Namara Marketplace

2015 QHP Landscape NV SHOP Market Medical

State

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County

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Metal Level

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Issuer Name

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Plan Id (Standard Component)

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Plan Marketing Name

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Plan Type

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Rating Area

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Child Only Offering

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Source

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Customer Service Phone Number Local

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Customer Service Phone Number Toll Free

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Customer Service Phone Number Tty

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Network Url

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Plan Brochure Url

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Summary Of Benefits Url

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Drug Formulary Url

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Accredidation

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Adult Dental

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Child Dental

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Premium Scenarios

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Premium Child

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Premium Adult Individual Age 21

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Premium Adult Individual Age 27

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Premium Adult Individual Age 30

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Premium Adult Individual Age 40

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Premium Adult Individual Age 50

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Premium Adult Individual Age 60

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Premium Couple 21

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Premium Couple 30

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Premium Couple 40

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Premium Couple 50

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Premium Couple 60

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Couple+1 Child, Age 21

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Couple+1 Child, Age 30

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Couple+1 Child, Age 40

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Couple+1 Child, Age 50

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Couple+2 Children, Age 21

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Couple+2 Children, Age 30

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Couple+2 Children, Age 40

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Couple+2 Children, Age 50

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Couple+3 Or More Children, Age 21

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Couple+3 Or More Children, Age 30

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Couple+3 Or More Children, Age 40

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Couple+3 Or More Children, Age 50

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Individual+1 Child, Age 21

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Individual+1 Child, Age 30

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Individual+1 Child, Age 40

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Individual+1 Child, Age 50

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Individual+2 Children, Age 21

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Individual+2 Children, Age 30

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Individual+2 Children, Age 40

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Individual+2 Children, Age 50

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Individual+3 Or More Children, Age 21

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Individual+3 Or More Children, Age 30

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Individual+3 Or More Children, Age 40

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Individual+3 Or More Children, Age 50

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Standard Plan Cost Sharing

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Medical Deductible-Individual-Standard

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Drug Deductible-Individual-Standard

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Medical Deductible-Family-Standard

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Drug Deductible - Family - Standard

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Medical Maximum Out Of Pocket - Individual - Standard

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Drug Maximum Out Of Pocket - Individual - Standard

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Medical Maximum Out Of Pocket - Family - Standard

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Drug Maximum Out Of Pocket - Family - Standard

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Primary Care Physician - Standard

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Specialist - Standard

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Emergency Room - Standard

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Inpatient Facility - Standard

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Inpatient Physician - Standard

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Generic Drugs - Standard

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Preferred Brand Drugs - Standard

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Non-Preferred Brand Drugs - Standard

