Value Benchmark Silver 0 Medical Deductible – no deductible for office visits – HMO
87% cost sharing reduction [Popular Plan]
Network type: HMO
Coverage tier: Silver
Primary care visit: No charge
Specialist visit: $30 copay
Urgent care visit: $30 copay
Description
This plan has 87% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | HMO |
| Deductible | Success
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| Out-of-pocket max | $3,000 per person $6,000 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | No charge |
| Specialist visit | $30 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $30 copay |
| Emergency room | $350 copay |
| Ambulance | 25% coinsurance |
| Hospital stay (facility) | 25% coinsurance |
| Hospital stay (physician) | 25% coinsurance |
| Outpatient procedure (facility) | 25% coinsurance |
| Outpatient procedure (physician) | 25% coinsurance |
| Physical rehabilitation | $30 copay |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | 25% coinsurance |
Pharmacy, Drugs, and Medication
| Generic | $25 copay |
| Brand | 15% coinsurance after deductible |
| Non-preferred Brand | 25% coinsurance after deductible |
| Specialty | 50% coinsurance after deductible |
Lab Tests and Diagnostic Procedures
| X-rays | $10 copay |
| Imaging (CT/PET/MRI) | $125 copay |
| Blood work | $10 copay |
Mental and Psychiatric Health Care
| Mental Health outpatient services | 25% coinsurance |
| Psychiatric hospital stay | 25% coinsurance |
Health Plan Provider Information
| Health Plan Benefits | https://selecthealth.org/files/sbc/I40A1979_20240101_GGGGGGGG_GGGG_SSSS.pdf |
| Drug and medication plan formulary | https://selecthealth.rxeob.com/mdb_sh/public/router?account=rxc_t5_ut_ds_24 |
| Search doctor list | https://selecthealth.org/find-a-doctor?state=UT&selectHealthPlan=X |
