Navigator Silver 3600 (73)

PacificSource Health Plans · 2026 plan year

Silver
Ind. deductible
$3,400
Family deductible
$3,400
Ind. OOP max
$8,450
Family OOP max
$8,450

More PacificSource Health Plans plans in ID

Live premium estimate

$

Benefits & cost sharing

Primary Care

BenefitIn-network
Preventive Care/Screening/ImmunizationNo charge
Primary Care Visit to Treat an Injury or Illness$20.00

Specialist

BenefitIn-network
Specialist Visit$50.00

Hospital

BenefitIn-network
Outpatient Surgery Physician/Surgical Services40.00% Coinsurance after deductible
Urgent Care Centers or Facilities$45.00
Emergency Room Services40.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)40.00% Coinsurance after deductible

Pharmacy

BenefitIn-network
Non-Preferred Brand Drugs40.00% Coinsurance after deductible
Preferred Brand Drugs$60.00 Copay after deductible
Specialty Drugs40.00% Coinsurance after deductible
Generic Drugs$10.00

Mental Health

BenefitIn-network
Mental/Behavioral Health Inpatient Services40.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services$20.00

Other

BenefitIn-network
Inpatient Physician and Surgical Services40.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services40.00% Coinsurance after deductible
Nutritional Counseling$20.00
Other Practitioner Office Visit (Nurse, Physician Assistant)$20.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)40.00% Coinsurance after deductible
Outpatient Rehabilitation Services40.00% Coinsurance after deductible
Prenatal and Postnatal Care40.00% Coinsurance after deductible
Prosthetic Devices40.00% Coinsurance after deductible
Radiation40.00% Coinsurance after deductible
Reconstructive Surgery40.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy40.00% Coinsurance after deductible
Rehabilitative Speech Therapy40.00% Coinsurance after deductible
Routine Eye Exam for ChildrenNo charge
Routine Foot Care40.00% Coinsurance after deductible
Skilled Nursing Facility40.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services40.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services$20.00
TransplantNo Charge after deductible
Well Baby Visits and CareNo charge
X-rays and Diagnostic Imaging40.00% Coinsurance after deductible
Accidental Dental40.00% Coinsurance after deductible
Acupuncture$20.00
Allergy Testing40.00% Coinsurance after deductible
Chemotherapy40.00% Coinsurance after deductible
Chiropractic Care$20.00
Cosmetic Surgery40.00% Coinsurance after deductible
Delivery and All Inpatient Services for Maternity Care40.00% Coinsurance after deductible
Diabetes Education$20.00
Dialysis40.00% Coinsurance after deductible
Durable Medical Equipment40.00% Coinsurance after deductible
Emergency Transportation/Ambulance40.00% Coinsurance after deductible
Eye Glasses for Children40.00% Coinsurance after deductible
Habilitation Services40.00% Coinsurance after deductible
Home Health Care Services40.00% Coinsurance after deductible
Hospice Services40.00% Coinsurance after deductible
Imaging (CT/PET Scans, MRIs)40.00% Coinsurance after deductible
Infusion Therapy40.00% Coinsurance after deductible

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