St Luke's Health Plan Silver 5000/1500 Rx

St. Luke's Health Plan, Inc. · 2027 plan year

Silver

Ind. medical deductible: $5,000
Rx deductible (separate): $1,500
Family deductible: $10,000
Ind. OOP max: $8,000
Family OOP max: $16,000

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:

73% AV Level Silver Plan 87% AV Level Silver Plan 94% AV Level Silver Plan Standard Silver Off Exchange Plan Standard Silver On Exchange Plan Zero Cost Sharing Plan Variation

More St. Luke's Health Plan, Inc. plans in ID

St Luke's Health Plan Expanded Bronze St Luke's Health Plan Expanded Bronze HDHP St Luke's Health Plan Silver 5800 St Luke's Health Plan Gold

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	$25.00

Specialist

Benefit	In-network
Specialist Visit	$150.00 Copay after deductible

Hospital

Benefit	In-network
Emergency Room Services	40.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	40.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services	40.00% Coinsurance after deductible
Urgent Care Centers or Facilities	$150.00 Copay after deductible

Pharmacy

Benefit	In-network
Generic Drugs	$25.00
Non-Preferred Brand Drugs	$100.00 Copay after deductible
Preferred Brand Drugs	$80.00 Copay after deductible
Specialty Drugs	50.00% Coinsurance after deductible

Mental Health

Benefit	In-network
Mental/Behavioral Health Inpatient Services	40.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services	$25.00

Other

Benefit	In-network
Accidental Dental	40.00% Coinsurance after deductible
Allergy Testing	40.00% Coinsurance after deductible
Chemotherapy	40.00% Coinsurance after deductible
Chiropractic Care	$30.00
Delivery and All Inpatient Services for Maternity Care	40.00% Coinsurance after deductible
Diabetes Education	No charge
Dialysis	40.00% Coinsurance after deductible
Durable Medical Equipment	40.00% Coinsurance after deductible
Emergency Transportation/Ambulance	40.00% Coinsurance after deductible
Eye Glasses for Children	40.00% Coinsurance after deductible
Habilitation Services	$30.00
Hearing Aids	40.00% Coinsurance after deductible
Home Health Care Services	40.00% Coinsurance after deductible
Hospice Services	No charge
Imaging (CT/PET Scans, MRIs)	40.00% Coinsurance after deductible
Infusion Therapy	40.00% Coinsurance after deductible
Inpatient Physician and Surgical Services	40.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services	$200.00 Copay after deductible
Nutritional Counseling	No charge
Other Practitioner Office Visit (Nurse, Physician Assistant)	$25.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)	40.00% Coinsurance after deductible
Outpatient Rehabilitation Services	$30.00
Prenatal and Postnatal Care	$25.00
Prosthetic Devices	40.00% Coinsurance after deductible
Radiation	40.00% Coinsurance after deductible
Reconstructive Surgery	40.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy	$30.00
Rehabilitative Speech Therapy	$30.00
Routine Eye Exam for Children	No charge
Skilled Nursing Facility	40.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services	40.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services	$25.00
Transplant	40.00% Coinsurance after deductible
Well Baby Visits and Care	No charge
X-rays and Diagnostic Imaging	$200.00 Copay after deductible

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