Indiana health plan · 2025

Anthem Bronze Essential POS 5500 ($0 Virtual PCP + $0 Select Drugs + Incentives) · 17575IN0760005

Anthem Insurance Companies, Inc. offers this marketplace health insurance plan (Plan ID 17575IN0760005) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Expanded Bronze Plan type: POS CSR: Limited Cost Sharing Plan Variation Issuer: Anthem Insurance Companies, Inc.
Telehealth Data pending HSA eligible No Dental Child Vision Child
Pay / Manage Plan View issuer site

Issuer actuarial value: 62.26%. Expect to pay roughly 37.74% of covered costs out of pocket, based on issuer reporting.

CMS AV Calculator output: 62.38% (37.62% member share on average). Learn about AV methodology.

2025 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$168 – $898

Before subsidies

Estimate after subsidies

Deductible

$5,500

$11000 per group

See deductible details

Max out-of-pocket

$9,200

$18400 per group

Review MOOP rules

Office visits

Primary care $50.00, 40.00% Coinsurance after deductible
Specialist 40.00% Coinsurance after deductible
HSA Not eligible

Drug tiers

Generic 40.00% Coinsurance after deductible
Preferred brand 40.00% Coinsurance after deductible

View formulary tiers

$276 / mo before subsidies

≈ $3307 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$950 / mo before subsidies

≈ $11401 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$945 / mo before subsidies

≈ $11338 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$752 / mo before subsidies

≈ $9019 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

$500.00 Copay after deductible, 40.00% Coinsurance after deductible

Durable Medical Equipment

40.00% Coinsurance after deductible

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Enrollment guidance

Stay on top of 2025 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2025 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Indiana). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • Limited Cost Sharing Plan Variation plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

$500.00 Copay after deductible, 40.00% Coinsurance after deductible

Durable Medical Equipment

40.00% Coinsurance after deductible

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 17575IN0760005
Coverage year 2025
State Indiana
Issuer Anthem Insurance Companies, Inc.
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 17575IN0760005-03
Available variants

Standard Off Exchange Plan · 17575IN0760005-00

Standard On Exchange Plan · 17575IN0760005-01

Open to Indians below 300% FPL · 17575IN0760005-02

Open to Indians above 300% FPL · 17575IN0760005-03
Last plan update Sat, 22 Mar 2025 00:00 GMT
Last HealthPorta import Tue, 02 Dec 2025 06:13 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in Indiana 2
PCPs in Indiana N/A
Telehealth support Data pending
Nationwide providers 25
2 doctors statewide

Provider network(s)

Providers Indiana All US states
All 2 25
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists 1 14

Drug coverage overview

3,793 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
TIER-FOUR 3,793
Prior authorization Drugs
Required 807
Not Required 2,986
Step therapy Drugs
Required 104
Not Required 3,689
Quantity limits Drugs
Has Limit 2,174
No Limit 1,619

Customer highlights

What stands out for members

  • Issuer: Anthem Insurance Companies, Inc. · Plan ID 17575IN0760005 · 2025 filing.
  • Disease management programs available: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 17575IN0760005-03 (Open to Indians above 300% FPL) currently displayed.
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Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

Limit: 12.0 Visit(s) per Year

nan

Exclusions: nan

Diabetes Education

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Home Health Care Services

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

Limit: 100.0 Visit(s) per Year

nan

Exclusions: nan

Laboratory Outpatient and Professional Services

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Other Practitioner Office Visit (Nurse, Physician Assistant)

$50.00, 40.00% Coinsurance after deductible
Tier 1 in-network $50.00, 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

First 3 visits subject to copay. Visits 4+ subject to deductible and coinsurance. You have $0 virtual visits and medical chats using our preferred virtual care-only Primary Care Physicians (PCP). These services can be accessed via our Sydney application or member website.

Exclusions: nan

Preventive Care/Screening/Immunization

No Charge
Tier 1 in-network No Charge
Out-of-network 60.00% Coinsurance after deductible

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.

