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You are viewing information for Uintah County, UT

Obamacare 2023 Rates for Uintah County

Obamacare > Rates > Utah > Uintah County

Obamacare is also known as the Affordable Care Act. This page gives you an overview of the rates for individual and family health insurance plans available from , the marketplace for Uintah County, UT.

The health insurance rates listed below are for calendar year 2023.

For information on subsidies to make your coverage affordable, you must take one of the following actions:

  • Contact a licensed health insurance agent
  • Complete an application at Healthcare.gov
  • Contact the provider directly

Obamacare Providers, 40 Plans and 2023 Rates for Uintah County, Utah

Below, you’ll find a summary of the 40 plans for Uintah County, Utah and rates for each of these providers.‡ This chart is designed to give you a preview of your health insurance options.

You may also be interested in:

Obamacare Rates and Providers for Other Years

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Regence BlueCross BlueShield of Utah

Local: 1-888-231-8424 | Toll Free: 1-888-231-8424

Toc - Plan #1 Regence BlueCross BlueShield of Utah
Silver

(EPO) Silver 4500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-231-8424

Annual Out of Pocket Expenses:

Individual Family
$4,500 $9,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$415.59
$577.67
$614.65
$883.96
$1,246.76 		$745.15
$907.23
$944.21
$1,213.52 		$1,074.71
$1,236.79
$1,273.77
$1,543.08 		$1,404.27
$1,566.35
$1,603.33
$1,872.64 		$329.56
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$831.18
$1,155.34
$1,229.30
$1,767.92
$2,493.52 		$1,160.74
$1,484.90
$1,558.86
$2,097.48 		$1,490.30
$1,814.46
$1,888.42
$2,427.04 		$1,819.86
$2,144.02
$2,217.98
$2,756.60 		$329.56
Toc - Plan #2 Regence BlueCross BlueShield of Utah
Silver

(EPO) Silver 5500 Separate RX Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-231-8424

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$417.95
$580.96
$618.15
$888.98
$1,253.85 		$749.39
$912.40
$949.59
$1,220.42 		$1,080.83
$1,243.84
$1,281.03
$1,551.86 		$1,412.27
$1,575.28
$1,612.47
$1,883.30 		$331.44
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$835.90
$1,161.92
$1,236.30
$1,777.96
$2,507.70 		$1,167.34
$1,493.36
$1,567.74
$2,109.40 		$1,498.78
$1,824.80
$1,899.18
$2,440.84 		$1,830.22
$2,156.24
$2,230.62
$2,772.28 		$331.44
Toc - Plan #3 Regence BlueCross BlueShield of Utah
Silver

(EPO) Silver 6500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-231-8424

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$398.17
$553.45
$588.89
$846.91
$1,194.51 		$713.92
$869.20
$904.64
$1,162.66 		$1,029.67
$1,184.95
$1,220.39
$1,478.41 		$1,345.42
$1,500.70
$1,536.14
$1,794.16 		$315.75
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$796.34
$1,106.90
$1,177.78
$1,693.82
$2,389.02 		$1,112.09
$1,422.65
$1,493.53
$2,009.57 		$1,427.84
$1,738.40
$1,809.28
$2,325.32 		$1,743.59
$2,054.15
$2,125.03
$2,641.07 		$315.75
Toc - Plan #4 Regence BlueCross BlueShield of Utah
Gold

(EPO) Gold 2500 With Dental and Vision Exam

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-231-8424

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$434.88
$604.48
$643.18
$924.99
$1,304.64 		$779.74
$949.34
$988.04
$1,269.85 		$1,124.60
$1,294.20
$1,332.90
$1,614.71 		$1,469.46
$1,639.06
$1,677.76
$1,959.57 		$344.86
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$869.76
$1,208.96
$1,286.36
$1,849.98
$2,609.28 		$1,214.62
$1,553.82
$1,631.22
$2,194.84 		$1,559.48
$1,898.68
$1,976.08
$2,539.70 		$1,904.34
$2,243.54
$2,320.94
$2,884.56 		$344.86
Toc - Plan #5 Regence BlueCross BlueShield of Utah
Expanded Bronze

