Anthem Catastrophic Pathway HMO 9200 - 29276OH0920425 Health Insurance Plan
Community Insurance Company(Anthem BCBS) health insurance plan with the Plan ID 29276OH0920425. The plan is called Anthem Catastrophic Pathway HMO 9200.
| Health Insurance Plan ID | 29276OH0920425 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2025 | ||||||||||||||||||
| State | Ohio | ||||||||||||||||||
| Health Insurance Issuer | Community Insurance Company(Anthem BCBS) | ||||||||||||||||||
| Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 29276OH0920425-01 | ||||||||||||||||||
| Provider Network(s) | PARTICIPATING | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 03 Dec 2024 06:24 GMT). |
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| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Wed, 16 Oct 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 03 Dec 2024 06:24 GMT |
Benefits of Anthem Catastrophic Pathway HMO 9200 Health Insurance Plan, 29276OH0920425-01
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Abortion for Which Public Funding is Prohibited
no coverage except limited to therapeutic coverage (only in case of rape, incest or health of mother) |
NO | ||
| Accidental Dental
Limit: 3000.0 Dollars per Episode Exclusions: Damage to teeth due to chewing or biting is not deemed an accidental injury and is not covered. Cost share will vary by the specific service rendered. Accident must have occurred on or after your effective date and treatment within 12 months of an accidental injury. |
YES | No Charge after deductible |
100.00% |
| Acupuncture
|
NO | ||
| Allergy Testing
|
YES | No Charge after deductible |
100.00% |
| Bariatric Surgery
|
NO | ||
| Basic Dental Care - Adult
|
NO | ||
| Basic Dental Care - Child
|
YES | No Charge after deductible |
100.00% |
| Chemotherapy
Cost share will vary by the specific service rendered. |
YES | No Charge after deductible |
100.00% |
| Chiropractic Care
Limit: 12.0 Visit(s) per Year Limit is combined across professional visits and outpatient facilities for Osteopathic/Chiropractic Manipulation Therapy. These services are not covered in the home. |
YES | No Charge after deductible |
100.00% |
| Cosmetic Surgery
|
NO | ||
| Delivery and All Inpatient Services for Maternity Care
Coverage includes inpatient maternity care in a Hospital for the mother, and inpatient newborn care in a Hospital for the infant, for at least 48 hours following a normal delivery and at least 96 hours following a caesarean section delivery, regardless of whether such care is Medically Necessary. Covered services include at-home post delivery care visits at your residence by a Physician or Nurse performed no later than 72 hours following you and your newborn child?s discharge from the hospital. |
YES | No Charge after deductible |
100.00% |
| Dental Check-Up for Children
Limit: 2.0 Visit(s) per Year |
YES | No Charge after deductible |
100.00% |
| Diabetes Education
|
YES | No Charge after deductible |
100.00% |
| Dialysis
|
YES | No Charge after deductible |
100.00% |
| Durable Medical Equipment
Wigs are limited to 1 wig per Member, per Benefit Period after cancer treatment. Coverage includes 4 surgical bras per benefit period. |
YES | No Charge after deductible |
100.00% |
| Emergency Room Services
Copay waived if admitted. |
YES | No Charge after deductible |
No Charge after deductible |
| Emergency Transportation/Ambulance
Nonemergency Ambulance Services must be Preauthorized by Us. |
YES | No Charge after deductible |
No Charge after deductible |
| Eye Glasses for Children
Limit: 1.0 Item(s) per Year |
YES | $0.00 Copay after deductible |
100.00% |
| Gender Affirming Care
|
NO | ||
| Generic Drugs
Cost share reflects a 30 day retail supply |
YES | 0.00% Coinsurance after deductible |
100.00% |
| Habilitation Services
Benefits include treatment of Autism Spectrum disorder for children ages 0-21. Applied Behavioral Analysis is limited to 20 hours per week. Limit is combined across professional visits and outpatient facilities. |
YES | No Charge after deductible |
100.00% |
| Hearing Aids
Cochlear implants are covered as durable medical equipment (DME). |
NO | ||
| Home Health Care Services
Limit: 100.0 Visit(s) per Year Benefit limit does not apply to Home Infusion Therapy or Home Dialysis.? Private Duty Nursing is only covered through Home Health Care Services and is limited to 90 visits per calendar year, which is separate from the 100 visits a year limit for "other" Home Health Care services. Benefit limit does not apply to Physical, Occupational or Speech Therapy when performed as part of Home Health. |
