Community Care Health Plan of Nevada - Battle Born State Plan Anthem Silver X 750 ($0 Virtual PCP + $0 Select Drugs + Incentives) S05
Primary Care Visit
No Charge
100% Coinsurance
Specialist Visit
$30 Copay
100% Coinsurance
Other Practitioner Office Visit (Nurse, Physician Assistant)
No Charge
100% Coinsurance
Preventive Care/Screening/Immunization
No Charge
100% Coinsurance
Laboratory Outpatient and Professional Services
20% Coinsurance after deductible
100% Coinsurance
X-rays and Diagnostic Imaging
20% Coinsurance after deductible
100% Coinsurance
Imaging (CT/PET scans, MRIs)
30% Coinsurance after deductible
100% Coinsurance
Generic Drugs
$5 Copay
100% Coinsurance
Preferred Brand Drugs
$40 Copay
100% Coinsurance
Non-Preferred Brand Drugs
35% Coinsurance after deductible
100% Coinsurance
Specialty drugs
40% Coinsurance after deductible
100% Coinsurance
Outpatient Facility Fee
20% Coinsurance after deductible
100% Coinsurance
Outpatient Surgery Physician/Surgical Services
20% Coinsurance after deductible
100% Coinsurance
Emergency Room Services
20% Coinsurance after deductible
20% Coinsurance after deductible
Emergency Transportation/Ambulance
20% Coinsurance after deductible
20% Coinsurance after deductible
Urgent Care
$30 Copay
$30 Copay
Inpatient Hospital Services
30% Coinsurance after deductible
100% Coinsurance
Inpatient Physician and Surgical Services
20% Coinsurance after deductible
100% Coinsurance
Mental/Behavioral Health Outpatient Services
20% Coinsurance after deductible
100% Coinsurance
Mental/Behavioral Health Inpatient Services
30% Coinsurance after deductible
100% Coinsurance
Substance Abuse Disorder Outpatient Services
20% Coinsurance after deductible
100% Coinsurance
Substance Abuse Disorder Inpatient Services
30% Coinsurance after deductible
100% Coinsurance
Prenatal and postnatal care
20% Coinsurance after deductible
100% Coinsurance
Delivery and All Inpatient Services for Maternity Care
30% Coinsurance after deductible
100% Coinsurance
Home Healthcare Services
20% Coinsurance after deductible
100% Coinsurance
Outpatient Rehabilitation Services
20% Coinsurance after deductible
100% Coinsurance
Habilitation Services
20% Coinsurance after deductible
100% Coinsurance
Skilled Nursing Facility
20% Coinsurance after deductible
100% Coinsurance
Durable Medical Equipment
20% Coinsurance after deductible
100% Coinsurance
Hospice Services
20% Coinsurance after deductible
100% Coinsurance
Chiropractic Care
20% Coinsurance after deductible
100% Coinsurance
Acupuncture
Not Covered
Not Covered
Rehabilitative Speech Therapy
20% Coinsurance after deductible
100% Coinsurance
Rehabilitative Occupational and Rehabilitative Physical Therapy
20% Coinsurance after deductible
100% Coinsurance
Well Baby Visits and Care
No Charge
100% Coinsurance
Allergy Testing
20% Coinsurance after deductible
100% Coinsurance
Diabetes Education
20% Coinsurance after deductible
100% Coinsurance
Nutritional Counseling
20% Coinsurance after deductible
100% Coinsurance
Eye Exam for Children
No Charge
100% Coinsurance
Eye Glasses for Children
No Charge
100% Coinsurance
Accidental Dental
$30 Copay
100% Coinsurance
Basic Dental Care (Adult)
Not Covered
Not Covered
Basic Dental Care (Child)
Not Covered
Not Covered
Dental Check Up (Child)
Not Covered
Not Covered
Major Dental Care (Adult)
Not Covered
Not Covered
Major Dental Care (Child)
Not Covered
Not Covered
Orthodontia (Adult)
Not Covered
Not Covered
Orthodontia (Child)
Not Covered
Not Covered
Routine Dental Services (Adult)
Not Covered
Not Covered