(EPO) Bronze HSA 6750

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-231-8424

Annual Out of Pocket Expenses:

Individual Family
$6,750 $13,500 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$314.08
$436.58
$464.53
$668.06
$942.24 		$563.14
$685.64
$713.59
$917.12 		$812.20
$934.70
$962.65
$1,166.18 		$1,061.26
$1,183.76
$1,211.71
$1,415.24 		$249.06
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$628.16
$873.16
$929.06
$1,336.12
$1,884.48 		$877.22
$1,122.22
$1,178.12
$1,585.18 		$1,126.28
$1,371.28
$1,427.18
$1,834.24 		$1,375.34
$1,620.34
$1,676.24
$2,083.30 		$249.06
Toc - Plan #6 Regence BlueCross BlueShield of Utah
Expanded Bronze

(EPO) Bronze Essential 8500 With 4 Copay No Deductible Office Visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-231-8424

Annual Out of Pocket Expenses:

Individual Family
$8,500 $17,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$294.78
$409.74
$435.97
$626.99
$884.34 		$528.54
$643.50
$669.73
$860.75 		$762.30
$877.26
$903.49
$1,094.51 		$996.06
$1,111.02
$1,137.25
$1,328.27 		$233.76
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$589.56
$819.48
$871.94
$1,253.98
$1,768.68 		$823.32
$1,053.24
$1,105.70
$1,487.74 		$1,057.08
$1,287.00
$1,339.46
$1,721.50 		$1,290.84
$1,520.76
$1,573.22
$1,955.26 		$233.76
Toc - Plan #7 Regence BlueCross BlueShield of Utah
Expanded Bronze

(EPO) Bronze 8000 Separate RX Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-231-8424

Annual Out of Pocket Expenses:

Individual Family
$8,000 $16,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$312.06
$433.77
$461.54
$663.76
$936.18 		$559.53
$681.24
$709.01
$911.23 		$807.00
$928.71
$956.48
$1,158.70 		$1,054.47
$1,176.18
$1,203.95
$1,406.17 		$247.47
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$624.12
$867.54
$923.08
$1,327.52
$1,872.36 		$871.59
$1,115.01
$1,170.55
$1,574.99 		$1,119.06
$1,362.48
$1,418.02
$1,822.46 		$1,366.53
$1,609.95
$1,665.49
$2,069.93 		$247.47
Toc - Plan #8 Regence BlueCross BlueShield of Utah
Gold

(EPO) Regence Standard Gold Plan

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-231-8424

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$447.16
$621.56
$661.36
$951.11
$1,341.48 		$801.77
$976.17
$1,015.97
$1,305.72 		$1,156.38
$1,330.78
$1,370.58
$1,660.33 		$1,510.99
$1,685.39
$1,725.19
$2,014.94 		$354.61
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$894.32
$1,243.12
$1,322.72
$1,902.22
$2,682.96 		$1,248.93
$1,597.73
$1,677.33
$2,256.83 		$1,603.54
$1,952.34
$2,031.94
$2,611.44 		$1,958.15
$2,306.95
$2,386.55
$2,966.05 		$354.61
Toc - Plan #9 Regence BlueCross BlueShield of Utah
Silver

(EPO) Regence Standard Silver Plan

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-231-8424

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 Annual Deductible
$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$405.32
$563.40
$599.48
$862.12
$1,215.96 		$726.75
$884.83
$920.91
$1,183.55 		$1,048.18
$1,206.26
$1,242.34
$1,504.98 		$1,369.61
$1,527.69
$1,563.77
$1,826.41 		$321.43
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$810.64
$1,126.80
$1,198.96
$1,724.24
$2,431.92 		$1,132.07
$1,448.23
$1,520.39
$2,045.67 		$1,453.50
$1,769.66
$1,841.82
$2,367.10 		$1,774.93
$2,091.09
$2,163.25
$2,688.53 		$321.43
Toc - Plan #10 Regence BlueCross BlueShield of Utah
Expanded Bronze

