KP NV Bronze 5900 HSA

HOMETOWN HEALTH PLAN, INC. · 2027 plan year

Expanded BronzeHSA eligible
Ind. deductible
$5,900
Family deductible
$11,800
Ind. OOP max
$11,800
Family OOP max
$23,600

Compare with other Expanded Bronze plans in NV

Side by side: deductibles, out-of-pocket limits and copays.

More HOMETOWN HEALTH PLAN, INC. plans in NV

Monthly premiums by age

Rating Area 2 — the lowest-priced of the 2 areas this plan covers. Premiums differ by area.

AgeIndividualIndividual + tobacco
Under 15$313$313
21$409$425
30$464$576
40$523$700
50$730$1,037
60$1,110$1,665
64 and over$1,227$1,840

Live premium estimate

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Benefits & cost sharing

Primary Care

BenefitIn-network
Preventive Care/Screening/ImmunizationNo charge
Primary Care Visit to Treat an Injury or Illness$45.00

Specialist

BenefitIn-network
Specialist Visit$90.00

Hospital

BenefitIn-network
Emergency Room Services50.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)50.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services50.00% Coinsurance after deductible
Urgent Care Centers or Facilities$50.00

Pharmacy

BenefitIn-network
Generic Drugs$20.00
Non-Preferred Brand Drugs50.00% Coinsurance after deductible
Preferred Brand Drugs50.00%
Specialty Drugs50.00% Coinsurance after deductible

Mental Health

BenefitIn-network
Mental/Behavioral Health Inpatient Services50.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services50.00% Coinsurance after deductible

Other

BenefitIn-network
Accidental Dental$180.00
Allergy Testing50.00% Coinsurance after deductible
Bariatric Surgery50.00% Coinsurance after deductible
Chemotherapy50.00% Coinsurance after deductible
Chiropractic Care$90.00
Delivery and All Inpatient Services for Maternity Care50.00% Coinsurance after deductible
Diabetes Education$90.00
Dialysis50.00% Coinsurance after deductible
Durable Medical Equipment50.00% Coinsurance after deductible
Emergency Transportation/Ambulance50.00% Coinsurance after deductible
Eye Glasses for ChildrenNo charge
Habilitation Services$90.00
Hearing Aids50.00% Coinsurance after deductible
Home Health Care Services$90.00
Hospice Respite ServiceNo charge
Imaging (CT/PET Scans, MRIs)50.00% Coinsurance after deductible
Infertility Treatment$90.00
Infusion Therapy50.00% Coinsurance after deductible
Inpatient Physician and Surgical Services50.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services50.00% Coinsurance after deductible
Nutritional Counseling$90.00
Other Practitioner Office Visit (Nurse, Physician Assistant)$90.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)50.00% Coinsurance after deductible
Outpatient Rehabilitation Services$90.00
Prenatal and Postnatal CareNo charge
Private-Duty Nursing$90.00
Prosthetic Devices50.00% Coinsurance after deductible
Radiation50.00% Coinsurance after deductible
Reconstructive Surgery50.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy$90.00
Rehabilitative Speech Therapy$90.00
Routine Eye Exam for ChildrenNo charge
Skilled Nursing Facility50.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services50.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services50.00% Coinsurance after deductible
Transplant50.00% Coinsurance after deductible
Treatment for Temporomandibular Joint Disorders$90.00
Well Baby Visits and CareNo charge
X-rays and Diagnostic Imaging50.00% Coinsurance after deductible

Service area

This plan covers 5 geographic areas.

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