Select Health Monument Value Silver $3500 Medical Deductible
SelectHealth, Inc. · 2027 plan year
Silver
- Ind. medical deductible
- $150
- Rx deductible (separate)
- $220
- Family deductible
- $300
- Ind. OOP max
- $3,400
- Family OOP max
- $6,800
This plan sets a separate deductible for prescription drugs. The medical deductible shown does not cover prescriptions; they have their own.
Other cost-sharing reduction variants for this plan:
More SelectHealth, Inc. plans in CO
Select Health Value Colorado Option Bronze HSA EligibleSelect Health Monument Value Colorado Option Bronze HSA EligibleSelect Health Value Bronze $6900 Medical Deductible HSA EligibleSelect Health Monument Value Bronze $6900 Medical Deductible HSA EligibleSelect Health Value Bronze $8500 Medical Deductible HSA Eligible
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Benefits & cost sharing
Primary Care
| Benefit | In-network |
|---|---|
| Preventive Care/Screening/Immunization | No charge |
| Primary Care Visit to Treat an Injury or Illness | $5.00 |
Specialist
| Benefit | In-network |
|---|---|
| Specialist Visit | $15.00 |
Hospital
| Benefit | In-network |
|---|---|
| Emergency Room Services | $125.00 Copay after deductible |
| Inpatient Hospital Services (e.g., Hospital Stay) | 15.00% Coinsurance after deductible |
| Outpatient Surgery Physician/Surgical Services | 15.00% Coinsurance after deductible |
| Urgent Care Centers or Facilities | $10.00 |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | No charge |
| Medical Service Drugs | 50.00% Coinsurance after deductible |
| Non-Preferred Brand Drugs | 15.00% Coinsurance after deductible |
| Non-Preferred Generic Drugs | $5.00 |
| Preferred Brand Drugs | 5.00% Coinsurance after deductible |
| Preventive Drugs | No charge |
| Specialty Drugs | 50.00% Coinsurance after deductible |
Mental Health
| Benefit | In-network |
|---|---|
| Intensive Outpatient for Mental/Behavioral Health | 15.00% Coinsurance after deductible |
| Intensive Outpatient for Substance Use Disorder | 15.00% Coinsurance after deductible |
| Mental Health Wellness Visit | No charge |
| Mental/Behavioral Health Inpatient Services | 15.00% Coinsurance after deductible |
| Mental/Behavioral Health Outpatient Services | $15.00 |
| Mental/Behavioral Health Prenatal Care | $5.00 |
| Office Visit - Mental/Behavioral Health | $15.00 |
| Office Visit - Substance Use Disorder | $15.00 |
| Partial Hospitalization for Mental/Behavioral Health | 15.00% Coinsurance after deductible |
| Partial Hospitalization for Substance Use Disorder | 15.00% Coinsurance after deductible |
| Postpartum Mental/Behavioral Health | $5.00 |
| Postpartum Substance Use Disorder | $5.00 |
| Residential Day Treatment for Mental/Behavioral Health | 15.00% Coinsurance after deductible |
| Residential Day Treatment for Substance Use Disorder | 15.00% Coinsurance after deductible |
| Substance Use Disorder Prenatal Care | $5.00 |
| Telehealth Mental/Behavioral Health | $5.00 |
| Telehealth Substance Use Disorder | $5.00 |
Other
| Benefit | In-network |
|---|---|
| Routine Eye Exam for Children | No charge |
| Abortion for Which Public Funding is Prohibited | No charge |
| Acupuncture | $5.00 |
| Allergy Testing | $15.00 |
| Applied Behavior Analysis Based Therapies | No Charge after deductible |
| Autism Spectrum Disorders - Assessment and Evaluation Services | $15.00 |
| Bariatric Surgery | 15.00% Coinsurance after deductible |
| Chemotherapy | 50.00% Coinsurance after deductible |
| Chiropractic Care | $5.00 |
| Delivery and All Inpatient Services for Maternity Care | 15.00% Coinsurance after deductible |
| Diabetes Education | $15.00 |
| Diabetic Supplies | 15.00% Coinsurance after deductible |
| Dialysis | $15.00 |
| Durable Medical Equipment | 15.00% Coinsurance after deductible |
| Emergency Transportation/Ambulance | $125.00 Copay after deductible |
| Eye Glasses for Children | $15.00 |
| Gender Affirming Care | 15.00% Coinsurance after deductible |
| Habilitation Services | $15.00 Copay after deductible |
| Hearing Aids | 15.00% Coinsurance after deductible |
| Home Health Care Services | $15.00 |
| Hospice Services | $15.00 |
| Imaging (CT/PET Scans, MRIs) | 15.00% Coinsurance after deductible |
| Infertility Treatment | 15.00% Coinsurance after deductible |
| Infusion Therapy | 15.00% Coinsurance after deductible |
| Inpatient Physician and Surgical Services | 15.00% Coinsurance after deductible |
| Inpatient Rehabilitation | 15.00% Coinsurance after deductible |
| Laboratory Outpatient and Professional Services | $5.00 |
| Nutritional Counseling | $15.00 |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $5.00 |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | 15.00% Coinsurance after deductible |
| Outpatient Rehabilitation Services | $15.00 Copay after deductible |
| Prenatal and Postnatal Care | $5.00 |
| Private-Duty Nursing | $15.00 |
| Prosthetic Devices | 15.00% Coinsurance after deductible |
| Prosthetics: Legs and Arms | 20.00% |
| Prosthetics: Recreational | 15.00% Coinsurance after deductible |
| Radiation | 15.00% Coinsurance after deductible |
| Reconstructive Surgery | 15.00% Coinsurance after deductible |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | $15.00 Copay after deductible |
| Rehabilitative Occupational Therapy | $15.00 Copay after deductible |
| Rehabilitative Physical Therapy | $15.00 Copay after deductible |
| Rehabilitative Speech Therapy | $15.00 Copay after deductible |
| Skilled Nursing Facility | 15.00% Coinsurance after deductible |
| Standalone Laboratory | $5.00 |
| Substance Abuse Disorder Inpatient Services | 15.00% Coinsurance after deductible |
| Substance Abuse Disorder Outpatient Services | $15.00 |
| Telehealth PCP | No charge |
| Telehealth Specialist | $15.00 |
| Transplant | 15.00% Coinsurance after deductible |
| Treatment for Temporomandibular Joint Disorders | 15.00% Coinsurance after deductible |
| Well Baby Visits and Care | No charge |
| X-rays and Diagnostic Imaging | 15.00% Coinsurance after deductible |
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