(EPO) Regence Standard Expanded Bronze Plan

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-231-8424

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$308.75
$429.17
$456.64
$656.71
$926.25 		$553.58
$674.00
$701.47
$901.54 		$798.41
$918.83
$946.30
$1,146.37 		$1,043.24
$1,163.66
$1,191.13
$1,391.20 		$244.83
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$617.50
$858.34
$913.28
$1,313.42
$1,852.50 		$862.33
$1,103.17
$1,158.11
$1,558.25 		$1,107.16
$1,348.00
$1,402.94
$1,803.08 		$1,351.99
$1,592.83
$1,647.77
$2,047.91 		$244.83

ADVERTISEMENT

BridgeSpan Health Company

Local: 1-855-857-9944 | Toll Free: 1-855-857-9944 | TTY: 1-800-735-2900
Toc - Plan #11 BridgeSpan Health Company
Gold

(HMO) BridgeSpan Standard Gold Plan

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-857-9944

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$457.08
$635.34
$676.03
$972.21
$1,371.24 		$819.55
$997.81
$1,038.50
$1,334.68 		$1,182.02
$1,360.28
$1,400.97
$1,697.15 		$1,544.49
$1,722.75
$1,763.44
$2,059.62 		$362.47
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$914.16
$1,270.68
$1,352.06
$1,944.42
$2,742.48 		$1,276.63
$1,633.15
$1,714.53
$2,306.89 		$1,639.10
$1,995.62
$2,077.00
$2,669.36 		$2,001.57
$2,358.09
$2,439.47
$3,031.83 		$362.47
Toc - Plan #12 BridgeSpan Health Company
Silver

(HMO) BridgeSpan Standard Silver Plan

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-857-9944

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 Annual Deductible
$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$414.40
$576.01
$612.89
$881.42
$1,243.19 		$743.01
$904.62
$941.50
$1,210.03 		$1,071.62
$1,233.23
$1,270.11
$1,538.64 		$1,400.23
$1,561.84
$1,598.72
$1,867.25 		$328.61
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$828.80
$1,152.02
$1,225.78
$1,762.84
$2,486.38 		$1,157.41
$1,480.63
$1,554.39
$2,091.45 		$1,486.02
$1,809.24
$1,883.00
$2,420.06 		$1,814.63
$2,137.85
$2,211.61
$2,748.67 		$328.61
Toc - Plan #13 BridgeSpan Health Company
Expanded Bronze

(HMO) BridgeSpan Standard Expanded Bronze Plan

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-857-9944

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$316.13
$439.42
$467.55
$672.40
$948.38 		$566.82
$690.11
$718.24
$923.09 		$817.51
$940.80
$968.93
$1,173.78 		$1,068.20
$1,191.49
$1,219.62
$1,424.47 		$250.69
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$632.26
$878.84
$935.10
$1,344.80
$1,896.76 		$882.95
$1,129.53
$1,185.79
$1,595.49 		$1,133.64
$1,380.22
$1,436.48
$1,846.18 		$1,384.33
$1,630.91
$1,687.17
$2,096.87 		$250.69
Toc - Plan #14 BridgeSpan Health Company
Expanded Bronze

(HMO) Bronze Virtual Saver 8500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-857-9944

Annual Out of Pocket Expenses:

Individual Family
$8,500 $17,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$292.88
$407.10
$433.17
$622.95
$878.63 		$525.13
$639.35
$665.42
$855.20 		$757.38
$871.60
$897.67
$1,087.45 		$989.63
$1,103.85
$1,129.92
$1,319.70 		$232.25
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$585.76
$814.20
$866.34
$1,245.90
$1,757.26 		$818.01
$1,046.45
$1,098.59
$1,478.15 		$1,050.26
$1,278.70
$1,330.84
$1,710.40 		$1,282.51
$1,510.95
$1,563.09
$1,942.65 		$232.25

