Namara Marketplace

2016 QHP Landscape NV SHOP Market Medical

State Code

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County Name

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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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Ehb Percent Of Total Premium

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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 Deductible - Family (Per Person) - Standard

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Drug Deductible - Family (Per Person) - 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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Medical Maximum Out Of Pocket - Family (Per Person) - Standard

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Drug Maximum Out Of Pocket - Family (Per Person) - 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
HMO Colorado, Inc., dba HMO Nevada
60156NV0240007
Anthem Bronze Pathway X HMO 5000/30%/6850 Plus
HMO
Rating Area 3
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VK
https://www.anthem.com/NVSelectdrugtier4
X
0.992
156.81
246.95
258.8
280.29
315.6
441.05
670.22
493.9
560.58
631.2
882.1
1340.44
650.71
717.39
788.01
1038.91
807.52
874.2
944.82
1195.72
964.33
1031.01
1101.63
1352.53
403.76
437.1
472.41
597.86
560.57
593.91
629.22
754.67
717.38
750.72
786.03
911.48
5000
500
10000
1000
5000
500
6850
Included in Medical
13700
Included in Medical
6850
Included in Medical
$30 Copay before deductible and 30% Coinsurance after deductible
$30 Copay before deductible and 30% Coinsurance after deductible
$300 Copay after deductible
$500 Copay per Stay after deductible
30% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Carson City
Gold
HMO Colorado, Inc., dba HMO Nevada
60156NV0240009
Anthem Gold Pathway X HMO 1000/10%/5500 Plus
HMO
Rating Area 3
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VP
https://www.anthem.com/NVSelectdrugtier4
X
0.995
234.78
369.74
387.49
419.65
472.53
660.36
1003.47
739.48
839.3
945.06
1320.72
2006.94
974.26
1074.08
1179.84
1555.5
1209.04
1308.86
1414.62
1790.28
1443.82
1543.64
1649.4
2025.06
604.52
654.43
707.31
895.14
839.3
889.21
942.09
1129.92
1074.08
1123.99
1176.87
1364.7
1000
250
3000
500
1000
250
5500
Included in Medical
11000
Included in Medical
5500
Included in Medical
$20
$50
$200 and 10%
10% Coinsurance after deductible
10% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Churchill
Bronze
HMO Colorado, Inc., dba HMO Nevada
60156NV0240007
Anthem Bronze Pathway X HMO 5000/30%/6850 Plus
HMO
Rating Area 4
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VK
https://www.anthem.com/NVSelectdrugtier4
X
0.992
192.43
303.04
317.59
343.95
387.29
541.23
822.45
606.08
687.9
774.58
1082.46
1644.9
798.51
880.33
967.01
1274.89
990.94
1072.76
1159.44
1467.32
1183.37
1265.19
1351.87
1659.75
495.47
536.38
579.72
733.66
687.9
728.81
772.15
926.09
880.33
921.24
964.58
1118.52
5000
500
10000
1000
5000
500
6850
Included in Medical
13700
Included in Medical
6850
Included in Medical
$30 Copay before deductible and 30% Coinsurance after deductible
$30 Copay before deductible and 30% Coinsurance after deductible
$300 Copay after deductible
$500 Copay per Stay after deductible
30% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Churchill
Gold
HMO Colorado, Inc., dba HMO Nevada
60156NV0240009
Anthem Gold Pathway X HMO 1000/10%/5500 Plus
HMO
Rating Area 4
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VP
https://www.anthem.com/NVSelectdrugtier4
X
0.995
288.11
453.72
475.5
514.97
579.85
810.34
1231.4
907.44
1029.94
1159.7
1620.68
2462.8
1195.55
1318.05
1447.81
1908.79
1483.66
1606.16
1735.92
2196.9
1771.77
1894.27
2024.03
2485.01
741.83
803.08
867.96
1098.45
1029.94
1091.19
1156.07
1386.56
1318.05
1379.3
1444.18
1674.67
1000
250
3000
500
1000
250
5500
Included in Medical
11000
Included in Medical
5500
Included in Medical
$20
$50
$200 and 10%
10% Coinsurance after deductible
10% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Clark
Bronze
HMO Colorado, Inc., dba HMO Nevada
60156NV0240007
Anthem Bronze Pathway X HMO 5000/30%/6850 Plus
HMO
Rating Area 1
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VK
https://www.anthem.com/NVSelectdrugtier4
X
0.992
139.59
219.83
230.38
249.51
280.94
392.62
596.62
439.66
499.02
561.88
785.24
1193.24
579.25
638.61
701.47
924.83
718.84
778.2
841.06
1064.42
858.43
917.79
980.65
1204.01
359.42
389.1
420.53
532.21
499.01
528.69
560.12
671.8
638.6
668.28
699.71
811.39
5000
500
10000
1000
5000
500
6850
Included in Medical
13700
Included in Medical
6850
Included in Medical
$30 Copay before deductible and 30% Coinsurance after deductible
$30 Copay before deductible and 30% Coinsurance after deductible
$300 Copay after deductible
$500 Copay per Stay after deductible
30% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Clark
Gold
HMO Colorado, Inc., dba HMO Nevada
60156NV0240009
