Utah health plan · 2026

Signature Benchmark Gold · 68781UT0200030

Select Health offers this marketplace health insurance plan (Plan ID 68781UT0200030) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Gold Plan type: HMO CSR: Zero Cost Sharing Plan Variation Issuer: Select Health
Telehealth Data pending HSA eligible No Dental Not listed Vision Child

CMS AV Calculator output: 100.00% (0.00% member share on average). Learn about AV methodology.

2026 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$346 – $1376

Before subsidies

Estimate after subsidies

Deductible

N/A

N/A

See deductible details

Max out-of-pocket

$0

$0 per group

Review MOOP rules

Office visits

Primary care $0.00
Specialist $0.00
HSA Not eligible

Drug tiers

Generic $0.00
Preferred brand 0.00%

View formulary tiers

$625 / mo before subsidies

≈ $7506 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$1688 / mo before subsidies

≈ $20255 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$1996 / mo before subsidies

≈ $23954 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$1331 / mo before subsidies

≈ $15973 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

$0.00, 0.00%

Emergency Room Services

0.00%

Durable Medical Equipment

0.00%

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Enrollment guidance

Stay on top of 2026 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2026 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Utah). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • Zero Cost Sharing Plan Variation plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

$0.00, 0.00%

Emergency Room Services

0.00%

Durable Medical Equipment

0.00%

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 68781UT0200030
Coverage year 2026
State Utah
Issuer Select Health
Formulary document Download formulary
Variant ID 68781UT0200030-02
Available variants

Standard Off Exchange Plan · 68781UT0200030-00

Standard On Exchange Plan · 68781UT0200030-01

Open to Indians below 300% FPL · 68781UT0200030-02

Open to Indians above 300% FPL · 68781UT0200030-03

Last plan update Wed, 15 Oct 2025 00:00 GMT
Last HealthPorta import Tue, 02 Dec 2025 06:13 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in Utah 16289
PCPs in Utah 1956
Telehealth support Data pending
Nationwide providers 21366
16,289 doctors statewide 1,956 PCPs 77 OB/GYN
Providers Utah All US states
All 16289 21366
PCP 1956 2543
Allergy 7 12
OB/GYN 77 100
Dentists 1054 1209

Drug coverage overview

3,856 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
NON-PREFERRED-GENERIC 2,238
NON-PREFERRED-BRAND 658
SPECIALTY-DRUGS 501
ZERO-COST-SHARE-PREVENTIVE-DRUGS 459
Prior authorization Drugs
Required 528
Not Required 3,328
Step therapy Drugs
Required 211
Not Required 3,645
Quantity limits Drugs
Has Limit 423
No Limit 3,433

Customer highlights

What stands out for members

  • Issuer: Select Health · Plan ID 68781UT0200030 · 2026 filing.
  • Disease management programs available: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs.
  • Download the latest formulary directly from the issuer here.
  • Variant 68781UT0200030-02 (Open to Indians below 300% FPL) currently displayed.
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Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

Coverage details pending

Diabetes Education

0.00%

Home Health Care Services

0.00%

Laboratory Outpatient and Professional Services

$0.00, 0.00%

Other Practitioner Office Visit (Nurse, Physician Assistant)

$0.00

Preventive Care/Screening/Immunization

$0.00, 0.00%

Primary Care Visit to Treat an Injury or Illness

$0.00

Rehabilitative Occupational and Rehabilitative Physical Therapy

$0.00

Rehabilitative Speech Therapy

$0.00

Specialist Visit

$0.00

Urgent Care Centers or Facilities

$0.00

X-rays and Diagnostic Imaging

$0.00, 0.00%

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

0.00%

Delivery and All Inpatient Services for Maternity Care

0.00%

Dialysis

0.00%

Durable Medical Equipment

0.00%

Emergency Room Services

0.00%

Emergency Transportation/Ambulance

0.00%

Hospice Services

0.00%

Inpatient Hospital Services (e.g., Hospital Stay)

0.00%

Inpatient Physician and Surgical Services

0.00%

Mental/Behavioral Health Inpatient Services

0.00%

Mental/Behavioral Health Outpatient Services

$0.00

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

0.00%

Outpatient Rehabilitation Services

$0.00

Outpatient Surgery Physician/Surgical Services

0.00%

Radiation

0.00%

Skilled Nursing Facility

0.00%

Substance Abuse Disorder Inpatient Services

0.00%

Substance Abuse Disorder Outpatient Services

$0.00

Transplant

0.00%

Mental health & substance use

Behavioral health visits and substance use treatment.