ADVERTISEMENT

University of Utah Health Plans

Local: 1-801-213-4111x1 | Toll Free: 1-833-981-0214 | TTY: 1-800-346-4128
Toc - Plan #15 University of Utah Health Plans
Gold

(EPO) Healthy Premier Gold Copay

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-981-0214

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$538.64
$748.71
$796.65
$1,145.69
$1,615.92 		$965.78
$1,175.85
$1,223.79
$1,572.83 		$1,392.92
$1,602.99
$1,650.93
$1,999.97 		$1,820.06
$2,030.13
$2,078.07
$2,427.11 		$427.14
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,077.28
$1,497.42
$1,593.30
$2,291.38
$3,231.84 		$1,504.42
$1,924.56
$2,020.44
$2,718.52 		$1,931.56
$2,351.70
$2,447.58
$3,145.66 		$2,358.70
$2,778.84
$2,874.72
$3,572.80 		$427.14
Toc - Plan #16 University of Utah Health Plans
Silver

(EPO) Healthy Premier Silver Copay

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-981-0214

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$495.00
$688.06
$732.11
$1,052.87
$1,485.00 		$887.54
$1,080.60
$1,124.65
$1,445.41 		$1,280.08
$1,473.14
$1,517.19
$1,837.95 		$1,672.62
$1,865.68
$1,909.73
$2,230.49 		$392.54
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$990.00
$1,376.12
$1,464.22
$2,105.74
$2,970.00 		$1,382.54
$1,768.66
$1,856.76
$2,498.28 		$1,775.08
$2,161.20
$2,249.30
$2,890.82 		$2,167.62
$2,553.74
$2,641.84
$3,283.36 		$392.54
Toc - Plan #17 University of Utah Health Plans
Expanded Bronze

(EPO) Healthy Premier Bronze HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-981-0214

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$321.36
$446.69
$475.29
$683.53
$964.08 		$576.20
$701.53
$730.13
$938.37 		$831.04
$956.37
$984.97
$1,193.21 		$1,085.88
$1,211.21
$1,239.81
$1,448.05 		$254.84
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$642.72
$893.38
$950.58
$1,367.06
$1,928.16 		$897.56
$1,148.22
$1,205.42
$1,621.90 		$1,152.40
$1,403.06
$1,460.26
$1,876.74 		$1,407.24
$1,657.90
$1,715.10
$2,131.58 		$254.84
Toc - Plan #18 University of Utah Health Plans
Expanded Bronze

(EPO) Healthy Premier Expanded Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-981-0214

Annual Out of Pocket Expenses:

Individual Family
$8,000 $16,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$359.14
$499.21
$531.17
$763.90
$1,077.42 		$643.94
$784.01
$815.97
$1,048.70 		$928.74
$1,068.81
$1,100.77
$1,333.50 		$1,213.54
$1,353.61
$1,385.57
$1,618.30 		$284.80
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$718.28
$998.42
$1,062.34
$1,527.80
$2,154.84 		$1,003.08
$1,283.22
$1,347.14
$1,812.60 		$1,287.88
$1,568.02
$1,631.94
$2,097.40 		$1,572.68
$1,852.82
$1,916.74
$2,382.20 		$284.80
Toc - Plan #19 University of Utah Health Plans
Bronze

(EPO) Healthy Premier Bronze Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-981-0214

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$338.05
$469.89
$499.98
$719.04
$1,014.15 		$606.13
$737.97
$768.06
$987.12 		$874.21
$1,006.05
$1,036.14
$1,255.20 		$1,142.29
$1,274.13
$1,304.22
$1,523.28 		$268.08
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$676.10
$939.78
$999.96
$1,438.08
$2,028.30 		$944.18
$1,207.86
$1,268.04
$1,706.16 		$1,212.26
$1,475.94
$1,536.12
$1,974.24 		$1,480.34
$1,744.02
$1,804.20
$2,242.32 		$268.08
Toc - Plan #20 University of Utah Health Plans
Gold

(EPO) Healthy Premier Gold Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-981-0214

