Anthem Silver X 3500 ($0 Virtual PCP + $0 Select Drugs + Incentives) S03

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

Silver

Ind. deductible: $3,500
Family deductible: $7,000
Ind. OOP max: $12,000
Family OOP max: $24,000

Other cost-sharing reduction variants for this plan:

73% AV Level Silver Plan 87% AV Level Silver Plan 94% AV Level Silver Plan 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	$20.00

Specialist

Benefit	In-network
Specialist Visit	$60.00

Hospital

Benefit	In-network
Emergency Room Services	$1000.00 Copay after deductible + 20.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	$500.00 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	$10.00
Non-Preferred Brand Drugs	30.00% Coinsurance after deductible
Preferred Brand Drugs	$50.00
Specialty Drugs	40.00% Coinsurance after deductible

Mental Health

Benefit	In-network
Mental/Behavioral Health Inpatient Services	$500.00 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	$500.00 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	$500.00 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)	$500.00 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)	$20.00
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	$500.00 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	$500.00 Copay per Stay after deductible + 30.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services	20.00% Coinsurance after deductible
Transplant	$500.00 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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