Select Health Value Silver $1800 Medical Deductible

SelectHealth, Inc. · 2027 plan year

Silver
Ind. medical deductible
$500
Rx deductible (separate)
$500
Family deductible
$1,000
Ind. OOP max
$4,000
Family OOP max
$8,000

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

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Live premium estimate

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Benefits & cost sharing

Primary Care

BenefitIn-network
Preventive Care/Screening/ImmunizationNo charge
Primary Care Visit to Treat an Injury or Illness$5.00

Specialist

BenefitIn-network
Specialist Visit$30.00

Hospital

BenefitIn-network
Emergency Room Services$600.00
Inpatient Hospital Services (e.g., Hospital Stay)$1500.00 Copay per Day after deductible
Outpatient Surgery Physician/Surgical Services40.00% Coinsurance after deductible
Urgent Care Centers or Facilities$15.00

Pharmacy

BenefitIn-network
Generic Drugs$10.00
Medical Service Drugs40.00% Coinsurance after deductible
Non-Preferred Brand Drugs15.00% Coinsurance after deductible
Non-Preferred Generic Drugs$15.00
Preferred Brand Drugs$75.00 Copay after deductible
Preventive DrugsNo charge
Specialty Drugs40.00% Coinsurance after deductible

Mental Health

BenefitIn-network
Intensive Outpatient for Mental/Behavioral Health40.00% Coinsurance after deductible
Intensive Outpatient for Substance Use Disorder40.00% Coinsurance after deductible
Mental Health Wellness VisitNo charge
Mental/Behavioral Health Inpatient Services$1500.00 Copay per Day after deductible
Mental/Behavioral Health Outpatient Services$30.00
Mental/Behavioral Health Prenatal Care$5.00
Office Visit - Mental/Behavioral Health$30.00
Office Visit - Substance Use Disorder$30.00
Partial Hospitalization for Mental/Behavioral Health40.00% Coinsurance after deductible
Partial Hospitalization for Substance Use Disorder40.00% Coinsurance after deductible
Postpartum Mental/Behavioral Health$5.00
Postpartum Substance Use Disorder$5.00
Residential Day Treatment for Mental/Behavioral Health40.00% Coinsurance after deductible
Residential Day Treatment for Substance Use Disorder40.00% Coinsurance after deductible
Substance Use Disorder Prenatal Care$5.00
Telehealth Mental/Behavioral Health$5.00
Telehealth Substance Use Disorder$5.00

Other

BenefitIn-network
Abortion for Which Public Funding is ProhibitedNo charge
Acupuncture$5.00
Allergy Testing$30.00
Applied Behavior Analysis Based TherapiesNo Charge after deductible
Autism Spectrum Disorders - Assessment and Evaluation Services$30.00
Bariatric Surgery$1500.00 Copay after deductible
Chemotherapy40.00% Coinsurance after deductible
Chiropractic Care$5.00
Delivery and All Inpatient Services for Maternity Care$1500.00 Copay after deductible
Diabetes Education$30.00
Diabetic Supplies40.00% Coinsurance after deductible
Dialysis$30.00
Durable Medical Equipment40.00% Coinsurance after deductible
Emergency Transportation/Ambulance$150.00
Eye Glasses for Children$30.00
Gender Affirming Care40.00% Coinsurance after deductible
Habilitation Services$30.00 Copay after deductible
Hearing Aids40.00% Coinsurance after deductible
Home Health Care Services$30.00
Hospice Services$30.00
Imaging (CT/PET Scans, MRIs)40.00% Coinsurance after deductible
Infertility Treatment40.00% Coinsurance after deductible
Infusion Therapy40.00% Coinsurance after deductible
Inpatient Physician and Surgical ServicesNo charge
Inpatient Rehabilitation$1500.00 Copay after deductible
Laboratory Outpatient and Professional Services$10.00
Nutritional Counseling$30.00
Other Practitioner Office Visit (Nurse, Physician Assistant)$5.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)40.00% Coinsurance after deductible
Outpatient Rehabilitation Services$30.00 Copay after deductible
Prenatal and Postnatal Care$5.00
Private-Duty Nursing$30.00
Prosthetic Devices40.00% Coinsurance after deductible
Prosthetics: Legs and Arms20.00%
Prosthetics: Recreational40.00% Coinsurance after deductible
Radiation40.00% Coinsurance after deductible
Reconstructive Surgery$1500.00 Copay after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy$30.00 Copay after deductible
Rehabilitative Occupational Therapy$30.00 Copay after deductible
Rehabilitative Physical Therapy$30.00 Copay after deductible
Rehabilitative Speech Therapy$30.00 Copay after deductible
Routine Eye Exam for ChildrenNo charge
Skilled Nursing Facility$1500.00 Copay per Day after deductible
Standalone Laboratory$10.00
Substance Abuse Disorder Inpatient Services$1500.00 Copay per Day after deductible
Substance Abuse Disorder Outpatient Services$30.00
Telehealth PCPNo charge
Telehealth Specialist$30.00
Transplant$1500.00 Copay after deductible
Treatment for Temporomandibular Joint Disorders40.00% Coinsurance after deductible
Well Baby Visits and CareNo charge
X-rays and Diagnostic Imaging40.00% Coinsurance after deductible

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