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Specialty Drugs - Standard

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NV
Carson City
Bronze
Nevada Health CO-OP
34996NV0060003
Northern Simple/Fácil Bronze HSA
POS
Rating Area 3
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Northern-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Northern-Simple-Bronze-HSA.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Northern-Simple-Bronze-HSA.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
126.63
199.42
208.99
226.34
254.86
356.17
541.23
398.84
452.68
509.72
712.34
1082.46
525.47
579.31
636.35
838.97
652.1
705.94
762.98
965.6
778.73
832.57
889.61
1092.23
326.05
352.97
381.49
482.8
452.68
479.6
508.12
609.43
579.31
606.23
634.75
736.06
6250
Included in Medical
12500
Included in Medical
6250
Included in Medical
12500
Included in Medical
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
NV
Carson City
Gold
Nevada Health CO-OP
34996NV0060001
Northern Simple/Fácil Gold
POS
Rating Area 3
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Northern-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Northern-Simple-Gold.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Northern-Simple-Gold.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
188.63
297.05
311.31
337.15
379.63
530.53
806.19
594.1
674.3
759.26
1061.06
1612.38
782.73
862.93
947.89
1249.69
971.36
1051.56
1136.52
1438.32
1159.99
1240.19
1325.15
1626.95
485.68
525.78
568.26
719.16
674.31
714.41
756.89
907.79
862.94
903.04
945.52
1096.42
650
Included in Medical
1300
Included in Medical
6350
Included in Medical
12700
Included in Medical
20% Coinsurance after deductible
20% Coinsurance after deductible
20% Coinsurance after deductible
20% Coinsurance after deductible
No Charge
20% Coinsurance after deductible
20% Coinsurance after deductible
20% Coinsurance after deductible
20% Coinsurance after deductible
NV
Carson City
Platinum
Nevada Health CO-OP
34996NV0060004
Northern Simple/Fácil Platinum
POS
Rating Area 3
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Northern-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Northern-Simple-Platinum.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Northern-Simple-Platinum.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
216.97
341.68
358.08
387.81
436.67
610.24
927.32
683.36
775.62
873.34
1220.48
1854.64
900.33
992.59
1090.31
1437.45
1117.3
1209.56
1307.28
1654.42
1334.27
1426.53
1524.25
1871.39
558.65
604.78
653.64
827.21
775.62
821.75
870.61
1044.18
992.59
1038.72
1087.58
1261.15
250
Included in Medical
500
Included in Medical
6350
Included in Medical
12700
Included in Medical
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
No Charge
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
NV
Carson City
Silver
Nevada Health CO-OP
34996NV0060002
Northern Simple/Fácil Silver
POS
Rating Area 3
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Northern-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Northern-Simple-Silver.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Northern-Simple-Silver.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
161.57
254.44
266.65
288.79
325.18
454.43
690.55
508.88
577.58
650.36
908.86
1381.1
670.45
739.15
811.93
1070.43
832.02
900.72
973.5
1232
993.59
1062.29
1135.07
1393.57
416.01
450.36
486.75
616
577.58
611.93
648.32
777.57
739.15
773.5
809.89
939.14
1500
Included in Medical
3000
Included in Medical
6350
Included in Medical
12700
Included in Medical
30% Coinsurance after deductible
30% Coinsurance after deductible
30% Coinsurance after deductible
30% Coinsurance after deductible
No Charge
30% Coinsurance after deductible
30% Coinsurance after deductible
30% Coinsurance after deductible
30% Coinsurance after deductible
NV
Churchill
Bronze
Nevada Health CO-OP
34996NV0060007
Frontier Simple/Fácil Bronze HSA
POS
Rating Area 4
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Frontier-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Frontier-Simple-Bronze-HSA.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Frontier-Simple-Bronze-HSA.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
177.44
279.43
292.85
317.16
357.12
499.07
758.38
558.86
634.32
714.24
998.14
1516.76
736.3
811.76
891.68
1175.58
913.74
989.2
1069.12
1353.02
1091.18
1166.64
1246.56
1530.46
456.87
494.6
534.56
676.51
634.31
672.04
712
853.95
811.75
849.48
889.44
1031.39
6250
Included in Medical
12500
Included in Medical
6250
Included in Medical
12500
Included in Medical
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
NV
Churchill
Gold
Nevada Health CO-OP
34996NV0060005
Frontier Simple/Fácil Gold
POS
Rating Area 4
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Frontier-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Frontier-Simple-Gold.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Frontier-Simple-Gold.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
264.31
416.23
436.21
472.42
531.94
743.39
1129.65
832.46
944.84
1063.88
1486.78
2259.3
1096.77
1209.15
1328.19
1751.09
1361.08
1473.46
1592.5
2015.4
1625.39
1737.77
1856.81
2279.71
680.54
736.73
796.25
1007.7
944.85
1001.04
1060.56
1272.01
1209.16
1265.35
1324.87
1536.32
650
Included in Medical
1300
Included in Medical
6350
Included in Medical
12700
Included in Medical
20% Coinsurance after deductible
20% Coinsurance after deductible
20% Coinsurance after deductible
20% Coinsurance after deductible
No Charge
20% Coinsurance after deductible
20% Coinsurance after deductible
20% Coinsurance after deductible
20% Coinsurance after deductible
NV
Churchill
Platinum
Nevada Health CO-OP
34996NV0060008
Frontier Simple/Fácil Platinum
POS
Rating Area 4
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Frontier-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Frontier-Simple-Platinum.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Frontier-Simple-Platinum.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
304.02
478.77
501.75
543.4
611.86
855.08
1299.37
957.54
1086.8
1223.72
1710.16
2598.74
1261.56
1390.82
1527.74
2014.18
1565.58
1694.84
1831.76
2318.2
1869.6
1998.86
2135.78
2622.22
782.79
847.42
915.88
1159.1
1086.81
1151.44
1219.9
1463.12
1390.83
1455.46
1523.92
1767.14
250
Included in Medical
500
Included in Medical
6350
Included in Medical
12700
Included in Medical
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