Anthem Gold Pathway X HMO 1000/10%/5500 Plus
HMO
Rating Area 1
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VP
https://www.anthem.com/NVSelectdrugtier4
X
0.995
209
329.14
344.94
373.57
420.64
587.84
893.29
658.28
747.14
841.28
1175.68
1786.58
867.28
956.14
1050.28
1384.68
1076.28
1165.14
1259.28
1593.68
1285.28
1374.14
1468.28
1802.68
538.14
582.57
629.64
796.84
747.14
791.57
838.64
1005.84
956.14
1000.57
1047.64
1214.84
1000
250
3000
500
1000
250
5500
Included in Medical
11000
Included in Medical
5500
Included in Medical
$20
$50
$200 and 10%
10% Coinsurance after deductible
10% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Douglas
Bronze
HMO Colorado, Inc., dba HMO Nevada
60156NV0240007
Anthem Bronze Pathway X HMO 5000/30%/6850 Plus
HMO
Rating Area 3
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VK
https://www.anthem.com/NVSelectdrugtier4
X
0.992
156.81
246.95
258.8
280.29
315.6
441.05
670.22
493.9
560.58
631.2
882.1
1340.44
650.71
717.39
788.01
1038.91
807.52
874.2
944.82
1195.72
964.33
1031.01
1101.63
1352.53
403.76
437.1
472.41
597.86
560.57
593.91
629.22
754.67
717.38
750.72
786.03
911.48
5000
500
10000
1000
5000
500
6850
Included in Medical
13700
Included in Medical
6850
Included in Medical
$30 Copay before deductible and 30% Coinsurance after deductible
$30 Copay before deductible and 30% Coinsurance after deductible
$300 Copay after deductible
$500 Copay per Stay after deductible
30% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Douglas
Gold
HMO Colorado, Inc., dba HMO Nevada
60156NV0240009
Anthem Gold Pathway X HMO 1000/10%/5500 Plus
HMO
Rating Area 3
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VP
https://www.anthem.com/NVSelectdrugtier4
X
0.995
234.78
369.74
387.49
419.65
472.53
660.36
1003.47
739.48
839.3
945.06
1320.72
2006.94
974.26
1074.08
1179.84
1555.5
1209.04
1308.86
1414.62
1790.28
1443.82
1543.64
1649.4
2025.06
604.52
654.43
707.31
895.14
839.3
889.21
942.09
1129.92
1074.08
1123.99
1176.87
1364.7
1000
250
3000
500
1000
250
5500
Included in Medical
11000
Included in Medical
5500
Included in Medical
$20
$50
$200 and 10%
10% Coinsurance after deductible
10% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Elko
Bronze
HMO Colorado, Inc., dba HMO Nevada
60156NV0240007
Anthem Bronze Pathway X HMO 5000/30%/6850 Plus
HMO
Rating Area 4
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VK
https://www.anthem.com/NVSelectdrugtier4
X
0.992
192.43
303.04
317.59
343.95
387.29
541.23
822.45
606.08
687.9
774.58
1082.46
1644.9
798.51
880.33
967.01
1274.89
990.94
1072.76
1159.44
1467.32
1183.37
1265.19
1351.87
1659.75
495.47
536.38
579.72
733.66
687.9
728.81
772.15
926.09
880.33
921.24
964.58
1118.52
5000
500
10000
1000
5000
500
6850
Included in Medical
13700
Included in Medical
6850
Included in Medical
$30 Copay before deductible and 30% Coinsurance after deductible
$30 Copay before deductible and 30% Coinsurance after deductible
$300 Copay after deductible
$500 Copay per Stay after deductible
30% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Elko
Gold
HMO Colorado, Inc., dba HMO Nevada
60156NV0240009
Anthem Gold Pathway X HMO 1000/10%/5500 Plus
HMO
Rating Area 4
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VP
https://www.anthem.com/NVSelectdrugtier4
X
0.995
288.11
453.72
475.5
514.97
579.85
810.34
1231.4
907.44
1029.94
1159.7
1620.68
2462.8
1195.55
1318.05
1447.81
1908.79
1483.66
1606.16
1735.92
2196.9
1771.77
1894.27
2024.03
2485.01
741.83
803.08
867.96
1098.45
1029.94
1091.19
1156.07
1386.56
1318.05
1379.3
1444.18
1674.67
1000
250
3000
500
1000
250
5500
Included in Medical
11000
Included in Medical
5500
Included in Medical
$20
$50
$200 and 10%
10% Coinsurance after deductible
10% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Esmeralda
Bronze
HMO Colorado, Inc., dba HMO Nevada
60156NV0240007
Anthem Bronze Pathway X HMO 5000/30%/6850 Plus
HMO
Rating Area 4
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VK
https://www.anthem.com/NVSelectdrugtier4
X
0.992
192.43
303.04
317.59
343.95
387.29
541.23
822.45
606.08
687.9
774.58
1082.46
1644.9
798.51
880.33
967.01
1274.89
990.94
1072.76
1159.44
1467.32
1183.37
1265.19
1351.87
1659.75
495.47
536.38
579.72
733.66
687.9
728.81
772.15
926.09
880.33
921.24
964.58
1118.52
5000
500
10000
1000
5000
500
6850
Included in Medical
13700
Included in Medical
6850
Included in Medical
$30 Copay before deductible and 30% Coinsurance after deductible
$30 Copay before deductible and 30% Coinsurance after deductible
$300 Copay after deductible
$500 Copay per Stay after deductible
30% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Esmeralda
Gold
HMO Colorado, Inc., dba HMO Nevada
60156NV0240009
Anthem Gold Pathway X HMO 1000/10%/5500 Plus
HMO
Rating Area 4
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VP
https://www.anthem.com/NVSelectdrugtier4
X
0.995
288.11
453.72
475.5
514.97
579.85
810.34
1231.4
907.44
1029.94
1159.7
1620.68
2462.8
1195.55
