The health insurance rates listed below are for calendar year 2016.
2016 Rates and Providers
(click here for 2014)
(click here for 2015)
This page gives you an overview of the rates for individual and family health insurance plans available from HealthCare.gov, the marketplace for West Point, UT.
Obamacare Providers, Plans and 2016 Rates for Davis County
Davis County is in “Rating Area 3” of Utah.
Currently, there are 6 providers offering 91 plans to Rating Area 3. †
Below, you’ll find a summary of plans and rates for each of these providers.‡ This chart is designed to give you a preview of your health insurance options. For detailed information on available subsidies to make your coverage affordable, you must complete an application at HealthCare.gov or contact the provider directly.
The table below shows premiums for the following scenarios for:
- Individual
- Couple
- Couple with 1 2 or 3 children
- Individual with 1 2 or 3 children
- A child alone
Each scenario is covered for age
- Age 21, 30, 40, 50
- Age 60 (Individual and Couple only)
For each plan, there are links that go to the insurance provider's website in a new window. You can find links to:
- a summary of plan benefits and costs,
- a plan brochure, and
- a "Provider Directory" -- where you can find out which doctors and hospitals in the West Point, UT area accept this insurance coverage as within the plan's "network".
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Molina Healthcare of UtahLocal: 1-801-858-0400 | Toll Free: 1-888-858-3973 |
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Plan: (HMO) Molina Marketplace Gold PlanSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-858-3973 - Provider Directory for This Plan: (Molina Healthcare of Utah)
Deductible: Individual:
$500
: Family:
$1,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$170.12 $236.47 $251.61 $361.85 $510.36 |
$340.24 $472.94 $503.22 $723.70 $1020.72 |
$475.15 $607.85 $638.13 $858.61 |
$610.06 $742.76 $773.04 $993.52 |
$744.97 $877.67 $907.95 $1128.43 |
$305.03 $371.38 $386.52 $496.76 |
$439.94 $506.29 $521.43 $631.67 |
$574.85 $641.20 $656.34 $766.58 |
$134.91 |
Plan: (HMO) Molina Marketplace Silver PlanSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-858-3973 - Provider Directory for This Plan: (Molina Healthcare of Utah)
Deductible: Individual:
$2,000
: Family:
$4,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$144.66 $201.08 $213.95 $307.69 $433.98 |
$289.32 $402.16 $427.90 $615.38 $867.96 |
$404.04 $516.88 $542.62 $730.10 |
$518.76 $631.60 $657.34 $844.82 |
$633.48 $746.32 $772.06 $959.54 |
$259.38 $315.80 $328.67 $422.41 |
$374.10 $430.52 $443.39 $537.13 |
$488.82 $545.24 $558.11 $651.85 |
$114.72 |
Plan: (HMO) Molina Marketplace Bronze PlanSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-858-3973 - Provider Directory for This Plan: (Molina Healthcare of Utah)
Deductible: Individual:
$5,000
: Family:
$10,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$121.79 $169.29 $180.13 $259.06 $365.37 |
$243.58 $338.58 $360.26 $518.12 $730.74 |
$340.16 $435.16 $456.84 $614.70 |
$436.74 $531.74 $553.42 $711.28 |
$533.32 $628.32 $650.00 $807.86 |
$218.37 $265.87 $276.71 $355.64 |
$314.95 $362.45 $373.29 $452.22 |
$411.53 $459.03 $469.87 $548.80 |
$96.58 |
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Arches Mutual Insurance CompanyLocal: 1-801-312-9853 | Toll Free: 1-877-337-6633 |
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Plan: (HMO) Arches Secure WELLth - $6000/100%Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-337-6633 - Provider Directory for This Plan: (Arches Mutual Insurance Company)
Deductible: Individual:
$6,000
: Family:
$12,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$174.09 $241.98 $257.47 $370.28 $522.26 |
$348.18 $483.96 $514.94 $740.56 $1044.52 |
$486.23 $622.01 $652.99 $878.61 |
$624.28 $760.06 $791.04 $1016.66 |
$762.33 $898.11 $929.09 $1154.71 |
$312.14 $380.03 $395.52 $508.33 |
$450.19 $518.08 $533.57 $646.38 |
$588.24 $656.13 $671.62 $784.43 |
$138.05 |
Plan: (HMO) Arches Classic - $5000/$25/40%Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-337-6633 - Provider Directory for This Plan: (Arches Mutual Insurance Company)
Deductible: Individual:
$5,000
: Family:
$10,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$177.00 $246.03 $261.78 $376.47 $530.99 |
$354.00 $492.06 $523.56 $752.94 $1061.98 |
$494.36 $632.42 $663.92 $893.30 |
$634.72 $772.78 $804.28 $1033.66 |
$775.08 $913.14 $944.64 $1174.02 |
$317.36 $386.39 $402.14 $516.83 |
$457.72 $526.75 $542.50 $657.19 |
$598.08 $667.11 $682.86 $797.55 |
$140.36 |
Plan: (HMO) Arches Secure WELLth - $3500/50%Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-337-6633 - Provider Directory for This Plan: (Arches Mutual Insurance Company)
Deductible: Individual:
$3,500
: Family:
$7,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$180.33 $250.66 $266.71 $383.57 $540.99 |
$360.66 $501.32 $533.42 $767.14 $1081.98 |
$503.66 $644.32 $676.42 $910.14 |
$646.66 $787.32 $819.42 $1053.14 |
$789.66 $930.32 $962.42 $1196.14 |
$323.33 $393.66 $409.71 $526.57 |
$466.33 $536.66 $552.71 $669.57 |
$609.33 $679.66 $695.71 $812.57 |
$143.00 |
Plan: (HMO) Arches Preferred Care - $3000/$5/40%Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-337-6633 - Provider Directory for This Plan: (Arches Mutual Insurance Company)
Deductible: Individual:
$3,000
: Family:
$6,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$235.82 $327.79 $348.78 $501.59 $707.46 |
$471.64 $655.58 $697.56 $1003.18 $1414.92 |
$658.65 $842.59 $884.57 $1190.19 |
$845.66 $1029.60 $1071.58 $1377.20 |
$1032.67 $1216.61 $1258.59 $1564.21 |
$422.83 $514.80 $535.79 $688.60 |
$609.84 $701.81 $722.80 $875.61 |
$796.85 $888.82 $909.81 $1062.62 |
$187.01 |
Plan: (HMO) Arches Preferred Care $6800/$5 2 visits/40% BasicSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-337-6633 - Provider Directory for This Plan: (Arches Mutual Insurance Company)
Deductible: Individual:
$6,800
: Family:
$13,600 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$168.32 $233.96 $248.94 $358.01 $504.96 |
$336.64 $467.92 $497.88 $716.02 $1009.92 |
$470.12 $601.40 $631.36 $849.50 |
$603.60 $734.88 $764.84 $982.98 |
$737.08 $868.36 $898.32 $1116.46 |
$301.80 $367.44 $382.42 $491.49 |
$435.28 $500.92 $515.90 $624.97 |
$568.76 $634.40 $649.38 $758.45 |
$133.48 |