Autism Spectrum Disorders

0.00%

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

Coverage details pending

Hearing Aids

Coverage details pending

Major Dental Care - Child

Coverage details pending

Prenatal and Postnatal Care

$0.00

Routine Eye Exam for Children

$0.00

Well Baby Visits and Care

$0.00, 0.00%

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$0.00

Non-Preferred Brand Drugs

0.00%

Preferred Brand Drugs

0.00%

Specialty Drugs

0.00%

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

Coverage details pending

Basic Dental Care - Adult

Coverage details pending

Dental Check-Up for Children

Coverage details pending

Infusion Therapy

0.00%

Major Dental Care - Adult

Coverage details pending

Nutritional Counseling

Coverage details pending

Orthodontia - Adult

Coverage details pending

Orthodontia - Child

Coverage details pending

Prosthetic Devices

Coverage details pending

Routine Dental Services (Adult)

Coverage details pending

Weight Loss Programs

Coverage details pending

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

Acupuncture

Coverage details pending

Allergy Testing

$0.00

Bariatric Surgery

Coverage details pending

Cosmetic Surgery

Coverage details pending

Eye Glasses for Children

0.00%

Gender Affirming Care

Coverage details pending

Habilitation Services

$0.00

Imaging (CT/PET Scans, MRIs)

0.00%

Infertility Treatment

Coverage details pending

Inherited Metabolic Disorder - PKU

$0.00

Long-Term/Custodial Nursing Home Care

Coverage details pending

Private-Duty Nursing

Coverage details pending

Reconstructive Surgery

0.00%

Routine Eye Exam (Adult)

Coverage details pending

Routine Foot Care

Coverage details pending

Treatment for Temporomandibular Joint Disorders

Coverage details pending

Variant attributes

Signature Benchmark Gold · Variant 68781UT0200030-02

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2026

CSR Variation Type

Zero Cost Sharing Plan Variation

HIOS Product ID

68781UT020

Metal Level

Gold

Plan ID (Standard Component ID with Variant)

68781UT0200030-02

Plan Marketing Name

Signature Benchmark Gold

Plan Variant Marketing Name

Signature Benchmark Gold

Issuer & service area

Issuer-provided metadata for this variant.

Issuer ID

68781

Issuer Marketplace Marketing Name

Select Health

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

UTN003

Out of Country Coverage

No

Out of Country Coverage Description

Urgent or emergency care only

Out of Service Area Coverage

No

Out of Service Area Coverage Description

Urgent or emergency care only

Service Area ID

UTS003

State Code

UT

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

1

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

0.00%

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

No

Medical Drug Maximum Out of Pocket Integrated

Yes

Medical EHB Deductible, In Network (Tier 1), Default Coinsurance

0.00%

SBC Scenario, Having a Baby, Coinsurance

$0

SBC Scenario, Having a Baby, Copayment

$0

SBC Scenario, Having a Baby, Deductible

$0

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$0

SBC Scenario, Having Diabetes, Deductible

$0

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$0

SBC Scenario, Treatment of a Simple Fracture, Copayment

$0

SBC Scenario, Treatment of a Simple Fracture, Deductible

$0

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group

$0 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person

$0 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual

$0

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group

$0 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person

$0 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$0

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group

$0 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person

$0 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

$0

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

UTF015

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$60

SBC Scenario, Having Diabetes, Limit

$60

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

0

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Drug EHB Deductible, Combined In/Out of Network, Family Per Group

$0 per group

Drug EHB Deductible, Combined In/Out of Network, Family Per Person

$0 per person

Drug EHB Deductible, Combined In/Out of Network, Individual

$0

Drug EHB Deductible, In Network (Tier 1), Family Per Group

$0 per group

Drug EHB Deductible, In Network (Tier 1), Family Per Person

$0 per person

Drug EHB Deductible, In Network (Tier 1), Individual

$0

Drug EHB Deductible, Out of Network, Family Per Group

$0 per group

Drug EHB Deductible, Out of Network, Family Per Person

$0 per person

Drug EHB Deductible, Out of Network, Individual

$0

Dental Only Plan

No

Design Type

Not Applicable

Disease Management Programs Offered

Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs

EHB Percent of Total Premium

1

First Tier Utilization

100%

Import Date

10/15/2025

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

Existing

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

No

Medical EHB Deductible, Combined In/Out of Network, Family Per Group

$0 per group

Medical EHB Deductible, Combined In/Out of Network, Family Per Person

$0 per person

Medical EHB Deductible, Combined In/Out of Network, Individual

$0

Medical EHB Deductible, In Network (Tier 1), Family Per Group

$0 per group

Medical EHB Deductible, In Network (Tier 1), Family Per Person

$0 per person

Medical EHB Deductible, In Network (Tier 1), Individual

$0

Medical EHB Deductible, Out of Network, Family Per Group

$0 per group

Medical EHB Deductible, Out of Network, Family Per Person

$0 per person

Medical EHB Deductible, Out of Network, Individual

$0

Plan Effective Date

1/1/2026

Plan Expiration Date

12/31/2026

Plan Level Exclusions

Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Travel-Related Expenses; computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.

Plan Type

HMO

QHP/Non QHP

Both

Source Name

SERFF

Plan ID

68781UT0200030

Unique Plan Design

No

Wellness Program Offered

No

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in Utah?

Signature Benchmark Gold (68781UT0200030) is a Gold HMO from Select Health in Utah for the 2026 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does Signature Benchmark Gold support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is Signature Benchmark Gold HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental coverage is not listed for this plan.

Vision add-ons: Child.

Does Signature Benchmark Gold support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with Signature Benchmark Gold?

The issuer lists disease management resources for: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs.

Is there out-of-country coverage for Signature Benchmark Gold?

No, out-of-country services are not covered for this plan. Details: Urgent or emergency care only

Does Signature Benchmark Gold cover care outside the service area?

No, the issuer indicates out-of-service-area care is not covered except for emergencies. Details: Urgent or emergency care only

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
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