YES | No Charge after deductible |
100.00% |
| Hospice Services
|
YES | No Charge after deductible |
100.00% |
| Imaging (CT/PET Scans, MRIs)
|
YES | No Charge after deductible |
100.00% |
| Infertility Treatment
Includes services to diagnose and treat MEDICAL conditions resulting in infertility. Excludes: Artificial insemination, in vitro fertilization, other types of artificial or surgical means of conception including drugs administered in connection with these procedures. |
YES | No Charge after deductible |
100.00% |
| Infusion Therapy
Home IV therapy includes but is not limited to: injections (intra-muscular, subcutaneous, continuous subcutaneous), Total Parenteral Nutrition (TPN), Enteral nutrition therapy, antibiotic therapy, pain management and chemotherapy. Home Infusion Therapy is not included in the Home Health Care visit maximum |
YES | No Charge after deductible |
100.00% |
| Inpatient Hospital Services (e.g., Hospital Stay)
Inpatient Physical Medicine and Rehabilitation (includes Day Rehabilitation Therapy services on an Outpatient basis) is limited to a maximum of 60 days per member, per calendar year. Coverage includes inpatient maternity care in a hospital for the mother, and inpatient newborn care in a hospital for the infant, for at least 48 hours following a normal delivery and at least 96 hours following a caesarean section delivery, regardless of whether such care is medically necessary. |
YES | No Charge after deductible |
100.00% |
| Inpatient Physician and Surgical Services
|
YES | No Charge after deductible |
100.00% |
| Laboratory Outpatient and Professional Services
|
YES | No Charge after deductible |
100.00% |
| Long-Term/Custodial Nursing Home Care
|
NO | ||
| Major Dental Care - Adult
|
NO | ||
| Major Dental Care - Child
|
YES | No Charge after deductible |
100.00% |
| Mental/Behavioral Health Inpatient Services
|
YES | No Charge after deductible |
100.00% |
| Mental/Behavioral Health Outpatient Services
|
YES | No Charge after deductible |
100.00% |
| Non-Preferred Brand Drugs
Cost share reflects a 30 day retail supply |
YES | 0.00% Coinsurance after deductible |
100.00% |
| Nutritional Counseling
Covered benefit under Home Health Services or covered as US Preventive Services Task Force (USPSTF) A or B recommendation under preventive health services, which includes diet counseling for adults at higher risk for chronic disease, obesity screening and counseling for all adults, and healthy diet counseling for adults with cardiovascular risk factors. |
YES | No Charge after deductible |
100.00% |
| Orthodontia - Adult
|
NO | ||
| Orthodontia - Child
|
YES | No Charge after deductible |
100.00% |
| Other Practitioner Office Visit (Nurse, Physician Assistant)
First 3 visits subject to copay only. Visits 4+ are subject to the deductible. |
YES | $40.00, No Charge after deductible |
100.00% |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
|
YES | No Charge after deductible |
100.00% |
| Outpatient Rehabilitation Services
Limit: 116.0 Visit(s) per Year 20 visits each Physical Therapy, Occupational Therapy, Speech Therapy, Pulmonary Rehabilitation. 36 visits for Cardiac Rehabilitation. Limit is combined across professional visits and outpatient facilities. |
YES | No Charge after deductible |
100.00% |
| Outpatient Surgery Physician/Surgical Services
|
YES | No Charge after deductible |
100.00% |
| Preferred Brand Drugs
Cost share reflects a 30 day retail supply |
YES | 0.00% Coinsurance after deductible |
100.00% |
| Prenatal and Postnatal Care
Services related to surrogacy are excluded if the member is not the surrogate. |
YES | No Charge after deductible |
100.00% |
| Preventive Care/Screening/Immunization
You may have to pay for services that aren't preventive. Ask your provider if the services needed are preventive. Then check what your plan will pay for. |
YES | No Charge |
100.00% |
| Primary Care Visit to Treat an Injury or Illness
First 3 visits subject to copay only. Visits 4+ are subject to the deductible. |
YES | $40.00, No Charge after deductible |
100.00% |
| Private-Duty Nursing
Limit: 90.0 Visit(s) per Year Private Duty Nursing is only covered through Home Health Care Services and is limited to 90 visits per calendar year. |
YES | No Charge after deductible |
100.00% |
| Prosthetic Devices
