Benefit Snapshot
Below is a listing of our plan choices, including a sample of commonly used benefits and how they are covered under each plan. Each plan name has a unique four-letter code at the end. When filling out an application,make sure the entire plan name on the application (including the four letters) matches the plan you want to apply for. If you need more information about a certain benefit that is not listed here, please check with your Anthem Blue Cross Blue Shield (Anthem) authorized representative. You can also view and compare plans on anthem.com.
| Plan Name | Network Name | Calendar Year Deductible | Calendar Year Out-of-Pocket Limit | Office Visit: Primary Care Doctor | Preventive Care | Retail Prescription Drug Coverage | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Individual | Family | Individual | Family | Tier 1 | Tier 2 | Tier 3 | Tier 4 | ||||
| Anthem Bronze DirectAccess with HSA-cabp | Pathway X | $4,000 | $8,000 | $6,350 | $12,700 | 20% coinsurance | No cost to you | Deductible and 20% coinsurance applies | Deductible and 20% coinsurance applies | Deductible and 20% coinsurance applies | Deductible and 20% coinsurance applies |
| Anthem Bronze DirectAccess-cabr | Pathway X | $4,300 | $8,600 | $6,350 | $12,700 | $35 copay per visit for first 2 office visits, then deductible and 20% coinsurance applies | No cost to you | Deductible and 20% coinsurance applies | Deductible and 20% coinsurance applies | Deductible and 20% coinsurance applies | Deductible and 20% coinsurance applies |
| Anthem Bronze DirectAccess with Child Dental-cdbr | Pathway X | $4,300 | $8,600 | $6,350 | $12,700 | $35 copay for the first two office visits, then deductible and 20% coinsurance applies | No cost to you | Deductible and 20% coinsurance applies | Deductible and 20% coinsurance applies | Deductible and 20% coinsurance applies | Deductible and 20% coinsurance applies |
| Anthem Bronze DirectAccess-caaa | Pathway X | $5,750 | $11,500 | $6,350 | $12,700 | $40 copay per visit for first 2 office visits, then deductible and 20% coinsurance applies | No cost to you | $20 copay | $50 copay | Deductible and 20% coinsurance applies | Deductible and 20% coinsurance applies |
| Anthem Bronze DirectAccess-caae | Pathway X | $6,050 | $12,100 | $6,350 | $12,700 | $45 copay per visit for first 2 visits, then deductible and 25% coinsurance applies | No cost to you | $20 copay | $50 copay | Deductible and 25% coinsurance applies | Deductible and 25% coinsurance applies |
| Anthem Bronze DirectAccess with HSA-caar | Pathway X | $6,300 | $12,600 | $6,350 | $12,700 | 0% coinsurance | No cost to you | Deductible and 0% coinsurance applies | Deductible and 0% coinsurance applies | Deductible and 0% coinsurance applies | Deductible and 0% coinsurance applies |
| Anthem Silver DirectAccess-cbjc | Pathway X | $1,750 | $3,500 | $6,350 | $12,700 | $35 copay per visit for first 3 office visits, then deductible and 20% coinsurance applies | No cost to you | $15 copay | $40 copay | Deductible and 20% coinsurance applies | Deductible and 20% coinsurance applies |
| Anthem Silver DirectAccess-cbds | Pathway X | $2,500 | $5,000 | $6,350 | $12,700 | $40 copay per visit for first 3 office visits, then deductible and 10% coinsurance applies | No cost to you | $15 copay | $40 copay | Deductible and 10% coinsurance applies | Deductible and 10% coinsurance applies |
| Anthem Silver DirectAccess with HSA-cbbg | Pathway X | $3,000 | $6,000 | $3,600 | $7,200 | 10% coinsurance | No cost to you | Deductible and 10% coinsurance applies | Deductible and 10% coinsurance applies | Deductible and 10% coinsurance applies | Deductible and 10% coinsurance applies |
| Anthem Silver DirectAccess-cbaa | Pathway X | $3,500 | $7,000 | $4,500 | $9,000 | $45 copay, unlimited | No cost to you | $15 copay | $40 copay | Deductible and 0% coinsurance applies | Deductible and 0% coinsurance applies |
| Anthem Gold DirectAccess-ccab | Pathway X | $750 | $1,500 | $6,000 | $12,000 | $30 copay, unlimited | No cost to you | $15 copay | $40 copay | Deductible and 0% coinsurance applies | Deductible and 0% coinsurance applies |
| Anthem Gold DirectAccess with Chid Dental-cdcp | Pathway X | $750 | $1,500 | $6,000 | $12,000 | $30 copay, unlimited | No cost to you | $15 copay | $40 copay | Deductible and 0% coinsurance applies | Deductible and 0% coinsurance applies |
Preventive care services consist of services recommended by the United States Preventive Services Task Force, including well-child care, immunizations, PSA screenings, Pap tests, mammograms, and more.
These plans also include out-of-network benefits for services rendered by providers located in Missouri; emergency care, urgent care, and ambulance services; or services approved in advance by Anthem.
You may be able to get more cost-savings subsidies on Silver plans. Check with your Anthem authorized representative for more information and to find out if you qualify for a tax credit or subsidy.
These plans also include out-of-network benefits for services rendered by providers located in Missouri; emergency care, urgent care, and ambulance services; or services approved in advance by Anthem.
You may be able to get more cost-savings subsidies on Silver plans. Check with your Anthem authorized representative for more information and to find out if you qualify for a tax credit or subsidy.