No Charge
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
NV
Churchill
Silver
Nevada Health CO-OP
34996NV0060006
Frontier Simple/Fácil Silver
POS
Rating Area 4
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Frontier-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Frontier-Simple-Silver.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Frontier-Simple-Silver.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
226.39
356.53
373.64
404.66
455.64
636.76
967.61
713.06
809.32
911.28
1273.52
1935.22
939.45
1035.71
1137.67
1499.91
1165.84
1262.1
1364.06
1726.3
1392.23
1488.49
1590.45
1952.69
582.92
631.05
682.03
863.15
809.31
857.44
908.42
1089.54
1035.7
1083.83
1134.81
1315.93
1500
Included in Medical
3000
Included in Medical
6350
Included in Medical
12700
Included in Medical
30% Coinsurance after deductible
30% Coinsurance after deductible
30% Coinsurance after deductible
30% Coinsurance after deductible
No Charge
30% Coinsurance after deductible
30% Coinsurance after deductible
30% Coinsurance after deductible
30% Coinsurance after deductible
NV
Clark
Bronze
Nevada Health CO-OP
34996NV0050003
Southern Simple/Fácil Bronze
POS
Rating Area 1
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Southern-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Southern-Simple-Bronze.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Southern-Simple-Bronze.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
88.65
139.6
146.3
158.45
178.41
249.33
378.88
279.2
316.9
356.82
498.66
757.76
367.85
405.55
445.47
587.31
456.5
494.2
534.12
675.96
545.15
582.85
622.77
764.61
228.25
247.1
267.06
337.98
316.9
335.75
355.71
426.63
405.55
424.4
444.36
515.28
6250
Included in Medical
12500
Included in Medical
6250
Included in Medical
12500
Included in Medical
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
NV
Clark
Bronze
Nevada Health CO-OP
34996NV0270003
Southern Simple/Facil Bronze HSA
POS
Rating Area 1
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Southern-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Southern-Simple-Bronze-HSA.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Southern-Simple-Bronze-HSA.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
92.44
145.57
152.56
165.23
186.04
260
395.09
291.14
330.46
372.08
520
790.18
383.58
422.9
464.52
612.44
476.02
515.34
556.96
704.88
568.46
607.78
649.4
797.32
238.01
257.67
278.48
352.44
330.45
350.11
370.92
444.88
422.89
442.55
463.36
537.32
4000
Included in Medical
8000
Included in Medical
6450
Included in Medical
12900
Included in Medical
50% Coinsurance after deductible
50% Coinsurance after deductible
50% Coinsurance after deductible
50% Coinsurance after deductible
50% Coinsurance after deductible
50% Coinsurance after deductible
50% Coinsurance after deductible
50% Coinsurance after deductible
50% Coinsurance after deductible
NV
Clark
Gold
Nevada Health CO-OP
34996NV0050001
Southern Simple/Fácil Gold
POS
Rating Area 1
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Southern-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Southern-Simple-Gold.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Southern-Simple-Gold.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
147.85
232.83
244.01
264.26
297.56
415.83
631.9
465.66
528.52
595.12
831.66
1263.8
613.51
676.37
742.97
979.51
761.36
824.22
890.82
1127.36
909.21
972.07
1038.67
1275.21
380.68
412.11
445.41
563.68
528.53
559.96
593.26
711.53
676.38
707.81
741.11
859.38
500
Included in Medical
1000
Included in Medical
6350
Included in Medical
12700
Included in Medical
$20
$50
$600
20% Coinsurance after deductible
No Charge
$10
$25
$75
20% Coinsurance after deductible
NV
Clark
Gold
Nevada Health CO-OP
34996NV0070002
Southern Star/Estrella Gold
POS
Rating Area 1
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Southern-and-Union-Star-Tier-1.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Southern-Star-Gold.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Southern-Star-Gold.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
142.54
224.47
235.24
254.77
286.87
400.9
609.21
448.94
509.54
573.74
801.8
1218.42
591.48
652.08
716.28
944.34
734.02
794.62
858.82
1086.88
876.56
937.16
1001.36
1229.42
367.01
397.31
429.41
543.44
509.55
539.85
571.95
685.98
652.09
682.39
714.49
828.52
500
Included in Medical
1000
Included in Medical
3500
Included in Medical
7000
Included in Medical
$10
$40
$600
20% Coinsurance after deductible
No Charge
$10
$35
$75
20% Coinsurance after deductible
NV
Clark
Gold
Nevada Health CO-OP
34996NV0070005
Union Star/Estrella Gold
POS
Rating Area 1
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Southern-and-Union-Star-Tier-1.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Union-Star-Gold.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Union-Star-Gold.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-Union
142.54
224.47
235.24
254.77
286.87
400.9
609.21
448.94
509.54
573.74
801.8
1218.42
591.48
652.08
716.28
944.34
734.02
794.62
858.82
1086.88
876.56
937.16
1001.36
1229.42
367.01
397.31
429.41
543.44
509.55
539.85
571.95
685.98
652.09
682.39
714.49
828.52
500
Included in Medical
1000
Included in Medical
3500
Included in Medical
7000
Included in Medical
$10
$40
$600
20% Coinsurance after deductible
No Charge
$10
$35
$75
20% Coinsurance after deductible
NV
Clark
Gold
Nevada Health CO-OP
34996NV0080001
VIP Gold
POS
Rating Area 1
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-VIP-Plan-Tier-1.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-VIP-Plan-Gold.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-VIP-Plan-Gold.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
143.66
226.24
237.1
256.79
289.14
404.07
614.02
452.48
513.58
578.28
808.14
1228.04
596.14
657.24
721.94
951.8
739.8
800.9
865.6
1095.46
883.46
944.56
1009.26
1239.12
369.9
400.45
432.8
547.73
513.56
544.11
576.46
691.39
657.22
687.77
720.12
835.05
500
Included in Medical
1000
Included in Medical
4500
Included in Medical
9000
Included in Medical
No Charge
$40
$600
20% Coinsurance after deductible
No Charge
$5
$35
$75
20% Coinsurance after deductible
NV
Clark
Gold
Nevada Health CO-OP
34996NV0260002
Connected/Conectado Gold
POS
Rating Area 1
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Connected-Connectado.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Connected-Conectado-Gold.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Connected-Conectado-Gold.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
