Utah health plan · 2025

Value Silver 3000 Medical Deductible · 68781UT0020024

Select Health offers this marketplace health insurance plan (Plan ID 68781UT0020024) 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: Silver Plan type: HMO CSR: 73% AV Level Silver Plan Issuer: Select Health
Telehealth Data pending HSA eligible No Dental Adult/Child Vision Adult/Child
Pay / Manage Plan View issuer site

CMS AV Calculator output: 73.15% (26.85% member share on average). Learn about AV methodology.

2025 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

$283 – $1122

Before subsidies

Estimate after subsidies

Deductible

N/A

N/A

See deductible details

Max out-of-pocket

$6,750

$13500 per group

Review MOOP rules

Office visits

Primary care $30.00
Specialist $50.00
HSA Not eligible

Drug tiers

Generic $25.00
Preferred brand 25.00% Coinsurance after deductible

View formulary tiers

$495 / mo before subsidies

≈ $5943 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.

$1403 / mo before subsidies

≈ $16840 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.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$1660 / mo before subsidies

≈ $19916 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.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$1107 / mo before subsidies

≈ $13280 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

No Charge, No Charge

Emergency Room Services

$600.00 Copay after deductible

Durable Medical Equipment

40.00% Coinsurance after deductible

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Enrollment guidance

Stay on top of 2025 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2025 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.
  • 73% AV Level Silver Plan 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

No Charge, No Charge

Emergency Room Services

$600.00 Copay after deductible

Durable Medical Equipment

40.00% Coinsurance after deductible

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 68781UT0020024
Coverage year 2025
State Utah
Issuer Select Health
Formulary document Download formulary
Variant ID 68781UT0020024-04
Available variants

Standard Off Exchange Plan · 68781UT0020024-00

Standard On Exchange Plan · 68781UT0020024-01

Open to Indians below 300% FPL · 68781UT0020024-02

Open to Indians above 300% FPL · 68781UT0020024-03

73% AV Silver Plan · 68781UT0020024-04

87% AV Silver Plan · 68781UT0020024-05

94% AV Silver Plan · 68781UT0020024-06
Last plan update Wed, 23 Oct 2024 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 N/A
PCPs in Utah N/A
Telehealth support Data pending
Nationwide providers N/A

Provider network(s)

Providers Utah All US states
All N/A N/A
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A

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 68781UT0020024 · 2025 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 68781UT0020024-04 (73% AV Silver Plan) 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

nan

Exclusions: nan

Diabetes Education

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Home Health Care Services

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Laboratory Outpatient and Professional Services

$20.00
Tier 1 in-network $20.00
Out-of-network 100.00%

nan

Exclusions: nan

Other Practitioner Office Visit (Nurse, Physician Assistant)

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

nan

Exclusions: nan

Preventive Care/Screening/Immunization

No Charge, No Charge
Tier 1 in-network No Charge, No Charge
Out-of-network 100.00%

nan

Exclusions: nan

Primary Care Visit to Treat an Injury or Illness

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

nan

Exclusions: nan

Rehabilitative Occupational and Rehabilitative Physical Therapy

$40.00 Copay after deductible
Tier 1 in-network $40.00 Copay after deductible
Out-of-network 100.00%

Limit: 40.0 Days per Year

Outpatient physical, speech, and occupational therapies have a combined limit of 20 visits. Inpatient physical, speech, and occupational rehabilitation services have a combined limit of 40 days.

Exclusions: nan

Rehabilitative Speech Therapy

$40.00 Copay after deductible
Tier 1 in-network $40.00 Copay after deductible
Out-of-network 100.00%

Limit: 40.0 Days per Year

Outpatient physical, speech, and occupational therapies have a combined limit of 20 visits. Inpatient physical, speech, and occupational rehabilitation services have a combined limit of 40 days.

Exclusions: nan

Specialist Visit

$50.00
Tier 1 in-network $50.00
Out-of-network 100.00%

nan

Exclusions: nan

Urgent Care Centers or Facilities

$45.00
Tier 1 in-network $45.00
Out-of-network 100.00%

nan

Exclusions: nan

X-rays and Diagnostic Imaging

$20.00
Tier 1 in-network $20.00
Out-of-network 100.00%

nan

Exclusions: nan

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Delivery and All Inpatient Services for Maternity Care

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Dialysis

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Durable Medical Equipment

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: Certain limitations and exclusions exist. Refer to the plan materials for more information.

