St Luke's Health Plan Silver 300/0 Rx

St. Luke's Health Plan, Inc. · 2027 plan year

Silver

Ind. medical deductible: $300
Rx deductible (separate): $0
Family deductible: $600
Ind. OOP max: $2,500
Family OOP max: $5,000

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

Other cost-sharing reduction variants for this plan:

73% AV Level Silver Plan 87% AV Level Silver Plan Limited Cost Sharing Plan Variation Standard Silver Off Exchange Plan Standard Silver On Exchange Plan Zero Cost Sharing Plan Variation

More St. Luke's Health Plan, Inc. plans in ID

St Luke's Health Plan Expanded Bronze St Luke's Health Plan Expanded Bronze HDHP St Luke's Health Plan Silver 5800 St Luke's Health Plan Gold

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	No charge

Specialist

Benefit	In-network
Specialist Visit	$30.00

Hospital

Benefit	In-network
Emergency Room Services	20.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	20.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services	20.00% Coinsurance after deductible
Urgent Care Centers or Facilities	$30.00

Pharmacy

Benefit	In-network
Generic Drugs	$5.00
Non-Preferred Brand Drugs	$55.00
Preferred Brand Drugs	$30.00
Specialty Drugs	40.00%

Mental Health

Benefit	In-network
Mental/Behavioral Health Inpatient Services	20.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services	No charge

Other

Benefit	In-network
Accidental Dental	20.00% Coinsurance after deductible
Allergy Testing	20.00% Coinsurance after deductible
Chemotherapy	20.00% Coinsurance after deductible
Chiropractic Care	No charge
Delivery and All Inpatient Services for Maternity Care	20.00% Coinsurance after deductible
Diabetes Education	No charge
Dialysis	20.00% Coinsurance after deductible
Durable Medical Equipment	20.00% Coinsurance after deductible
Emergency Transportation/Ambulance	20.00% Coinsurance after deductible
Eye Glasses for Children	20.00% Coinsurance after deductible
Habilitation Services	No charge
Hearing Aids	20.00% Coinsurance after deductible
Home Health Care Services	20.00% Coinsurance after deductible
Hospice Services	No charge
Imaging (CT/PET Scans, MRIs)	20.00% Coinsurance after deductible
Infusion Therapy	20.00% Coinsurance after deductible
Inpatient Physician and Surgical Services	20.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services	No charge
Nutritional Counseling	No charge
Other Practitioner Office Visit (Nurse, Physician Assistant)	No charge
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)	20.00% Coinsurance after deductible
Outpatient Rehabilitation Services	No charge
Prenatal and Postnatal Care	No charge
Prosthetic Devices	20.00% Coinsurance after deductible
Radiation	20.00% Coinsurance after deductible
Reconstructive Surgery	20.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy	No charge
Rehabilitative Speech Therapy	No charge
Routine Eye Exam for Children	No charge
Skilled Nursing Facility	20.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services	20.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services	No charge
Transplant	20.00% Coinsurance after deductible
Well Baby Visits and Care	No charge
X-rays and Diagnostic Imaging	No charge

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