Anthem Catastrophic Pathway 9200 (+ Incentives) - 32753MO0950016 Health Insurance Plan

Healthy Alliance Life Co(Anthem BCBS) health insurance plan with the Plan ID 32753MO0950016. The plan is called Anthem Catastrophic Pathway 9200 (+ Incentives).

Health Insurance Plan ID 32753MO0950016
Health Insurance Plan Year 2025
State Missouri
Health Insurance Issuer Healthy Alliance Life Co(Anthem BCBS)
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 32753MO0950016-00
Provider Network(s) PARTICIPATING
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 10 Dec 2024 06:32 GMT).

Providers Missouri All US States
All 19547 110691
PCP 3125 4111
Allergy 16 20
OB/GYN 103 182
Dentists 919 57605
Available Variants of the Health Plan

Standard Off Exchange Plan - 32753MO0950016-00

Standard On Exchange Plan - 32753MO0950016-01

Last Plan Update Date Thu, 31 Oct 2024 00:00 GMT
Last Import Date Tue, 10 Dec 2024 06:32 GMT

Benefits of Anthem Catastrophic Pathway 9200 (+ Incentives) Health Insurance Plan, 32753MO0950016-00

Benefit Covered In Network Out Of Network
Abortion for Which Public Funding is Prohibited
NO
Accidental Dental

Limit: 3000.0 Dollars per Episode

YES

No Charge after deductible

100.00%
Acupuncture
NO
Allergy Testing
YES

No Charge after deductible

100.00%
Applied Behavior Analysis Based Therapies

Limited to members through 18 years of age.

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%
Bone Marrow Testing

a Member who is severely disabled and a Member who has a medical or behavioral condition that requires hospitalization or general anesthesia when dental services are provided.

YES

No Charge after deductible

100.00%
Chemotherapy
YES

No Charge after deductible

100.00%
Chiropractic Care

Limit: 26.0 Visit(s) per Year

Chiropractic Manipulation Therapy visits beyond the 26 visit limit require Prior Authorization from Anthem in order to be covered.

YES

No Charge after deductible

100.00%
Clinical Trials
YES

No Charge after deductible

100.00%
Cosmetic Surgery
NO
Delivery and All Inpatient Services for Maternity Care
YES

No Charge after deductible

100.00%
Dental Anesthesia

Benefits are provided only for the administration of general anesthesia and for both facility and professional charges occurring in connection with dental services, regardless of age, when prior authorization for an inpatient dental care procedure is approved by us. In addition and as required by law, benefits for the administration of general anesthesia, including facility and professional charges, are provided for the following Members; a Member through the age of four; a Member who is severely disabled and a Member who has a medical or behavioral condition that requires hospitalization or general anesthesia when dental services are provided.

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
YES

No Charge after deductible

100.00%
Emergency Room Services

Emergency Room copay is waived if directly admitted to the hospital.

YES

No Charge after deductible

No Charge after deductible
Emergency Transportation/Ambulance

Non-emergency ambulance/transportation out of network is NOT covered, unless prior authorization is obtained from Anthem. Authorized out of network is limited to $50,000 per occurrence.

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 shown is for a 30 day supply.

YES

0.00% Coinsurance after deductible

100.00%
Habilitation Services

Limit: 40.0 Visit(s) per Year

Rehabilitative Physical Therapy and Occupational Therapy is limited to 20 visits per year. For Covered Services you receive in the office from a Physical Therapist, you will not have to pay an office visit Copayment or office visit Coinsurance that is higher than what you would pay for a Primary Care Physician. ?For Covered Services you receive in the office from an Occupational Therapist, you will not have to pay an office visit Copayment or office visit Coinsurance that is higher than what you would pay for a Primary Care Physician. ?All other services are subject to Ded and or Coins. These limitations do not apply to any Autism Spectrum Disorder diagnosis. Cost share is driven by provider setting.

YES

No Charge after deductible

100.00%
Hearing Aids

One hearing aid per ear every 36 months. Limit does not apply to newborn.

YES

No Charge after deductible

100.00%
Home Health Care Services

Limit: 100.0 Visit(s) per Year

Benefit includes coverage for Private Duty Nursing in the home and Private Duty Nursing is limited to 82 visits per calendar year.

