Anthem BCBS offers health plans that can be customized for individuals, children, and families that include consumer-directed plans. Anthem no longer offers PPOs on the individual market. Starting in 2018 Anthem Indiana will only be offering one off-exchange plan in Benton, Newton, White, Jasper and Warren counties, available only to those who are 30 or younger.

Anthem Catastrophic Pathway X 7150

Indiana, 2018

Plan Type

HMO

Metal Tier

Catastrophic

Out of Pocket Maximum

$7,150

Deductible

$7,150

Emergency Room Care: No charge after deductible

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) $7,150
Deductible (Family) $14,300
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,150
Out of Pocket Maximum (Family) $14,300

Doctor Visits

Primary Care Visit $40 Copay before deductible
Specialist Visit No charge after deductible
Inpatient Facility No charge after deductible
Inpatient Physician No charge after deductible
Emergency Room Services No charge after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) No charge after deductible
Laboratory Outpatient and Professional Services No charge after deductible
X-Ray and Diagnostic Imaging No charge 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 No charge after deductible
Mental / Behavioral Health Outpatient No charge after deductible
Rehabilitative Speech Therapy No charge after deductible
Rehabilitative Occupational & Physical Therapy No charge after deductible
Outpatient Facility No charge after deductible
Outpatient Surgery No charge after deductible

Prescription Drugs

Generic Rx 0% Coinsurance after deductible
Preferred Brand Rx No charge after deductible
Non Preferred Brand Rx 0% Coinsurance after deductible
Specialty Drugs 0% Coinsurance after deductible
Contact Us
Phone: (312) 726-6565 Email: [email protected]

2017 Anthem Plans

Blue Cross Gold Plans

Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan (1GFE)
Network name Pathway X HMO/POS
Plan includes out-of-network coverage? No
Individual Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. $1,000
Individual CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max $7,150
Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services (percentage may vary for some covered services) 10%
Preventive care1 No additional cost to you.
Office visit: primary care physician (PCP)2,3 (Other office services may be subject to deductible and plan coinsurance) $30 copay
Office visit: specialist (Other office services may be subject to deductible and plan coinsurance) Deductible, then 10% coinsurance
Outpatient diagnostic tests (Ex. X-ray, EKG) Deductible, then 10% coinsurance
Outpatient advanced diagnostic tests (Ex. MRI, CT scan) Deductible, then $300 copay and 50% coinsurance
Urgent care Deductible, then $50 copay and 10% coinsurance
Emergency room care (Copay waived if admitted into the hospital from the emergency room.) Deductible, then $500 copay and 10% coinsurance
Hospital: inpatient admission (includes maternity, mental health / substance use) Deductible, then $500 copay and 50% coinsurance
Hospital: outpatient surgery hospital facility (includes maternity, mental health / substance use) Deductible, then 10% coinsurance
Pharmacy deductible3 (for tiers with deductible, cost share applies after deductible) Level 1 / Level 2 Pharmacy Tier 1, 2: No deductible Tier 3, 4: Medical deductible applies
Retail pharmacy tier 14: level 1 / level 2 $10 copay / $20 copay
Retail pharmacy tier 24: level 1 / level 2 $40 copay / $50 copay
Retail pharmacy tier 3: level 1 / level 2 40% coinsurance / 50% coinsurance
Retail pharmacy tier 4: level 1 / level 2 40% coinsurance / 50% coinsurance
Physical and occupational therapy (limits apply) Deductible, then 10% coinsurance
Speech therapy (limits apply) Deductible, then 10% coinsurance
Office visit: chiropractic (limits apply) Deductible, then 10% coinsurance

