Colorado HSA Plans
HSA plans are available through Anthem Blue Cross, and are easily identifiable since they are in the name of the plan themselves. Check out our HSA guide for more information about how health savings accounts can help you save money.
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| Anthem Bronze Pathway X HMO 6300 for HSA (1G0S) |
Anthem Bronze Pathway X HMO 5000 for HSA (1G0U)
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|
|---|---|---|
| Network name | Pathway X | Pathway X |
| Plan includes out-of-network coverage? | No | No |
| Individual deductible | $6,300 | $5,000 |
| Individual out-of-pocket limit | $6,550 | $6,550 |
| Coinsurance (percentage may vary for some covered services) | 0% | 25% |
| Preventive care1 | No additional cost to you. |
No additional cost to you.
|
| Office visit: primary care physician (PCP)2 (Other office services may be subject to deductible and plan coinsurance) | Deductible, then 0% coinsurance |
Deductible, then 25% coinsurance
|
| Office visit: specialist (Other office services may be subject to deductible and plan coinsurance) | Deductible, then 0% coinsurance |
Deductible, then 25% coinsurance
|
| Outpatient diagnostic tests (Ex. X-ray, EKG) | Deductible, then 0% coinsurance |
Deductible, then 25% coinsurance
|
| Outpatient advanced diagnostic tests (Ex. MRI, CT scan) | Deductible, then $200 copay |
Deductible, then $250 copay and 25% coinsurance
|
| Urgent care | Deductible, then 0% coinsurance |
Deductible, then $50 copay and 25% coinsurance
|
| Emergency room care (Copay waived if admitted into the hospital from the emergency room.) | Deductible, then 0% coinsurance |
Deductible, then $500 copay and 25% coinsurance
|
| Hospital: inpatient admission (includes maternity, mental health / substance use) | Deductible, then 0% coinsurance |
Deductible, then 25% coinsurance
|
| Hospital: outpatient surgery hospital facility (includes maternity, mental health / substance use) | Deductible, then 0% coinsurance |
Deductible, then 25% coinsurance
|
| Pharmacy deductible (for tiers with deductible, cost share applies after deductible) | Level 1 / Level 2 Pharmacy Tier 1, 2, 3, 4: Medical deductible applies |
Level 1 / Level 2 Pharmacy Tier 1, 2, 3, 4: Medical deductible applies
|
| Retail pharmacy tier 1: level 1 / level 2 | 0% coinsurance / 10% coinsurance |
25% coinsurance / 35% coinsurance
|
| Retail pharmacy tier 2: level 1 / level 2 | 0% coinsurance / 10% coinsurance |
25% coinsurance / 35% coinsurance
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| Retail pharmacy tier 3: level 1 / level 2 | 0% coinsurance / 50% coinsurance |
25% coinsurance / 50% coinsurance
|
| Retail pharmacy tier 4: level 1 / level 2 | 0% coinsurance / 50% coinsurance |
25% coinsurance / 50% coinsurance
|
| Physical and occupational therapy (limits apply) | Deductible, then 0% coinsurance |
Deductible, then 25% coinsurance
|
| Speech therapy (limits apply) | Deductible, then 0% coinsurance |
Deductible, then 25% coinsurance
|
Anthem BlueCross BlueShield of Colorado
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