Battle Born State Plan Ambetter PCP Referral Required Bronze
SilverSummit Healthplan, Inc. · 2027 plan year
Expanded BronzeHSA eligible
- Ind. deductible
- $6,150
- Family deductible
- $12,300
- Ind. OOP max
- $8,300
- Family OOP max
- $16,600
Compare with other Expanded Bronze plans in NV
Side by side: deductibles, out-of-pocket limits and copays.
Other cost-sharing reduction variants for this plan:
More SilverSummit Healthplan, Inc. plans in NV
Monthly premiums by age
Rating Area 4
| Age | Individual | Individual + tobacco |
|---|---|---|
| Under 15 | $567 | $567 |
| 21 | $742 | $853 |
| 30 | $842 | $968 |
| 40 | $948 | $1,090 |
| 50 | $1,325 | $1,524 |
| 60 | $2,013 | $2,315 |
| 64 and over | $2,225 | $2,559 |
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 | $55.00 Copay after deductible |
Specialist
| Benefit | In-network |
|---|---|
| Specialist Visit | $100.00 Copay after deductible |
Hospital
| Benefit | In-network |
|---|---|
| Emergency Room Services | 50.00% Coinsurance after deductible |
| Inpatient Hospital Services (e.g., Hospital Stay) | 50.00% Coinsurance after deductible |
| Mental/Behavioral Health Emergency Room | 50.00% Coinsurance after deductible |
| Mental/Behavioral Health Urgent Care | $55.00 Copay after deductible |
| Outpatient Surgery Physician/Surgical Services | 50.00% Coinsurance after deductible |
| Substance Use Disorder Emergency Room | 50.00% Coinsurance after deductible |
| Substance Use Disorder Urgent Care | $55.00 Copay after deductible |
| Urgent Care Centers or Facilities | $60.00 Copay after deductible |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | $3.00 |
| Non-Preferred Brand Drugs | $200.00 Copay after deductible |
| Preferred Brand Drugs | $50.00 Copay after deductible |
| Specialty Drugs | 50.00% Coinsurance after deductible |
| Tier 1b Generic Drugs | $20.00 |
Mental Health
| Benefit | In-network |
|---|---|
| Mental/Behavioral Health Emergency Transportation/Ambulance | 50.00% Coinsurance after deductible |
| Mental/Behavioral Health ER Physician Fee | 50.00% Coinsurance after deductible |
| Mental/Behavioral Health Inpatient Services | 50.00% Coinsurance after deductible |
| Mental/Behavioral Health Outpatient Other Services | 50.00% Coinsurance after deductible |
| Mental/Behavioral Health Outpatient Services | $55.00 Copay after deductible |
| Substance Use Disorder Emergency Transportation/Ambulance | 50.00% Coinsurance after deductible |
| Substance Use Disorder ER Physician Fee | 50.00% Coinsurance after deductible |
| Substance Use Disorder Outpatient Other Services | 50.00% Coinsurance after deductible |
Other
| Benefit | In-network |
|---|---|
| Accidental Dental | 50.00% Coinsurance after deductible |
| Allergy Testing | $100.00 Copay after deductible |
| Bariatric Surgery | 50.00% Coinsurance after deductible |
| Chemotherapy | 50.00% Coinsurance after deductible |
| Chiropractic Care | 50.00% Coinsurance after deductible |
| Delivery and All Inpatient Services for Maternity Care | 50.00% Coinsurance after deductible |
| Diabetes Education | 50.00% Coinsurance after deductible |
| Dialysis | 50.00% Coinsurance after deductible |
| Durable Medical Equipment | 50.00% Coinsurance after deductible |
| Emergency Transportation/Ambulance | 50.00% Coinsurance after deductible |
| Eye Glasses for Children | No charge |
| Gender Affirming Care | 50.00% Coinsurance after deductible |
| Habilitation Services | 50.00% Coinsurance after deductible |
| Hearing Aids | 50.00% Coinsurance after deductible |
| Home Health Care Services | 50.00% Coinsurance after deductible |
| Hospice Services | 50.00% Coinsurance after deductible |
| Imaging (CT/PET Scans, MRIs) | 50.00% Coinsurance after deductible |
| Infertility Treatment | 50.00% Coinsurance after deductible |
| Infusion Therapy | 50.00% Coinsurance after deductible |
| Inpatient Physician and Surgical Services | 50.00% Coinsurance after deductible |
| Laboratory Outpatient and Professional Services | $55.00 |
| Nutritional Counseling | $100.00 Copay after deductible |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $55.00 Copay after deductible |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | 50.00% Coinsurance after deductible |
| Outpatient Rehabilitation Services | 50.00% Coinsurance after deductible |
| Prenatal and Postnatal Care | $55.00 Copay after deductible |
| Private-Duty Nursing | 50.00% Coinsurance after deductible |
| Prosthetic Devices | 50.00% Coinsurance after deductible |
| Radiation | 50.00% Coinsurance after deductible |
| Reconstructive Surgery | 50.00% Coinsurance after deductible |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | 50.00% Coinsurance after deductible |
| Rehabilitative Speech Therapy | 50.00% Coinsurance after deductible |
| Routine Eye Exam for Children | No charge |
| Routine Foot Care | $100.00 Copay after deductible |
| Skilled Nursing Facility | 50.00% Coinsurance after deductible |
| Substance Abuse Disorder Inpatient Services | 50.00% Coinsurance after deductible |
| Substance Abuse Disorder Outpatient Services | $55.00 Copay after deductible |
| Transplant | 50.00% Coinsurance after deductible |
| Treatment for Temporomandibular Joint Disorders | 50.00% Coinsurance after deductible |
| Well Baby Visits and Care | No charge |
| X-rays and Diagnostic Imaging | 50.00% Coinsurance after deductible |
Service area
This plan covers 10 geographic areas.
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