Blue Cross Silver Plans

Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan (1GFA) Anthem Silver Pathway X 2500 (1GF6)
Anthem Silver Pathway X for HSA (1GF2)
Network name Pathway X HMO/POS Pathway X HMO/POS
Pathway X HMO/POS
Plan includes out-of-network coverage? No No No
Individual Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. $2,000 $2,500 $3,000
Individual Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services $7,150 $7,150 $4,500
CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max (percentage may vary for some covered services) 20% 10% 10%
Preventive care1 No additional cost to you. No additional cost to you.
No additional cost to you.
Office visit: primary care physician (PCP)2,3 (Other office services may be subject to deductible and plan coinsurance) $35 copay per visit for the first 3 visits, then deductible and 20% coinsurance $40 copay per visit for the first 3 visits, then deductible and 10% coinsurance
Deductible, then 10% coinsurance
Office visit: specialist (Other office services may be subject to deductible and plan coinsurance) Deductible, then 20% coinsurance Deductible, then 10% coinsurance
Deductible, then 10% coinsurance
Outpatient diagnostic tests (Ex. X-ray, EKG) Deductible, then 20% coinsurance Deductible, then 10% coinsurance
Deductible, then 10% coinsurance
Outpatient advanced diagnostic tests (Ex. MRI, CT scan) Deductible, then $300 copay and 50% coinsurance Deductible, then $300 copay and 50% coinsurance
Deductible, then $300 copay and 50% coinsurance
Urgent care Deductible, then $50 copay and 20% coinsurance Deductible, then $50 copay and 10% coinsurance
Deductible, then $50 copay and 10% coinsurance
Emergency room care (Copay waived if admitted into the hospital from the emergency room.) Deductible, then $500 copay and 20% coinsurance Deductible, then $500 copay and 10% coinsurance
Deductible, then $500 copay and 10% coinsurance
Hospital: inpatient admission (includes maternity, mental health / substance use) Deductible, then $500 copay and 50% coinsurance Deductible, then $500 copay and 50% coinsurance
Deductible, then $500 copay and 50% coinsurance
Hospital: outpatient surgery hospital facility (includes maternity, mental health / substance use) Deductible, then 20% coinsurance Deductible, then 10% coinsurance
Deductible, then 10% coinsurance
Pharmacy deductible3 (for tiers with deductible, cost share applies after deductible) Level 1 / Level 2 Pharmacy Tier 1, 2: No deductible Tier 3, 4: Medical deductible applies Level 1 / Level 2 Pharmacy Tier 1, 2: No deductible Tier 3, 4: Medical deductible applies
Level 1 / Level 2 Pharmacy Tier 1, 2, 3, 4: Medical deductible applies
Retail pharmacy tier 14: level 1 / level 2 $10 copay / $20 copay $15 copay / $25 copay
10% coinsurance / 20% coinsurance
Retail pharmacy tier 24: level 1 / level 2 $50 copay / $60 copay $50 copay / $60 copay
10% coinsurance / 20% coinsurance
Retail pharmacy tier 3: level 1 / level 2 40% coinsurance / 50% coinsurance 40% coinsurance / 50% coinsurance
40% coinsurance / 50% coinsurance
Retail pharmacy tier 4: level 1 / level 2 40% coinsurance / 50% coinsurance 40% coinsurance / 50% coinsurance
40% coinsurance / 50% coinsurance
Physical and occupational therapy (limits apply) Deductible, then 20% coinsurance Deductible, then 10% coinsurance
Deductible, then 10% coinsurance