136.74
215.34
225.68
244.42
275.21
384.6
584.44
430.68
488.84
550.42
769.2
1168.88
567.42
625.58
687.16
905.94
704.16
762.32
823.9
1042.68
840.9
899.06
960.64
1179.42
352.08
381.16
411.95
521.34
488.82
517.9
548.69
658.08
625.56
654.64
685.43
794.82
500
Included in Medical
1000
Included in Medical
6000
Included in Medical
12000
Included in Medical
$10
$40
$600
20% Coinsurance after deductible
No Charge
$10
$35
$75
20% Coinsurance after deductible
NV
Clark
Gold
Nevada Health CO-OP
34996NV0270001
Southern Simple/Facil Gold HSA
POS
Rating Area 1
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Southern-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Southern-Simple-Gold-HSA.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Southern-Simple-Gold-HSA.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
142.46
224.34
235.11
254.63
286.71
400.67
608.86
448.68
509.26
573.42
801.34
1217.72
591.14
651.72
715.88
943.8
733.6
794.18
858.34
1086.26
876.06
936.64
1000.8
1228.72
366.8
397.09
429.17
543.13
509.26
539.55
571.63
685.59
651.72
682.01
714.09
828.05
1300
Included in Medical
2600
Included in Medical
6000
Included in Medical
12000
Included in Medical
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
NV
Clark
Platinum
Nevada Health CO-OP
34996NV0050004
Southern Simple/Fácil Platinum
POS
Rating Area 1
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Southern-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Southern-Simple-Platinum.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Southern-Simple-Platinum.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
167.21
263.32
275.96
298.87
336.53
470.3
714.66
526.64
597.74
673.06
940.6
1429.32
693.85
764.95
840.27
1107.81
861.06
932.16
1007.48
1275.02
1028.27
1099.37
1174.69
1442.23
430.53
466.08
503.74
637.51
597.74
633.29
670.95
804.72
764.95
800.5
838.16
971.93
0
Included in Medical
0
Included in Medical
2500
Included in Medical
5000
Included in Medical
$15
$40
$450
10% Coinsurance after deductible
No Charge
$10
$20
$75
10% Coinsurance after deductible
NV
Clark
Platinum
Nevada Health CO-OP
34996NV0070001
Southern Star/Estrella Platinum
POS
Rating Area 1
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Southern-and-Union-Star-Tier-1.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Southern-Star-Platinum.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Southern-Star-Platinum.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
161.09
253.68
265.86
287.93
324.21
453.08
688.5
507.36
575.86
648.42
906.16
1377
668.45
736.95
809.51
1067.25
829.54
898.04
970.6
1228.34
990.63
1059.13
1131.69
1389.43
414.77
449.02
485.3
614.17
575.86
610.11
646.39
775.26
736.95
771.2
807.48
936.35
400
Included in Medical
800
Included in Medical
2000
Included in Medical
4000
Included in Medical
$5
$25
$450
10% Coinsurance after deductible
No Charge
No Charge
$15
$30
10% Coinsurance after deductible
NV
Clark
Platinum
Nevada Health CO-OP
34996NV0070004
Union Star/Estrella Platinum
POS
Rating Area 1
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Southern-and-Union-Star-Tier-1.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Union-Star-Platinum.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Union-Star-Platinum.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-Union
161.09
253.68
265.86
287.93
324.21
453.08
688.5
507.36
575.86
648.42
906.16
1377
668.45
736.95
809.51
1067.25
829.54
898.04
970.6
1228.34
990.63
1059.13
1131.69
1389.43
414.77
449.02
485.3
614.17
575.86
610.11
646.39
775.26
736.95
771.2
807.48
936.35
400
Included in Medical
800
Included in Medical
2000
Included in Medical
4000
Included in Medical
$5
$25
$450
10% Coinsurance after deductible
No Charge
No Charge
$15
$30
10% Coinsurance after deductible
NV
Clark
Platinum
Nevada Health CO-OP
34996NV0080003
VIP Platinum
POS
Rating Area 1
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-VIP-Plan-Tier-1.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-VIP-Plan-Platinum.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-VIP-Plan-Platinum.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
167.13
263.2
275.83
298.73
336.37
470.07
714.32
526.4
597.46
672.74
940.14
1428.64
693.53
764.59
839.87
1107.27
860.66
931.72
1007
1274.4
1027.79
1098.85
1174.13
1441.53
430.33
465.86
503.5
637.2
597.46
632.99
670.63
804.33
764.59
800.12
837.76
971.46
200
Included in Medical
400
Included in Medical
2500
Included in Medical
5000
Included in Medical
No Charge
$30
$450
10% Coinsurance after deductible
No Charge
$5
$25
$75
10% Coinsurance after deductible
NV
Clark
Platinum
Nevada Health CO-OP
34996NV0260001
Connected/Conectado Platinum
POS
Rating Area 1
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Connected-Connectado.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Connected-Conectado-Platinum.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Connected-Conectado-Platinum.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
153.03
240.99
252.56
273.53
307.99
430.41
654.05
481.98
547.06
615.98
860.82
1308.1
635.01
700.09
769.01
1013.85
788.04
853.12
922.04
1166.88
941.07
1006.15
1075.07
1319.91
394.02
426.56
461.02
583.44
547.05
579.59
614.05
736.47
700.08
732.62
767.08
889.5
250
Included in Medical
500
Included in Medical
2000
Included in Medical
4000
Included in Medical
$5
$35
$450
10% Coinsurance after deductible
No Charge
$10
$25
$75
10% Coinsurance after deductible
NV
Clark
Silver
Nevada Health CO-OP
34996NV0050002
Southern Simple/Fácil Silver
POS
Rating Area 1
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Southern-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Southern-Simple-Silver.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Southern-Simple-Silver.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
125.42
197.51
206.99
224.18
252.42
352.76
536.05
395.02
448.36
504.84
705.52
1072.1
520.44
573.78
630.26
830.94
645.86
699.2
755.68
956.36
771.28
824.62
881.1
1081.78
322.93
349.6
377.84
478.18
448.35
475.02
503.26
603.6
573.77
600.44
628.68
729.02
3000
Included in Medical
6000
Included in Medical
6350
Included in Medical
12700
Included in Medical
$40
$80
$600
30% Coinsurance after deductible
No Charge
$10
$35
$100
30% Coinsurance after deductible
NV
Clark
Silver
Nevada Health CO-OP
