KP NV Bronze 5500 HSA

HOMETOWN HEALTH PLAN, INC. · 2027 plan year

Expanded BronzeHSA eligible
Ind. deductible
$5,500
Family deductible
$11,000
Ind. OOP max
$8,700
Family OOP max
$17,400

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$311$311
21$406$423
30$461$572
40$519$696
50$726$1,030
60$1,103$1,654
64 and over$1,219$1,828

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 Copay after deductible

Specialist

BenefitIn-network
Specialist Visit$90.00 Copay after deductible

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 Copay after deductible

Pharmacy

BenefitIn-network
Generic Drugs$25.00 Copay after deductible
Non-Preferred Brand Drugs50.00% Coinsurance after deductible
Preferred Brand Drugs50.00% Coinsurance after deductible
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 Copay after deductible
Allergy Testing50.00% Coinsurance after deductible
Bariatric Surgery50.00% Coinsurance after deductible
Chemotherapy50.00% Coinsurance after deductible
Chiropractic Care$90.00 Copay after deductible
Delivery and All Inpatient Services for Maternity Care50.00% Coinsurance after deductible
Diabetes Education$90.00 Copay after deductible
Dialysis50.00% Coinsurance after deductible
Durable Medical Equipment50.00% Coinsurance after deductible
Emergency Transportation/Ambulance50.00% Coinsurance after deductible
Eye Glasses for ChildrenNo Charge after deductible
Habilitation Services$90.00 Copay after deductible
Hearing Aids50.00% Coinsurance after deductible
Home Health Care Services$90.00 Copay after deductible
Hospice Respite ServiceNo Charge after deductible
Imaging (CT/PET Scans, MRIs)50.00% Coinsurance after deductible
Infertility Treatment$90.00 Copay after deductible
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 Copay after deductible
Other Practitioner Office Visit (Nurse, Physician Assistant)$90.00 Copay after deductible
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)50.00% Coinsurance after deductible
Outpatient Rehabilitation Services$90.00 Copay after deductible
Prenatal and Postnatal CareNo charge
Private-Duty Nursing$90.00 Copay after deductible
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 Copay after deductible
Rehabilitative Speech Therapy$90.00 Copay after deductible
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 Copay after deductible
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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