Plan: (HMO) Arches Preferred Care $6800/$5 2 visits/40%Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-337-6633 - Provider Directory for This Plan: (Arches Mutual Insurance Company)
Deductible: Individual:
$6,800
: Family:
$13,600 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$169.04 $234.97 $250.01 $359.55 $507.12 |
$338.08 $469.94 $500.02 $719.10 $1014.24 |
$472.13 $603.99 $634.07 $853.15 |
$606.18 $738.04 $768.12 $987.20 |
$740.23 $872.09 $902.17 $1121.25 |
$303.09 $369.02 $384.06 $493.60 |
$437.14 $503.07 $518.11 $627.65 |
$571.19 $637.12 $652.16 $761.70 |
$134.05 |
Plan: (HMO) Arches Preferred Care - $1000/$5/20%Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-337-6633 - Provider Directory for This Plan: (Arches Mutual Insurance Company)
Deductible: Individual:
$1,000
: Family:
$2,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$289.48 $402.38 $428.14 $615.73 $868.44 |
$578.96 $804.76 $856.28 $1231.46 $1736.88 |
$808.52 $1034.32 $1085.84 $1461.02 |
$1038.08 $1263.88 $1315.40 $1690.58 |
$1267.64 $1493.44 $1544.96 $1920.14 |
$519.04 $631.94 $657.70 $845.29 |
$748.60 $861.50 $887.26 $1074.85 |
$978.16 $1091.06 $1116.82 $1304.41 |
$229.56 |
Plan: (HMO) Arches Personal Primary Access - $6800/$5/50%Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-337-6633 - Provider Directory for This Plan: (Arches Mutual Insurance Company)
Deductible: Individual:
$6,800
: Family:
$13,600 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$156.07 $216.93 $230.82 $331.95 $468.20 |
$312.14 $433.86 $461.64 $663.90 $936.40 |
$435.90 $557.62 $585.40 $787.66 |
$559.66 $681.38 $709.16 $911.42 |
$683.42 $805.14 $832.92 $1035.18 |
$279.83 $340.69 $354.58 $455.71 |
$403.59 $464.45 $478.34 $579.47 |
$527.35 $588.21 $602.10 $703.23 |
$123.76 |
Plan: (HMO) Arches Secure WELLth - $6550/100%Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-337-6633 - Provider Directory for This Plan: (Arches Mutual Insurance Company)
Deductible: Individual:
$6,550
: Family:
$13,100 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$189.25 $263.06 $279.90 $402.53 $567.75 |
$378.50 $526.12 $559.80 $805.06 $1135.50 |
$528.58 $676.20 $709.88 $955.14 |
$678.66 $826.28 $859.96 $1105.22 |
$828.74 $976.36 $1010.04 $1255.30 |
$339.33 $413.14 $429.98 $552.61 |
$489.41 $563.22 $580.06 $702.69 |
$639.49 $713.30 $730.14 $852.77 |
$150.08 |
Plan: (POS) CO-OPtions Arches Gold, a Multi-State PlanSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-337-6633 - Provider Directory for This Plan: (Arches Mutual Insurance Company)
Deductible: Individual:
$500
: Family:
$1,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$311.82 $433.42 $461.18 $663.23 $935.45 |
$623.64 $866.84 $922.36 $1326.46 $1870.90 |
$870.91 $1114.11 $1169.63 $1573.73 |
$1118.18 $1361.38 $1416.90 $1821.00 |
$1365.45 $1608.65 $1664.17 $2068.27 |
$559.09 $680.69 $708.45 $910.50 |
$806.36 $927.96 $955.72 $1157.77 |
$1053.63 $1175.23 $1202.99 $1405.04 |
$247.27 |
Plan: (POS) CO-OPtions Arches Silver, a Multi-State PlanSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-337-6633 - Provider Directory for This Plan: (Arches Mutual Insurance Company)
Deductible: Individual:
$3,000
: Family:
$6,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$252.20 $350.55 $373.00 $536.42 $756.59 |
$504.40 $701.10 $746.00 $1072.84 $1513.18 |
$704.39 $901.09 $945.99 $1272.83 |
$904.38 $1101.08 $1145.98 $1472.82 |
$1104.37 $1301.07 $1345.97 $1672.81 |
$452.19 $550.54 $572.99 $736.41 |
$652.18 $750.53 $772.98 $936.40 |
$852.17 $950.52 $972.97 $1136.39 |
$199.99 |
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University of Utah Health Insurance PlansLocal: 1-801-587-6480 x1 | Toll Free: 1-888-271-5870 TTY: 1-800-346-4128 |
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Plan: (PPO) Healthy Premier GoldSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-271-5870 - Provider Directory for This Plan: (University of Utah Health Insurance Plans)
Deductible: Individual:
$1,000
: Family:
$2,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$245.59 $341.37 $363.22 $522.36 $736.77 |
$491.18 $682.74 $726.44 $1044.72 $1473.54 |
$685.93 $877.49 $921.19 $1239.47 |
$880.68 $1072.24 $1115.94 $1434.22 |
$1075.43 $1266.99 $1310.69 $1628.97 |
$440.34 $536.12 $557.97 $717.11 |
$635.09 $730.87 $752.72 $911.86 |
$829.84 $925.62 $947.47 $1106.61 |
$194.75 |
Plan: (PPO) Healthy Premier SilverSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-271-5870 - Provider Directory for This Plan: (University of Utah Health Insurance Plans)
Deductible: Individual:
$3,500
: Family:
$7,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$208.59 $289.94 $308.50 $443.67 $625.77 |
$417.18 $579.88 $617.00 $887.34 $1251.54 |
$582.59 $745.29 $782.41 $1052.75 |
$748.00 $910.70 $947.82 $1218.16 |
$913.41 $1076.11 $1113.23 $1383.57 |
$374.00 $455.35 $473.91 $609.08 |
$539.41 $620.76 $639.32 $774.49 |
$704.82 $786.17 $804.73 $939.90 |
$165.41 |
Plan: (PPO) Healthy Premier BronzeSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-271-5870 - Provider Directory for This Plan: (University of Utah Health Insurance Plans)
Deductible: Individual:
$2,000
: Family:
$4,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$176.72 $245.64 $261.36 $375.88 $530.16 |
$353.44 $491.28 $522.72 $751.76 $1060.32 |
$493.57 $631.41 $662.85 $891.89 |
$633.70 $771.54 $802.98 $1032.02 |
$773.83 $911.67 $943.11 $1172.15 |
$316.85 $385.77 $401.49 $516.01 |
$456.98 $525.90 $541.62 $656.14 |
$597.11 $666.03 $681.75 $796.27 |
$140.13 |
Plan: (PPO) Healthy Premier CatastrophicSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-271-5870 - Provider Directory for This Plan: (University of Utah Health Insurance Plans)
Deductible: Individual:
$6,850
: Family:
$13,700 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Catastrophic | 21 30 40 50 60 |
$135.29 $188.05 $200.09 $287.76 $405.87 |
$270.58 $376.10 $400.18 $575.52 $811.74 |
$377.86 $483.38 $507.46 $682.80 |
$485.14 $590.66 $614.74 $790.08 |
$592.42 $697.94 $722.02 $897.36 |
$242.57 $295.33 $307.37 $395.04 |
$349.85 $402.61 $414.65 $502.32 |
$457.13 $509.89 $521.93 $609.60 |
$107.28 |
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Humana Medical Plan of Utah, Inc.Local: 1-877-720-4854 | Toll Free: 1-877-720-4854 TTY: 711 |
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Plan: (HMO) Humana Basic 6850/Salt Lake City HMOxSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Medical Plan of Utah, Inc.)