Benefits for artificial substitutes for body parts and tissues and materials inserted into tissue for functional or therapeutic purposes. Covered Services include purchase, fitting, needed adjustment, repairs, and replacements of prosthetic devices and supplies that 1) Replace all or part of a missing body part and its adjoining tissues; or 2) Replace all or part of the function of a permanently useless or malfunctioning body part. |
YES | No Charge after deductible |
100.00% |
| Radiation
|
YES | No Charge after deductible |
100.00% |
| Reconstructive Surgery
Cost shares may vary based on the setting in which Covered Services are received. |
YES | No Charge after deductible |
100.00% |
| Rehabilitative Occupational and Rehabilitative Physical Therapy
Limit: 40.0 Visit(s) per Year 20 visits per person per year for Physical Therapy and a separate 20 visits for Occupational Therapies. Autism limits are separate from Rehabilitation limits for Physical and Speech Therapy. Limit is combined across professional visits and outpatient facilities. |
YES | No Charge after deductible |
100.00% |
| Rehabilitative Speech Therapy
Limit: 20.0 Visit(s) per Year Autism limits are separate from Rehabilitation limits for Physical and Speech Therapy. Limit is combined across professional visits and outpatient facilities. |
YES | No Charge after deductible |
100.00% |
| Routine Dental Services (Adult)
|
NO | ||
| Routine Eye Exam (Adult)
|
NO | ||
| Routine Eye Exam for Children
Limit: 1.0 Exam(s) per Year |
YES | $0.00 Copay after deductible |
100.00% |
| Routine Foot Care
|
NO | ||
| Skilled Nursing Facility
Limit: 90.0 Days per Year Custodial or residential care in a skilled nursing facility or any other facility is not covered except when rendered as part of hospice care. |
YES | No Charge after deductible |
100.00% |
| Specialist Visit
|
YES | No Charge after deductible |
100.00% |
| Specialty Drugs
Cost share reflects a 30 day retail supply |
YES | 0.00% Coinsurance after deductible |
100.00% |
| Substance Abuse Disorder Inpatient Services
|
YES | No Charge after deductible |
100.00% |
| Substance Abuse Disorder Outpatient Services
|
YES | No Charge after deductible |
100.00% |
| Transplant
Transportation and lodging limited to $10000/transplant per benefit paid. The Plan will provide assistance with reasonable and necessary travel expenses when patient is required to travel more than 75 miles from residence to reach the facility where the Covered Transplant Procedure will be performed. If the Member receiving treatment is a minor, then reasonable and necessary expenses for transportation and lodging may be allowed for two companions. Unrelated Donor Search is Limited to a maximum of the 10 best matched donors, identified by an authorized registry |
YES | No Charge after deductible |
100.00% |
| Treatment for Temporomandibular Joint Disorders
|
YES | No Charge after deductible |
100.00% |
| Urgent Care Centers or Facilities
Urgent Care center services received outside of the service area are not covered, unless the service is rendered at a BlueCard facility. If out of area Urgent Care services are rendered at a BlueCard facility, the cost share is the same as In Network. |
YES | No Charge after deductible |
100.00% |
| Weight Loss Programs
|
NO | ||
| Well Baby Visits and Care
|
YES | No Charge |
100.00% |
| X-rays and Diagnostic Imaging
|
YES | No Charge after deductible |
100.00% |
Anthem Catastrophic Pathway X HMO 9200 Health Insurance Plan Variant 29276OH0920425-01 Attributes
| Plan Attribute | Value |
|---|---|
| Begin Primary Care Cost-Sharing After Number Of Visits | 0 |
| Begin Primary Care Deductible Coinsurance After Number Of Copays | 3 |
| Business Year | 2025 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Catastrophic On Exchange Plan |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| Disease Management Programs Offered | Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management |
| EHB Percent of Total Premium | 1.0 |
| First Tier Utilization | 61% |
| Formulary ID | OHF501 |
| Formulary URL | URL |
| HIOS Product ID | 29276OH092 |
| Import Date | 2024-10-16 20:01:50 |
| Limited Cost Sharing Plan Variation - Estimated Advanced Payment | $0.00 |
| Inpatient Copayment Maximum Days | 0 |
| HSA Eligible | No |
| New/Existing Plan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer ID | 29276 |
| Issuer Marketplace Marketing Name | Anthem Blue Cross and Blue Shield |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Catastrophic |
| Multiple In Network Tiers | Yes |
| National Network | No |
| Network ID | OHN001 |
| 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 |
| Plan Brochure | URL |
| Plan Effective Date | 2025-01-01 |
