2016 QHP Landscape NV SHOP Market Medical

State Code Want total control? Request access to start using the data.	County Name Want total control? Request access to start using the data.	Metal Level Want total control? Request access to start using the data.	Issuer Name Want total control? Request access to start using the data.	Plan Id (Standard Component) Want total control? Request access to start using the data.	Plan Marketing Name Want total control? Request access to start using the data.	Plan Type Want total control? Request access to start using the data.	Rating Area Want total control? Request access to start using the data.	Child Only Offering Want total control? Request access to start using the data.	Source Want total control? Request access to start using the data.	Customer Service Phone Number Local Want total control? Request access to start using the data.	Customer Service Phone Number Toll Free Want total control? Request access to start using the data.	Network Url Want total control? Request access to start using the data.	Plan Brochure Url Want total control? Request access to start using the data.	Summary Of Benefits Url Want total control? Request access to start using the data.	Drug Formulary Url Want total control? Request access to start using the data.	Child Dental Want total control? Request access to start using the data.	Ehb Percent Of Total Premium Want total control? Request access to start using the data.	Premium Child Want total control? Request access to start using the data.	Premium Adult Individual Age 21 Want total control? Request access to start using the data.	Premium Adult Individual Age 27 Want total control? Request access to start using the data.	Premium Adult Individual Age 30 Want total control? Request access to start using the data.	Premium Adult Individual Age 40 Want total control? Request access to start using the data.	Premium Adult Individual Age 50 Want total control? Request access to start using the data.	Premium Adult Individual Age 60 Want total control? Request access to start using the data.	Premium Couple 21 Want total control? Request access to start using the data.	Premium Couple 30 Want total control? Request access to start using the data.	Premium Couple 40 Want total control? Request access to start using the data.	Premium Couple 50 Want total control? Request access to start using the data.	Premium Couple 60 Want total control? Request access to start using the data.	Couple+1 Child, Age 21 Want total control? Request access to start using the data.	Couple+1 Child, Age 30 Want total control? Request access to start using the data.	Couple+1 Child, Age 40 Want total control? Request access to start using the data.	Couple+1 Child, Age 50 Want total control? Request access to start using the data.	Couple+2 Children, Age 21 Want total control? Request access to start using the data.	Couple+2 Children, Age 30 Want total control? Request access to start using the data.	Couple+2 Children, Age 40 Want total control? Request access to start using the data.	Couple+2 Children, Age 50 Want total control? Request access to start using the data.	Couple+3 Or More Children, Age 21 Want total control? Request access to start using the data.	Couple+3 Or More Children, Age 30 Want total control? Request access to start using the data.	Couple+3 Or More Children, Age 40 Want total control? Request access to start using the data.	Couple+3 Or More Children, Age 50 Want total control? Request access to start using the data.	Individual+1 Child, Age 21 Want total control? Request access to start using the data.	Individual+1 Child, Age 30 Want total control? Request access to start using the data.	Individual+1 Child, Age 40 Want total control? Request access to start using the data.	Individual+1 Child, Age 50 Want total control? Request access to start using the data.	Individual+2 Children, Age 21 Want total control? Request access to start using the data.	Individual+2 Children, Age 30 Want total control? Request access to start using the data.	Individual+2 Children, Age 40 Want total control? Request access to start using the data.	Individual+2 Children, Age 50 Want total control? Request access to start using the data.	Individual+3 Or More Children, Age 21 Want total control? Request access to start using the data.	Individual+3 Or More Children, Age 30 Want total control? Request access to start using the data.	Individual+3 Or More Children, Age 40 Want total control? Request access to start using the data.	Individual+3 Or More Children, Age 50 Want total control? Request access to start using the data.	Medical Deductible - Individual - Standard Want total control? Request access to start using the data.	Drug Deductible - Individual - Standard Want total control? Request access to start using the data.	Medical Deductible - Family - Standard Want total control? Request access to start using the data.	Drug Deductible - Family - Standard Want total control? Request access to start using the data.	Medical Deductible - Family (Per Person) - Standard Want total control? Request access to start using the data.	Drug Deductible - Family (Per Person) - Standard Want total control? Request access to start using the data.	Medical Maximum Out Of Pocket - Individual - Standard Want total control? Request access to start using the data.	Drug Maximum Out Of Pocket - Individual - Standard Want total control? Request access to start using the data.	Medical Maximum Out Of Pocket - Family - Standard Want total control? Request access to start using the data.	Drug Maximum Out Of Pocket - Family - Standard Want total control? Request access to start using the data.	Medical Maximum Out Of Pocket - Family (Per Person) - Standard Want total control? Request access to start using the data.	Drug Maximum Out Of Pocket - Family (Per Person) - Standard Want total control? Request access to start using the data.	Primary Care Physician - Standard Want total control? Request access to start using the data.	Specialist - Standard Want total control? Request access to start using the data.	Emergency Room - Standard Want total control? Request access to start using the data.	Inpatient Facility - Standard Want total control? Request access to start using the data.	Inpatient Physician - Standard Want total control? Request access to start using the data.	Generic Drugs - Standard Want total control? Request access to start using the data.	Preferred Brand Drugs - Standard Want total control? Request access to start using the data.	Non-Preferred Brand Drugs - Standard Want total control? Request access to start using the data.	Specialty Drugs - Standard Want total control? Request access to start using the data.
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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