Deductible: Individual:
$6,850
: Family:
$13,700 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Catastrophic | 21 30 40 50 60 |
$125.08 $173.86 $184.99 $266.05 $375.24 |
$250.16 $347.72 $369.98 $532.10 $750.48 |
$349.35 $446.91 $469.17 $631.29 |
$448.54 $546.10 $568.36 $730.48 |
$547.73 $645.29 $667.55 $829.67 |
$224.27 $273.05 $284.18 $365.24 |
$323.46 $372.24 $383.37 $464.43 |
$422.65 $471.43 $482.56 $563.62 |
$99.19 |
Plan: (HMO) Humana Bronze 6450/Salt Lake City HMOxSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Medical Plan of Utah, Inc.)
Deductible: Individual:
$6,450
: Family:
$12,900 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$139.72 $194.21 $206.65 $297.18 $419.16 |
$279.44 $388.42 $413.30 $594.36 $838.32 |
$390.24 $499.22 $524.10 $705.16 |
$501.04 $610.02 $634.90 $815.96 |
$611.84 $720.82 $745.70 $926.76 |
$250.52 $305.01 $317.45 $407.98 |
$361.32 $415.81 $428.25 $518.78 |
$472.12 $526.61 $539.05 $629.58 |
$110.80 |
Plan: (HMO) Humana Bronze 4850/Salt Lake City HMOxSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Medical Plan of Utah, Inc.)
Deductible: Individual:
$4,850
: Family:
$9,700 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$152.17 $211.52 $225.06 $323.67 $456.51 |
$304.34 $423.04 $450.12 $647.34 $913.02 |
$425.01 $543.71 $570.79 $768.01 |
$545.68 $664.38 $691.46 $888.68 |
$666.35 $785.05 $812.13 $1009.35 |
$272.84 $332.19 $345.73 $444.34 |
$393.51 $452.86 $466.40 $565.01 |
$514.18 $573.53 $587.07 $685.68 |
$120.67 |
Plan: (HMO) Humana Silver 3800/Salt Lake City HMOxSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Medical Plan of Utah, Inc.)
Deductible: Individual:
$3,800
: Family:
$7,600 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$164.78 $229.04 $243.71 $350.49 $494.34 |
$329.56 $458.08 $487.42 $700.98 $988.68 |
$460.23 $588.75 $618.09 $831.65 |
$590.90 $719.42 $748.76 $962.32 |
$721.57 $850.09 $879.43 $1092.99 |
$295.45 $359.71 $374.38 $481.16 |
$426.12 $490.38 $505.05 $611.83 |
$556.79 $621.05 $635.72 $742.50 |
$130.67 |
Plan: (HMO) Humana Gold 2250/Salt Lake City HMOxSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Medical Plan of Utah, Inc.)
Deductible: Individual:
$2,250
: Family:
$4,500 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$195.60 $271.88 $289.29 $416.04 $586.80 |
$391.20 $543.76 $578.58 $832.08 $1173.60 |
$546.31 $698.87 $733.69 $987.19 |
$701.42 $853.98 $888.80 $1142.30 |
$856.53 $1009.09 $1043.91 $1297.41 |
$350.71 $426.99 $444.40 $571.15 |
$505.82 $582.10 $599.51 $726.26 |
$660.93 $737.21 $754.62 $881.37 |
$155.11 |
Plan: (HMO) Humana Platinum 500/Salt Lake City HMOxSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Medical Plan of Utah, Inc.)
Deductible: Individual:
$500
: Family:
$1,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Platinum | 21 30 40 50 60 |
$233.09 $324.00 $344.74 $495.78 $699.27 |
$466.18 $648.00 $689.48 $991.56 $1398.54 |
$651.02 $832.84 $874.32 $1176.40 |
$835.86 $1017.68 $1059.16 $1361.24 |
$1020.70 $1202.52 $1244.00 $1546.08 |
$417.93 $508.84 $529.58 $680.62 |
$602.77 $693.68 $714.42 $865.46 |
$787.61 $878.52 $899.26 $1050.30 |
$184.84 |
ADVERTISEMENT
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||||||||||
SelectHealthLocal: 1-801-442-5038 | Toll Free: 1-800-538-5038 |
||||||||||
Plan: (HMO) Select Value Preference Gold 250Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$250
: Family:
$750 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$209.91 $291.78 $310.46 $446.48 $629.72 |
$419.82 $583.56 $620.92 $892.96 $1259.44 |
$586.28 $750.02 $787.38 $1059.42 |
$752.74 $916.48 $953.84 $1225.88 |
$919.20 $1082.94 $1120.30 $1392.34 |
$376.37 $458.24 $476.92 $612.94 |
$542.83 $624.70 $643.38 $779.40 |
$709.29 $791.16 $809.84 $945.86 |
$166.46 |
Plan: (HMO) Select Value Preference Gold 250 w/no deductible for office visitsSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$250
: Family:
$750 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$214.07 $297.57 $316.62 $455.34 $642.20 |
$428.14 $595.14 $633.24 $910.68 $1284.40 |
$597.90 $764.90 $803.00 $1080.44 |
$767.66 $934.66 $972.76 $1250.20 |
$937.42 $1104.42 $1142.52 $1419.96 |
$383.83 $467.33 $486.38 $625.10 |
$553.59 $637.09 $656.14 $794.86 |
$723.35 $806.85 $825.90 $964.62 |
$169.76 |
Plan: (HMO) Select Value Preference Gold 500Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$500
: Family:
$1,500 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$204.44 $284.17 $302.37 $434.84 $613.30 |
$408.88 $568.34 $604.74 $869.68 $1226.60 |
$571.00 $730.46 $766.86 $1031.80 |
$733.12 $892.58 $928.98 $1193.92 |
$895.24 $1054.70 $1091.10 $1356.04 |
$366.56 $446.29 $464.49 $596.96 |
$528.68 $608.41 $626.61 $759.08 |
$690.80 $770.53 $788.73 $921.20 |
$162.12 |
Plan: (HMO) Select Value Preference Gold 500 w/no deductible for office visitsSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$500
: Family:
$1,500 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$210.16 $292.13 $310.83 $447.02 $630.47 |
$420.32 $584.26 $621.66 $894.04 $1260.94 |
$586.98 $750.92 $788.32 $1060.70 |
$753.64 $917.58 $954.98 $1227.36 |
$920.30 $1084.24 $1121.64 $1394.02 |
$376.82 $458.79 $477.49 $613.68 |
$543.48 $625.45 $644.15 $780.34 |
$710.14 $792.11 $810.81 $947.00 |
$166.66 |
Plan: (HMO) Select Value Preference Silver 1250Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$1,250
: Family:
$2,500 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$170.32 $236.75 $251.91 $362.27 $510.95 |
$340.64 $473.50 $503.82 $724.54 $1021.90 |
$475.71 $608.57 $638.89 $859.61 |