1318.05
1447.81
1908.79
1483.66
1606.16
1735.92
2196.9
1771.77
1894.27
2024.03
2485.01
741.83
803.08
867.96
1098.45
1029.94
1091.19
1156.07
1386.56
1318.05
1379.3
1444.18
1674.67
1000
250
3000
500
1000
250
5500
Included in Medical
11000
Included in Medical
5500
Included in Medical
$20
$50
$200 and 10%
10% Coinsurance after deductible
10% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Eureka
Bronze
HMO Colorado, Inc., dba HMO Nevada
60156NV0240007
Anthem Bronze Pathway X HMO 5000/30%/6850 Plus
HMO
Rating Area 4
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VK
https://www.anthem.com/NVSelectdrugtier4
X
0.992
192.43
303.04
317.59
343.95
387.29
541.23
822.45
606.08
687.9
774.58
1082.46
1644.9
798.51
880.33
967.01
1274.89
990.94
1072.76
1159.44
1467.32
1183.37
1265.19
1351.87
1659.75
495.47
536.38
579.72
733.66
687.9
728.81
772.15
926.09
880.33
921.24
964.58
1118.52
5000
500
10000
1000
5000
500
6850
Included in Medical
13700
Included in Medical
6850
Included in Medical
$30 Copay before deductible and 30% Coinsurance after deductible
$30 Copay before deductible and 30% Coinsurance after deductible
$300 Copay after deductible
$500 Copay per Stay after deductible
30% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Eureka
Gold
HMO Colorado, Inc., dba HMO Nevada
60156NV0240009
Anthem Gold Pathway X HMO 1000/10%/5500 Plus
HMO
Rating Area 4
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VP
https://www.anthem.com/NVSelectdrugtier4
X
0.995
288.11
453.72
475.5
514.97
579.85
810.34
1231.4
907.44
1029.94
1159.7
1620.68
2462.8
1195.55
1318.05
1447.81
1908.79
1483.66
1606.16
1735.92
2196.9
1771.77
1894.27
2024.03
2485.01
741.83
803.08
867.96
1098.45
1029.94
1091.19
1156.07
1386.56
1318.05
1379.3
1444.18
1674.67
1000
250
3000
500
1000
250
5500
Included in Medical
11000
Included in Medical
5500
Included in Medical
$20
$50
$200 and 10%
10% Coinsurance after deductible
10% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Humboldt
Bronze
HMO Colorado, Inc., dba HMO Nevada
60156NV0240007
Anthem Bronze Pathway X HMO 5000/30%/6850 Plus
HMO
Rating Area 4
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VK
https://www.anthem.com/NVSelectdrugtier4
X
0.992
192.43
303.04
317.59
343.95
387.29
541.23
822.45
606.08
687.9
774.58
1082.46
1644.9
798.51
880.33
967.01
1274.89
990.94
1072.76
1159.44
1467.32
1183.37
1265.19
1351.87
1659.75
495.47
536.38
579.72
733.66
687.9
728.81
772.15
926.09
880.33
921.24
964.58
1118.52
5000
500
10000
1000
5000
500
6850
Included in Medical
13700
Included in Medical
6850
Included in Medical
$30 Copay before deductible and 30% Coinsurance after deductible
$30 Copay before deductible and 30% Coinsurance after deductible
$300 Copay after deductible
$500 Copay per Stay after deductible
30% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Humboldt
Gold
HMO Colorado, Inc., dba HMO Nevada
60156NV0240009
Anthem Gold Pathway X HMO 1000/10%/5500 Plus
HMO
Rating Area 4
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VP
https://www.anthem.com/NVSelectdrugtier4
X
0.995
288.11
453.72
475.5
514.97
579.85
810.34
1231.4
907.44
1029.94
1159.7
1620.68
2462.8
1195.55
1318.05
1447.81
1908.79
1483.66
1606.16
1735.92
2196.9
1771.77
1894.27
2024.03
2485.01
741.83
803.08
867.96
1098.45
1029.94
1091.19
1156.07
1386.56
1318.05
1379.3
1444.18
1674.67
1000
250
3000
500
1000
250
5500
Included in Medical
11000
Included in Medical
5500
Included in Medical
$20
$50
$200 and 10%
10% Coinsurance after deductible
10% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Lander
Bronze
HMO Colorado, Inc., dba HMO Nevada
60156NV0240007
Anthem Bronze Pathway X HMO 5000/30%/6850 Plus
HMO
Rating Area 4
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VK
https://www.anthem.com/NVSelectdrugtier4
X
0.992
192.43
303.04
317.59
343.95
387.29
541.23
822.45
606.08
687.9
774.58
1082.46
1644.9
798.51
880.33
967.01
1274.89
990.94
1072.76
1159.44
1467.32
1183.37
1265.19
1351.87
1659.75
495.47
536.38
579.72
733.66
687.9
728.81
772.15
926.09
880.33
921.24
964.58
1118.52
5000
500
10000
1000
5000
500
6850
Included in Medical
13700
Included in Medical
6850
Included in Medical
$30 Copay before deductible and 30% Coinsurance after deductible
$30 Copay before deductible and 30% Coinsurance after deductible
$300 Copay after deductible
$500 Copay per Stay after deductible
30% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Lander
Gold
HMO Colorado, Inc., dba HMO Nevada
60156NV0240009
Anthem Gold Pathway X HMO 1000/10%/5500 Plus
HMO
Rating Area 4
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VP
https://www.anthem.com/NVSelectdrugtier4
X
0.995
288.11
453.72
475.5
514.97
579.85
810.34
1231.4
907.44
1029.94
1159.7
1620.68
2462.8
1195.55
1318.05
1447.81
1908.79
1483.66
1606.16
1735.92
2196.9
1771.77
1894.27
2024.03
2485.01
741.83
803.08
867.96
1098.45
1029.94
1091.19
1156.07
1386.56
1318.05
1379.3
1444.18
1674.67
1000
250
3000
500
1000
250
5500
Included in Medical