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$521.39
$724.73
$771.14
$1,109.00
$1,564.17 		$934.85
$1,138.19
$1,184.60
$1,522.46 		$1,348.31
$1,551.65
$1,598.06
$1,935.92 		$1,761.77
$1,965.11
$2,011.52
$2,349.38 		$413.46
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,042.78
$1,449.46
$1,542.28
$2,218.00
$3,128.34 		$1,456.24
$1,862.92
$1,955.74
$2,631.46 		$1,869.70
$2,276.38
$2,369.20
$3,044.92 		$2,283.16
$2,689.84
$2,782.66
$3,458.38 		$413.46
Toc - Plan #21 University of Utah Health Plans
Silver

(EPO) Healthy Premier Silver Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-981-0214

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 Annual Deductible
$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$491.76
$683.54
$727.31
$1,045.97
$1,475.27 		$881.72
$1,073.50
$1,117.27
$1,435.93 		$1,271.68
$1,463.46
$1,507.23
$1,825.89 		$1,661.64
$1,853.42
$1,897.19
$2,215.85 		$389.96
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$983.52
$1,367.08
$1,454.62
$2,091.94
$2,950.54 		$1,373.48
$1,757.04
$1,844.58
$2,481.90 		$1,763.44
$2,147.00
$2,234.54
$2,871.86 		$2,153.40
$2,536.96
$2,624.50
$3,261.82 		$389.96
Toc - Plan #22 University of Utah Health Plans
Expanded Bronze

(EPO) Healthy Premier Expanded Bronze Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-981-0214

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$361.80
$502.90
$535.10
$769.54
$1,085.39 		$648.71
$789.81
$822.01
$1,056.45 		$935.62
$1,076.72
$1,108.92
$1,343.36 		$1,222.53
$1,363.63
$1,395.83
$1,630.27 		$286.91
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$723.60
$1,005.80
$1,070.20
$1,539.08
$2,170.78 		$1,010.51
$1,292.71
$1,357.11
$1,825.99 		$1,297.42
$1,579.62
$1,644.02
$2,112.90 		$1,584.33
$1,866.53
$1,930.93
$2,399.81 		$286.91
Toc - Plan #23 University of Utah Health Plans
Expanded Bronze

(EPO) Healthy Premier Bronze w.3 Copays

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-981-0214

Annual Out of Pocket Expenses:

Individual Family
$8,750 $17,500 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$322.86
$448.78
$477.51
$686.73
$968.58 		$578.89
$704.81
$733.54
$942.76 		$834.92
$960.84
$989.57
$1,198.79 		$1,090.95
$1,216.87
$1,245.60
$1,454.82 		$256.03
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$645.72
$897.56
$955.02
$1,373.46
$1,937.16 		$901.75
$1,153.59
$1,211.05
$1,629.49 		$1,157.78
$1,409.62
$1,467.08
$1,885.52 		$1,413.81
$1,665.65
$1,723.11
$2,141.55 		$256.03
Toc - Plan #24 University of Utah Health Plans
Expanded Bronze

(EPO) Healthy Premier Expanded Bronze Standard Choice

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-981-0214

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$361.80
$502.90
$535.10
$769.54
$1,085.39 		$648.71
$789.81
$822.01
$1,056.45 		$935.62
$1,076.72
$1,108.92
$1,343.36 		$1,222.53
$1,363.63
$1,395.83
$1,630.27 		$286.91
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$723.60
$1,005.80
$1,070.20
$1,539.08
$2,170.78 		$1,010.51
$1,292.71
$1,357.11
$1,825.99 		$1,297.42
$1,579.62
$1,644.02
$2,112.90 		$1,584.33
$1,866.53
$1,930.93
$2,399.81 		$286.91

