450A BC Gold EPO High
Anthem Blue Access EPO
Anthem Gold Blue Access EPO 25/50 — $25/$50 copays, 0% coinsurance, no referrals. In-network only.
Monthly premiums
- Member
- $1,883.00/mo
- Member & Children
- $3,132.00/mo
- Member & Spouse
- $3,612.00/mo
- Member & Family
- $5,110.00/mo
$0 deductible — copays only. $25 PCP / $50 specialist, $500 hospital admission, 0% coinsurance.
Plan details
- Deductible (Individual)
- $0
- Deductible (Family)
- $0
- Out-of-Pocket Max (Individual)
- $9,150
- Out-of-Pocket Max (Family)
- $18,300
- Coinsurance (In-Network)
- 0%
- Primary Care Copay
- $30
- Specialist Copay
- $60
- Urgent Care Copay
- $90
- ER Copay
- $750
Benefits
Deductible
$0
OON: Not Covered
Max Out of Pocket
$9,150 / $18,300
OON: Not Covered
Copay
$30 / $60 / $90
PCP / Specialist / Urgent Care
Coinsurance
0%
Copays only
Emergency Room
$750 copay
Waived if admitted
Rx Coverage
$10 / $65 / $90
Generic / Preferred / Non-Preferred; $150 Rx ded on Tier 2–3
Pregnancy
Covered
$50 prenatal visits; $500 delivery admission
Mental Health
Covered
$25 outpatient; $500 inpatient admission
Hospital Admission
$600 copay
Per admission
Referrals
Not Required
Dependents
To Age 26
Coverage
Nationwide
Anthem Blue Access EPO
Work Requirement
Work Required
Plan documents
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