11000
Included in Medical
5500
Included in Medical
$20
$50
$200 and 10%
10% Coinsurance after deductible
10% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Lincoln
Bronze
HMO Colorado, Inc., dba HMO Nevada
60156NV0240007
Anthem Bronze Pathway X HMO 5000/30%/6850 Plus
HMO
Rating Area 4
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VK
https://www.anthem.com/NVSelectdrugtier4
X
0.992
192.43
303.04
317.59
343.95
387.29
541.23
822.45
606.08
687.9
774.58
1082.46
1644.9
798.51
880.33
967.01
1274.89
990.94
1072.76
1159.44
1467.32
1183.37
1265.19
1351.87
1659.75
495.47
536.38
579.72
733.66
687.9
728.81
772.15
926.09
880.33
921.24
964.58
1118.52
5000
500
10000
1000
5000
500
6850
Included in Medical
13700
Included in Medical
6850
Included in Medical
$30 Copay before deductible and 30% Coinsurance after deductible
$30 Copay before deductible and 30% Coinsurance after deductible
$300 Copay after deductible
$500 Copay per Stay after deductible
30% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Lincoln
Gold
HMO Colorado, Inc., dba HMO Nevada
60156NV0240009
Anthem Gold Pathway X HMO 1000/10%/5500 Plus
HMO
Rating Area 4
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VP
https://www.anthem.com/NVSelectdrugtier4
X
0.995
288.11
453.72
475.5
514.97
579.85
810.34
1231.4
907.44
1029.94
1159.7
1620.68
2462.8
1195.55
1318.05
1447.81
1908.79
1483.66
1606.16
1735.92
2196.9
1771.77
1894.27
2024.03
2485.01
741.83
803.08
867.96
1098.45
1029.94
1091.19
1156.07
1386.56
1318.05
1379.3
1444.18
1674.67
1000
250
3000
500
1000
250
5500
Included in Medical
11000
Included in Medical
5500
Included in Medical
$20
$50
$200 and 10%
10% Coinsurance after deductible
10% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Lyon
Bronze
HMO Colorado, Inc., dba HMO Nevada
60156NV0240007
Anthem Bronze Pathway X HMO 5000/30%/6850 Plus
HMO
Rating Area 3
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VK
https://www.anthem.com/NVSelectdrugtier4
X
0.992
156.81
246.95
258.8
280.29
315.6
441.05
670.22
493.9
560.58
631.2
882.1
1340.44
650.71
717.39
788.01
1038.91
807.52
874.2
944.82
1195.72
964.33
1031.01
1101.63
1352.53
403.76
437.1
472.41
597.86
560.57
593.91
629.22
754.67
717.38
750.72
786.03
911.48
5000
500
10000
1000
5000
500
6850
Included in Medical
13700
Included in Medical
6850
Included in Medical
$30 Copay before deductible and 30% Coinsurance after deductible
$30 Copay before deductible and 30% Coinsurance after deductible
$300 Copay after deductible
$500 Copay per Stay after deductible
30% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Lyon
Gold
HMO Colorado, Inc., dba HMO Nevada
60156NV0240009
Anthem Gold Pathway X HMO 1000/10%/5500 Plus
HMO
Rating Area 3
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VP
https://www.anthem.com/NVSelectdrugtier4
X
0.995
234.78
369.74
387.49
419.65
472.53
660.36
1003.47
739.48
839.3
945.06
1320.72
2006.94
974.26
1074.08
1179.84
1555.5
1209.04
1308.86
1414.62
1790.28
1443.82
1543.64
1649.4
2025.06
604.52
654.43
707.31
895.14
839.3
889.21
942.09
1129.92
1074.08
1123.99
1176.87
1364.7
1000
250
3000
500
1000
250
5500
Included in Medical
11000
Included in Medical
5500
Included in Medical
$20
$50
$200 and 10%
10% Coinsurance after deductible
10% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Mineral
Bronze
HMO Colorado, Inc., dba HMO Nevada
60156NV0240007
Anthem Bronze Pathway X HMO 5000/30%/6850 Plus
HMO
Rating Area 4
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VK
https://www.anthem.com/NVSelectdrugtier4
X
0.992
192.43
303.04
317.59
343.95
387.29
541.23
822.45
606.08
687.9
774.58
1082.46
1644.9
798.51
880.33
967.01
1274.89
990.94
1072.76
1159.44
1467.32
1183.37
1265.19
1351.87
1659.75
495.47
536.38
579.72
733.66
687.9
728.81
772.15
926.09
880.33
921.24
964.58
1118.52
5000
500
10000
1000
5000
500
6850
Included in Medical
13700
Included in Medical
6850
Included in Medical
$30 Copay before deductible and 30% Coinsurance after deductible
$30 Copay before deductible and 30% Coinsurance after deductible
$300 Copay after deductible
$500 Copay per Stay after deductible
30% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Mineral
Gold
HMO Colorado, Inc., dba HMO Nevada
60156NV0240009
Anthem Gold Pathway X HMO 1000/10%/5500 Plus
HMO
Rating Area 4
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VP
https://www.anthem.com/NVSelectdrugtier4
X
0.995
288.11
453.72
475.5
514.97
579.85
810.34
1231.4
907.44
1029.94
1159.7
1620.68
2462.8
1195.55
1318.05
1447.81
1908.79
1483.66
1606.16
1735.92
2196.9
1771.77
1894.27
2024.03
2485.01
741.83
803.08
867.96
1098.45
1029.94
1091.19
1156.07
1386.56
1318.05
1379.3
1444.18
1674.67
1000
250
3000
500
1000
250
5500
Included in Medical
11000
Included in Medical
5500
Included in Medical
$20
$50
$200 and 10%
10% Coinsurance after deductible
10% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Nye
Bronze
HMO Colorado, Inc., dba HMO Nevada
60156NV0240007