ADVERTISEMENT

SelectHealth

Local: 1-801-442-5038 | Toll Free: 1-800-538-5038

Toc - Plan #25 SelectHealth
Silver

(HMO) Med Silver 3000 - no deductible for office visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$397.80
$552.94
$588.34
$846.12
$1,193.40 		$713.25
$868.39
$903.79
$1,161.57 		$1,028.70
$1,183.84
$1,219.24
$1,477.02 		$1,344.15
$1,499.29
$1,534.69
$1,792.47 		$315.45
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$795.60
$1,105.88
$1,176.68
$1,692.24
$2,386.80 		$1,111.05
$1,421.33
$1,492.13
$2,007.69 		$1,426.50
$1,736.78
$1,807.58
$2,323.14 		$1,741.95
$2,052.23
$2,123.03
$2,638.59 		$315.45
Toc - Plan #26 SelectHealth
Gold

(HMO) Med Gold 1500 - no deductible for office visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$496.49
$690.12
$734.31
$1,056.03
$1,489.47 		$890.21
$1,083.84
$1,128.03
$1,449.75 		$1,283.93
$1,477.56
$1,521.75
$1,843.47 		$1,677.65
$1,871.28
$1,915.47
$2,237.19 		$393.72
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$992.98
$1,380.24
$1,468.62
$2,112.06
$2,978.94 		$1,386.70
$1,773.96
$1,862.34
$2,505.78 		$1,780.42
$2,167.68
$2,256.06
$2,899.50 		$2,174.14
$2,561.40
$2,649.78
$3,293.22 		$393.72
Toc - Plan #27 SelectHealth
Expanded Bronze

(HMO) Med Expanded Bronze 6900 - no deductible for office visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

Annual Out of Pocket Expenses:

Individual Family
$6,900 $13,800 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$296.58
$412.24
$438.64
$630.82
$889.73 		$531.77
$647.43
$673.83
$866.01 		$766.96
$882.62
$909.02
$1,101.20 		$1,002.15
$1,117.81
$1,144.21
$1,336.39 		$235.19
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$593.16
$824.48
$877.28
$1,261.64
$1,779.46 		$828.35
$1,059.67
$1,112.47
$1,496.83 		$1,063.54
$1,294.86
$1,347.66
$1,732.02 		$1,298.73
$1,530.05
$1,582.85
$1,967.21 		$235.19
Toc - Plan #28 SelectHealth
Expanded Bronze

(HMO) Med Expanded Bronze 7500 HSA Qualified

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$301.64
$419.28
$446.12
$641.59
$904.92 		$540.84
$658.48
$685.32
$880.79 		$780.04
$897.68
$924.52
$1,119.99 		$1,019.24
$1,136.88
$1,163.72
$1,359.19 		$239.20
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$603.28
$838.56
$892.24
$1,283.18
$1,809.84 		$842.48
$1,077.76
$1,131.44
$1,522.38 		$1,081.68
$1,316.96
$1,370.64
$1,761.58 		$1,320.88
$1,556.16
$1,609.84
$2,000.78 		$239.20
Toc - Plan #29 SelectHealth
Expanded Bronze

(HMO) Med Expanded Bronze 5900 Copay Plan - no deductible for all office visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$321.38
$446.71
$475.32
$683.57
$964.13 		$576.23
$701.56
$730.17
$938.42 		$831.08
$956.41
$985.02
$1,193.27 		$1,085.93
$1,211.26
$1,239.87
$1,448.12 		$254.85
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$642.76
$893.42
$950.64
$1,367.14
$1,928.26 		$897.61
$1,148.27
$1,205.49
$1,621.99 		$1,152.46
$1,403.12
$1,460.34
$1,876.84 		$1,407.31
$1,657.97
$1,715.19
$2,131.69 		$254.85
Toc - Plan #30 SelectHealth
Silver

(HMO) Med Silver 6500 - Diabetes Support Plan

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$426.14
$592.34
$630.26
$906.40
$1,278.42 		$764.07
$930.27
$968.19
$1,244.33 		$1,102.00
$1,268.20
$1,306.12
$1,582.26 		$1,439.93
$1,606.13
$1,644.05
$1,920.19 		$337.93
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$852.28
$1,184.68
$1,260.52
$1,812.80
$2,556.84 		$1,190.21
$1,522.61
$1,598.45
$2,150.73 		$1,528.14
$1,860.54
$1,936.38
$2,488.66 		$1,866.07
$2,198.47
$2,274.31
$2,826.59 		$337.93
Toc - Plan #31 SelectHealth
Bronze