Speech therapy (limits apply) Deductible, then 20% coinsurance Deductible, then 10% coinsurance
Deductible, then 10% coinsurance
Office visit: chiropractic (limits apply) Deductible, then 20% coinsurance Deductible, then 10% coinsurance
Deductible, then 10% coinsurance
Anthem Silver Pathway X 3500 (1GEY) Anthem Silver Pathway X 4350 (1XA2)
Anthem Silver Core Pathway X 5300 (2EQD)
Network name Pathway X HMO/POS Pathway X HMO/POS
Pathway X HMO/POS
Plan includes out-of-network coverage? No No No
Individual deductible $3,500 $4,350 $5,300
Individual out-of-pocket limit $6,150 $5,700 $6,600
Coinsurance (percentage may vary for some covered services) 0% 30% 25%
Preventive care1 No additional cost to you. No additional cost to you.
No additional cost to you.
Office visit: primary care physician (PCP)2,3 (Other office services may be subject to deductible and plan coinsurance) $45 copay $25 copay $30 copay
Office visit: specialist (Other office services may be subject to deductible and plan coinsurance) Deductible, then 0% coinsurance $50 copay
Deductible, then 25% coinsurance
Outpatient diagnostic tests (Ex. X-ray, EKG) Deductible, then 0% coinsurance Deductible, then 30% coinsurance
Deductible, then 25% coinsurance
Outpatient advanced diagnostic tests (Ex. MRI, CT scan) Deductible, then $300 copay and 50% coinsurance Deductible, then $300 copay and 50% coinsurance
Deductible, then $300 copay and 50% coinsurance
Urgent care Deductible, then $50 copay $90 copay
Deductible, then $50 copay and 25% coinsurance
Emergency room care (Copay waived if admitted into the hospital from the emergency room.) Deductible, then $500 copay Deductible, then 30% coinsurance
Deductible, then $500 copay and 25% coinsurance
Hospital: inpatient admission (includes maternity, mental health / substance use) Deductible, then $500 copay and 50% coinsurance Deductible, then $500 copay and 50% coinsurance
Deductible, then $500 copay and 50% coinsurance
Hospital: outpatient surgery hospital facility (includes maternity, mental health / substance use) Deductible, then 0% coinsurance Deductible, then 30% coinsurance
Deductible, then 25% coinsurance
Pharmacy deductible3 (for tiers with deductible, cost share applies after deductible) Level 1 / Level 2 Pharmacy Tier 1, 2: No deductible Tier 3, 4: Medical deductible applies Level 1 / Level 2 Pharmacy Tier 1: No deductible Tier 2, 3, 4: $1,000 Combined pharmacy deductible
Level 1 / Level 2 Pharmacy Tier 1, 2: No deductible Tier 3, 4: Medical deductible applies
Retail Pharmacy tier 14: level 1 / level 2 $15 copay / $25 copay $10 copay / $20 copay
$10 copay / $20 copay
Retail pharmacy tier 24: level 1 / level 2 $50 copay / $60 copay $40 copay / $50 copay
$40 copay / $50 copay
Retail pharmacy tier 3: level 1 / level 2 40% coinsurance / 50% coinsurance 50% coinsurance / 50% coinsurance
40% coinsurance / 50% coinsurance
Retail pharmacy tier 4: level 1 / level 2 40% coinsurance / 50% coinsurance 50% coinsurance / 50% coinsurance
40% coinsurance / 50% coinsurance
Physical and occupational therapy (limits apply) Deductible, then 0% coinsurance Deductible, then 30% coinsurance
Deductible, then 25% coinsurance
Speech therapy (limits apply) Deductible, then 0% coinsurance Deductible, then 30% coinsurance
Deductible, then 25% coinsurance
Office visit: chiropractic (limits apply) Deductible, then 0% coinsurance Deductible, then 30% coinsurance
Deductible, then 25% coinsurance

