UHC Kelsey-Seybold Gold Copay Focus $0 Indiv Med Ded ($8 Tier 2 Rx)
UnitedHealthcare · 2026 plan year
Gold
- Ind. medical deductible
- $0
- Rx deductible (separate)
- $500
- Family deductible
- $0
- Ind. OOP max
- $7,800
- Family OOP max
- $15,600
This plan sets a separate deductible for prescription drugs. The medical deductible shown does not cover prescriptions; they have their own.
Compare with other Gold plans in TX
Side by side: deductibles, out-of-pocket limits and copays.
Other cost-sharing reduction variants for this plan:
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Monthly premiums by age
Rating Area 26 — the lowest-priced of the 3 areas this plan covers. Premiums differ by area.
| Age | Individual | Individual + tobacco |
|---|---|---|
| Under 15 | $370 | $370 |
| 21 | $483 | $507 |
| 30 | $549 | $603 |
| 40 | $618 | $679 |
| 50 | $863 | $1,036 |
| 60 | $1,312 | $1,574 |
| 64 and over | $1,450 | $1,740 |
Live premium estimate
Benefits & cost sharing
Primary Care
| Benefit | In-network |
|---|---|
| Primary Care Visit to Treat an Injury or Illness | $15.00 |
| Preventive Care/Screening/Immunization | No charge |
Specialist
| Benefit | In-network |
|---|---|
| Specialist Visit | $40.00 |
Hospital
| Benefit | In-network |
|---|---|
| Emergency Room Services | $1,000.00 |
| Inpatient Hospital Services (e.g., Hospital Stay) | $2000.00 Copay per Day |
| Outpatient Surgery Physician/Surgical Services | $250.00 |
| Urgent Care Centers or Facilities | $50.00 |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | $8.00 |
| Non-Preferred Brand Drugs | 40.00% Coinsurance after deductible |
| Preferred Brand Drugs | $50.00 |
| Specialty Drugs | 45.00% Coinsurance after deductible |
Mental Health
| Benefit | In-network |
|---|---|
| Mental/Behavioral Health Inpatient Services | $2000.00 Copay per Day |
| Mental/Behavioral Health Outpatient Services | $15.00 |
Other
| Benefit | In-network |
|---|---|
| Radiation | $75.00 |
| Prosthetic Devices | 45.00% |
| Abortion for Which Public Funding is Prohibited | Not covered |
| Accidental Dental | 45.00% |
| Acupuncture | Not covered |
| Allergy Testing | 45.00% |
| Bariatric Surgery | Not covered |
| Basic Dental Care - Adult | Not covered |
| Basic Dental Care - Child | 45.00% |
| Chemotherapy | $500.00 |
| Chiropractic Care | 45.00% |
| Cosmetic Surgery | Not covered |
| Delivery and All Inpatient Services for Maternity Care | $2,000.00 |
| Dental Check-Up for Children | No charge |
| Diabetes Education | 45.00% |
| Dialysis | $300.00 |
| Durable Medical Equipment | 45.00% |
| Emergency Transportation/Ambulance | $1,000.00 |
| Eye Glasses for Children | 45.00% |
| Gender Affirming Care | $600.00 |
| Private-Duty Nursing | 45.00% |
| Habilitation Services | $40.00 |
| Hearing Aids | 45.00% |
| Home Health Care Services | 45.00% |
| Hospice Services | 45.00% |
| Imaging (CT/PET Scans, MRIs) | $300.00 |
| Infertility Treatment | Not covered |
| Infusion Therapy | $75.00 |
| Inpatient Physician and Surgical Services | No charge |
| Laboratory Outpatient and Professional Services | $20.00 |
| Long-Term/Custodial Nursing Home Care | Not covered |
| Major Dental Care - Adult | Not covered |
| Major Dental Care - Child | 45.00% |
| Nutritional Counseling | Not covered |
| Orthodontia - Adult | Not covered |
| Orthodontia - Child | 50.00% |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | 45.00% |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | $600.00 |
| Outpatient Rehabilitation Services | $40.00 |
| Prenatal and Postnatal Care | No charge |
| Reconstructive Surgery | $600.00 |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | $40.00 |
| Rehabilitative Speech Therapy | $40.00 |
| Routine Dental Services (Adult) | Not covered |
| Routine Eye Exam (Adult) | Not covered |
| Routine Eye Exam for Children | No charge |
| Routine Foot Care | Not covered |
| Skilled Nursing Facility | $2000.00 Copay per Day |
| Substance Abuse Disorder Inpatient Services | $2000.00 Copay per Day |
| Substance Abuse Disorder Outpatient Services | $15.00 |
| Transplant | $2,000.00 |
| Treatment for Temporomandibular Joint Disorders | 45.00% |
| Weight Loss Programs | Not covered |
| Well Baby Visits and Care | No charge |
| X-rays and Diagnostic Imaging | $65.00 |
Plan rules
Service area
This plan covers 5 geographic areas.
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