34996NV0070003
Southern Star/Estrella Silver
POS
Rating Area 1
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Southern-and-Union-Star-Tier-1.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Southern-Star-Silver.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Southern-Star-Silver.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
118.1
185.98
194.91
211.09
237.69
332.17
504.76
371.96
422.18
475.38
664.34
1009.52
490.06
540.28
593.48
782.44
608.16
658.38
711.58
900.54
726.26
776.48
829.68
1018.64
304.08
329.19
355.79
450.27
422.18
447.29
473.89
568.37
540.28
565.39
591.99
686.47
4250
Included in Medical
8500
Included in Medical
6350
Included in Medical
12700
Included in Medical
$15
$50
$600
30% Coinsurance after deductible
No Charge
$10
$35
$50
30% Coinsurance after deductible
NV
Clark
Silver
Nevada Health CO-OP
34996NV0070006
Union Star/Estrella Silver
POS
Rating Area 1
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Southern-and-Union-Star-Tier-1.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Union-Star-Silver.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Union-Star-Silver.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-Union
118.1
185.98
194.91
211.09
237.69
332.17
504.76
371.96
422.18
475.38
664.34
1009.52
490.06
540.28
593.48
782.44
608.16
658.38
711.58
900.54
726.26
776.48
829.68
1018.64
304.08
329.19
355.79
450.27
422.18
447.29
473.89
568.37
540.28
565.39
591.99
686.47
4250
Included in Medical
8500
Included in Medical
6350
Included in Medical
12700
Included in Medical
$15
$50
$600
30% Coinsurance after deductible
No Charge
$10
$35
$50
30% Coinsurance after deductible
NV
Clark
Silver
Nevada Health CO-OP
34996NV0080002
VIP Silver
POS
Rating Area 1
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-VIP-Plan-Tier-1.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-VIP-Plan-Silver.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-VIP-Plan-Silver.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
118.93
187.3
196.29
212.58
239.37
334.52
508.33
374.6
425.16
478.74
669.04
1016.66
493.53
544.09
597.67
787.97
612.46
663.02
716.6
906.9
731.39
781.95
835.53
1025.83
306.23
331.51
358.3
453.45
425.16
450.44
477.23
572.38
544.09
569.37
596.16
691.31
5500
Included in Medical
11000
Included in Medical
6350
Included in Medical
12700
Included in Medical
No Charge
$50
$600
30% Coinsurance after deductible
No Charge
$10
$35
$50
30% Coinsurance after deductible
NV
Clark
Silver
Nevada Health CO-OP
34996NV0260003
Connected/Conectado Silver
POS
Rating Area 1
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Connected-Connectado.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Connected-Conectado-Silver.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Connected-Conectado-Silver.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
115.85
182.44
191.2
207.07
233.16
325.84
495.14
364.88
414.14
466.32
651.68
990.28
480.73
529.99
582.17
767.53
596.58
645.84
698.02
883.38
712.43
761.69
813.87
999.23
298.29
322.92
349.01
441.69
414.14
438.77
464.86
557.54
529.99
554.62
580.71
673.39
5000
Included in Medical
10000
Included in Medical
6450
Included in Medical
12900
Included in Medical
$15
$50
$600
30% Coinsurance after deductible
No Charge
$10
$35
$75
30% Coinsurance after deductible
NV
Douglas
Bronze
Nevada Health CO-OP
34996NV0060003
Northern Simple/Fácil Bronze HSA
POS
Rating Area 3
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Northern-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Northern-Simple-Bronze-HSA.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Northern-Simple-Bronze-HSA.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
126.63
199.42
208.99
226.34
254.86
356.17
541.23
398.84
452.68
509.72
712.34
1082.46
525.47
579.31
636.35
838.97
652.1
705.94
762.98
965.6
778.73
832.57
889.61
1092.23
326.05
352.97
381.49
482.8
452.68
479.6
508.12
609.43
579.31
606.23
634.75
736.06
6250
Included in Medical
12500
Included in Medical
6250
Included in Medical
12500
Included in Medical
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
NV
Douglas
Gold
Nevada Health CO-OP
34996NV0060001
Northern Simple/Fácil Gold
POS
Rating Area 3
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Northern-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Northern-Simple-Gold.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Northern-Simple-Gold.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
188.63
297.05
311.31
337.15
379.63
530.53
806.19
594.1
674.3
759.26
1061.06
1612.38
782.73
862.93
947.89
1249.69
971.36
1051.56
1136.52
1438.32
1159.99
1240.19
1325.15
1626.95
485.68
525.78
568.26
719.16
674.31
714.41
756.89
907.79
862.94
903.04
945.52
1096.42
650
Included in Medical
1300
Included in Medical
6350
Included in Medical
12700
Included in Medical
20% Coinsurance after deductible
20% Coinsurance after deductible
20% Coinsurance after deductible
20% Coinsurance after deductible
No Charge
20% Coinsurance after deductible
20% Coinsurance after deductible
20% Coinsurance after deductible
20% Coinsurance after deductible
NV
Douglas
Platinum
Nevada Health CO-OP
34996NV0060004
Northern Simple/Fácil Platinum
POS
Rating Area 3
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Northern-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Northern-Simple-Platinum.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Northern-Simple-Platinum.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
216.97
341.68
358.08
387.81
436.67
610.24
927.32
683.36
775.62
873.34
1220.48
1854.64
900.33
992.59
1090.31
1437.45
1117.3
1209.56
1307.28
1654.42
1334.27
1426.53
1524.25
1871.39
558.65
604.78
653.64
827.21
775.62
821.75
870.61
1044.18
992.59
1038.72
1087.58
1261.15
250
Included in Medical
500
Included in Medical
6350
Included in Medical
12700
Included in Medical
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
No Charge
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
NV
Douglas
Silver
Nevada Health CO-OP
34996NV0060002
Northern Simple/Fácil Silver
POS
Rating Area 3
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Northern-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Northern-Simple-Silver.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Northern-Simple-Silver.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
161.57
254.44
266.65
288.79
325.18
454.43
690.55
508.88
577.58
650.36
908.86