Blue Cross Bronze Plans

Anthem Bronze Pathway X POS 5000 (1GEV) Anthem Bronze Pathway X 4950 (1XAE) Anthem Bronze Pathway X 20% for HSA (1GEW)
Network name Pathway X HMO/POS Pathway X HMO/POS Pathway X HMO/POS
Plan includes out-of-network coverage? Yes No No
Individual Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. $5,000 / $15,000 Network / Non-network $4,950 $5,200
Individual Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services $7,150 / $30,000 Network / Non-network $7,150 $6,550
CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max (percentage may vary for some covered services) 40% / 60% Network / Non-network 50% 20%
Preventive care1 No additional cost to you. No additional cost to you. No additional cost to you.
Office visit: primary care physician (PCP)2,3 (Other office services may be subject to deductible and plan coinsurance) $50 copay per visit for the first 2 visits, then deductible and 40% coinsurance Deductible, then 50% coinsurance Deductible, then 20% coinsurance
Office visit: specialist (Other office services may be subject to deductible and plan coinsurance) Deductible, then 40% coinsurance Deductible, then 50% coinsurance Deductible, then 20% coinsurance
Outpatient diagnostic tests (Ex. X-ray, EKG) Deductible, then 40% coinsurance Deductible, then 50% coinsurance Deductible, then 20% coinsurance
Outpatient advanced diagnostic tests (Ex. MRI, CT scan) Deductible, then $500 copay and 50% coinsurance Deductible, then $300 copay and 50% coinsurance Deductible, then $500 copay and 50% coinsurance
Urgent care Deductible, then $50 copay and 40% coinsurance Deductible, then $75 copay and 50% coinsurance Deductible, then $50 copay and 20% coinsurance
Emergency room care (Copay waived if admitted into the hospital from the emergency room.) Deductible, then $500 copay and 40% coinsurance Deductible, then $500 copay and 50% coinsurance Deductible, then $500 copay and 20% coinsurance
Hospital: inpatient admission (includes maternity, mental health / substance use) Deductible, then 50% coinsurance Deductible, then $1,500 copay and 50% coinsurance Deductible, then 20% coinsurance
Hospital: outpatient surgery hospital facility (includes maternity, mental health / substance use) Deductible, then 40% coinsurance Deductible, then 50% coinsurance Deductible, then 20% coinsurance
Pharmacy deductible3 (for tiers with deductible, cost share applies after deductible) Level 1 / Level 2 Pharmacy Tier 1, 2, 3, 4: Medical deductible applies Level 1 / Level 2 Pharmacy Tier 1, 2, 3, 4: Medical deductible applies Level 1 / Level 2 Pharmacy Tier 1, 2, 3, 4: Medical deductible applies
Retail pharmacy tier 14: level 1 / level 2 40% coinsurance / 50% coinsurance 40% coinsurance / 50% coinsurance 20% coinsurance / 30% coinsurance
Retail pharmacy tier 24: level 1 / level 2 40% coinsurance / 50% coinsurance 50% coinsurance / 50% coinsurance 20% coinsurance / 30% coinsurance
Retail pharmacy tier 3: level 1 / level 2 40% coinsurance / 50% coinsurance 50% coinsurance / 50% coinsurance 40% coinsurance / 50% coinsurance
Retail pharmacy tier 4: level 1 / level 2 40% coinsurance / 50% coinsurance 50% coinsurance / 50% coinsurance 40% coinsurance / 50% coinsurance
Physical and occupational therapy (limits apply) Deductible, then 40% coinsurance Deductible, then 50% coinsurance Deductible, then 20% coinsurance
Speech therapy (limits apply) Deductible, then 40% coinsurance Deductible, then 50% coinsurance Deductible, then 20% coinsurance
Office visit: chiropractic (limits apply) Deductible, then 40% coinsurance Deductible, then 50% coinsurance Deductible, then 20% coinsurance
Anthem Bronze Pathway X 5300 (1GEX) Anthem Bronze Pathway X 5850 (1XAB) Anthem Bronze Pathway X 6500 (1GET)
Network name Pathway X HMO/POS Pathway X HMO/POS Pathway X HMO/POS
Plan includes out-of-network coverage? No No No
Individual deductible $5,300 $5,850 $6,500
Individual out-of-pocket limit $7,150 $7,150 $7,150
Coinsurance (percentage may vary for some covered services) 20% 35% 30%
Preventive care1 No additional cost to you. No additional cost to you. No additional cost to you.
Office visit: primary care physician (PCP)2,3 (Other office services may be subject to deductible and plan coinsurance) $45 copay per visit for the first 2 visits, then deductible and 20% coinsurance Deductible, then 35% coinsurance $50 copay per visit for the first 2 visits, then deductible and 30% coinsurance
Office visit: specialist (Other office services may be subject to deductible and plan coinsurance) Deductible, then 20% coinsurance Deductible, then 35% coinsurance Deductible, then 30% coinsurance
Outpatient diagnostic tests (Ex. X-ray, EKG) Deductible, then 20% coinsurance Deductible, then 35% coinsurance Deductible, then 30% coinsurance
