California Health Insurance: Anthem Blue Cross Bronze Pathway 5850 EPO

Anthem Bronze 5850 EPO

In-Network

Cost Share Information 
Individual Deductible  $5,850
Family Deductible  $11,700
Out of Pocket Limit-Individual  $7,150 (including deductible)
Out of Pocket Limit-Family  $14,300 (including deductible)
Co-Insurance  20%
Lifetime Maximum  None
Office Visits 

Primary Care 

$50 deductible waived visits 1-2; 

20% after deductible visits 3+

Specialist  20% after deductible
Adult Preventive Care  No Charge
Child Preventive Care  No Charge
Maternity Prenatal/Postnatal Care 

Pre-No charge; Post-$50 ded waived

visits 1-2/20% after deductible visits 3+

Rehabilitation Services  20% after deductible
Chiropractic Care  Refer to carrier
Inpatient Services 
Inpatient Hospital 50% after deductible 
Maternity Delivery/Inpatient  50% after deductible 
Outpatient Services 
Outpatient Facility  20% after deductible 
Mental Health Outpatient  20% after deductible 
Lab/X-Ray  20% after deductible 
Emergency Care 
Emergency Room  $350 (waived if admitted) + 20% after deductible 
Urgent Care  $50 + 20% after deductible
Ambulance  20% after deductible 
Prescription Drugs 
Rx Deductible  Integrated Medical/Rx 
Rx Generic  20% after deductible (T1); 30% after deductible (T2) 
Rx Preferred  20% after deductible (T1); 30% after deductible (T2)
Rx Non-Preferred  20% after deductible (T1); 30% after deductible (T2)
Recovery/ Special Needs 
Home Health Care  20% after deductible; 100 visits per year 
Durable Medical Equipment  20% after deductible 
 
Optional Benefits  None  


If you you have questions about the Anthem Blue Cross Bronze 5850 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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