$610.78 $743.64 $773.96 $994.68 |
$745.85 $878.71 $909.03 $1129.75 |
$305.39 $371.82 $386.98 $497.34 |
$440.46 $506.89 $522.05 $632.41 |
$575.53 $641.96 $657.12 $767.48 |
$135.07 |
Plan: (HMO) Select Value Preference Gold 1000Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$1,000
: Family:
$2,500 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$205.22 $285.25 $303.52 $436.49 $615.63 |
$410.44 $570.50 $607.04 $872.98 $1231.26 |
$573.18 $733.24 $769.78 $1035.72 |
$735.92 $895.98 $932.52 $1198.46 |
$898.66 $1058.72 $1095.26 $1361.20 |
$367.96 $447.99 $466.26 $599.23 |
$530.70 $610.73 $629.00 $761.97 |
$693.44 $773.47 $791.74 $924.71 |
$162.74 |
Plan: (HMO) Select Value Preference Gold 1000 w/no deductible for office visitsSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$1,000
: Family:
$2,500 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$220.06 $305.88 $325.47 $468.07 $660.17 |
$440.12 $611.76 $650.94 $936.14 $1320.34 |
$614.62 $786.26 $825.44 $1110.64 |
$789.12 $960.76 $999.94 $1285.14 |
$963.62 $1135.26 $1174.44 $1459.64 |
$394.56 $480.38 $499.97 $642.57 |
$569.06 $654.88 $674.47 $817.07 |
$743.56 $829.38 $848.97 $991.57 |
$174.50 |
Plan: (HMO) Select Value Preference Silver 2500Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$2,500
: Family:
$5,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$179.70 $249.78 $265.77 $382.21 $539.07 |
$359.40 $499.56 $531.54 $764.42 $1078.14 |
$501.90 $642.06 $674.04 $906.92 |
$644.40 $784.56 $816.54 $1049.42 |
$786.90 $927.06 $959.04 $1191.92 |
$322.20 $392.28 $408.27 $524.71 |
$464.70 $534.78 $550.77 $667.21 |
$607.20 $677.28 $693.27 $809.71 |
$142.50 |
Plan: (HMO) Select Value Preference Silver 2500 w/limited office visit waiverSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$2,500
: Family:
$5,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$187.25 $260.27 $276.94 $398.27 $561.72 |
$374.50 $520.54 $553.88 $796.54 $1123.44 |
$522.99 $669.03 $702.37 $945.03 |
$671.48 $817.52 $850.86 $1093.52 |
$819.97 $966.01 $999.35 $1242.01 |
$335.74 $408.76 $425.43 $546.76 |
$484.23 $557.25 $573.92 $695.25 |
$632.72 $705.74 $722.41 $843.74 |
$148.49 |
Plan: (HMO) Select Value Preference Bronze 5000Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$5,000
: Family:
$10,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$146.62 $203.80 $216.86 $311.86 $439.85 |
$293.24 $407.60 $433.72 $623.72 $879.70 |
$409.51 $523.87 $549.99 $739.99 |
$525.78 $640.14 $666.26 $856.26 |
$642.05 $756.41 $782.53 $972.53 |
$262.89 $320.07 $333.13 $428.13 |
$379.16 $436.34 $449.40 $544.40 |
$495.43 $552.61 $565.67 $660.67 |
$116.27 |
Plan: (HMO) Select Value Preference Bronze 6000 w/limited office visit waiverSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$6,000
: Family:
$12,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$151.83 $211.04 $224.56 $322.94 $455.47 |
$303.66 $422.08 $449.12 $645.88 $910.94 |
$424.07 $542.49 $569.53 $766.29 |
$544.48 $662.90 $689.94 $886.70 |
$664.89 $783.31 $810.35 $1007.11 |
$272.24 $331.45 $344.97 $443.35 |
$392.65 $451.86 $465.38 $563.76 |
$513.06 $572.27 $585.79 $684.17 |
$120.41 |
Plan: (HMO) Select Value Preference Silver 3800 Copay PlanSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$3,800
: Family:
$7,600 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$185.43 $257.75 $274.25 $394.41 $556.28 |
$370.86 $515.50 $548.50 $788.82 $1112.56 |
$517.90 $662.54 $695.54 $935.86 |
$664.94 $809.58 $842.58 $1082.90 |
$811.98 $956.62 $989.62 $1229.94 |
$332.47 $404.79 $421.29 $541.45 |
$479.51 $551.83 $568.33 $688.49 |
$626.55 $698.87 $715.37 $835.53 |
$147.04 |
Plan: (HMO) Select Value HealthSave Silver 1500 (HSA Qualified)Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$1,500
: Family:
$3,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$186.73 $259.56 $276.17 $397.18 $560.18 |
$373.46 $519.12 $552.34 $794.36 $1120.36 |
$521.53 $667.19 $700.41 $942.43 |
$669.60 $815.26 $848.48 $1090.50 |
$817.67 $963.33 $996.55 $1238.57 |
$334.80 $407.63 $424.24 $545.25 |
$482.87 $555.70 $572.31 $693.32 |
$630.94 $703.77 $720.38 $841.39 |
$148.07 |
Plan: (HMO) Select Value HealthSave Silver 2000 (HSA Qualified)Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$2,000
: Family:
$4,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$175.27 $243.63 $259.22 $372.80 $525.80 |
$350.54 $487.26 $518.44 $745.60 $1051.60 |
$489.53 $626.25 $657.43 $884.59 |
$628.52 $765.24 $796.42 $1023.58 |
$767.51 $904.23 $935.41 $1162.57 |
$314.26 $382.62 $398.21 $511.79 |
$453.25 $521.61 $537.20 $650.78 |
$592.24 $660.60 $676.19 $789.77 |
$138.99 |
Plan: (HMO) Select Value HealthSave Bronze 4500 (HSA Qualified)Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$4,500
: Family:
$9,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$147.67 $205.26 $218.40 $314.09 $442.99 |
$295.34 $410.52 $436.80 $628.18 $885.98 |
$412.44 $527.62 $553.90 $745.28 |
$529.54 $644.72 $671.00 $862.38 |
$646.64 $761.82 $788.10 $979.48 |
$264.77 $322.36 $335.50 $431.19 |
$381.87 $439.46 $452.60 $548.29 |
$498.97 $556.56 $569.70 $665.39 |
$117.10 |
Plan: (HMO) Select Value HealthSave Silver 3500 (HSA Qualified)Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$3,500
: Family:
$7,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$179.44 $249.42 $265.38 $381.66 $538.29 |
$358.88 $498.84 $530.76 $763.32 $1076.58 |
$501.17 $641.13 $673.05 $905.61 |
$643.46 $783.42 $815.34 $1047.90 |
$785.75 $925.71 $957.63 $1190.19 |
$321.73 $391.71 $407.67 $523.95 |
$464.02 $534.00 $549.96 $666.24 |