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
NO
Infusion Therapy
YES

No Charge after deductible

100.00%
Inherited Metabolic Disorder - PKU
YES

0.00% Coinsurance after deductible

100.00%
Inpatient Hospital Services (e.g., Hospital Stay)
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

Limitation of Two office visits per member per Year with a Non-Network licensed provider.

YES

No Charge after deductible

No Charge after deductible
Newborn Hearing Screening
YES

No Charge after deductible

100.00%
Non-Preferred Brand Drugs

Cost share shown is for a 30 day supply.

YES

0.00% Coinsurance after deductible

100.00%
Nutritional Counseling
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. Visits 4+ subject to deductible and coinsurance. 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.

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: 40.0 Visit(s) per Year

Rehabilitative Physical Therapy and Occupational Therapy is limited to 20 visits per year. For Covered Services you receive in the office from a Physical Therapist, you will not have to pay an office visit Copayment or office visit Coinsurance that is higher than what you would pay for a Primary Care Physician. ?For Covered Services you receive in the office from an Occupational Therapist, you will not have to pay an office visit Copayment or office visit Coinsurance that is higher than what you would pay for a Primary Care Physician. ?All other services are subject to Ded and or Coins. These limitations do not apply to any Autism Spectrum Disorder diagnosis. Cost share is driven by provider setting.

YES

No Charge after deductible

100.00%
Outpatient Surgery Physician/Surgical Services
YES

No Charge after deductible

100.00%
Preferred Brand Drugs

Cost share shown is for a 30 day supply.

YES

0.00% Coinsurance after deductible

100.00%
Prenatal and Postnatal Care
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. Immunizations prior to 6th birthday covered in full.

YES

No Charge

100.00%
Primary Care Visit to Treat an Injury or Illness

First 3 visits subject to copay. Visits 4+ subject to deductible and coinsurance. 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.

YES

$40.00, No Charge after deductible

100.00%
Private-Duty Nursing

Limit: 82.0 Visit(s) per Year

Benefit includes coverage for Private Duty Nursing in the home and Private Duty Nursing is limited to 82 visits per calendar year.

YES

No Charge after deductible

100.00%
Prosthetic Devices

Benefits include the purchase, fitting, adjustments, repairs and replacements.

YES

No Charge after deductible

100.00%
Radiation
YES

No Charge after deductible

100.00%
Reconstructive Surgery

Benefits include reconstructive surgery to correct significant deformities caused by congenital or developmental abnormalities, illness, injury or an earlier treatment in order to create a more normal appearance.

YES

No Charge after deductible

100.00%
Rehabilitative Occupational and Rehabilitative Physical Therapy

Limit: 40.0 Visit(s) per Year

Rehabilitative Physical Therapy and Occupational Therapy is limited to 20 visits per year. For Covered Services you receive in the office from a Physical Therapist, you will not have to pay an office visit Copayment or office visit Coinsurance that is higher than what you would pay for a Primary Care Physician. ?For Covered Services you receive in the office from an Occupational Therapist, you will not have to pay an office visit Copayment or office visit Coinsurance that is higher than what you would pay for a Primary Care Physician. ?All other services are subject to Ded and or Coins. These limitations do not apply to any Autism Spectrum Disorder diagnosis. Cost share is driven by provider setting.

YES

$40.00, No Charge after deductible

100.00%
Rehabilitative Speech Therapy
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 Visit(s) per Year

YES

$0.00 Copay after deductible

100.00%
Routine Foot Care

Coverage is available if Medically Necessary Services

YES

No Charge after deductible

100.00%
Skilled Nursing Facility

Limit: 150.0 Days per Year

Limited to 150 combined days per calendar year for Physical Medicine, Rehabilitation and Skilled Nursing Facility services.

YES

No Charge after deductible

100.00%
Specialist Visit

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.

YES

No Charge after deductible

100.00%
Specialty Drugs

Cost share shown is for a 30 day 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

Limitation of Two office visits per member per Year with a Non-Network licensed provider.

YES

No Charge after deductible

No Charge after deductible
Transplant

Includes coverage for travel/lodging as approved by the plan ($10,000 per transplant). Donor search charges are limited to 10 best matched donors identified by an authorized registry.

YES

No Charge after deductible

100.00%
Treatment for Temporomandibular Joint Disorders

Covered Services include removable appliances for TMJ repositioning and related surgery, medical care, and diagnostic services. Covered 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).