Emergency Room Services

$600.00 Copay after deductible
Tier 1 in-network $600.00 Copay after deductible
Out-of-network $600.00 Copay after deductible

nan

Exclusions: nan

Emergency Transportation/Ambulance

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 40.00% Coinsurance after deductible

nan

Exclusions: nan

Hospice Services

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

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

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Inpatient Physician and Surgical Services

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Mental/Behavioral Health Inpatient Services

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: Certain limitations and exclusions exist. Refer to the plan materials for more information.

Mental/Behavioral Health Outpatient Services

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

Office visits for Mental/Behavioral Health Outpatient Services: please refer to the Primary Care Visit for cost sharing information. All other outpatient services (e.g., partial hospitalization, day treatment, intensive outpatient) may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.

Exclusions: Certain limitations and exclusions exist. Refer to the plan materials for more information.

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

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

A procedure in a Freestanding Ambulatory Surgery Center, will cost the member less than the amount shown for other outpatient facilities.

Exclusions: nan

Outpatient Rehabilitation Services

$25.00
Tier 1 in-network $25.00
Out-of-network 100.00%

Limit: 20.0 Visit(s) per Year

Outpatient physical, speech, and occupational therapies have a combined limit of 20 visits. Inpatient physical, speech, and occupational rehabilitation services have a combined limit of 40 days.

Exclusions: nan

Outpatient Surgery Physician/Surgical Services

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Radiation

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Skilled Nursing Facility

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 60.0 Days per Year

nan

Exclusions: nan

Substance Abuse Disorder Inpatient Services

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: Certain limitations and exclusions exist. Refer to the plan materials for more information.

Substance Abuse Disorder Outpatient Services

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

Office visits for Mental/Behavioral Health Outpatient Services: please refer to the Primary Care Visit for cost sharing information

Exclusions: Certain limitations and exclusions exist. Refer to the plan materials for more information.

Transplant

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: Covered only in limited circumstances

Mental health & substance use

Behavioral health visits and substance use treatment.

Autism Spectrum Disorders

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

Covered as required by state law.

Exclusions: nan

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

Coverage details pending

nan

Exclusions: nan

Hearing Aids

Coverage details pending

nan

Exclusions: nan

Major Dental Care - Child

Coverage details pending

nan

Exclusions: nan

Prenatal and Postnatal Care

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

nan

Exclusions: nan

Routine Eye Exam for Children

$50.00
Tier 1 in-network $50.00
Out-of-network 100.00%

Limit: 1.0 Visit(s) per Year

nan

Exclusions: nan

Well Baby Visits and Care

No Charge, No Charge
Tier 1 in-network No Charge, No Charge
Out-of-network 100.00%

nan

Exclusions: nan

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$25.00
Tier 1 in-network $25.00
Out-of-network $25.00

Certain generic and brand name drugs have lower cost sharing than the generic tier

Exclusions: nan

Non-Preferred Brand Drugs

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

The Hepatitis C Virus (HCV) drugs covered on non-preferred brand tier are eligible to receive a rebate from the drug manufacturer. The member out-of-pocket costs will be applied to the deductible and the maximum out-of-pocket.

Exclusions: nan

Preferred Brand Drugs

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Out-of-network 25.00% Coinsurance after deductible

nan

Exclusions: nan

Specialty Drugs

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

Coinsurance or copay may differ depending on the place where services are received. See inpatient, outpatient, or emergency room benefits.

Exclusions: Covered only in limited circumstances

Basic Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Dental Check-Up for Children

$50.00
Tier 1 in-network $50.00
Out-of-network 100.00%

Limit: 2.0 Visit(s) per Year

nan

Exclusions: nan

Infusion Therapy

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Major Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Nutritional Counseling

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Orthodontia - Adult

Coverage details pending

nan

Exclusions: nan

Orthodontia - Child

Coverage details pending

nan

Exclusions: nan

Prosthetic Devices

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Routine Dental Services (Adult)

$50.00
Tier 1 in-network $50.00
Out-of-network 100.00%

Limit: 2.0 Visit(s) per Year

nan

Exclusions: nan

Weight Loss Programs

Coverage details pending

nan

Exclusions: nan

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

nan

Exclusions: nan

Acupuncture

Coverage details pending

nan

Exclusions: nan

Allergy Testing

$50.00
Tier 1 in-network $50.00
Out-of-network 100.00%

nan

Exclusions: nan

Bariatric Surgery

Coverage details pending

nan

Exclusions: nan

Cosmetic Surgery

Coverage details pending

nan

Exclusions: nan

Eye Glasses for Children

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 1.0 Item(s) per Year

nan

Exclusions: Frames are not covered

Gender Affirming Care

Coverage details pending

nan

Exclusions: nan

Habilitation Services

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

Limit: 20.0 Visit(s) per Year

Outpatient physical, speech, and occupational therapies have a combined limit of 20 visits.