$606.31 $676.29 $692.25 $808.53 |
$142.29 |
Plan: (HMO) Select Value HealthSave Bronze 6550 (HSA Qualified)Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$6,550
: Family:
$13,100 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$151.57 $210.68 $224.17 $322.39 $454.69 |
$303.14 $421.36 $448.34 $644.78 $909.38 |
$423.34 $541.56 $568.54 $764.98 |
$543.54 $661.76 $688.74 $885.18 |
$663.74 $781.96 $808.94 $1005.38 |
$271.77 $330.88 $344.37 $442.59 |
$391.97 $451.08 $464.57 $562.79 |
$512.17 $571.28 $584.77 $682.99 |
$120.20 |
Plan: (HMO) Select Value Millennial 6850 (Catastrophic Plan)Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$6,850
: Family:
$13,700 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Catastrophic | 21 30 40 50 60 |
$133.60 $185.70 $197.59 $284.17 $400.79 |
$267.20 $371.40 $395.18 $568.34 $801.58 |
$373.14 $477.34 $501.12 $674.28 |
$479.08 $583.28 $607.06 $780.22 |
$585.02 $689.22 $713.00 $886.16 |
$239.54 $291.64 $303.53 $390.11 |
$345.48 $397.58 $409.47 $496.05 |
$451.42 $503.52 $515.41 $601.99 |
$105.94 |
Plan: (HMO) Select Med Preference Gold 250Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$250
: Family:
$750 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$232.46 $323.12 $343.81 $494.44 $697.36 |
$464.92 $646.24 $687.62 $988.88 $1394.72 |
$649.26 $830.58 $871.96 $1173.22 |
$833.60 $1014.92 $1056.30 $1357.56 |
$1017.94 $1199.26 $1240.64 $1541.90 |
$416.80 $507.46 $528.15 $678.78 |
$601.14 $691.80 $712.49 $863.12 |
$785.48 $876.14 $896.83 $1047.46 |
$184.34 |
Plan: (HMO) Select Med Preference Gold 250 w/no deductible for office visitsSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$250
: Family:
$750 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$237.07 $329.53 $350.63 $504.25 $711.19 |
$474.14 $659.06 $701.26 $1008.50 $1422.38 |
$662.14 $847.06 $889.26 $1196.50 |
$850.14 $1035.06 $1077.26 $1384.50 |
$1038.14 $1223.06 $1265.26 $1572.50 |
$425.07 $517.53 $538.63 $692.25 |
$613.07 $705.53 $726.63 $880.25 |
$801.07 $893.53 $914.63 $1068.25 |
$188.00 |
Plan: (HMO) Select Med Preference Gold 500Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$500
: Family:
$1,500 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$226.40 $314.70 $334.85 $481.55 $679.18 |
$452.80 $629.40 $669.70 $963.10 $1358.36 |
$632.34 $808.94 $849.24 $1142.64 |
$811.88 $988.48 $1028.78 $1322.18 |
$991.42 $1168.02 $1208.32 $1501.72 |
$405.94 $494.24 $514.39 $661.09 |
$585.48 $673.78 $693.93 $840.63 |
$765.02 $853.32 $873.47 $1020.17 |
$179.54 |
Plan: (HMO) Select Med Preference Gold 500 w/no deductible for office visitsSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$500
: Family:
$1,500 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$232.74 $323.51 $344.22 $495.04 $698.20 |
$465.48 $647.02 $688.44 $990.08 $1396.40 |
$650.04 $831.58 $873.00 $1174.64 |
$834.60 $1016.14 $1057.56 $1359.20 |
$1019.16 $1200.70 $1242.12 $1543.76 |
$417.30 $508.07 $528.78 $679.60 |
$601.86 $692.63 $713.34 $864.16 |
$786.42 $877.19 $897.90 $1048.72 |
$184.56 |
Plan: (HMO) Select Med Preference Silver 1250Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$1,250
: Family:
$2,500 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$188.62 $262.18 $278.97 $401.19 $565.84 |
$377.24 $524.36 $557.94 $802.38 $1131.68 |
$526.82 $673.94 $707.52 $951.96 |
$676.40 $823.52 $857.10 $1101.54 |
$825.98 $973.10 $1006.68 $1251.12 |
$338.20 $411.76 $428.55 $550.77 |
$487.78 $561.34 $578.13 $700.35 |
$637.36 $710.92 $727.71 $849.93 |
$149.58 |
Plan: (HMO) Select Med Preference Gold 1000Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$1,000
: Family:
$2,500 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$227.26 $315.89 $336.12 $483.38 $681.76 |
$454.52 $631.78 $672.24 $966.76 $1363.52 |
$634.74 $812.00 $852.46 $1146.98 |
$814.96 $992.22 $1032.68 $1327.20 |
$995.18 $1172.44 $1212.90 $1507.42 |
$407.48 $496.11 $516.34 $663.60 |
$587.70 $676.33 $696.56 $843.82 |
$767.92 $856.55 $876.78 $1024.04 |
$180.22 |
Plan: (HMO) Select Med Preference Gold 1000 w/no deductible for office visitsSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$1,000
: Family:
$2,500 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$243.70 $338.74 $360.43 $518.35 $731.08 |
$487.40 $677.48 $720.86 $1036.70 $1462.16 |
$680.65 $870.73 $914.11 $1229.95 |
$873.90 $1063.98 $1107.36 $1423.20 |
$1067.15 $1257.23 $1300.61 $1616.45 |
$436.95 $531.99 $553.68 $711.60 |
$630.20 $725.24 $746.93 $904.85 |
$823.45 $918.49 $940.18 $1098.10 |
$193.25 |
Plan: (HMO) Select Med Preference Silver 2500Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$2,500
: Family:
$5,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$199.00 $276.61 $294.32 $423.27 $596.98 |
$398.00 $553.22 $588.64 $846.54 $1193.96 |
$555.81 $711.03 $746.45 $1004.35 |
$713.62 $868.84 $904.26 $1162.16 |
$871.43 $1026.65 $1062.07 $1319.97 |
$356.81 $434.42 $452.13 $581.08 |
$514.62 $592.23 $609.94 $738.89 |
$672.43 $750.04 $767.75 $896.70 |
$157.81 |
Plan: (HMO) Select Med Preference Silver 2500 w/limited office visit waiverSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$2,500
: Family:
$5,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$207.36 $288.23 $306.69 $441.05 $622.06 |
$414.72 $576.46 $613.38 $882.10 $1244.12 |
$579.16 $740.90 $777.82 $1046.54 |
$743.60 $905.34 $942.26 $1210.98 |
$908.04 $1069.78 $1106.70 $1375.42 |
$371.80 $452.67 $471.13 $605.49 |
$536.24 $617.11 $635.57 $769.93 |
$700.68 $781.55 $800.01 $934.37 |
$164.44 |