| Plan Expiration Date | 2025-12-31 |
| Plan ID (Standard Component ID with Variant) | 29276OH0920425-01 |
| Plan Marketing Name | Anthem Catastrophic Pathway HMO 9200 |
| Plan Type | HMO |
| Plan Variant Marketing Name | Anthem Catastrophic Pathway X HMO 9200 |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $9,200 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $100 |
| SBC Scenario, Having Diabetes, Deductible | $5,200 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $2,800 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Second Tier Utilization | 39% |
| Service Area ID | OHS001 |
| Source Name | SERFF |
| Plan ID | 29276OH0920425 |
| State Code | OH |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group | per group not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person | per person not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual | Not Applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group | per group not applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person | per person not applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 0.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group | $18400 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person | $9200 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $9,200 |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Default Coinsurance | 0.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Group | $18400 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Person | $9200 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Individual | $9,200 |
| Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group | per group not applicable |
| Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person | per person not applicable |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | Not Applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group | $18400 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $9200 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $9,200 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Group | $18400 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Person | $9200 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual | $9,200 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group | per group not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person | per person not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | Not Applicable |
| Unique Plan Design | Yes |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
| Wellness Program Offered | No |
Copay & Coinsurance of Anthem Catastrophic Pathway HMO 9200 Health Insurance Plan, 29276OH0920425
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about Anthem Catastrophic Pathway HMO 9200, 29276OH0920425 Health Insurance Plan, 29276OH0920425
-
Does Anthem Catastrophic Pathway HMO 9200 Health Insurance Plan, 29276OH0920425 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (29276OH0920425) Health Insurance Plan, Variant (29276OH0920425-01) offer Disease Management Programs?
Does (29276OH0920425) Health Insurance Plan, Variant (29276OH0920425-01) have Out Of Country Coverage?
Does (29276OH0920425) Health Insurance Plan, Variant (29276OH0920425-01) have Out of Service Area Coverage?
Does (29276OH0920425) Health Insurance Plan, Variant (29276OH0920425-01) offer Disease Management Programs?
Does Anthem Catastrophic Pathway X HMO 9200 Health Insurance Plan, Variant (29276OH0920425-01) offer Disease Management Programs for Asthma?
Does Anthem Catastrophic Pathway X HMO 9200 Health Insurance Plan, Variant (29276OH0920425-01) offer Disease Management Programs for Heart disease?
Does Anthem Catastrophic Pathway X HMO 9200 Health Insurance Plan, Variant (29276OH0920425-01) offer Disease Management Programs for Depression?
Does Anthem Catastrophic Pathway X HMO 9200 Health Insurance Plan, Variant (29276OH0920425-01) offer Disease Management Programs for Diabetes?
Does Anthem Catastrophic Pathway X HMO 9200 Health Insurance Plan, Variant (29276OH0920425-01) offer Disease Management Programs for High blood pressure & high cholesterol?
Does Anthem Catastrophic Pathway X HMO 9200 Health Insurance Plan, Variant (29276OH0920425-01) offer Disease Management Programs for Low back pain?
Disclaimer: This is based on the import(Date: Tue, 03 Dec 2024 06:24 GMT) of the data from Healthcare Issuers listed by CMS. While we make every effort to ensure that data is accurate, you should assume all results are unvalidated. Source: CMS.gov, HealthPorta HEALTHCARE MRF API