Med Exp Bronze 7500 Medical Deductible - HSA Eligible

SelectHealth, Inc. · 2027 plan year

Expanded BronzeHSA eligible
Ind. medical deductible
$7,500
Rx deductible (separate)
$2,500
Family deductible
$15,000
Ind. OOP max
$12,000
Family OOP max
$24,000

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$45.00

Specialist

BenefitIn-network
Specialist Visit$70.00 Copay after deductible

Hospital

BenefitIn-network
Emergency Room Services$750.00 Copay after deductible
Inpatient Hospital Services (e.g., Hospital Stay)50.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services50.00% Coinsurance after deductible
Urgent Care Centers or Facilities$100.00

Pharmacy

BenefitIn-network
Generic Drugs$40.00
Non-Preferred Brand Drugs50.00% Coinsurance after deductible
Preferred Brand Drugs25.00% Coinsurance after deductible
Specialty Drugs50.00% Coinsurance after deductible

Mental Health

BenefitIn-network
Mental/Behavioral Health Inpatient Services50.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services$55.00

Other

BenefitIn-network
Private-Duty Nursing50.00% Coinsurance after deductible
Prosthetic Devices50.00% Coinsurance after deductible
Radiation50.00% Coinsurance after deductible
Accidental Dental$750.00 Copay after deductible
Allergy Testing$70.00 Copay after deductible
Bariatric Surgery50.00% Coinsurance after deductible
Chemotherapy50.00% Coinsurance after deductible
Chiropractic Care$45.00
Delivery and All Inpatient Services for Maternity Care50.00% Coinsurance after deductible
Diabetes Education$45.00
Dialysis50.00% Coinsurance after deductible
Durable Medical Equipment50.00% Coinsurance after deductible
Emergency Transportation/Ambulance50.00% Coinsurance after deductible
Eye Glasses for ChildrenNo charge
Gender Affirming Care50.00% Coinsurance after deductible
Habilitation Services$100.00 Copay after deductible
Hearing Aids50.00% Coinsurance after deductible
Home Health Care Services50.00% Coinsurance after deductible
Hospice Services50.00% Coinsurance after deductible
Imaging (CT/PET Scans, MRIs)50.00% Coinsurance after deductible
Infertility Treatment50.00% Coinsurance after deductible
Infusion Therapy50.00% Coinsurance after deductible
Inpatient Physician and Surgical Services50.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services$65.00
Nutritional Counseling$45.00
Other Practitioner Office Visit (Nurse, Physician Assistant)$45.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)50.00% Coinsurance after deductible
Outpatient Rehabilitation Services$100.00
Prenatal and Postnatal Care$45.00
Reconstructive Surgery50.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy50.00% Coinsurance after deductible
Rehabilitative Speech Therapy50.00% Coinsurance after deductible
Routine Eye Exam for ChildrenNo charge
Skilled Nursing Facility50.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services50.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services$55.00
Transplant50.00% Coinsurance after deductible
Treatment for Temporomandibular Joint Disorders50.00% Coinsurance after deductible
Well Baby Visits and CareNo charge
X-rays and Diagnostic Imaging$100.00

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