SimpliveraCoverage Companion

Gold HMO 3400 $0 Healthy heart care + Adult Vision & Fitness LCS

CareSource Nevada Co. · 2027 plan year

Gold
Ind. deductible
$3,400
Family deductible
$6,800
Ind. OOP max
$8,000
Family OOP max
$16,000

Other cost-sharing reduction variants for this plan:

Standard Gold Off Exchange PlanStandard Gold On Exchange PlanZero Cost Sharing Plan Variation

More CareSource Nevada Co. plans in NV

Core Bronze HMO 8500 $50 PCPLow Premium Silver HMO 7000 $40 PCP

Live premium estimate

$

Benefits & cost sharing

Primary Care

BenefitIn-network
Preventive Care/Screening/ImmunizationNo charge
Primary Care Visit to Treat an Injury or Illness$10.00

Specialist

BenefitIn-network
Specialist Visit$40.00

Hospital

BenefitIn-network
Emergency Room Services30.00% 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$30.00

Pharmacy

BenefitIn-network
Generic Drugs$10.00
Non-Preferred Brand Drugs50.00% Coinsurance after deductible
Preferred Brand Drugs$60.00
Specialty Drugs50.00% Coinsurance after deductible

Mental Health

BenefitIn-network
Mental/Behavioral Health Inpatient Services30.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services$10.00

Other

BenefitIn-network
Accidental Dental30.00% Coinsurance after deductible
Allergy Testing$40.00
Bariatric Surgery30.00% 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 Education30.00% Coinsurance after deductible
Dialysis30.00% Coinsurance after deductible
Durable Medical Equipment30.00% Coinsurance after deductible
Emergency Transportation/Ambulance30.00% Coinsurance after deductible
Eye Glasses for ChildrenNo charge
Gender Affirming Care30.00% Coinsurance after deductible
Habilitation Services30.00% Coinsurance after deductible
Hearing Aids30.00% Coinsurance after deductible
Home Health Care Services30.00% Coinsurance after deductible
Hospice Services30.00% Coinsurance after deductible
Imaging (CT/PET Scans, MRIs)30.00% Coinsurance after deductible
Infertility Treatment30.00% Coinsurance after deductible
Infusion Therapy30.00% Coinsurance after deductible
Inpatient Physician and Surgical Services30.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services$30.00
Nutritional Counseling30.00% Coinsurance after deductible
Other Practitioner Office Visit (Nurse, Physician Assistant)$10.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)30.00% Coinsurance after deductible
Outpatient Rehabilitation Services30.00% Coinsurance after deductible
Prenatal and Postnatal Care$40.00
Private-Duty Nursing30.00% Coinsurance after deductible
Prosthetic Devices30.00% Coinsurance after deductible
Radiation30.00% Coinsurance after deductible
Reconstructive Surgery30.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy30.00% Coinsurance after deductible
Rehabilitative Speech Therapy30.00% Coinsurance after deductible
Routine Eye Exam (Adult)No charge
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$10.00
Transplant30.00% Coinsurance after deductible
Treatment for Temporomandibular Joint Disorders30.00% Coinsurance after deductible
Well Baby Visits and CareNo charge
X-rays and Diagnostic Imaging30.00% Coinsurance after deductible

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