California Health Insurance: Anthem Blue Cross Bronze Pathway 5250 EPO

Anthem Bronze 5250 EPO

In-Network

Cost Share Information 
Individual Deductible  $5,250
Family Deductible  $10,500
Out of Pocket Limit-Individual  $6,700 (including deductible)
Out of Pocket Limit-Family  $13,400 (including deductible)
Co-Insurance  25%
Lifetime Maximum  Unlimited
Office Visits 

Primary Care 

25% after deductible

Specialist  25% after deductible
Adult Preventive Care  No Charge
Child Preventive Care  No Charge
Maternity Prenatal/Postnatal Care 

Pre-No charge; Post-25% after deductible

Rehabilitation Services  25% after deductible
Chiropractic Care  Refer to carrier
Inpatient Services 
Inpatient Hospital 50% after deductible 
Maternity Delivery/Inpatient  50% after deductible 
Outpatient Services 
Outpatient Facility  25% after deductible 
Mental Health Outpatient  25% after deductible 
Lab/X-Ray  25% after deductible 
Emergency Care 
Emergency Room  $200 (waived if admitted) + 25% after deductible 
Urgent Care  $50 + 25% after deductible
Ambulance  25% after deductible 
Prescription Drugs 
Rx Deductible  Integrated Medical/Rx 
Rx Generic  25% after deductible (T1); 35% after deductible (T2) 
Rx Preferred  25% after deductible (T1); 35% after deductible (T2)
Rx Non-Preferred  25% after deductible (T1); 50% after deductible (T2)
Recovery/ Special Needs 
Home Health Care  25% after deductible; 100 visits per year 
Durable Medical Equipment  25% after deductible 
 
Optional Benefits  None  


If you you have questions about the Anthem Blue Cross Bronze 5250 EPO plan or any other plans from Anthem Blue Cross of California please call The Lynn Company at (800)-326-5966 for more information on California Health Insurance Plans
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