SimpliveraCoverage Companion

KP NV SENSIBLE Silver 3050 73% CSR

HOMETOWN HEALTH PLAN, INC. · 2027 plan year

Silver
Ind. deductible
$3,050
Family deductible
$6,100
Ind. OOP max
$6,100
Family OOP max
$12,200

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 HOMETOWN HEALTH PLAN, INC. plans in NV

KP NV SENSIBLE Bronze 11750 HSAKP NV Gold 2400KP NV Silver 3700 HSAKP NV Bronze 11750 HSAKP NV Bronze 5500 HSA

Live premium estimate

$

Benefits & cost sharing

Primary Care

BenefitIn-network
Preventive Care/Screening/ImmunizationNo charge
Primary Care Visit to Treat an Injury or Illness$5.00 Copay after deductible

Specialist

BenefitIn-network
Specialist Visit$80.00 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$13.00 Copay after deductible
Non-Preferred Brand Drugs50.00% Coinsurance after deductible
Preferred Brand Drugs$55.00 Copay 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$160.00 Copay after deductible
Allergy Testing50.00% Coinsurance after deductible
Bariatric Surgery50.00% Coinsurance after deductible
Chemotherapy50.00% Coinsurance after deductible
Chiropractic Care$80.00 Copay after deductible
Delivery and All Inpatient Services for Maternity Care50.00% Coinsurance after deductible
Diabetes Education$80.00 Copay after deductible
Dialysis50.00% Coinsurance after deductible
Transplant50.00% Coinsurance after deductible
Durable Medical Equipment50.00% Coinsurance after deductible
Emergency Transportation/Ambulance50.00% Coinsurance after deductible
Eye Glasses for ChildrenNo charge
Habilitation Services$80.00 Copay after deductible
Hearing Aids50.00% Coinsurance after deductible
Home Health Care Services$80.00 Copay after deductible
Hospice Respite ServiceNo Charge after deductible
Imaging (CT/PET Scans, MRIs)50.00% Coinsurance after deductible
Infertility Treatment$80.00 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$80.00 Copay after deductible
Other Practitioner Office Visit (Nurse, Physician Assistant)$80.00 Copay after deductible
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)50.00% Coinsurance after deductible
Outpatient Rehabilitation Services$80.00 Copay after deductible
Prenatal and Postnatal CareNo charge
Private-Duty Nursing$80.00 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$80.00 Copay after deductible
Rehabilitative Speech Therapy$80.00 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
Treatment for Temporomandibular Joint Disorders$80.00 Copay after deductible
Well Baby Visits and CareNo charge
X-rays and Diagnostic Imaging50.00% Coinsurance after deductible

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