SimpliveraCoverage Companion

Navigator Silver 3600 (87)

PacificSource Health Plans · 2026 plan year

Silver
Ind. deductible
$1,100
Family deductible
$1,100
Ind. OOP max
$2,700
Family OOP max
$2,700

Other cost-sharing reduction variants for this plan:

73% AV Level Silver Plan94% AV Level Silver PlanLimited Cost Sharing Plan VariationStandard Silver Off Exchange PlanStandard Silver On Exchange PlanZero Cost Sharing Plan Variation

More PacificSource Health Plans plans in ID

Navigator Bronze HSA 8300Navigator Bronze HSA 6000Navigator Bronze HSA 10600Navigator Silver 6000Navigator Gold 2000

Live premium estimate

$

Benefits & cost sharing

Primary Care

BenefitIn-network
Preventive Care/Screening/ImmunizationNo charge
Primary Care Visit to Treat an Injury or Illness$15.00

Specialist

BenefitIn-network
Specialist Visit$50.00

Hospital

BenefitIn-network
Urgent Care Centers or Facilities$20.00
Emergency Room Services25.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)25.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services25.00% Coinsurance after deductible

Pharmacy

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

Mental Health

BenefitIn-network
Mental/Behavioral Health Inpatient Services25.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services$15.00

Other

BenefitIn-network
Cosmetic Surgery25.00% Coinsurance after deductible
TransplantNo Charge after deductible
Well Baby Visits and CareNo charge
X-rays and Diagnostic Imaging25.00% Coinsurance after deductible
Acupuncture$15.00
Allergy Testing25.00% Coinsurance after deductible
Chemotherapy25.00% Coinsurance after deductible
Chiropractic Care$15.00
Accidental Dental25.00% Coinsurance after deductible
Delivery and All Inpatient Services for Maternity Care25.00% Coinsurance after deductible
Diabetes Education$15.00
Dialysis25.00% Coinsurance after deductible
Durable Medical Equipment25.00% Coinsurance after deductible
Emergency Transportation/Ambulance25.00% Coinsurance after deductible
Eye Glasses for Children25.00% Coinsurance after deductible
Habilitation Services25.00% Coinsurance after deductible
Home Health Care Services25.00% Coinsurance after deductible
Hospice Services25.00% Coinsurance after deductible
Imaging (CT/PET Scans, MRIs)25.00% Coinsurance after deductible
Infusion Therapy25.00% Coinsurance after deductible
Inpatient Physician and Surgical Services25.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services25.00% Coinsurance after deductible
Nutritional Counseling$15.00
Other Practitioner Office Visit (Nurse, Physician Assistant)$15.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)25.00% Coinsurance after deductible
Outpatient Rehabilitation Services25.00% Coinsurance after deductible
Prenatal and Postnatal Care25.00% Coinsurance after deductible
Prosthetic Devices25.00% Coinsurance after deductible
Radiation25.00% Coinsurance after deductible
Reconstructive Surgery25.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy25.00% Coinsurance after deductible
Rehabilitative Speech Therapy25.00% Coinsurance after deductible
Routine Eye Exam for ChildrenNo charge
Routine Foot Care25.00% Coinsurance after deductible
Skilled Nursing Facility25.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services25.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services$15.00

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