Anthem Bronze Pathway X HMO 5000/30%/6850 Plus
HMO
Rating Area 1
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VK
https://www.anthem.com/NVSelectdrugtier4
X
0.992
139.59
219.83
230.38
249.51
280.94
392.62
596.62
439.66
499.02
561.88
785.24
1193.24
579.25
638.61
701.47
924.83
718.84
778.2
841.06
1064.42
858.43
917.79
980.65
1204.01
359.42
389.1
420.53
532.21
499.01
528.69
560.12
671.8
638.6
668.28
699.71
811.39
5000
500
10000
1000
5000
500
6850
Included in Medical
13700
Included in Medical
6850
Included in Medical
$30 Copay before deductible and 30% Coinsurance after deductible
$30 Copay before deductible and 30% Coinsurance after deductible
$300 Copay after deductible
$500 Copay per Stay after deductible
30% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Nye
Gold
HMO Colorado, Inc., dba HMO Nevada
60156NV0240009
Anthem Gold Pathway X HMO 1000/10%/5500 Plus
HMO
Rating Area 1
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VP
https://www.anthem.com/NVSelectdrugtier4
X
0.995
209
329.14
344.94
373.57
420.64
587.84
893.29
658.28
747.14
841.28
1175.68
1786.58
867.28
956.14
1050.28
1384.68
1076.28
1165.14
1259.28
1593.68
1285.28
1374.14
1468.28
1802.68
538.14
582.57
629.64
796.84
747.14
791.57
838.64
1005.84
956.14
1000.57
1047.64
1214.84
1000
250
3000
500
1000
250
5500
Included in Medical
11000
Included in Medical
5500
Included in Medical
$20
$50
$200 and 10%
10% Coinsurance after deductible
10% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Pershing
Bronze
HMO Colorado, Inc., dba HMO Nevada
60156NV0240007
Anthem Bronze Pathway X HMO 5000/30%/6850 Plus
HMO
Rating Area 4
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VK
https://www.anthem.com/NVSelectdrugtier4
X
0.992
192.43
303.04
317.59
343.95
387.29
541.23
822.45
606.08
687.9
774.58
1082.46
1644.9
798.51
880.33
967.01
1274.89
990.94
1072.76
1159.44
1467.32
1183.37
1265.19
1351.87
1659.75
495.47
536.38
579.72
733.66
687.9
728.81
772.15
926.09
880.33
921.24
964.58
1118.52
5000
500
10000
1000
5000
500
6850
Included in Medical
13700
Included in Medical
6850
Included in Medical
$30 Copay before deductible and 30% Coinsurance after deductible
$30 Copay before deductible and 30% Coinsurance after deductible
$300 Copay after deductible
$500 Copay per Stay after deductible
30% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Pershing
Gold
HMO Colorado, Inc., dba HMO Nevada
60156NV0240009
Anthem Gold Pathway X HMO 1000/10%/5500 Plus
HMO
Rating Area 4
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VP
https://www.anthem.com/NVSelectdrugtier4
X
0.995
288.11
453.72
475.5
514.97
579.85
810.34
1231.4
907.44
1029.94
1159.7
1620.68
2462.8
1195.55
1318.05
1447.81
1908.79
1483.66
1606.16
1735.92
2196.9
1771.77
1894.27
2024.03
2485.01
741.83
803.08
867.96
1098.45
1029.94
1091.19
1156.07
1386.56
1318.05
1379.3
1444.18
1674.67
1000
250
3000
500
1000
250
5500
Included in Medical
11000
Included in Medical
5500
Included in Medical
$20
$50
$200 and 10%
10% Coinsurance after deductible
10% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Storey
Bronze
HMO Colorado, Inc., dba HMO Nevada
60156NV0240007
Anthem Bronze Pathway X HMO 5000/30%/6850 Plus
HMO
Rating Area 3
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VK
https://www.anthem.com/NVSelectdrugtier4
X
0.992
156.81
246.95
258.8
280.29
315.6
441.05
670.22
493.9
560.58
631.2
882.1
1340.44
650.71
717.39
788.01
1038.91
807.52
874.2
944.82
1195.72
964.33
1031.01
1101.63
1352.53
403.76
437.1
472.41
597.86
560.57
593.91
629.22
754.67
717.38
750.72
786.03
911.48
5000
500
10000
1000
5000
500
6850
Included in Medical
13700
Included in Medical
6850
Included in Medical
$30 Copay before deductible and 30% Coinsurance after deductible
$30 Copay before deductible and 30% Coinsurance after deductible
$300 Copay after deductible
$500 Copay per Stay after deductible
30% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Storey
Gold
HMO Colorado, Inc., dba HMO Nevada
60156NV0240009
Anthem Gold Pathway X HMO 1000/10%/5500 Plus
HMO
Rating Area 3
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VP
https://www.anthem.com/NVSelectdrugtier4
X
0.995
234.78
369.74
387.49
419.65
472.53
660.36
1003.47
739.48
839.3
945.06
1320.72
2006.94
974.26
1074.08
1179.84
1555.5
1209.04
1308.86
1414.62
1790.28
1443.82
1543.64
1649.4
2025.06
604.52
654.43
707.31
895.14
839.3
889.21
942.09
1129.92
1074.08
1123.99
1176.87
1364.7
1000
250
3000
500
1000
250
5500
Included in Medical
11000
Included in Medical
5500
Included in Medical
$20
$50
$200 and 10%
10% Coinsurance after deductible
10% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Washoe
Bronze
HMO Colorado, Inc., dba HMO Nevada
60156NV0240007
Anthem Bronze Pathway X HMO 5000/30%/6850 Plus
HMO
Rating Area 2
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VK
https://www.anthem.com/NVSelectdrugtier4
X
0.992
140.92
221.92
232.57
251.88
283.61
396.35
602.29
443.84
503.76
567.22
792.7
1204.58
584.76
644.68
708.14
933.62