Plan: (HMO) Select Med Preference Bronze 5000Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$5,000
: Family:
$10,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$162.37 $225.69 $240.15 $345.36 $487.10 |
$324.74 $451.38 $480.30 $690.72 $974.20 |
$453.50 $580.14 $609.06 $819.48 |
$582.26 $708.90 $737.82 $948.24 |
$711.02 $837.66 $866.58 $1077.00 |
$291.13 $354.45 $368.91 $474.12 |
$419.89 $483.21 $497.67 $602.88 |
$548.65 $611.97 $626.43 $731.64 |
$128.76 |
Plan: (HMO) Select Med Preference Bronze 6000 w/limited office visit waiverSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$6,000
: Family:
$12,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$168.14 $233.71 $248.68 $357.63 $504.40 |
$336.28 $467.42 $497.36 $715.26 $1008.80 |
$469.62 $600.76 $630.70 $848.60 |
$602.96 $734.10 $764.04 $981.94 |
$736.30 $867.44 $897.38 $1115.28 |
$301.48 $367.05 $382.02 $490.97 |
$434.82 $500.39 $515.36 $624.31 |
$568.16 $633.73 $648.70 $757.65 |
$133.34 |
Plan: (HMO) Select Med Preference Silver 3800 Copay PlanSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$3,800
: Family:
$7,600 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$205.35 $285.44 $303.71 $436.78 $616.03 |
$410.70 $570.88 $607.42 $873.56 $1232.06 |
$573.54 $733.72 $770.26 $1036.40 |
$736.38 $896.56 $933.10 $1199.24 |
$899.22 $1059.40 $1095.94 $1362.08 |
$368.19 $448.28 $466.55 $599.62 |
$531.03 $611.12 $629.39 $762.46 |
$693.87 $773.96 $792.23 $925.30 |
$162.84 |
Plan: (HMO) Select Med HealthSave Silver 1500 (HSA Qualified)Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$1,500
: Family:
$3,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$206.79 $287.44 $305.84 $439.84 $620.35 |
$413.58 $574.88 $611.68 $879.68 $1240.70 |
$577.56 $738.86 $775.66 $1043.66 |
$741.54 $902.84 $939.64 $1207.64 |
$905.52 $1066.82 $1103.62 $1371.62 |
$370.77 $451.42 $469.82 $603.82 |
$534.75 $615.40 $633.80 $767.80 |
$698.73 $779.38 $797.78 $931.78 |
$163.98 |
Plan: (HMO) Select Med HealthSave Silver 2000 (HSA Qualified)Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$2,000
: Family:
$4,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$194.10 $269.80 $287.07 $412.85 $582.28 |
$388.20 $539.60 $574.14 $825.70 $1164.56 |
$542.12 $693.52 $728.06 $979.62 |
$696.04 $847.44 $881.98 $1133.54 |
$849.96 $1001.36 $1035.90 $1287.46 |
$348.02 $423.72 $440.99 $566.77 |
$501.94 $577.64 $594.91 $720.69 |
$655.86 $731.56 $748.83 $874.61 |
$153.92 |
Plan: (HMO) Select Med HealthSave Bronze 4500 (HSA Qualified)Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$4,500
: Family:
$9,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$163.53 $227.31 $241.86 $347.83 $490.58 |
$327.06 $454.62 $483.72 $695.66 $981.16 |
$456.74 $584.30 $613.40 $825.34 |
$586.42 $713.98 $743.08 $955.02 |
$716.10 $843.66 $872.76 $1084.70 |
$293.21 $356.99 $371.54 $477.51 |
$422.89 $486.67 $501.22 $607.19 |
$552.57 $616.35 $630.90 $736.87 |
$129.68 |
Plan: (HMO) Select Med HealthSave Silver 3500 (HSA Qualified)Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$3,500
: Family:
$7,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$198.71 $276.21 $293.89 $422.66 $596.11 |
$397.42 $552.42 $587.78 $845.32 $1192.22 |
$555.00 $710.00 $745.36 $1002.90 |
$712.58 $867.58 $902.94 $1160.48 |
$870.16 $1025.16 $1060.52 $1318.06 |
$356.29 $433.79 $451.47 $580.24 |
$513.87 $591.37 $609.05 $737.82 |
$671.45 $748.95 $766.63 $895.40 |
$157.58 |
Plan: (HMO) Select Med HealthSave Bronze 6550 (HSA Qualified)Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$6,550
: Family:
$13,100 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$167.85 $233.31 $248.25 $357.02 $503.53 |
$335.70 $466.62 $496.50 $714.04 $1007.06 |
$468.81 $599.73 $629.61 $847.15 |
$601.92 $732.84 $762.72 $980.26 |
$735.03 $865.95 $895.83 $1113.37 |
$300.96 $366.42 $381.36 $490.13 |
$434.07 $499.53 $514.47 $623.24 |
$567.18 $632.64 $647.58 $756.35 |
$133.11 |
Plan: (HMO) Select Med Millennial 6850 (Catastrophic Plan)Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$6,850
: Family:
$13,700 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Catastrophic | 21 30 40 50 60 |
$147.95 $205.65 $218.82 $314.69 $443.84 |
$295.90 $411.30 $437.64 $629.38 $887.68 |
$413.22 $528.62 $554.96 $746.70 |
$530.54 $645.94 $672.28 $864.02 |
$647.86 $763.26 $789.60 $981.34 |
$265.27 $322.97 $336.14 $432.01 |
$382.59 $440.29 $453.46 $549.33 |
$499.91 $557.61 $570.78 $666.65 |
$117.32 |
Plan: (HMO) Select Care Preference Gold 250Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$250
: Family:
$750 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$268.49 $373.20 $397.10 $571.08 $805.45 |
$536.98 $746.40 $794.20 $1142.16 $1610.90 |
$749.89 $959.31 $1007.11 $1355.07 |
$962.80 $1172.22 $1220.02 $1567.98 |
$1175.71 $1385.13 $1432.93 $1780.89 |
$481.40 $586.11 $610.01 $783.99 |
$694.31 $799.02 $822.92 $996.90 |
$907.22 $1011.93 $1035.83 $1209.81 |
$212.91 |
Plan: (HMO) Select Care Preference Gold 250 w/no deductible for office visitsSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$250
: Family:
$750 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$273.82 $380.61 $404.98 $582.41 $821.42 |
$547.64 $761.22 $809.96 $1164.82 $1642.84 |
$764.78 $978.36 $1027.10 $1381.96 |
$981.92 $1195.50 $1244.24 $1599.10 |
$1199.06 $1412.64 $1461.38 $1816.24 |
$490.96 $597.75 $622.12 $799.55 |
$708.10 $814.89 $839.26 $1016.69 |
$925.24 $1032.03 $1056.40 $1233.83 |
$217.14 |
Plan: (HMO) Select Care Preference Gold 500Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$500
: Family:
