Anthem Silver X 800 ($0 Virtual PCP + $0 Select Drugs + Incentives) S05

HMO Colorado, Inc., DBA HMO Nevada · 2027 plan year

Silver

Ind. deductible: $800
Family deductible: $1,600
Ind. OOP max: $3,100
Family OOP max: $6,200

Other cost-sharing reduction variants for this plan:

73% AV Level Silver Plan 94% AV Level Silver Plan Limited Cost Sharing Plan Variation Standard Silver Off Exchange Plan Standard Silver On Exchange Plan Zero Cost Sharing Plan Variation

More HMO Colorado, Inc., DBA HMO Nevada plans in NV

Anthem Bronze X 6000 HSA ($0 Virtual PCP + $0 Select Drugs + Incentives)Anthem Silver Convenient Care X 5000 ($0 Virtual PCP + $0 Select Drugs + Incentives)Anthem Catastrophic X HSA ($0 Virtual PCP + Incentives)Anthem Bronze X 8050 HSA ($0 Virtual PCP + $0 Select Drugs + Incentives)Anthem Bronze X 12000 HSA ($0 Virtual PCP + $0 Select Drugs + Incentives)

Live premium estimate

Benefits & cost sharing

Primary Care

Benefit	In-network
Preventive Care/Screening/Immunization	No charge
Primary Care Visit to Treat an Injury or Illness	$5.00

Specialist

Benefit	In-network
Specialist Visit	$30.00

Hospital

Benefit	In-network
Emergency Room Services	$100.00 Copay after deductible + 20.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	$250.00 Copay per Stay after deductible + 30.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services	20.00% Coinsurance after deductible
Urgent Care Centers or Facilities	$50.00

Pharmacy

Benefit	In-network
Generic Drugs	$5.00
Non-Preferred Brand Drugs	30.00% Coinsurance after deductible
Preferred Brand Drugs	$30.00
Specialty Drugs	40.00% Coinsurance after deductible

Mental Health

Benefit	In-network
Mental/Behavioral Health Inpatient Services	$250.00 Copay per Stay after deductible + 30.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services	20.00% Coinsurance after deductible

Other

Benefit	In-network
Accidental Dental	20.00% Coinsurance after deductible
Allergy Testing	20.00% Coinsurance after deductible
Bariatric Surgery	$250.00 Copay after deductible + 30.00% Coinsurance after deductible
Chemotherapy	20.00% Coinsurance after deductible
Chiropractic Care	20.00% Coinsurance after deductible
Delivery and All Inpatient Services for Maternity Care	$250.00 Copay after deductible + 30.00% Coinsurance after deductible
Diabetes Education	20.00% Coinsurance after deductible
Dialysis	20.00% Coinsurance after deductible
Durable Medical Equipment	20.00% Coinsurance after deductible
Emergency Transportation/Ambulance	20.00% Coinsurance after deductible
Eye Glasses for Children	No charge
Gender Affirming Care	20.00% Coinsurance after deductible
Habilitation Services	20.00% Coinsurance after deductible
Hearing Aids	20.00% Coinsurance after deductible
Home Health Care Services	20.00% Coinsurance after deductible
Hospice Services	20.00% Coinsurance after deductible
Imaging (CT/PET Scans, MRIs)	$200.00 Copay after deductible + 20.00% Coinsurance after deductible
Infertility Treatment	20.00% Coinsurance after deductible
Infusion Therapy	20.00% Coinsurance after deductible
Inpatient Physician and Surgical Services	20.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services	20.00% Coinsurance after deductible
Nutritional Counseling	20.00% Coinsurance after deductible
Other Practitioner Office Visit (Nurse, Physician Assistant)	$5.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)	20.00% Coinsurance after deductible
Outpatient Rehabilitation Services	20.00% Coinsurance after deductible
Prenatal and Postnatal Care	20.00% Coinsurance after deductible
Private-Duty Nursing	20.00% Coinsurance after deductible
Prosthetic Devices	20.00% Coinsurance after deductible
Radiation	20.00% Coinsurance after deductible
Reconstructive Surgery	$250.00 Copay after deductible + 30.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy	20.00% Coinsurance after deductible
Rehabilitative Speech Therapy	20.00% Coinsurance after deductible
Routine Eye Exam for Children	No charge
Skilled Nursing Facility	20.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services	$250.00 Copay per Stay after deductible + 30.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services	20.00% Coinsurance after deductible
Transplant	$250.00 Copay after deductible + 30.00% Coinsurance after deductible
Treatment for Temporomandibular Joint Disorders	20.00% Coinsurance after deductible
Well Baby Visits and Care	No charge
X-rays and Diagnostic Imaging	$50.00

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