SimpliveraCoverage Companion

Silver AH

Arkansas Blue Cross and Blue Shield · 2026 plan year

Silver
Ind. medical deductible
$6,350
Rx deductible (separate)
$0
Family deductible
$12,700
Ind. OOP max
$6,550
Family OOP max
$13,100

This plan sets a separate deductible for prescription drugs. The medical deductible shown does not cover prescriptions; they have their own.

Compare with other Silver plans in AR

Side by side: deductibles, out-of-pocket limits and copays.

Compare 4 plansBrowse all Silver plans in AR

Other cost-sharing reduction variants for this plan:

73% AV Level Silver Plan87% AV Level Silver Plan94% AV Level Silver PlanLimited Cost Sharing Plan VariationStandard Silver Off Exchange PlanZero Cost Sharing Plan Variation

More Arkansas Blue Cross and Blue Shield plans in AR

Bronze ValueGold StandardizedBronze Exp StandardizedGold Value

Monthly premiums by age

The same in all 7 areas this plan covers.

AgeIndividualIndividual + tobacco
Under 15$481$481
21$629$755
30$714$857
40$804$965
50$1,123$1,348
60$1,707$2,049
64 and over$1,887$2,265

Live premium estimate

$

Benefits & cost sharing

Primary Care

BenefitIn-network
Preventive Care/Screening/ImmunizationNo charge
Primary Care Visit to Treat an Injury or Illness$30.00 Copay after deductible

Specialist

BenefitIn-network
Specialist Visit$45.00 Copay after deductible

Hospital

BenefitIn-network
Emergency Room Services$200.00 Copay after deductible
Inpatient Hospital Services (e.g., Hospital Stay)$200.00 Copay per Day after deductible
Outpatient Surgery Physician/Surgical Services$45.00 Copay after deductible
Urgent Care Centers or Facilities$45.00 Copay after deductible

Pharmacy

BenefitIn-network
Generic Drugs$100.00
Non-Preferred Brand Drugs$2,000.00
Off Label Prescription Drugs30.00% Coinsurance after deductible
Preferred Brand Drugs$1,000.00
Preventive DrugsNo charge
Specialty Drugs$6,550.00
Specialty Drugs Tier 2$6,550.00

Mental Health

BenefitIn-network
Mental/Behavioral Health Inpatient Services$200.00 Copay per Day after deductible
Mental/Behavioral Health Outpatient Services$30.00 Copay after deductible

Other

BenefitIn-network
Abortion for Which Public Funding is ProhibitedNot covered
Accidental Dental30.00% Coinsurance after deductible
Acquired Brain Injury30.00% Coinsurance after deductible
AcupunctureNot covered
Allergy Testing30.00% Coinsurance after deductible
Applied Behavior Analysis Based Therapies30.00% Coinsurance after deductible
Bariatric Surgery30.00% Coinsurance after deductible
Basic Dental Care - AdultNot covered
Basic Dental Care - ChildNot covered
Biomarke30.00% Coinsurance after deductible
Chemotherapy30.00% Coinsurance after deductible
Chiropractic Care$30.00 Copay after deductible
Cochlear Implants30.00% Coinsurance after deductible
Community Health Worke30.00% Coinsurance after deductible
Cosmetic SurgeryNot covered
Craniofacial Surgery30.00% Coinsurance after deductible
Delivery and All Inpatient Services for Maternity Care30.00% Coinsurance after deductible
Dental Anesthesia30.00% Coinsurance after deductible
Dental Check-Up for ChildrenNot covered
Diabetes Care Management30.00% Coinsurance after deductible
Diabetes EducationNo charge
Dialysis30.00% Coinsurance after deductible
Doulas30.00% Coinsurance after deductible
Durable Medical Equipment$200.00 Copay after deductible
Emergency Transportation/Ambulance30.00% Coinsurance after deductible
Eye Glasses for Children30.00% Coinsurance after deductible
Gastric Electrical Stimulation30.00% Coinsurance after deductible
Genetic Testing for CanceNo charge
Habilitation Services$30.00 Copay after deductible
Hearing Aids80.00%
Home Health Care Services30.00% Coinsurance after deductible
Prenatal and Postnatal Care30.00% Coinsurance after deductible
Hospice Services30.00% Coinsurance after deductible
Imaging (CT/PET Scans, MRIs)$200.00 Copay after deductible
Infertility Treatment30.00% Coinsurance after deductible
Infusion Therapy30.00% Coinsurance after deductible
Inherited Metabolic Disorder - PKU30.00% Coinsurance after deductible
Inpatient Physician and Surgical Services30.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services$30.00 Copay after deductible
Long-Term/Custodial Nursing Home CareNot covered
Lung Cancer ScreeningNo charge
Major Dental Care - AdultNot covered
Major Dental Care - ChildNot covered
Nutritional Counseling30.00% Coinsurance after deductible
Orthodontia - AdultNot covered
Orthodontia - ChildNot covered
Other Practitioner Office Visit (Nurse, Physician Assistant)$30.00 Copay after deductible
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)$45.00 Copay after deductible
Outpatient Rehabilitation Services$30.00 Copay after deductible
PANS/PANDA30.00% Coinsurance after deductible
Private-Duty NursingNot covered
Prosthetic Devices30.00% Coinsurance after deductible
Radiation30.00% Coinsurance after deductible
Reconstructive Surgery30.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy$30.00 Copay after deductible
Rehabilitative Speech Therapy$30.00 Copay after deductible
Restorative Reproductive Treatment30.00% Coinsurance after deductible
Routine Dental Services (Adult)Not covered
Routine Eye Exam (Adult)Not covered
Routine Eye Exam for ChildrenNo charge
Routine Foot Care30.00% Coinsurance after deductible
Skilled Nursing Facility$200.00 Copay per Day after deductible
Substance Abuse Disorder Inpatient Services$200.00 Copay per Day after deductible
Substance Abuse Disorder Outpatient Services$30.00 Copay after deductible
Transplant30.00% Coinsurance after deductible
Treatment for Temporomandibular Joint Disorders30.00% Coinsurance after deductible
Weight Loss ProgramsNot covered
Weight Loss Treatment30.00% Coinsurance after deductible
Well Baby Visits and CareNo charge
Well Child CareNo charge
X-rays and Diagnostic Imaging$30.00 Copay after deductible

Plan rules

Service area

This plan covers 1 geographic area.

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