Exclusions: nan

Primary Care Visit to Treat an Injury or Illness

$50.00, 40.00% Coinsurance after deductible
Tier 1 in-network $50.00, 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

First 3 visits subject to copay. Visits 4+ subject to deductible and coinsurance. You have $0 virtual visits and medical chats using our preferred virtual care-only Primary Care Physicians (PCP). These services can be accessed via our Sydney application or member website.

Exclusions: nan

Rehabilitative Occupational and Rehabilitative Physical Therapy

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

Limit: 40.0 Visit(s) per Year

Limited to 20 visits each for Rehabilitative Physical, and Occupational Therapy. Cost share determined by service rendered.

Exclusions: nan

Rehabilitative Speech Therapy

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

Limit: 20.0 Visit(s) per Year

Cost share determined by services rendered.

Exclusions: nan

Specialist Visit

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

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 Sydney application.

Exclusions: nan

Urgent Care Centers or Facilities

$90.00
Tier 1 in-network $90.00
Out-of-network $90.00

nan

Exclusions: nan

X-rays and Diagnostic Imaging

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Delivery and All Inpatient Services for Maternity Care

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Dialysis

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Durable Medical Equipment

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

Wigs limited to the first one following cancer treatment.

Exclusions: nan

Emergency Room Services

$500.00 Copay after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network $500.00 Copay after deductible, 40.00% Coinsurance after deductible
Out-of-network $500.00 Copay after deductible, 40.00% Coinsurance after deductible

nan

Exclusions: nan

Emergency Transportation/Ambulance

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 40.00% Coinsurance after deductible

Non-emergency ambulance/transportation out of network is not covered unless authorized. Authorized out of network is limited to $50,000 per trip.

Exclusions: nan

Hospice Services

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Inpatient Hospital Services (e.g., Hospital Stay)

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

Maximum 60 days per Benefit Period for Physical Medicine and Rehabilitation (includes Day Rehabilitation Therapy services on an Outpatient basis).

Exclusions: nan

Inpatient Physician and Surgical Services

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Mental/Behavioral Health Inpatient Services

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Mental/Behavioral Health Outpatient Services

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

Cost share determined by services rendered.

Exclusions: nan

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Outpatient Rehabilitation Services

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

Limit: 60.0 Visit(s) per Year

Limited to 20 visits each for Rehabilitative Physical, Occupational and Speech Therapy. Limited to 36 visits for Cardiac Rehabilitation. Cost share determined by service rendered.

Exclusions: nan

Outpatient Surgery Physician/Surgical Services

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Radiation

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Skilled Nursing Facility

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

Limit: 90.0 Days per Year

nan

Exclusions: nan

Substance Abuse Disorder Inpatient Services

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Substance Abuse Disorder Outpatient Services

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

Cost share determined by services rendered.

Exclusions: nan

Transplant

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

$10,000 limit per transplant for transportation and lodging. Unrelated Donor Search is Limited to a maximum of the 10 best matched donors, identified by an authorized registry.

Exclusions: nan

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Hearing Aids

Coverage details pending

nan

Exclusions: nan

Major Dental Care - Child

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Prenatal and Postnatal Care

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Routine Eye Exam for Children

No Charge
Tier 1 in-network No Charge
Out-of-network $0.00

Limit: 1.0 Visit(s) per Benefit Period

Limited reimbursement up to maximum allowable for all services. Eye exams are covered once per benefit period. Limit is combined in network and out of network across all outpatient settings.

Exclusions: nan

Well Baby Visits and Care

No Charge
Tier 1 in-network No Charge
Out-of-network 60.00% Coinsurance after deductible

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.

Exclusions: nan

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Tier 2 in-network 55.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

Cost share shown is for a 30 day supply.

Exclusions: nan

Non-Preferred Brand Drugs

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Tier 2 in-network 55.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

Cost share shown is for a 30 day supply.

Exclusions: nan

Preferred Brand Drugs

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Tier 2 in-network 55.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

Cost share shown is for a 30 day supply.

Exclusions: nan

Specialty Drugs

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Tier 2 in-network 55.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

Cost share shown is for a 30 day supply.