Outpatient advanced diagnostic tests (Ex. MRI, CT scan) Deductible, then $500 copay and 50% coinsurance Deductible, then $300 copay and 50% coinsurance Deductible, then $400 copay and 50% coinsurance
Urgent care Deductible, then $50 copay and 20% coinsurance Deductible, then $75 copay and 35% coinsurance Deductible, then $50 copay and 30% coinsurance
Emergency room care (Copay waived if admitted into the hospital from the emergency room.) Deductible, then $500 copay and 20% coinsurance Deductible, then $500 copay and 35% coinsurance Deductible, then $450 copay and 30% coinsurance
Hospital: inpatient admission (includes maternity, mental health / substance use) Deductible, then 20% coinsurance Deductible, then $1,000 copay and 50% coinsurance Deductible, then 30% coinsurance
Hospital: outpatient surgery hospital facility (includes maternity, mental health / substance use) Deductible, then 20% coinsurance Deductible, then 35% coinsurance Deductible, then 30% coinsurance
Pharmacy deductible3 (for tiers with deductible, cost share applies after deductible) Level 1 / Level 2 Pharmacy Tier 1, 2, 3, 4: Medical deductible applies Level 1 / Level 2 Pharmacy Tier 1, 2, 3, 4: Medical deductible applies Level 1 / Level 2 Pharmacy Tier 1, 2: No deductible Tier 3, 4: Medical deductible applies
Retail Pharmacy tier 14: level 1 / level 2 20% coinsurance / 30% coinsurance 35% coinsurance / 45% coinsurance $20 copay / $30 copay
Retail pharmacy tier 24: level 1 / level 2 20% coinsurance / 30% coinsurance 35% coinsurance / 45% coinsurance $80 copay / $90 copay
Retail pharmacy tier 3: level 1 / level 2 40% coinsurance / 50% coinsurance 40% coinsurance / 50% coinsurance 40% coinsurance / 50% coinsurance
Retail pharmacy tier 4: level 1 / level 2 40% coinsurance / 50% coinsurance 40% coinsurance / 50% coinsurance 40% coinsurance / 50% coinsurance
Physical and occupational therapy (limits apply) Deductible, then 20% coinsurance Deductible, then 35% coinsurance Deductible, then 30% coinsurance
Speech therapy (limits apply) Deductible, then 20% coinsurance Deductible, then 35% coinsurance Deductible, then 30% coinsurance
Office visit: chiropractic (limits apply) Deductible, then 20% coinsurance Deductible, then 35% coinsurance Deductible, then 30% coinsurance
Anthem Bronze Pathway X 0% for HSA (1GES)
Anthem Bronze Pathway X 7150 (1XAG)
Network name Pathway X HMO/POS
Pathway X HMO/POS
Plan includes out-of-network coverage? No No
Individual deductible $6,550 $7,150
Individual out-of-pocket limit $6,550 $7,150
Coinsurance (percentage may vary for some covered services) 0% 0%
Preventive care1 No additional cost to you.
No additional cost to you.
Office visit: primary care physician (PCP)2,3 (Other office services may be subject to deductible and plan coinsurance) Deductible, then 0% coinsurance
Deductible, then 0% coinsurance
Office visit: specialist (Other office services may be subject to deductible and plan coinsurance) Deductible, then 0% coinsurance
Deductible, then 0% coinsurance
Outpatient diagnostic tests (Ex. X-ray, EKG) Deductible, then 0% coinsurance
Deductible, then 0% coinsurance
Outpatient advanced diagnostic tests (Ex. MRI, CT scan) Deductible, then 0% coinsurance
Deductible, then 0% coinsurance
Urgent care Deductible, then 0% coinsurance
Deductible, then 0% coinsurance
Emergency room care (Copay waived if admitted into the hospital from the emergency room.) Deductible, then 0% coinsurance
Deductible, then 0% coinsurance
Hospital: inpatient admission (includes maternity, mental health / substance use) Deductible, then 0% coinsurance
Deductible, then 0% coinsurance
Hospital: outpatient surgery hospital facility (includes maternity, mental health / substance use) Deductible, then 0% coinsurance
Deductible, then 0% coinsurance
Pharmacy deductible3 (for tiers with deductible, cost share applies after deductible) Level 1 / Level 2 Pharmacy Tier 1, 2, 3, 4: Medical deductible applies
Level 1 / Level 2 Pharmacy Tier 1, 2, 3, 4: Medical deductible applies
Retail pharmacy tier 14: level 1 / level 2 0% coinsurance / 0% coinsurance
0% coinsurance / 0% coinsurance
Retail pharmacy tier 24: level 1 / level 2 0% coinsurance / 0% coinsurance
0% coinsurance / 0% coinsurance
Retail pharmacy tier 3: level 1 / level 2 0% coinsurance / 0% coinsurance
0% coinsurance / 0% coinsurance
Retail pharmacy tier 4: level 1 / level 2 0% coinsurance / 0% coinsurance
0% coinsurance / 0% coinsurance
Physical and occupational therapy (limits apply) Deductible, then 0% coinsurance
Deductible, then 0% coinsurance
Speech therapy (limits apply) Deductible, then 0% coinsurance
Deductible, then 0% coinsurance
Office visit: chiropractic (limits apply) Deductible, then 0% coinsurance
Deductible, then 0% coinsurance

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