Value Benchmark Expanded Bronze Select Copay Plan
Select Health · 2026 plan year
Expanded BronzeHSA eligible
- Ind. medical deductible
- $0
- Rx deductible (separate)
- $4,000
- Family deductible
- $0
- Ind. OOP max
- $10,500
- Family OOP max
- $21,000
This plan sets a separate deductible for prescription drugs. The medical deductible shown does not cover prescriptions; they have their own.
Compare with other Expanded Bronze plans in UT
Side by side: deductibles, out-of-pocket limits and copays.
Other cost-sharing reduction variants for this plan:
More Select Health plans in UT
Monthly premiums by age
Rating Area 3 — the lowest-priced of the 3 areas this plan covers. Premiums differ by area.
| Age | Individual | Individual + tobacco |
|---|---|---|
| Under 15 | $265 | $265 |
| 21 | $334 | $334 |
| 30 | $464 | $464 |
| 40 | $494 | $528 |
| 50 | $710 | $781 |
| 60 | $1,001 | $1,221 |
| 64 and over | $1,001 | $1,221 |
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 | $45.00 |
Specialist
| Benefit | In-network |
|---|---|
| Specialist Visit | $90.00 |
Hospital
| Benefit | In-network |
|---|---|
| Emergency Room Services | $1,500.00 |
| Inpatient Hospital Services (e.g., Hospital Stay) | 50.00% |
| Outpatient Surgery Physician/Surgical Services | $250.00 |
| Urgent Care Centers or Facilities | $70.00 |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | $30.00 |
| Non-Preferred Brand Drugs | 50.00% Coinsurance after deductible |
| Preferred Brand Drugs | $125.00 Copay after deductible |
| Specialty Drugs | 50.00% Coinsurance after deductible |
Mental Health
| Benefit | In-network |
|---|---|
| Mental/Behavioral Health Inpatient Services | 50.00% |
| Mental/Behavioral Health Outpatient Services | $45.00 |
Other
| Benefit | In-network |
|---|---|
| Abortion for Which Public Funding is Prohibited | Not covered |
| Accidental Dental | Not covered |
| Acupuncture | Not covered |
| Allergy Testing | $90.00 |
| Autism Spectrum Disorders | $45.00 |
| Bariatric Surgery | Not covered |
| Basic Dental Care - Adult | Not covered |
| Basic Dental Care - Child | Not covered |
| Chemotherapy | 50.00% |
| Chiropractic Care | Not covered |
| Cosmetic Surgery | Not covered |
| Delivery and All Inpatient Services for Maternity Care | 50.00% |
| Dental Check-Up for Children | Not covered |
| Diabetes Education | $90.00 |
| Dialysis | $90.00 |
| Durable Medical Equipment | 50.00% |
| Emergency Transportation/Ambulance | $250.00 |
| Eye Glasses for Children | $90.00 |
| Gender Affirming Care | Not covered |
| Habilitation Services | $40.00 |
| Hearing Aids | Not covered |
| Home Health Care Services | $90.00 |
| Hospice Services | $90.00 |
| Imaging (CT/PET Scans, MRIs) | $750.00 |
| Infertility Treatment | Not covered |
| Infusion Therapy | $90.00 |
| Inherited Metabolic Disorder - PKU | $90.00 |
| Inpatient Physician and Surgical Services | No charge |
| Laboratory Outpatient and Professional Services | $75.00 |
| Long-Term/Custodial Nursing Home Care | Not covered |
| Major Dental Care - Adult | Not covered |
| Major Dental Care - Child | Not covered |
| Nutritional Counseling | Not covered |
| Orthodontia - Adult | Not covered |
| Orthodontia - Child | Not covered |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $45.00 |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | $1,500.00 |
| Outpatient Rehabilitation Services | $25.00 |
| Prenatal and Postnatal Care | $45.00 |
| Private-Duty Nursing | Not covered |
| Prosthetic Devices | Not covered |
| Radiation | 50.00% |
| Reconstructive Surgery | 50.00% |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | $90.00 |
| Rehabilitative Speech Therapy | $90.00 |
| Routine Dental Services (Adult) | Not covered |
| Routine Eye Exam (Adult) | Not covered |
| Routine Eye Exam for Children | $90.00 |
| Routine Foot Care | Not covered |
| Skilled Nursing Facility | 50.00% |
| Substance Abuse Disorder Inpatient Services | 50.00% |
| Substance Abuse Disorder Outpatient Services | $45.00 |
| Transplant | 50.00% |
| Treatment for Temporomandibular Joint Disorders | Not covered |
| Weight Loss Programs | Not covered |
| Well Baby Visits and Care | No charge |
| X-rays and Diagnostic Imaging | $100.00 |
Plan rules
Service area
This plan covers 9 geographic areas.
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