$1,500 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$261.49 $363.48 $386.75 $556.19 $784.45 |
$522.98 $726.96 $773.50 $1112.38 $1568.90 |
$730.35 $934.33 $980.87 $1319.75 |
$937.72 $1141.70 $1188.24 $1527.12 |
$1145.09 $1349.07 $1395.61 $1734.49 |
$468.86 $570.85 $594.12 $763.56 |
$676.23 $778.22 $801.49 $970.93 |
$883.60 $985.59 $1008.86 $1178.30 |
$207.37 |
Plan: (HMO) Select Care Preference Gold 500 w/no deductible for office visitsSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$500
: Family:
$1,500 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$268.81 $373.65 $397.57 $571.77 $806.42 |
$537.62 $747.30 $795.14 $1143.54 $1612.84 |
$750.79 $960.47 $1008.31 $1356.71 |
$963.96 $1173.64 $1221.48 $1569.88 |
$1177.13 $1386.81 $1434.65 $1783.05 |
$481.98 $586.82 $610.74 $784.94 |
$695.15 $799.99 $823.91 $998.11 |
$908.32 $1013.16 $1037.08 $1211.28 |
$213.17 |
Plan: (HMO) Select Care Preference Silver 1250Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$1,250
: Family:
$2,500 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$217.86 $302.82 $322.21 $463.37 $653.55 |
$435.72 $605.64 $644.42 $926.74 $1307.10 |
$608.48 $778.40 $817.18 $1099.50 |
$781.24 $951.16 $989.94 $1272.26 |
$954.00 $1123.92 $1162.70 $1445.02 |
$390.62 $475.58 $494.97 $636.13 |
$563.38 $648.34 $667.73 $808.89 |
$736.14 $821.10 $840.49 $981.65 |
$172.76 |
Plan: (HMO) Select Care Preference Gold 1000Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$1,000
: Family:
$2,500 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$262.49 $364.85 $388.22 $558.30 $787.43 |
$524.98 $729.70 $776.44 $1116.60 $1574.86 |
$733.13 $937.85 $984.59 $1324.75 |
$941.28 $1146.00 $1192.74 $1532.90 |
$1149.43 $1354.15 $1400.89 $1741.05 |
$470.64 $573.00 $596.37 $766.45 |
$678.79 $781.15 $804.52 $974.60 |
$886.94 $989.30 $1012.67 $1182.75 |
$208.15 |
Plan: (HMO) Select Care Preference Gold 1000 w/no deductible for office visitsSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$1,000
: Family:
$2,500 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$281.47 $391.24 $416.30 $598.69 $844.40 |
$562.94 $782.48 $832.60 $1197.38 $1688.80 |
$786.14 $1005.68 $1055.80 $1420.58 |
$1009.34 $1228.88 $1279.00 $1643.78 |
$1232.54 $1452.08 $1502.20 $1866.98 |
$504.67 $614.44 $639.50 $821.89 |
$727.87 $837.64 $862.70 $1045.09 |
$951.07 $1060.84 $1085.90 $1268.29 |
$223.20 |
Plan: (HMO) Select Care Preference Silver 2500Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$2,500
: Family:
$5,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$229.85 $319.48 $339.94 $488.88 $689.51 |
$459.70 $638.96 $679.88 $977.76 $1379.02 |
$641.97 $821.23 $862.15 $1160.03 |
$824.24 $1003.50 $1044.42 $1342.30 |
$1006.51 $1185.77 $1226.69 $1524.57 |
$412.12 $501.75 $522.21 $671.15 |
$594.39 $684.02 $704.48 $853.42 |
$776.66 $866.29 $886.75 $1035.69 |
$182.27 |
Plan: (HMO) Select Care Preference Silver 2500 w/limited office visit waiverSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$2,500
: Family:
$5,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$239.50 $332.91 $354.23 $509.41 $718.48 |
$479.00 $665.82 $708.46 $1018.82 $1436.96 |
$668.93 $855.75 $898.39 $1208.75 |
$858.86 $1045.68 $1088.32 $1398.68 |
$1048.79 $1235.61 $1278.25 $1588.61 |
$429.43 $522.84 $544.16 $699.34 |
$619.36 $712.77 $734.09 $889.27 |
$809.29 $902.70 $924.02 $1079.20 |
$189.93 |
Plan: (HMO) Select Care Preference Bronze 5000Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$5,000
: Family:
$10,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$187.54 $260.67 $277.37 $398.89 $562.60 |
$375.08 $521.34 $554.74 $797.78 $1125.20 |
$523.80 $670.06 $703.46 $946.50 |
$672.52 $818.78 $852.18 $1095.22 |
$821.24 $967.50 $1000.90 $1243.94 |
$336.26 $409.39 $426.09 $547.61 |
$484.98 $558.11 $574.81 $696.33 |
$633.70 $706.83 $723.53 $845.05 |
$148.72 |
Plan: (HMO) Select Care Preference Bronze 6000 w/limited office visit waiverSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$6,000
: Family:
$12,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$194.20 $269.94 $287.23 $413.06 $582.58 |
$388.40 $539.88 $574.46 $826.12 $1165.16 |
$542.41 $693.89 $728.47 $980.13 |
$696.42 $847.90 $882.48 $1134.14 |
$850.43 $1001.91 $1036.49 $1288.15 |
$348.21 $423.95 $441.24 $567.07 |
$502.22 $577.96 $595.25 $721.08 |
$656.23 $731.97 $749.26 $875.09 |
$154.01 |
Plan: (HMO) Select Care Preference Silver 3800 Copay PlanSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$3,800
: Family:
$7,600 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$237.18 $329.68 $350.79 $504.48 $711.51 |
$474.36 $659.36 $701.58 $1008.96 $1423.02 |
$662.44 $847.44 $889.66 $1197.04 |
$850.52 $1035.52 $1077.74 $1385.12 |
$1038.60 $1223.60 $1265.82 $1573.20 |
$425.26 $517.76 $538.87 $692.56 |
$613.34 $705.84 $726.95 $880.64 |
$801.42 $893.92 $915.03 $1068.72 |
$188.08 |
Plan: (HMO) Select Care HealthSave Silver 1500 (HSA Qualified)Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$1,500
: Family:
$3,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$238.84 $331.99 $353.25 $508.02 $716.50 |
$477.68 $663.98 $706.50 $1016.04 $1433.00 |
$667.08 $853.38 $895.90 $1205.44 |
$856.48 $1042.78 $1085.30 $1394.84 |
$1045.88 $1232.18 $1274.70 $1584.24 |
$428.24 $521.39 $542.65 $697.42 |
$617.64 $710.79 $732.05 $886.82 |
$807.04 $900.19 $921.45 $1076.22 |
$189.40 |
Plan: (HMO) Select Care HealthSave Silver 2000 (HSA Qualified)Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$2,000
: Family:
$4,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$224.19 $311.62 $331.57 $476.84 $672.53 |
