Navigator Gold 2000 (AI)

PacificSource Health Plans · 2026 plan year

Gold

Ind. deductible: $2,000
Family deductible: $2,000
Ind. OOP max: $9,200
Family OOP max: $9,200

Other cost-sharing reduction variants for this plan:

Standard Gold Off Exchange Plan Standard Gold On Exchange Plan Zero Cost Sharing Plan Variation

More PacificSource Health Plans plans in ID

Navigator Bronze HSA 8300 Navigator Bronze HSA 6000 Navigator Bronze HSA 10600 Navigator Silver 3600

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	$25.00

Specialist

Benefit	In-network
Specialist Visit	$50.00

Hospital

Benefit	In-network
Emergency Room Services	10.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	10.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services	10.00% Coinsurance after deductible
Urgent Care Centers or Facilities	$25.00

Pharmacy

Benefit	In-network
Non-Preferred Brand Drugs	10.00% Coinsurance after deductible
Generic Drugs	$15.00
Preferred Brand Drugs	$60.00 Copay after deductible
Specialty Drugs	10.00% Coinsurance after deductible

Mental Health

Benefit	In-network
Mental/Behavioral Health Inpatient Services	10.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services	$25.00

Other

Benefit	In-network
Nutritional Counseling	$25.00
Accidental Dental	10.00% Coinsurance after deductible
Acupuncture	$25.00
Allergy Testing	10.00% Coinsurance after deductible
Chemotherapy	10.00% Coinsurance after deductible
Chiropractic Care	$25.00
Cosmetic Surgery	10.00% Coinsurance after deductible
Delivery and All Inpatient Services for Maternity Care	10.00% Coinsurance after deductible
Diabetes Education	$25.00
Dialysis	10.00% Coinsurance after deductible
Durable Medical Equipment	10.00% Coinsurance after deductible
Emergency Transportation/Ambulance	10.00% Coinsurance after deductible
Eye Glasses for Children	10.00% Coinsurance after deductible
Habilitation Services	10.00% Coinsurance after deductible
Home Health Care Services	10.00% Coinsurance after deductible
Hospice Services	10.00% Coinsurance after deductible
Imaging (CT/PET Scans, MRIs)	10.00% Coinsurance after deductible
Infusion Therapy	10.00% Coinsurance after deductible
Inpatient Physician and Surgical Services	10.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services	10.00% Coinsurance after deductible
Other Practitioner Office Visit (Nurse, Physician Assistant)	$25.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)	10.00% Coinsurance after deductible
Outpatient Rehabilitation Services	10.00% Coinsurance after deductible
Prenatal and Postnatal Care	10.00% Coinsurance after deductible
Prosthetic Devices	10.00% Coinsurance after deductible
Radiation	10.00% Coinsurance after deductible
Reconstructive Surgery	10.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy	10.00% Coinsurance after deductible
Rehabilitative Speech Therapy	10.00% Coinsurance after deductible
Routine Eye Exam for Children	No charge
Routine Foot Care	10.00% Coinsurance after deductible
Skilled Nursing Facility	10.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services	10.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services	$25.00
Transplant	No Charge after deductible
Well Baby Visits and Care	No charge
X-rays and Diagnostic Imaging	10.00% Coinsurance after deductible

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