Med Expanded Bronze 4800 Copay Plan - no deductible for one urgent care and all PCP visits Plan Details for 2020- HealthPocket

Med Expanded Bronze 4800 Copay Plan - no deductible for one urgent care and all PCP visits

$277.53/mo

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Zip Code84120
Applicant12/14/1984 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameMed Expanded Bronze 4800 Copay Plan - no deductible for one urgent care and all PCP visits
Plan IDqhp-68781UT0020043
Plan Year2020
Insurance ProviderSelectHealth
Metal LevelExpanded Bronze
Plan TypeHMO
Deductible$4,800
Out-of-Pocket Maximum$7,900
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$25 Copay
Specialist Visit$60 Copay
Laboratory Outpatient and Professional ServicesNo Charge after deductible
X-rays and Diagnostic ImagingNo Charge after deductible
Deductible - Family$9600
Out-of-Pocket Maximum - Family$15800

Prescription drug coverage

Generic Drugs$25 Copay
Preferred Brand Drugs$55 Copay
Non-Preferred Brand Drugs$70 Copay
Specialty Drugs50% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttp://selecthealth.org/providers/default.aspx?medical=med&dental=classic

Hospital services

Emergency Room Services$600 Copay
Inpatient Hospital Services (e.g., Hospital Stay)40% Coinsurance after deductible
Inpatient Physician and Surgical Services$650 Copay

Maternity

Prenatal and Postnatal Care40.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services40.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient ServicesNot Applicable

Vision Coverage

Routine Eye Exam for ChildrenNo Charge
Eye Glasses for Children40.00% Coinsurance after deductible

Exclusions and Limitations

More Included BenefitsOther Practitioner Office Visit (Nurse, Physician Assistant)
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Outpatient Surgery Physician/Surgical Services
Hospice Services
Private-Duty Nursing
Urgent Care Centers or Facilities
Home Health Care Services
Inpatient Physician and Surgical Services
Skilled Nursing Facility
Outpatient Rehabilitation Services
Habilitation Services
Durable Medical Equipment
Imaging (CT/PET Scans, MRIs)
Preventive Care/Screening/Immunization
Dental Check-Up for Children
Rehabilitative Speech Therapy
Rehabilitative Occupational and Rehabilitative Physical Therapy
Well Baby Visits and Care
Transplant
Accidental Dental
Dialysis
Allergy Testing
Chemotherapy
Radiation
Diabetes Education
Prosthetic Devices
Infusion Therapy
Nutritional Counseling
Reconstructive Surgery
Inherited Metabolic Disorder - PKU
Autism Spectrum Disorders
More Excluded BenefitsInfertility Treatment
Long-Term/Custodial Nursing Home Care
Bariatric Surgery
Cosmetic Surgery
Chiropractic Care
Hearing Aids
Routine Foot Care
Acupuncture
Weight Loss Programs
Abortion for Which Public Funding is Prohibited
Treatment for Temporomandibular Joint Disorders
PremiumPlan NameDeductible
from $245
Value Expanded Bronze 4800 Copay Plan - no deductible for one urgent care and all PCP visits
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  • Phone Number
    (801) 924-0029
  • Office Locations
    3715 W 4100 S
    West Valley City, UT 84120
3715 W 4100 S West Valley City UT, 84120

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is part of the Health Insurance Innovations, Inc. family of companies (NASDAQ: HIIQ).

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is part of the Health Insurance Innovations, Inc. family of companies (NASDAQ: HIIQ).