725.68
785.6
849.06
1074.54
866.6
926.52
989.98
1215.46
362.84
392.8
424.53
537.27
503.76
533.72
565.45
678.19
644.68
674.64
706.37
819.11
5000
500
10000
1000
5000
500
6850
Included in Medical
13700
Included in Medical
6850
Included in Medical
$30 Copay before deductible and 30% Coinsurance after deductible
$30 Copay before deductible and 30% Coinsurance after deductible
$300 Copay after deductible
$500 Copay per Stay after deductible
30% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Washoe
Gold
HMO Colorado, Inc., dba HMO Nevada
60156NV0240009
Anthem Gold Pathway X HMO 1000/10%/5500 Plus
HMO
Rating Area 2
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VP
https://www.anthem.com/NVSelectdrugtier4
X
0.995
210.99
332.26
348.21
377.12
424.63
593.42
901.75
664.52
754.24
849.26
1186.84
1803.5
875.51
965.23
1060.25
1397.83
1086.5
1176.22
1271.24
1608.82
1297.49
1387.21
1482.23
1819.81
543.25
588.11
635.62
804.41
754.24
799.1
846.61
1015.4
965.23
1010.09
1057.6
1226.39
1000
250
3000
500
1000
250
5500
Included in Medical
11000
Included in Medical
5500
Included in Medical
$20
$50
$200 and 10%
10% Coinsurance after deductible
10% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
White Pine
Bronze
HMO Colorado, Inc., dba HMO Nevada
60156NV0240007
Anthem Bronze Pathway X HMO 5000/30%/6850 Plus
HMO
Rating Area 4
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VK
https://www.anthem.com/NVSelectdrugtier4
X
0.992
192.43
303.04
317.59
343.95
387.29
541.23
822.45
606.08
687.9
774.58
1082.46
1644.9
798.51
880.33
967.01
1274.89
990.94
1072.76
1159.44
1467.32
1183.37
1265.19
1351.87
1659.75
495.47
536.38
579.72
733.66
687.9
728.81
772.15
926.09
880.33
921.24
964.58
1118.52
5000
500
10000
1000
5000
500
6850
Included in Medical
13700
Included in Medical
6850
Included in Medical
$30 Copay before deductible and 30% Coinsurance after deductible
$30 Copay before deductible and 30% Coinsurance after deductible
$300 Copay after deductible
$500 Copay per Stay after deductible
30% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
White Pine
Gold
HMO Colorado, Inc., dba HMO Nevada
60156NV0240009
Anthem Gold Pathway X HMO 1000/10%/5500 Plus
HMO
Rating Area 4
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VP
https://www.anthem.com/NVSelectdrugtier4
X
0.995
288.11
453.72
475.5
514.97
579.85
810.34
1231.4
907.44
1029.94
1159.7
1620.68
2462.8
1195.55
1318.05
1447.81
1908.79
1483.66
1606.16
1735.92
2196.9
1771.77
1894.27
2024.03
2485.01
741.83
803.08
867.96
1098.45
1029.94
1091.19
1156.07
1386.56
1318.05
1379.3
1444.18
1674.67
1000
250
3000
500
1000
250
5500
Included in Medical
11000
Included in Medical
5500
Included in Medical
$20
$50
$200 and 10%
10% Coinsurance after deductible
10% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Carson City
Silver
HMO Colorado, Inc., dba HMO Nevada
60156NV0240008
Anthem Silver Pathway X HMO 3000/20%/6000 Plus
HMO
Rating Area 3
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VM
https://www.anthem.com/NVSelectdrugtier4
X
0.993
187.69
295.58
309.77
335.48
377.75
527.91
802.2
591.16
670.96
755.5
1055.82
1604.4
778.85
858.65
943.19
1243.51
966.54
1046.34
1130.88
1431.2
1154.23
1234.03
1318.57
1618.89
483.27
523.17
565.44
715.6
670.96
710.86
753.13
903.29
858.65
898.55
940.82
1090.98
3000
500
6000
1000
3000
500
6000
Included in Medical
12000
Included in Medical
6000
Included in Medical
$25
$50
$300 Copay after deductible
$500 Copay per Stay after deductible
20% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Churchill
Silver
HMO Colorado, Inc., dba HMO Nevada
60156NV0240008
Anthem Silver Pathway X HMO 3000/20%/6000 Plus
HMO
Rating Area 4
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VM
https://www.anthem.com/NVSelectdrugtier4
X
0.993
230.33
362.72
380.13
411.69
463.56
647.82
984.42
725.44
823.38
927.12
1295.64
1968.84
955.77
1053.71
1157.45
1525.97
1186.1
1284.04
1387.78
1756.3
1416.43
1514.37
1618.11
1986.63
593.05
642.02
693.89
878.15
823.38
872.35
924.22
1108.48
1053.71
1102.68
1154.55
1338.81
3000
500
6000
1000
3000
500
6000
Included in Medical
12000
Included in Medical
6000
Included in Medical
$25
$50
$300 Copay after deductible
$500 Copay per Stay after deductible
20% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Clark
Silver
HMO Colorado, Inc., dba HMO Nevada
60156NV0240008
Anthem Silver Pathway X HMO 3000/20%/6000 Plus
HMO
Rating Area 1
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VM
https://www.anthem.com/NVSelectdrugtier4
X
0.993
167.09
263.13
275.76
298.65
336.28
469.95
714.13
526.26
597.3
672.56
939.9
1428.26
693.35
764.39
839.65
1106.99
860.44
931.48
1006.74
1274.08
1027.53
1098.57
1173.83
1441.17
430.22
465.74
503.37
637.04
597.31
632.83
670.46
804.13
764.4
799.92
837.55
971.22
3000
500
6000
1000
3000
500
6000
Included in Medical
12000
Included in Medical
6000
Included in Medical
$25
$50
$300 Copay after deductible
$500 Copay per Stay after deductible
20% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Douglas
Silver
HMO Colorado, Inc., dba HMO Nevada
60156NV0240008
Anthem Silver Pathway X HMO 3000/20%/6000 Plus
HMO
Rating Area 3
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VM
https://www.anthem.com/NVSelectdrugtier4
X
0.993
187.69
295.58
309.77
335.48
377.75
527.91
802.2
591.16
670.96
755.5
1055.82
1604.4
778.85
858.65
943.19
1243.51
966.54
1046.34
1130.88
1431.2
1154.23
1234.03
1318.57
1618.89
483.27
523.17
565.44
715.6
670.96
710.86
753.13
903.29
858.65
898.55
940.82
1090.98
3000
500
6000
1000
3000
500
6000
Included in Medical
12000
Included in Medical
6000
Included in Medical
$25
$50
$300 Copay after deductible
$500 Copay per Stay after deductible
20% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Elko
Silver
HMO Colorado, Inc., dba HMO Nevada
60156NV0240008
Anthem Silver Pathway X HMO 3000/20%/6000 Plus
HMO
Rating Area 4
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VM
https://www.anthem.com/NVSelectdrugtier4
X
0.993
230.33
362.72
380.13
411.69
463.56
647.82
984.42
725.44
823.38
927.12
1295.64
1968.84
955.77
1053.71
1157.45
1525.97
1186.1
1284.04
1387.78
1756.3
1416.43
1514.37
1618.11
1986.63
593.05
642.02
693.89
878.15
823.38
872.35
924.22
1108.48
1053.71
1102.68
1154.55
1338.81
3000
500
6000
1000
3000
500
6000
Included in Medical
12000
Included in Medical
6000
Included in Medical
$25
$50
$300 Copay after deductible
$500 Copay per Stay after deductible
20% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Esmeralda
Silver
HMO Colorado, Inc., dba HMO Nevada
60156NV0240008
Anthem Silver Pathway X HMO 3000/20%/6000 Plus
HMO
Rating Area 4
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VM
https://www.anthem.com/NVSelectdrugtier4
X
0.993
230.33
362.72
380.13
411.69
463.56
647.82
984.42
725.44
823.38
927.12
1295.64
1968.84
955.77
1053.71
1157.45
1525.97
1186.1
1284.04
1387.78
1756.3
1416.43
1514.37
1618.11
1986.63
593.05
642.02
693.89
878.15
823.38
872.35
924.22
1108.48
1053.71
1102.68
1154.55
1338.81
3000
500
6000
1000
3000
500
6000
Included in Medical
12000
Included in Medical
6000
Included in Medical
$25
$50
$300 Copay after deductible
$500 Copay per Stay after deductible
20% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Eureka
Silver
HMO Colorado, Inc., dba HMO Nevada
60156NV0240008
Anthem Silver Pathway X HMO 3000/20%/6000 Plus
HMO
Rating Area 4
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VM
https://www.anthem.com/NVSelectdrugtier4
X
0.993
230.33
362.72
380.13
411.69
463.56
647.82
984.42
725.44
823.38
927.12
1295.64
1968.84
955.77
1053.71
1157.45
1525.97
1186.1
1284.04
1387.78
1756.3
1416.43
1514.37
1618.11
1986.63
593.05
642.02
693.89
878.15
823.38
872.35
924.22
1108.48
1053.71
1102.68
1154.55
1338.81
3000
500
6000
1000
3000
500
6000
Included in Medical
12000
Included in Medical
6000
Included in Medical
$25
$50
$300 Copay after deductible
$500 Copay per Stay after deductible
20% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Humboldt
Silver
HMO Colorado, Inc., dba HMO Nevada
60156NV0240008
Anthem Silver Pathway X HMO 3000/20%/6000 Plus
HMO
Rating Area 4
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VM
https://www.anthem.com/NVSelectdrugtier4
X
0.993
230.33
362.72
380.13
411.69
463.56
647.82
984.42
725.44
823.38
927.12
1295.64
1968.84
955.77
1053.71
1157.45
1525.97
1186.1
1284.04
1387.78
1756.3
1416.43
1514.37
1618.11
1986.63
593.05
642.02
693.89
878.15
823.38
872.35
924.22
1108.48
1053.71
1102.68
1154.55
1338.81
3000
500
6000
1000
3000
500
6000
Included in Medical
12000
Included in Medical
6000
Included in Medical
$25
$50
$300 Copay after deductible
$500 Copay per Stay after deductible
20% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Lander
Silver
HMO Colorado, Inc., dba HMO Nevada
60156NV0240008
Anthem Silver Pathway X HMO 3000/20%/6000 Plus
HMO
Rating Area 4
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VM
https://www.anthem.com/NVSelectdrugtier4
X
0.993
230.33
362.72
380.13
411.69
463.56
647.82
984.42
725.44
823.38
927.12
1295.64
1968.84
955.77
1053.71
1157.45
1525.97
1186.1
1284.04
1387.78
1756.3
1416.43
1514.37
1618.11
1986.63
593.05
642.02
693.89
878.15
823.38
872.35
924.22
1108.48
1053.71
1102.68
1154.55
1338.81
3000
500
6000
1000
3000
500
6000
Included in Medical
12000
Included in Medical
6000
Included in Medical
$25
$50
$300 Copay after deductible
$500 Copay per Stay after deductible
20% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Lincoln
Silver
HMO Colorado, Inc., dba HMO Nevada
60156NV0240008
Anthem Silver Pathway X HMO 3000/20%/6000 Plus
HMO
Rating Area 4
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VM
https://www.anthem.com/NVSelectdrugtier4
X
0.993
230.33
362.72
380.13
411.69
463.56
647.82
984.42
725.44
823.38
927.12
1295.64
1968.84
955.77
1053.71
1157.45
1525.97
1186.1
1284.04
1387.78
1756.3
1416.43
1514.37
1618.11
1986.63
593.05
642.02
693.89
878.15
823.38
872.35
924.22
1108.48
1053.71