(HMO) Med Benchmark Bronze 9100

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$277.34
$385.50
$410.19
$589.90
$832.02 		$497.27
$605.43
$630.12
$809.83 		$717.20
$825.36
$850.05
$1,029.76 		$937.13
$1,045.29
$1,069.98
$1,249.69 		$219.93
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$554.68
$771.00
$820.38
$1,179.80
$1,664.04 		$774.61
$990.93
$1,040.31
$1,399.73 		$994.54
$1,210.86
$1,260.24
$1,619.66 		$1,214.47
$1,430.79
$1,480.17
$1,839.59 		$219.93
Toc - Plan #32 SelectHealth
Silver

(HMO) Med Benchmark Silver 6300 - no deductible for office visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

Annual Out of Pocket Expenses:

Individual Family
$6,300 $12,600 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$384.64
$534.65
$568.88
$818.13
$1,153.92 		$689.66
$839.67
$873.90
$1,123.15 		$994.68
$1,144.69
$1,178.92
$1,428.17 		$1,299.70
$1,449.71
$1,483.94
$1,733.19 		$305.02
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$769.28
$1,069.30
$1,137.76
$1,636.26
$2,307.84 		$1,074.30
$1,374.32
$1,442.78
$1,941.28 		$1,379.32
$1,679.34
$1,747.80
$2,246.30 		$1,684.34
$1,984.36
$2,052.82
$2,551.32 		$305.02
Toc - Plan #33 SelectHealth
Expanded Bronze

(HMO) Med Benchmark Expanded Bronze 0 Copay Plan

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$308.69
$429.07
$456.55
$656.58
$926.06 		$553.48
$673.86
$701.34
$901.37 		$798.27
$918.65
$946.13
$1,146.16 		$1,043.06
$1,163.44
$1,190.92
$1,390.95 		$244.79
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$617.38
$858.14
$913.10
$1,313.16
$1,852.12 		$862.17
$1,102.93
$1,157.89
$1,557.95 		$1,106.96
$1,347.72
$1,402.68
$1,802.74 		$1,351.75
$1,592.51
$1,647.47
$2,047.53 		$244.79
Toc - Plan #34 SelectHealth
Silver

(HMO) Med Benchmark Silver 0 Copay Plan

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$421.06
$585.27
$622.75
$895.59
$1,263.18 		$754.96
$919.17
$956.65
$1,229.49 		$1,088.86
$1,253.07
$1,290.55
$1,563.39 		$1,422.76
$1,586.97
$1,624.45
$1,897.29 		$333.90
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$842.12
$1,170.54
$1,245.50
$1,791.18
$2,526.36 		$1,176.02
$1,504.44
$1,579.40
$2,125.08 		$1,509.92
$1,838.34
$1,913.30
$2,458.98 		$1,843.82
$2,172.24
$2,247.20
$2,792.88 		$333.90
Toc - Plan #35 SelectHealth
Gold

(HMO) Med Benchmark Gold Standardized Plan

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$525.80
$730.86
$777.65
$1,118.37
$1,577.39 		$942.76
$1,147.82
$1,194.61
$1,535.33 		$1,359.72
$1,564.78
$1,611.57
$1,952.29 		$1,776.68
$1,981.74
$2,028.53
$2,369.25 		$416.96
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,051.60
$1,461.72
$1,555.30
$2,236.74
$3,154.78 		$1,468.56
$1,878.68
$1,972.26
$2,653.70 		$1,885.52
$2,295.64
$2,389.22
$3,070.66 		$2,302.48
$2,712.60
$2,806.18
$3,487.62 		$416.96
Toc - Plan #36 SelectHealth
Silver

