| | Select Value | Select Med | Select Care |
| Plan Type | HMO | HMO | HMO |
| Participating Hospitals | 10 | 34 | 43 |
| Participating Physicians | 1,300+ | 3,900+ | 5,000+ |
| Nonparticipating Coverage | Urgent/emergent only | Urgent/emergent only | Urgent/emergent only |
| Primary Care Office Visits (participating) | $25* | $25* | $25* |
| Preventive Care Office Visits (participating) | Covered 100% | Covered 100% | Covered 100% |
| Immunizations (participating) | Covered 100% | Covered 100% | Covered 100% |
| Specialist Office Visits (participating) | $40* | $40* | $40* |
| Coinsurance | 20% after deductible | 20% after deductible | 20% after deductible |
| Deductible Options (participating) | $500, $1,000, $2,500, $5,000, $7,500 | $500, $1,000, $2,500, $5,000, $7,500 | $500, $1,000, $2,500, $5,000, $7,500 |
| Out-of-Pocket Maximum | Varies based on deductible level | Varies based on deductible level | Varies based on deductible level |
| Prescription Drugs | Tier 1: $10
Tier 2: 25% after deductible
Tier 3: 50% after deductible
Tier 4: 20% after deductible | Tier 1: $10
Tier 2: 25% after deductible
Tier 3: 50% after deductible
Tier 4: 20% after deductible | Tier 1: $10
Tier 2: 25% after deductible
Tier 3: 50% after deductible
Tier 4: 20% after deductible |
| Emergency Room (participating/nonparticipating) | $250 after deductible | $250 after deductible | $250 after deductible |
| Urgent Care | $40* | $40* | $40* |
| Counties Served | Davis, Salt Lake, Weber, and parts of Utah county
| Beaver, Cache, Davis, Duchesne, Iron, Juab, Millard, Morgan, Salt Lake, Sanpete, Sevier, Summit, Utah, Wasatch, Washington, Weber, and parts of Box Elder, Garfield, Piute, Tooele, Uintah, and Wayne
| Beaver, Cache, Davis, Duchesne, Garfield, Iron, Juab, Kane, Millard, Morgan, Piute, Rich, Salt Lake, Sanpete, Sevier, Summit, Uintah, Utah, Wasatch, Washington, Wayne, Weber, and parts of Box Elder and Tooele
|
| *Deductible Waiver | *Deductible may or may not apply for this service based on plan selected | *Deductible may be waived for this service based on plan selected
| *Deductible may be waived for this service based on plan selected
|