YES

No Charge after deductible

100.00%
Urgent Care Centers or Facilities
YES

No Charge after deductible

No Charge after deductible
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 9200 (+ Incentives) Health Insurance Plan Variant 32753MO0950016-00 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 Off 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 40%
Formulary ID MOF501
Formulary URL URL
HIOS Product ID 32753MO095
Import Date 2024-10-31 01:01:26
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 32753
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 MON001
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 Standard Bluecard PPO Network
Plan Brochure URL
Plan Effective Date 2025-01-01
Plan Expiration Date 2025-12-31
Plan ID (Standard Component ID with Variant) 32753MO0950016-00
Plan Marketing Name Anthem Catastrophic Pathway 9200 (+ Incentives)
Plan Type EPO
Plan Variant Marketing Name Anthem Catastrophic Pathway 9200 (+ Incentives)
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 60%
Service Area ID MOS001
Source Name HIOS
Plan ID 32753MO0950016
State Code MO
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 9200 (+ Incentives) Health Insurance Plan, 32753MO0950016

Drug Tier Pharmacy Type Copay amount Copay option Coinsurance rate Coinsurance option Mail Order

Frequently Asked Questions(FAQ) about Anthem Catastrophic Pathway 9200 (+ Incentives), 32753MO0950016 Health Insurance Plan, 32753MO0950016

  • Does Anthem Catastrophic Pathway 9200 (+ Incentives) Health Insurance Plan, 32753MO0950016 support Mail Ordering?

    Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.

  • Does (32753MO0950016) Health Insurance Plan, Variant (32753MO0950016-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management

    Does (32753MO0950016) Health Insurance Plan, Variant (32753MO0950016-00) have Out Of Country Coverage?

    No, unfortunately there is no Out Of Country Coverage for this Health Insurance Plan (variant of plan). Details: Urgent/Emergency Coverage Only

    Does (32753MO0950016) Health Insurance Plan, Variant (32753MO0950016-00) have Out of Service Area Coverage?

    No, unfortunately there is no Out of Service Area Coverage for this Health Insurance Plan (variant of plan). Details: Standard Bluecard PPO Network

    Does (32753MO0950016) Health Insurance Plan, Variant (32753MO0950016-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management

    Does Anthem Catastrophic Pathway 9200 (+ Incentives) Health Insurance Plan, Variant (32753MO0950016-00) offer Disease Management Programs for Asthma?

    Yes, the Anthem Catastrophic Pathway 9200 (+ Incentives) Health Insurance Plan Variant 32753MO0950016-00 offers Disease Management Program for Asthma.

    Does Anthem Catastrophic Pathway 9200 (+ Incentives) Health Insurance Plan, Variant (32753MO0950016-00) offer Disease Management Programs for Heart disease?

    Yes, the Anthem Catastrophic Pathway 9200 (+ Incentives) Health Insurance Plan Variant 32753MO0950016-00 offers Disease Management Program for Heart disease.

    Does Anthem Catastrophic Pathway 9200 (+ Incentives) Health Insurance Plan, Variant (32753MO0950016-00) offer Disease Management Programs for Depression?

    Yes, the Anthem Catastrophic Pathway 9200 (+ Incentives) Health Insurance Plan Variant 32753MO0950016-00 offers Disease Management Program for Depression.

    Does Anthem Catastrophic Pathway 9200 (+ Incentives) Health Insurance Plan, Variant (32753MO0950016-00) offer Disease Management Programs for Diabetes?

    Yes, the Anthem Catastrophic Pathway 9200 (+ Incentives) Health Insurance Plan Variant 32753MO0950016-00 offers Disease Management Program for Diabetes.

    Does Anthem Catastrophic Pathway 9200 (+ Incentives) Health Insurance Plan, Variant (32753MO0950016-00) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the Anthem Catastrophic Pathway 9200 (+ Incentives) Health Insurance Plan Variant 32753MO0950016-00 offers Disease Management Program for High blood pressure & high cholesterol.

    Does Anthem Catastrophic Pathway 9200 (+ Incentives) Health Insurance Plan, Variant (32753MO0950016-00) offer Disease Management Programs for Low back pain?

    Yes, the Anthem Catastrophic Pathway 9200 (+ Incentives) Health Insurance Plan Variant 32753MO0950016-00 offers Disease Management Program for Low back pain.

 

Disclaimer: This is based on the import(Date: Tue, 10 Dec 2024 06:32 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