(HMO) Med Benchmark Silver Standardized Plan

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 Annual Deductible
$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$436.23
$606.36
$645.18
$927.86
$1,308.69 		$782.16
$952.29
$991.11
$1,273.79 		$1,128.09
$1,298.22
$1,337.04
$1,619.72 		$1,474.02
$1,644.15
$1,682.97
$1,965.65 		$345.93
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$872.46
$1,212.72
$1,290.36
$1,855.72
$2,617.38 		$1,218.39
$1,558.65
$1,636.29
$2,201.65 		$1,564.32
$1,904.58
$1,982.22
$2,547.58 		$1,910.25
$2,250.51
$2,328.15
$2,893.51 		$345.93
Toc - Plan #37 SelectHealth
Expanded Bronze

(HMO) Med Benchmark Expanded Bronze Standardized Plan

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$329.99
$458.68
$488.05
$701.88
$989.96 		$591.67
$720.36
$749.73
$963.56 		$853.35
$982.04
$1,011.41
$1,225.24 		$1,115.03
$1,243.72
$1,273.09
$1,486.92 		$261.68
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$659.98
$917.36
$976.10
$1,403.76
$1,979.92 		$921.66
$1,179.04
$1,237.78
$1,665.44 		$1,183.34
$1,440.72
$1,499.46
$1,927.12 		$1,445.02
$1,702.40
$1,761.14
$2,188.80 		$261.68
Toc - Plan #38 SelectHealth
Gold

(HMO) Med Benchmark Gold 0

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$8,950 $17,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$501.53
$697.13
$741.77
$1,066.76
$1,504.59 		$899.25
$1,094.85
$1,139.49
$1,464.48 		$1,296.97
$1,492.57
$1,537.21
$1,862.20 		$1,694.69
$1,890.29
$1,934.93
$2,259.92 		$397.72
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,003.06
$1,394.26
$1,483.54
$2,133.52
$3,009.18 		$1,400.78
$1,791.98
$1,881.26
$2,531.24 		$1,798.50
$2,189.70
$2,278.98
$2,928.96 		$2,196.22
$2,587.42
$2,676.70
$3,326.68 		$397.72
Toc - Plan #39 SelectHealth
Platinum

(HMO) Med Benchmark Platinum 0

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$8,950 $17,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$594.16
$825.89
$878.77
$1,263.79
$1,782.48 		$1,065.33
$1,297.06
$1,349.94
$1,734.96 		$1,536.50
$1,768.23
$1,821.11
$2,206.13 		$2,007.67
$2,239.40
$2,292.28
$2,677.30 		$471.17
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,188.32
$1,651.78
$1,757.54
$2,527.58
$3,564.96 		$1,659.49
$2,122.95
$2,228.71
$2,998.75 		$2,130.66
$2,594.12
$2,699.88
$3,469.92 		$2,601.83
$3,065.29
$3,171.05
$3,941.09 		$471.17
Toc - Plan #40 SelectHealth
Platinum

(HMO) Med Benchmark Platinum Standardized Plan

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$3,000 $6,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$630.58
$876.51
$932.63
$1,341.25
$1,891.74 		$1,130.63
$1,376.56
$1,432.68
$1,841.30 		$1,630.68
$1,876.61
$1,932.73
$2,341.35 		$2,130.73
$2,376.66
$2,432.78
$2,841.40 		$500.05
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,261.16
$1,753.02
$1,865.26
$2,682.50
$3,783.48 		$1,761.21
$2,253.07
$2,365.31
$3,182.55 		$2,261.26
$2,753.12
$2,865.36
$3,682.60 		$2,761.31
$3,253.17
$3,365.41
$4,182.65 		$500.05

‡Source: HealthCare.gov has released sample rates for all counties in the 36 states served by HealthCare.gov. We have integrated that data into our tables and provide you that information for Uintah County here.

Uintah County is in “Rating Area 6” of Utah.

Currently, there are 40 plans offered in Rating Area 6.

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2023 Obamacare Plans for Uintah County, UT

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