Exclusions: nan

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

Limit: 3000.0 Dollars per Episode

Limit is combined in network and out of network.

Exclusions: nan

Basic Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Dental Anesthesia

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

Limited to Accidental Dental or a Member less than 19 years of age or a Member with intellectual or physical disability, are covered if the Member requires dental treatment to be given in a Hospital or Outpatient Ambulatory Surgical Facility.

Exclusions: nan

Dental Check-Up for Children

No Charge after deductible
Tier 1 in-network No Charge after deductible
Out-of-network 30.00% Coinsurance after deductible

Limit: 2.0 Visit(s) per Year

nan

Exclusions: nan

Infusion Therapy

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Major Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Nutritional Counseling

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

Covered under preventive guidelines and for diabetes. Cost share is driven by provider/setting.

Exclusions: nan

Orthodontia - Adult

Coverage details pending

nan

Exclusions: nan

Orthodontia - Child

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Prosthetic Devices

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Routine Dental Services (Adult)

Coverage details pending

nan

Exclusions: nan

Weight Loss Programs

Coverage details pending

nan

Exclusions: nan

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

Covered only in the case of rape or incest, or for a pregnancy which, as certified by a doctor, places the woman in danger of death unless an abortion is performed (i.e., abortions for which federal funding is allowed).

Exclusions: nan

Acupuncture

Coverage details pending

nan

Exclusions: nan

Allergy Testing

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

nan

Exclusions: nan

Bariatric Surgery

Coverage details pending

nan

Exclusions: nan

Cosmetic Surgery

Coverage details pending

nan

Exclusions: nan

Eye Glasses for Children

No Charge
Tier 1 in-network No Charge
Out-of-network $0.00

Limit: 1.0 Item(s) per Year

Limited reimbursement up to maximum allowable for all services. Eye glasses are covered once per benefit period. Limit is combined in network and out of network across all outpatient settings.

Exclusions: nan

Gender Affirming Care

Coverage details pending

nan

Exclusions: nan

Habilitation Services

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

Limit: 60.0 Visit(s) per Year

Cost share is driven by provider/setting. Habilitation and rehabilitation visits count toward the rehabilitation limit. PT, OT and ST include an additional 20 visits each for habilitative services. Limits are not combined but separate based on determination of Habilitative Service or Rehabilitative Service) for both in and out of network services.. The limits do not apply to Mental Health and Substance Abuse conditions.

Exclusions: nan

Imaging (CT/PET Scans, MRIs)

$500.00 Copay after deductible, 50.00% Coinsurance after deductible
Tier 1 in-network $500.00 Copay after deductible, 50.00% Coinsurance after deductible
Out-of-network $1000.00 Copay after deductible, 60.00% Coinsurance after deductible

nan

Exclusions: nan

Infertility Treatment

Coverage details pending

nan

Exclusions: nan

Long-Term/Custodial Nursing Home Care

Coverage details pending

nan

Exclusions: nan

Private-Duty Nursing

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

Limit: 82.0 Visit(s) per Year

Private Duty Nursing care provided in home setting is limited to a maximum of 82 visits per Member, per Calendar Year and a maximum of 164 visits per Member, per lifetime.

Exclusions: nan

Reconstructive Surgery

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

Reconstruction is covered when required following a mastectomy and certain other deformities caused by disease, trauma, congenital anomalies and previous therapeutic process.

Exclusions: nan

Routine Eye Exam (Adult)

Coverage details pending

nan

Exclusions: nan

Routine Foot Care

Coverage details pending

nan

Exclusions: nan

Treatment for Temporomandibular Joint Disorders

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 60.00% Coinsurance after deductible

Services do not include fixed or removable appliances that involve movement or repositioning of the teeth, repair of teeth (fillings), or prosthetics (crowns, bridges, dentures).

