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, 2021
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
|
Anthem BlueCross BlueShield of Indiana
Contact Us
(312) 726-6565
Agents available
Mon-Fri, 8am - 6pm
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