1381.1
670.45
739.15
811.93
1070.43
832.02
900.72
973.5
1232
993.59
1062.29
1135.07
1393.57
416.01
450.36
486.75
616
577.58
611.93
648.32
777.57
739.15
773.5
809.89
939.14
1500
Included in Medical
3000
Included in Medical
6350
Included in Medical
12700
Included in Medical
30% Coinsurance after deductible
30% Coinsurance after deductible
30% Coinsurance after deductible
30% Coinsurance after deductible
No Charge
30% Coinsurance after deductible
30% Coinsurance after deductible
30% Coinsurance after deductible
30% Coinsurance after deductible
NV
Elko
Bronze
Nevada Health CO-OP
34996NV0060007
Frontier Simple/Fácil Bronze HSA
POS
Rating Area 4
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Frontier-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Frontier-Simple-Bronze-HSA.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Frontier-Simple-Bronze-HSA.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
177.44
279.43
292.85
317.16
357.12
499.07
758.38
558.86
634.32
714.24
998.14
1516.76
736.3
811.76
891.68
1175.58
913.74
989.2
1069.12
1353.02
1091.18
1166.64
1246.56
1530.46
456.87
494.6
534.56
676.51
634.31
672.04
712
853.95
811.75
849.48
889.44
1031.39
6250
Included in Medical
12500
Included in Medical
6250
Included in Medical
12500
Included in Medical
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
NV
Elko
Gold
Nevada Health CO-OP
34996NV0060005
Frontier Simple/Fácil Gold
POS
Rating Area 4
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Frontier-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Frontier-Simple-Gold.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Frontier-Simple-Gold.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
264.31
416.23
436.21
472.42
531.94
743.39
1129.65
832.46
944.84
1063.88
1486.78
2259.3
1096.77
1209.15
1328.19
1751.09
1361.08
1473.46
1592.5
2015.4
1625.39
1737.77
1856.81
2279.71
680.54
736.73
796.25
1007.7
944.85
1001.04
1060.56
1272.01
1209.16
1265.35
1324.87
1536.32
650
Included in Medical
1300
Included in Medical
6350
Included in Medical
12700
Included in Medical
20% Coinsurance after deductible
20% Coinsurance after deductible
20% Coinsurance after deductible
20% Coinsurance after deductible
No Charge
20% Coinsurance after deductible
20% Coinsurance after deductible
20% Coinsurance after deductible
20% Coinsurance after deductible
NV
Elko
Platinum
Nevada Health CO-OP
34996NV0060008
Frontier Simple/Fácil Platinum
POS
Rating Area 4
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Frontier-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Frontier-Simple-Platinum.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Frontier-Simple-Platinum.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
304.02
478.77
501.75
543.4
611.86
855.08
1299.37
957.54
1086.8
1223.72
1710.16
2598.74
1261.56
1390.82
1527.74
2014.18
1565.58
1694.84
1831.76
2318.2
1869.6
1998.86
2135.78
2622.22
782.79
847.42
915.88
1159.1
1086.81
1151.44
1219.9
1463.12
1390.83
1455.46
1523.92
1767.14
250
Included in Medical
500
Included in Medical
6350
Included in Medical
12700
Included in Medical
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
No Charge
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
NV
Elko
Silver
Nevada Health CO-OP
34996NV0060006
Frontier Simple/Fácil Silver
POS
Rating Area 4
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Frontier-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Frontier-Simple-Silver.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Frontier-Simple-Silver.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
226.39
356.53
373.64
404.66
455.64
636.76
967.61
713.06
809.32
911.28
1273.52
1935.22
939.45
1035.71
1137.67
1499.91
1165.84
1262.1
1364.06
1726.3
1392.23
1488.49
1590.45
1952.69
582.92
631.05
682.03
863.15
809.31
857.44
908.42
1089.54
1035.7
1083.83
1134.81
1315.93
1500
Included in Medical
3000
Included in Medical
6350
Included in Medical
12700
Included in Medical
30% Coinsurance after deductible
30% Coinsurance after deductible
30% Coinsurance after deductible
30% Coinsurance after deductible
No Charge
30% Coinsurance after deductible
30% Coinsurance after deductible
30% Coinsurance after deductible
30% Coinsurance after deductible
NV
Esmeralda
Bronze
Nevada Health CO-OP
34996NV0060007
Frontier Simple/Fácil Bronze HSA
POS
Rating Area 4
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Frontier-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Frontier-Simple-Bronze-HSA.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Frontier-Simple-Bronze-HSA.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
177.44
279.43
292.85
317.16
357.12
499.07
758.38
558.86
634.32
714.24
998.14
1516.76
736.3
811.76
891.68
1175.58
913.74
989.2
1069.12
1353.02
1091.18
1166.64
1246.56
1530.46
456.87
494.6
534.56
676.51
634.31
672.04
712
853.95
811.75
849.48
889.44
1031.39
6250
Included in Medical
12500
Included in Medical
6250
Included in Medical
12500
Included in Medical
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
NV
Esmeralda
Gold
Nevada Health CO-OP
34996NV0060005
Frontier Simple/Fácil Gold
POS
Rating Area 4
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Frontier-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Frontier-Simple-Gold.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Frontier-Simple-Gold.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
264.31
416.23
436.21
472.42
531.94
743.39
1129.65
832.46
944.84
1063.88
1486.78
2259.3
1096.77
1209.15
1328.19
1751.09
1361.08
1473.46
1592.5
2015.4
1625.39
1737.77
1856.81
2279.71
680.54
736.73
796.25
1007.7
944.85
1001.04
1060.56
1272.01
1209.16
1265.35
1324.87
1536.32
650
Included in Medical
1300
Included in Medical
6350
Included in Medical
12700
Included in Medical
20% Coinsurance after deductible
20% Coinsurance after deductible
20% Coinsurance after deductible
20% Coinsurance after deductible
No Charge
20% Coinsurance after deductible
20% Coinsurance after deductible
20% Coinsurance after deductible
20% Coinsurance after deductible
NV
Esmeralda
Platinum
Nevada Health CO-OP
34996NV0060008
Frontier Simple/Fácil Platinum
POS
Rating Area 4
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Frontier-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Frontier-Simple-Platinum.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Frontier-Simple-Platinum.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