Exclusions: nan

Variant attributes

Anthem Bronze Essential POS 5500 ($0 Virtual PCP + $0 Select Drugs + Incentives) · Variant 17575IN0760005-03

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

Limited Cost Sharing Plan Variation

HIOS Product ID

17575IN076

Metal Level

Expanded Bronze

Plan ID (Standard Component ID with Variant)

17575IN0760005-03

Plan Marketing Name

Anthem Bronze Essential POS 5500 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Plan Variant Marketing Name

Anthem Bronze Essential POS 5500 ($0 Virtual PCP + $0 Select Drugs + Incentives) S03

Issuer & service area

Issuer-provided metadata for this variant.

Issuer Actuarial Value

62.26%

Issuer ID

17575

Issuer Marketplace Marketing Name

Anthem Blue Cross and Blue Shield

Market Coverage

Individual

Multiple In Network Tiers

Yes

National Network

No

Network ID

INN005

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

Service Area ID

INS021

State Code

IN

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

0.62379672057077

Begin Primary Care Deductible Coinsurance After Number Of Copays

3

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

Yes

Medical Drug Maximum Out of Pocket Integrated

Yes

SBC Scenario, Having a Baby, Coinsurance

$3,500

SBC Scenario, Having a Baby, Copayment

$0

SBC Scenario, Having a Baby, Deductible

$5,500

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$100

SBC Scenario, Having Diabetes, Deductible

$5,200

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

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, In Network (Tier 1), Default Coinsurance

40.00%

Combined Medical and Drug EHB Deductible, In Network (Tier 2), Default Coinsurance

40.00%

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

$55200 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person

$27600 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

$27,600

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

INF517

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$60

SBC Scenario, Having Diabetes, Limit

$20

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

0

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Dental Only Plan

No

Design Type

Not Applicable

Disease Management Programs Offered

Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management

EHB Percent of Total Premium

1.0

First Tier Utilization

71%

Import Date

2025-03-22 02:01:57

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

Existing

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

No

Plan Effective Date

2025-01-01

Plan Expiration Date

2025-12-31

Plan Type

POS

QHP/Non QHP

Both

Second Tier Utilization

29%

Source Name

HIOS

Plan ID

17575IN0760005

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), Family Per Group

$11000 per group

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person

$5500 per person

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual

$5,500

Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Group

$11000 per group

Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Person

$5500 per person

Combined Medical and Drug EHB Deductible, In Network (Tier 2), Individual

$5,500

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group

$33000 per group

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person

$16500 per person

Combined Medical and Drug EHB Deductible, Out of Network, Individual

$16,500

Unique Plan Design

Yes

Wellness Program Offered

No

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in Indiana?

Anthem Bronze Essential POS 5500 ($0 Virtual PCP + $0 Select Drugs + Incentives) (17575IN0760005) is a Expanded Bronze POS from Anthem Insurance Companies, Inc. in Indiana for the 2025 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does Anthem Bronze Essential POS 5500 ($0 Virtual PCP + $0 Select Drugs + Incentives) support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is Anthem Bronze Essential POS 5500 ($0 Virtual PCP + $0 Select Drugs + Incentives) HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental add-ons: Child.

Vision add-ons: Child.

Does Anthem Bronze Essential POS 5500 ($0 Virtual PCP + $0 Select Drugs + Incentives) support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with Anthem Bronze Essential POS 5500 ($0 Virtual PCP + $0 Select Drugs + Incentives)?

The issuer lists disease management resources for: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management.

Is there out-of-country coverage for Anthem Bronze Essential POS 5500 ($0 Virtual PCP + $0 Select Drugs + Incentives)?

No, out-of-country services are not covered for this plan. Details: Urgent/Emergency Coverage Only

Does Anthem Bronze Essential POS 5500 ($0 Virtual PCP + $0 Select Drugs + Incentives) cover care outside the service area?

No, the issuer indicates out-of-service-area care is not covered except for emergencies. Details: TRAD/PAR network

How do I enroll in or manage payments for Anthem Bronze Essential POS 5500 ($0 Virtual PCP + $0 Select Drugs + Incentives)?

Use the issuer portal https://payment.anthem.com/sales/payment/exchange?state=IN to pay premiums or start enrollment, then return to HealthPorta for benefit comparisons.

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
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