SelectHealth

SelectHealth Value Expanded Bronze 6900 - no deductible for urgent care and PCP office visits

Prescription Drug Information

Inpatient Coverage

Emergency and Urgent Care

Links

Plan Overview

Medical Deductible	Individual: $6,900 Family: $13,800 Per Person: $6,900
Prescription Drug Deductible	Individual: Included in Medical Family: Included in Medical Per Person: Included in Medical
Medical Out-of-Pocket Maximum	Individual: $8,700 Family: $17,400 Per Person: $8,700
Drug Out-of-Pocket Maximum	Individual: Included in Medical Family: Included in Medical Per Person: Included in Medical

Office Visit

Primary Doctor	Standard: $35 Copay
Specialist	Standard: $70 Copay after deductible

Prescription Drug Information

Preferred Brand Drugs	Standard: $55 Copay after deductible
Non Preferred Brand Drugs	Standard: $70 Copay after deductible
Generic Drugs	Standard: $30 Copay
Specialty Drugs	Standard: 50% Coinsurance after deductible

Inpatient Coverage

Hospital Services	Standard: 40% Coinsurance after deductible
Inpatient Services	Standard: 40% Coinsurance after deductible

Emergency and Urgent Care

Emergency Room

Standard: $600 Copay after deductible

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