1102.68
1154.55
1338.81
3000
500
6000
1000
3000
500
6000
Included in Medical
12000
Included in Medical
6000
Included in Medical
$25
$50
$300 Copay after deductible
$500 Copay per Stay after deductible
20% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Lyon
Silver
HMO Colorado, Inc., dba HMO Nevada
60156NV0240008
Anthem Silver Pathway X HMO 3000/20%/6000 Plus
HMO
Rating Area 3
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VM
https://www.anthem.com/NVSelectdrugtier4
X
0.993
187.69
295.58
309.77
335.48
377.75
527.91
802.2
591.16
670.96
755.5
1055.82
1604.4
778.85
858.65
943.19
1243.51
966.54
1046.34
1130.88
1431.2
1154.23
1234.03
1318.57
1618.89
483.27
523.17
565.44
715.6
670.96
710.86
753.13
903.29
858.65
898.55
940.82
1090.98
3000
500
6000
1000
3000
500
6000
Included in Medical
12000
Included in Medical
6000
Included in Medical
$25
$50
$300 Copay after deductible
$500 Copay per Stay after deductible
20% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Mineral
Silver
HMO Colorado, Inc., dba HMO Nevada
60156NV0240008
Anthem Silver Pathway X HMO 3000/20%/6000 Plus
HMO
Rating Area 4
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VM
https://www.anthem.com/NVSelectdrugtier4
X
0.993
230.33
362.72
380.13
411.69
463.56
647.82
984.42
725.44
823.38
927.12
1295.64
1968.84
955.77
1053.71
1157.45
1525.97
1186.1
1284.04
1387.78
1756.3
1416.43
1514.37
1618.11
1986.63
593.05
642.02
693.89
878.15
823.38
872.35
924.22
1108.48
1053.71
1102.68
1154.55
1338.81
3000
500
6000
1000
3000
500
6000
Included in Medical
12000
Included in Medical
6000
Included in Medical
$25
$50
$300 Copay after deductible
$500 Copay per Stay after deductible
20% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Nye
Silver
HMO Colorado, Inc., dba HMO Nevada
60156NV0240008
Anthem Silver Pathway X HMO 3000/20%/6000 Plus
HMO
Rating Area 1
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VM
https://www.anthem.com/NVSelectdrugtier4
X
0.993
167.09
263.13
275.76
298.65
336.28
469.95
714.13
526.26
597.3
672.56
939.9
1428.26
693.35
764.39
839.65
1106.99
860.44
931.48
1006.74
1274.08
1027.53
1098.57
1173.83
1441.17
430.22
465.74
503.37
637.04
597.31
632.83
670.46
804.13
764.4
799.92
837.55
971.22
3000
500
6000
1000
3000
500
6000
Included in Medical
12000
Included in Medical
6000
Included in Medical
$25
$50
$300 Copay after deductible
$500 Copay per Stay after deductible
20% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Pershing
Silver
HMO Colorado, Inc., dba HMO Nevada
60156NV0240008
Anthem Silver Pathway X HMO 3000/20%/6000 Plus
HMO
Rating Area 4
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VM
https://www.anthem.com/NVSelectdrugtier4
X
0.993
230.33
362.72
380.13
411.69
463.56
647.82
984.42
725.44
823.38
927.12
1295.64
1968.84
955.77
1053.71
1157.45
1525.97
1186.1
1284.04
1387.78
1756.3
1416.43
1514.37
1618.11
1986.63
593.05
642.02
693.89
878.15
823.38
872.35
924.22
1108.48
1053.71
1102.68
1154.55
1338.81
3000
500
6000
1000
3000
500
6000
Included in Medical
12000
Included in Medical
6000
Included in Medical
$25
$50
$300 Copay after deductible
$500 Copay per Stay after deductible
20% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Storey
Silver
HMO Colorado, Inc., dba HMO Nevada
60156NV0240008
Anthem Silver Pathway X HMO 3000/20%/6000 Plus
HMO
Rating Area 3
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VM
https://www.anthem.com/NVSelectdrugtier4
X
0.993
187.69
295.58
309.77
335.48
377.75
527.91
802.2
591.16
670.96
755.5
1055.82
1604.4
778.85
858.65
943.19
1243.51
966.54
1046.34
1130.88
1431.2
1154.23
1234.03
1318.57
1618.89
483.27
523.17
565.44
715.6
670.96
710.86
753.13
903.29
858.65
898.55
940.82
1090.98
3000
500
6000
1000
3000
500
6000
Included in Medical
12000
Included in Medical
6000
Included in Medical
$25
$50
$300 Copay after deductible
$500 Copay per Stay after deductible
20% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible
NV
Washoe
Silver
HMO Colorado, Inc., dba HMO Nevada
60156NV0240008
Anthem Silver Pathway X HMO 3000/20%/6000 Plus
HMO
Rating Area 2
Allows Adult and Child-Only
SERFF
1-855-711-8949
1-855-711-8949
https://www.anthem.com/health-insurance/provider-directory/searchcriteria?alphaprefix=YFI
http://sgplans.anthem.com/nv/brochure/
http://www.sbc.anthem.com/dps/CCD20VM
https://www.anthem.com/NVSelectdrugtier4
X
0.993
168.67
265.62
278.37
301.48
339.46
474.4
720.89
531.24
602.96
678.92
948.8
1441.78
699.91
771.63
847.59
1117.47
868.58
940.3
1016.26
1286.14
1037.25
1108.97
1184.93
1454.81
434.29
470.15
508.13
643.07
602.96
638.82
676.8
811.74
771.63
807.49
845.47
980.41
3000
500
6000
1000
3000
500
6000
Included in Medical
12000
Included in Medical
6000
Included in Medical
$25
$50
$300 Copay after deductible
$500 Copay per Stay after deductible
20% Coinsurance after deductible
15
$40 Copay after deductible
$80 Copay after deductible
30% Coinsurance after deductible

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