304.02
478.77
501.75
543.4
611.86
855.08
1299.37
957.54
1086.8
1223.72
1710.16
2598.74
1261.56
1390.82
1527.74
2014.18
1565.58
1694.84
1831.76
2318.2
1869.6
1998.86
2135.78
2622.22
782.79
847.42
915.88
1159.1
1086.81
1151.44
1219.9
1463.12
1390.83
1455.46
1523.92
1767.14
250
Included in Medical
500
Included in Medical
6350
Included in Medical
12700
Included in Medical
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
No Charge
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
NV
Esmeralda
Silver
Nevada Health CO-OP
34996NV0060006
Frontier Simple/Fácil Silver
POS
Rating Area 4
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Frontier-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Frontier-Simple-Silver.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Frontier-Simple-Silver.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
226.39
356.53
373.64
404.66
455.64
636.76
967.61
713.06
809.32
911.28
1273.52
1935.22
939.45
1035.71
1137.67
1499.91
1165.84
1262.1
1364.06
1726.3
1392.23
1488.49
1590.45
1952.69
582.92
631.05
682.03
863.15
809.31
857.44
908.42
1089.54
1035.7
1083.83
1134.81
1315.93
1500
Included in Medical
3000
Included in Medical
6350
Included in Medical
12700
Included in Medical
30% Coinsurance after deductible
30% Coinsurance after deductible
30% Coinsurance after deductible
30% Coinsurance after deductible
No Charge
30% Coinsurance after deductible
30% Coinsurance after deductible
30% Coinsurance after deductible
30% Coinsurance after deductible
NV
Eureka
Bronze
Nevada Health CO-OP
34996NV0060007
Frontier Simple/Fácil Bronze HSA
POS
Rating Area 4
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Frontier-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Frontier-Simple-Bronze-HSA.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Frontier-Simple-Bronze-HSA.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
177.44
279.43
292.85
317.16
357.12
499.07
758.38
558.86
634.32
714.24
998.14
1516.76
736.3
811.76
891.68
1175.58
913.74
989.2
1069.12
1353.02
1091.18
1166.64
1246.56
1530.46
456.87
494.6
534.56
676.51
634.31
672.04
712
853.95
811.75
849.48
889.44
1031.39
6250
Included in Medical
12500
Included in Medical
6250
Included in Medical
12500
Included in Medical
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
NV
Eureka
Gold
Nevada Health CO-OP
34996NV0060005
Frontier Simple/Fácil Gold
POS
Rating Area 4
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Frontier-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Frontier-Simple-Gold.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Frontier-Simple-Gold.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
264.31
416.23
436.21
472.42
531.94
743.39
1129.65
832.46
944.84
1063.88
1486.78
2259.3
1096.77
1209.15
1328.19
1751.09
1361.08
1473.46
1592.5
2015.4
1625.39
1737.77
1856.81
2279.71
680.54
736.73
796.25
1007.7
944.85
1001.04
1060.56
1272.01
1209.16
1265.35
1324.87
1536.32
650
Included in Medical
1300
Included in Medical
6350
Included in Medical
12700
Included in Medical
20% Coinsurance after deductible
20% Coinsurance after deductible
20% Coinsurance after deductible
20% Coinsurance after deductible
No Charge
20% Coinsurance after deductible
20% Coinsurance after deductible
20% Coinsurance after deductible
20% Coinsurance after deductible
NV
Eureka
Platinum
Nevada Health CO-OP
34996NV0060008
Frontier Simple/Fácil Platinum
POS
Rating Area 4
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Frontier-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Frontier-Simple-Platinum.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Frontier-Simple-Platinum.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
304.02
478.77
501.75
543.4
611.86
855.08
1299.37
957.54
1086.8
1223.72
1710.16
2598.74
1261.56
1390.82
1527.74
2014.18
1565.58
1694.84
1831.76
2318.2
1869.6
1998.86
2135.78
2622.22
782.79
847.42
915.88
1159.1
1086.81
1151.44
1219.9
1463.12
1390.83
1455.46
1523.92
1767.14
250
Included in Medical
500
Included in Medical
6350
Included in Medical
12700
Included in Medical
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
No Charge
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
NV
Eureka
Silver
Nevada Health CO-OP
34996NV0060006
Frontier Simple/Fácil Silver
POS
Rating Area 4
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Frontier-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Frontier-Simple-Silver.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Frontier-Simple-Silver.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
226.39
356.53
373.64
404.66
455.64
636.76
967.61
713.06
809.32
911.28
1273.52
1935.22
939.45
1035.71
1137.67
1499.91
1165.84
1262.1
1364.06
1726.3
1392.23
1488.49
1590.45
1952.69
582.92
631.05
682.03
863.15
809.31
857.44
908.42
1089.54
1035.7
1083.83
1134.81
1315.93
1500
Included in Medical
3000
Included in Medical
6350
Included in Medical
12700
Included in Medical
30% Coinsurance after deductible
30% Coinsurance after deductible
30% Coinsurance after deductible
30% Coinsurance after deductible
No Charge
30% Coinsurance after deductible
30% Coinsurance after deductible
30% Coinsurance after deductible
30% Coinsurance after deductible
NV
Humboldt
Bronze
Nevada Health CO-OP
34996NV0060007
Frontier Simple/Fácil Bronze HSA
POS
Rating Area 4
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Frontier-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Frontier-Simple-Bronze-HSA.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Frontier-Simple-Bronze-HSA.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
177.44
279.43
292.85
317.16
357.12
499.07
758.38
558.86
634.32
714.24
998.14
1516.76
736.3
811.76
891.68
1175.58
913.74
989.2
1069.12
1353.02
1091.18
1166.64
1246.56
1530.46
456.87
494.6
534.56
676.51
634.31
672.04
712
853.95
811.75
849.48
889.44
1031.39
6250
Included in Medical
12500
Included in Medical
6250
Included in Medical
12500
Included in Medical
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
NV
Humboldt
Gold
Nevada Health CO-OP
34996NV0060005
Frontier Simple/Fácil Gold
POS
Rating Area 4
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Frontier-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Frontier-Simple-Gold.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Frontier-Simple-Gold.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
264.31
416.23
436.21
472.42
531.94
743.39
