California Health Insurance: Anthem Blue Cross Gold 80 EPO

Anthem Gold 80 EPO


Cost Share Information 
Individual Deductible  $0
Family Deductible  $0
Out of Pocket Limit-Individual  $6,750
Out of Pocket Limit-Family  $13,500
Co-Insurance  20%
Lifetime Maximum  Unlimited
Office Visits 
Primary Care  $30
Specialist  $55
Adult Preventive Care  No Charge
Child Preventive Care  No Charge
Maternity Prenatal/Postnatal Care  Pre-No charge; Post $50
Rehabilitation Services  $30
Chiropractic Care  Refer to carrier
Inpatient Services 

Inpatient Hospital


Maternity Delivery/Inpatient 


Outpatient Services 
Outpatient Facility  20% 
Mental Health Outpatient  $30
Lab/X-Ray  $35/$55
Emergency Care 
Emergency Room  $325 (waived if admitted)
Urgent Care  $30  
Ambulance  $250 
Prescription Drugs 
Rx Deductible  N/A
Rx Generic  $15
Rx Preferred  $55
Rx Non-Preferred  $75
Recovery/ Special Needs 

Home Health Care

20%; 100 visits per year

Durable Medical Equipment  20%
Optional Benefits  None 
If you you have questions about the Anthem Blue Cross Gold 80 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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