$448.38 $623.24 $663.14 $953.68 $1345.06 |
$626.16 $801.02 $840.92 $1131.46 |
$803.94 $978.80 $1018.70 $1309.24 |
$981.72 $1156.58 $1196.48 $1487.02 |
$401.97 $489.40 $509.35 $654.62 |
$579.75 $667.18 $687.13 $832.40 |
$757.53 $844.96 $864.91 $1010.18 |
$177.78 |
Plan: (HMO) Select Care HealthSave Bronze 4500 (HSA Qualified)Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$4,500
: Family:
$9,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$188.88 $262.54 $279.35 $401.74 $566.62 |
$377.76 $525.08 $558.70 $803.48 $1133.24 |
$527.54 $674.86 $708.48 $953.26 |
$677.32 $824.64 $858.26 $1103.04 |
$827.10 $974.42 $1008.04 $1252.82 |
$338.66 $412.32 $429.13 $551.52 |
$488.44 $562.10 $578.91 $701.30 |
$638.22 $711.88 $728.69 $851.08 |
$149.78 |
Plan: (HMO) Select Care HealthSave Silver 3500 (HSA Qualified)Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$3,500
: Family:
$7,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$229.51 $319.02 $339.44 $488.17 $688.51 |
$459.02 $638.04 $678.88 $976.34 $1377.02 |
$641.02 $820.04 $860.88 $1158.34 |
$823.02 $1002.04 $1042.88 $1340.34 |
$1005.02 $1184.04 $1224.88 $1522.34 |
$411.51 $501.02 $521.44 $670.17 |
$593.51 $683.02 $703.44 $852.17 |
$775.51 $865.02 $885.44 $1034.17 |
$182.00 |
Plan: (HMO) Select Care HealthSave Bronze 6550 (HSA Qualified)Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$6,550
: Family:
$13,100 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$193.87 $269.47 $286.73 $412.36 $581.58 |
$387.74 $538.94 $573.46 $824.72 $1163.16 |
$541.48 $692.68 $727.20 $978.46 |
$695.22 $846.42 $880.94 $1132.20 |
$848.96 $1000.16 $1034.68 $1285.94 |
$347.61 $423.21 $440.47 $566.10 |
$501.35 $576.95 $594.21 $719.84 |
$655.09 $730.69 $747.95 $873.58 |
$153.74 |
Plan: (HMO) Select Care Millennial 6850 (Catastrophic Plan)Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$6,850
: Family:
$13,700 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Catastrophic | 21 30 40 50 60 |
$170.88 $237.53 $252.74 $363.47 $512.64 |
$341.76 $475.06 $505.48 $726.94 $1025.28 |
$477.26 $610.56 $640.98 $862.44 |
$612.76 $746.06 $776.48 $997.94 |
$748.26 $881.56 $911.98 $1133.44 |
$306.38 $373.03 $388.24 $498.97 |
$441.88 $508.53 $523.74 $634.47 |
$577.38 $644.03 $659.24 $769.97 |
$135.50 |
Plan: (HMO) Select Value Preference Benchmark Silver 1250Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$1,250
: Family:
$2,500 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$168.24 $233.85 $248.82 $357.84 $504.70 |
$336.48 $467.70 $497.64 $715.68 $1009.40 |
$469.89 $601.11 $631.05 $849.09 |
$603.30 $734.52 $764.46 $982.50 |
$736.71 $867.93 $897.87 $1115.91 |
$301.65 $367.26 $382.23 $491.25 |
$435.06 $500.67 $515.64 $624.66 |
$568.47 $634.08 $649.05 $758.07 |
$133.41 |
Plan: (HMO) Select Value Preference Benchmark Bronze 5000Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$5,000
: Family:
$10,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$144.80 $201.27 $214.16 $307.98 $434.38 |
$289.60 $402.54 $428.32 $615.96 $868.76 |
$404.43 $517.37 $543.15 $730.79 |
$519.26 $632.20 $657.98 $845.62 |
$634.09 $747.03 $772.81 $960.45 |
$259.63 $316.10 $328.99 $422.81 |
$374.46 $430.93 $443.82 $537.64 |
$489.29 $545.76 $558.65 $652.47 |
$114.83 |
Plan: (HMO) Select Med Preference Benchmark Silver 1250Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$1,250
: Family:
$2,500 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$186.31 $258.97 $275.55 $396.28 $558.91 |
$372.62 $517.94 $551.10 $792.56 $1117.82 |
$520.36 $665.68 $698.84 $940.30 |
$668.10 $813.42 $846.58 $1088.04 |
$815.84 $961.16 $994.32 $1235.78 |
$334.05 $406.71 $423.29 $544.02 |
$481.79 $554.45 $571.03 $691.76 |
$629.53 $702.19 $718.77 $839.50 |
$147.74 |
Plan: (HMO) Select Med Preference Benchmark Bronze 5000Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$5,000
: Family:
$10,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$160.35 $222.89 $237.16 $341.06 $481.04 |
$320.70 $445.78 $474.32 $682.12 $962.08 |
$447.86 $572.94 $601.48 $809.28 |
$575.02 $700.10 $728.64 $936.44 |
$702.18 $827.26 $855.80 $1063.60 |
$287.51 $350.05 $364.32 $468.22 |
$414.67 $477.21 $491.48 $595.38 |
$541.83 $604.37 $618.64 $722.54 |
$127.16 |
Plan: (HMO) Select Care Preference Benchmark Silver 1250Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$1,250
: Family:
$2,500 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$215.19 $299.11 $318.26 $457.70 $645.54 |
$430.38 $598.22 $636.52 $915.40 $1291.08 |
$601.02 $768.86 $807.16 $1086.04 |
$771.66 $939.50 $977.80 $1256.68 |
$942.30 $1110.14 $1148.44 $1427.32 |
$385.83 $469.75 $488.90 $628.34 |
$556.47 $640.39 $659.54 $798.98 |
$727.11 $811.03 $830.18 $969.62 |
$170.64 |
Plan: (HMO) Select Care Preference Benchmark Bronze 5000Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-5038 - Provider Directory for This Plan: (SelectHealth)
Deductible: Individual:
$5,000
: Family:
$10,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$185.20 $257.44 $273.92 $393.92 $555.60 |
$370.40 $514.88 $547.84 $787.84 $1111.20 |
$517.27 $661.75 $694.71 $934.71 |
$664.14 $808.62 $841.58 $1081.58 |
$811.01 $955.49 $988.45 $1228.45 |
$332.07 $404.31 $420.79 $540.79 |
$478.94 $551.18 $567.66 $687.66 |
$625.81 $698.05 $714.53 $834.53 |
$146.87 |
†Source: Our summary of lowest costs and numbers of providers is based on a government report released September 25, 2013. For more detailed information about specific plans and providers, see HealthCare.gov.
‡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 Davis County here.