all newborns; and regular screenings for children and adolescents as recommended by their provider
- Height, weight and body mass index (BMI) measurements taken regularly for all children
- Hematocrit or hemoglobin screening for all children
- Hemoglobinopathies or sickle cell screening for newborns
- Hepatitis B screening for adolescents at higher risk
- HIV screening for adolescents at higher risk
- Hypothyroidism screening for newborns
- PrEP (pre-exposure prophylaxis) HIV prevention medication for HIV-negative adolescents at high risk for getting HIV through sex or injection drug use
Immunizations for children from birth to age 18 — doses, recommended ages, and recommended populations vary:
- Chickenpox (Varicella)
- Diphtheria, tetanus, and pertussis (DTaP)
- Haemophilus influenza type b
- Hepatitis A
- Hepatitis B
- Human Papillomavirus (HPV)
- Inactivated Poliovirus
- Influenza (flu shot)
- Measles
- Meningococcal
- Mumps
- Pneumococcal
- Rubella
- Rotavirus
Lead screening for children at risk of exposure
Obesity screening and counseling
- Oral health risk assessment for young children from 6 months to 6 years
- Phenylketonuria (PKU) screening for newborns
- Sexually transmitted infection (STI) prevention counseling and screening for adolescents at higher risk
- Tuberculin testing for children at higher risk of tuberculosis: Age 0 -17
- Vision screening for all children
- Well-baby and well-child visits
Additional Resources
Below are additional resources for Anthem Catastrophic Pathway X HMO 9450 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 HMO 9450?
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