Exclusions: nan

Imaging (CT/PET Scans, MRIs)

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Infertility Treatment

Coverage details pending

nan

Exclusions: nan

Inherited Metabolic Disorder - PKU

$50.00
Tier 1 in-network $50.00
Out-of-network 100.00%

nan

Exclusions: nan

Long-Term/Custodial Nursing Home Care

Coverage details pending

nan

Exclusions: nan

Private-Duty Nursing

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Reconstructive Surgery

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: Covered only in limited circumstances

Routine Eye Exam (Adult)

$50.00
Tier 1 in-network $50.00
Out-of-network 100.00%

Limit: 1.0 Visit(s) per Year

nan

Exclusions: nan

Routine Foot Care

Coverage details pending

nan

Exclusions: nan

Treatment for Temporomandibular Joint Disorders

Coverage details pending

nan

Exclusions: nan

Variant attributes

Value Silver 3000 Medical Deductible · Variant 68781UT0020024-04

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

73% AV Level Silver Plan

HIOS Product ID

68781UT002

Metal Level

Silver

Plan ID (Standard Component ID with Variant)

68781UT0020024-04

Plan Marketing Name

Value Silver 3000 Medical Deductible

Plan Variant Marketing Name

Value Silver 3000 Medical Deductible

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

UTN002

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

UTS002

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

0.731535057102182

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

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

50.00%

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

40.00%

SBC Scenario, Having a Baby, Coinsurance

$3,400

SBC Scenario, Having a Baby, Copayment

$300

SBC Scenario, Having a Baby, Deductible

$3,000

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$600

SBC Scenario, Having Diabetes, Deductible

$800

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$0

SBC Scenario, Treatment of a Simple Fracture, Copayment

$400

SBC Scenario, Treatment of a Simple Fracture, Deductible

$2,100

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

per group not applicable

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

per person not applicable

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

Not Applicable

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

$13500 per group

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

$6750 per person

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

$6,750

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

per group not applicable

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

per person not applicable

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

Not Applicable

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

UTF016

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$60

SBC Scenario, Having Diabetes, Limit

$20

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

$1800 per group

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

$600 per person

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

$600

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

per group not applicable

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

per person not applicable

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

Not Applicable

Drug EHB Deductible, Out of Network, Family Per Group

per group not applicable

Drug EHB Deductible, Out of Network, Family Per Person

per person not applicable

Drug EHB Deductible, Out of Network, Individual

Not Applicable

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

0.9861

First Tier Utilization

100%

Import Date

2024-10-23 20:01:37

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

per group not applicable

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

per person not applicable

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

Not Applicable

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

$6000 per group

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

$3000 per person

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

$3,000

Medical EHB Deductible, Out of Network, Family Per Group

per group not applicable

Medical EHB Deductible, Out of Network, Family Per Person

per person not applicable

Medical EHB Deductible, Out of Network, Individual

Not Applicable

Plan Effective Date

2025-01-01

Plan Expiration Date

2025-12-31

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

68781UT0020024

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?

Value Silver 3000 Medical Deductible (68781UT0020024) is a Silver HMO from Select Health in Utah for the 2025 coverage year.

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

Does Value Silver 3000 Medical Deductible 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 Value Silver 3000 Medical Deductible 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 add-ons: Adult, Child.

Vision add-ons: Adult, Child.

Does Value Silver 3000 Medical Deductible 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 Value Silver 3000 Medical Deductible?

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 Value Silver 3000 Medical Deductible?

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

Does Value Silver 3000 Medical Deductible 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

How do I enroll in or manage payments for Value Silver 3000 Medical Deductible?

Use the issuer portal https://selecthealth.org/ffmpayment/medical.aspx to pay premiums or start enrollment, then return to HealthPorta for benefit comparisons.

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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