SimpliveraCoverage Companion

IDID Southwest Silver 5500 CSR 73

Blue Cross of Idaho · 2026 plan year

Silver
Ind. deductible
$4,750
Family deductible
$4,750
Ind. OOP max
$8,250
Family OOP max
$8,250

Other cost-sharing reduction variants for this plan:

87% 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 Blue Cross of Idaho plans in ID

MVN East Silver Connect 5500PQA Southeast Silver Connect 5500PQA Southeast Silver Connect 7100PQA Southeast Gold Connect 2000SLHP Gold CarePoint 2000

Live premium estimate

$

Benefits & cost sharing

Primary Care

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

Specialist

BenefitIn-network
Specialist Visit$55.00

Hospital

BenefitIn-network
Emergency Room Services$350.00 Copay after deductible + 30.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)30.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services30.00% Coinsurance after deductible
Urgent Care Centers or Facilities$50.00

Pharmacy

BenefitIn-network
Generic Drugs$15.00
Non-Preferred Brand Drugs$50.00 Copay after deductible
Preferred Brand Drugs$30.00 Copay after deductible
Specialty Drugs50.00% Coinsurance after deductible

Mental Health

BenefitIn-network
Mental/Behavioral Health Inpatient Services30.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services$20.00 + 30.00% Coinsurance after deductible

Other

BenefitIn-network
Radiation30.00% Coinsurance after deductible
Reconstructive Surgery30.00% Coinsurance after deductible
Prosthetic Devices30.00% Coinsurance after deductible
Prenatal and Postnatal Care30.00% Coinsurance after deductible
Accidental Dental30.00% Coinsurance after deductible
Allergy Testing30.00% Coinsurance after deductible
Chemotherapy30.00% Coinsurance after deductible
Chiropractic Care30.00% Coinsurance after deductible
Delivery and All Inpatient Services for Maternity Care30.00% Coinsurance after deductible
Diabetes Education$20.00
Dialysis30.00% Coinsurance after deductible
Durable Medical Equipment30.00% Coinsurance after deductible
Emergency Transportation/Ambulance30.00% Coinsurance after deductible
Eye Glasses for ChildrenNo charge
Habilitation Services30.00% Coinsurance after deductible
Hearing Aids30.00% Coinsurance after deductible
Home Health Care Services30.00% Coinsurance after deductible
Hospice ServicesNo charge
Imaging (CT/PET Scans, MRIs)$300.00 + 30.00% Coinsurance after deductible
Infusion Therapy30.00% Coinsurance after deductible
Inpatient Physician and Surgical Services30.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services30.00% Coinsurance after deductible
Nutritional CounselingNo charge
Other Practitioner Office Visit (Nurse, Physician Assistant)$20.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)30.00% Coinsurance after deductible
Outpatient Rehabilitation Services30.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy30.00% Coinsurance after deductible
Rehabilitative Speech Therapy30.00% Coinsurance after deductible
Routine Eye Exam for ChildrenNo charge
Skilled Nursing Facility30.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services30.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services$20.00 + 30.00% Coinsurance after deductible
Transplant30.00% Coinsurance after deductible
Well Baby Visits and CareNo charge
X-rays and Diagnostic Imaging30.00% Coinsurance after deductible

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