Med Silver 7500 Health Deductible - No deductible for office visits

SelectHealth, Inc. · 2027 plan year

Silver
Ind. deductible
$1,000
Family deductible
$2,000
Ind. OOP max
$4,000
Family OOP max
$8,000

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Live premium estimate

$

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$20.00

Hospital

BenefitIn-network
Emergency Room Services$350.00 Copay after deductible
Inpatient Hospital Services (e.g., Hospital Stay)30.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services30.00% Coinsurance after deductible
Urgent Care Centers or Facilities$15.00

Pharmacy

BenefitIn-network
Generic Drugs$25.00
Non-Preferred Brand Drugs25.00% Coinsurance after deductible
Preferred Brand Drugs5.00% Coinsurance after deductible
Specialty Drugs40.00% Coinsurance after deductible

Mental Health

BenefitIn-network
Mental/Behavioral Health Inpatient Services30.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services$15.00

Other

BenefitIn-network
Accidental Dental$350.00 Copay after deductible
Allergy Testing$20.00
Bariatric Surgery30.00% Coinsurance after deductible
Chemotherapy50.00% Coinsurance after deductible
Chiropractic Care$5.00
Delivery and All Inpatient Services for Maternity Care30.00% Coinsurance after deductible
Diabetes Education$5.00
Dialysis30.00% Coinsurance after deductible
Durable Medical Equipment30.00% Coinsurance after deductible
Emergency Transportation/Ambulance30.00% Coinsurance after deductible
Eye Glasses for ChildrenNo charge
Gender Affirming Care30.00% Coinsurance after deductible
Habilitation Services$15.00 Copay after deductible
Hearing Aids30.00% Coinsurance after deductible
Home Health Care Services30.00% Coinsurance after deductible
Hospice Services30.00% Coinsurance after deductible
Imaging (CT/PET Scans, MRIs)30.00% Coinsurance after deductible
Infertility Treatment50.00% Coinsurance after deductible
Infusion Therapy30.00% Coinsurance after deductible
Inpatient Physician and Surgical Services30.00% Coinsurance after deductible
Laboratory Outpatient and Professional ServicesNo charge
Nutritional Counseling$5.00
Other Practitioner Office Visit (Nurse, Physician Assistant)$5.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)30.00% Coinsurance after deductible
Outpatient Rehabilitation Services$15.00
Prenatal and Postnatal Care$5.00
Private-Duty Nursing30.00% Coinsurance after deductible
Prosthetic Devices30.00% Coinsurance after deductible
Radiation30.00% Coinsurance after deductible
Reconstructive Surgery30.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy30.00% Coinsurance after deductible
Rehabilitative Speech Therapy30.00% Coinsurance after deductible
Routine Eye Exam for ChildrenNo charge
Skilled Nursing Facility30.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services30.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services$15.00
Transplant30.00% Coinsurance after deductible
Treatment for Temporomandibular Joint Disorders30.00% Coinsurance after deductible
Well Baby Visits and CareNo charge
X-rays and Diagnostic ImagingNo charge

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