1129.65
832.46
944.84
1063.88
1486.78
2259.3
1096.77
1209.15
1328.19
1751.09
1361.08
1473.46
1592.5
2015.4
1625.39
1737.77
1856.81
2279.71
680.54
736.73
796.25
1007.7
944.85
1001.04
1060.56
1272.01
1209.16
1265.35
1324.87
1536.32
650
Included in Medical
1300
Included in Medical
6350
Included in Medical
12700
Included in Medical
20% Coinsurance after deductible
20% Coinsurance after deductible
20% Coinsurance after deductible
20% Coinsurance after deductible
No Charge
20% Coinsurance after deductible
20% Coinsurance after deductible
20% Coinsurance after deductible
20% Coinsurance after deductible
NV
Humboldt
Platinum
Nevada Health CO-OP
34996NV0060008
Frontier Simple/Fácil Platinum
POS
Rating Area 4
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Frontier-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Frontier-Simple-Platinum.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Frontier-Simple-Platinum.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
304.02
478.77
501.75
543.4
611.86
855.08
1299.37
957.54
1086.8
1223.72
1710.16
2598.74
1261.56
1390.82
1527.74
2014.18
1565.58
1694.84
1831.76
2318.2
1869.6
1998.86
2135.78
2622.22
782.79
847.42
915.88
1159.1
1086.81
1151.44
1219.9
1463.12
1390.83
1455.46
1523.92
1767.14
250
Included in Medical
500
Included in Medical
6350
Included in Medical
12700
Included in Medical
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
No Charge
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
NV
Humboldt
Silver
Nevada Health CO-OP
34996NV0060006
Frontier Simple/Fácil Silver
POS
Rating Area 4
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Frontier-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Frontier-Simple-Silver.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Frontier-Simple-Silver.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
226.39
356.53
373.64
404.66
455.64
636.76
967.61
713.06
809.32
911.28
1273.52
1935.22
939.45
1035.71
1137.67
1499.91
1165.84
1262.1
1364.06
1726.3
1392.23
1488.49
1590.45
1952.69
582.92
631.05
682.03
863.15
809.31
857.44
908.42
1089.54
1035.7
1083.83
1134.81
1315.93
1500
Included in Medical
3000
Included in Medical
6350
Included in Medical
12700
Included in Medical
30% Coinsurance after deductible
30% Coinsurance after deductible
30% Coinsurance after deductible
30% Coinsurance after deductible
No Charge
30% Coinsurance after deductible
30% Coinsurance after deductible
30% Coinsurance after deductible
30% Coinsurance after deductible
NV
Lander
Bronze
Nevada Health CO-OP
34996NV0060007
Frontier Simple/Fácil Bronze HSA
POS
Rating Area 4
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Frontier-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Frontier-Simple-Bronze-HSA.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Frontier-Simple-Bronze-HSA.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
177.44
279.43
292.85
317.16
357.12
499.07
758.38
558.86
634.32
714.24
998.14
1516.76
736.3
811.76
891.68
1175.58
913.74
989.2
1069.12
1353.02
1091.18
1166.64
1246.56
1530.46
456.87
494.6
534.56
676.51
634.31
672.04
712
853.95
811.75
849.48
889.44
1031.39
6250
Included in Medical
12500
Included in Medical
6250
Included in Medical
12500
Included in Medical
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
No Charge after Deductible
NV
Lander
Gold
Nevada Health CO-OP
34996NV0060005
Frontier Simple/Fácil Gold
POS
Rating Area 4
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Frontier-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Frontier-Simple-Gold.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Frontier-Simple-Gold.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
264.31
416.23
436.21
472.42
531.94
743.39
1129.65
832.46
944.84
1063.88
1486.78
2259.3
1096.77
1209.15
1328.19
1751.09
1361.08
1473.46
1592.5
2015.4
1625.39
1737.77
1856.81
2279.71
680.54
736.73
796.25
1007.7
944.85
1001.04
1060.56
1272.01
1209.16
1265.35
1324.87
1536.32
650
Included in Medical
1300
Included in Medical
6350
Included in Medical
12700
Included in Medical
20% Coinsurance after deductible
20% Coinsurance after deductible
20% Coinsurance after deductible
20% Coinsurance after deductible
No Charge
20% Coinsurance after deductible
20% Coinsurance after deductible
20% Coinsurance after deductible
20% Coinsurance after deductible
NV
Lander
Platinum
Nevada Health CO-OP
34996NV0060008
Frontier Simple/Fácil Platinum
POS
Rating Area 4
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Frontier-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Frontier-Simple-Platinum.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Frontier-Simple-Platinum.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
304.02
478.77
501.75
543.4
611.86
855.08
1299.37
957.54
1086.8
1223.72
1710.16
2598.74
1261.56
1390.82
1527.74
2014.18
1565.58
1694.84
1831.76
2318.2
1869.6
1998.86
2135.78
2622.22
782.79
847.42
915.88
1159.1
1086.81
1151.44
1219.9
1463.12
1390.83
1455.46
1523.92
1767.14
250
Included in Medical
500
Included in Medical
6350
Included in Medical
12700
Included in Medical
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
No Charge
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
10% Coinsurance after deductible
NV
Lander
Silver
Nevada Health CO-OP
34996NV0060006
Frontier Simple/Fácil Silver
POS
Rating Area 4
Allows Adult and Child-Only
SERFF
1-702-823-2667
1-855-606-2667
711
http://nevadahealthcoop.org/wp-content/uploads/2014/11/PD15-Frontier-Simple.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/DBS-SHOP-Frontier-Simple-Silver.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/SBC-SHOP-Frontier-Simple-Silver.pdf
http://nevadahealthcoop.org/wp-content/uploads/2014/11/RXF15-One
226.39
356.53
373.64
404.66
455.64
636.76
967.61
713.06
809.32
911.28
1273.52
1935.22
939.45
1035.71
1137.67
1499.91
1165.84
1262.1
1364.06
1726.3
1392.23
1488.49
1590.45
1952.69
582.92
631.05
682.03
863.15
809.31
857.44
908.42
1089.54
1035.7
1083.83
1134.81
1315.93
1500
Included in Medical
3000
Included in Medical
6350
Included in Medical
12700
Included in Medical
30% Coinsurance after deductible
30% Coinsurance after deductible
30% Coinsurance after deductible
30% Coinsurance after deductible
No Charge
30% Coinsurance after deductible
30% Coinsurance after deductible
30% Coinsurance after deductible
30% Coinsurance after deductible

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