Molina Healthcare of Utah Marketplace

Constant Care Silver 4 250

Plan Overview

Combined Medical and Drug Deductible
  • Individual: $7,450
  • Family: $14,900
  • Per Person: $7,450
Combined Medical and Drug Out of Pocket Maximum
  • Individual: $7,450
  • Family: $14,900
  • Per Person: $7,450

Office Visit

Primary Doctor
  • CoPay: $30.00
  • CoInsurance: Not Applicable
  • Covered: Covered
Specialist
  • CoPay: $65.00
  • CoInsurance: Not Applicable
  • Covered: Covered

Prescription Drug Information

Preferred Brand Drugs
  • CoPay: $75.00
  • CoInsurance: Not Applicable
  • Covered: Covered
  • Limit Quantity: 30
  • Limit Unit : Item(s) per Month
  • Benefit Explanation: Per Utah State Law, during calendar year 2022, the insulin prescription cap for a 30-day prescription supply of at least one insulin in each therapy category will $28.00
Non Preferred Brand Drugs
  • CoPay: Not Applicable
  • CoInsurance: 0.00% Coinsurance after deductible
  • Covered: Covered
  • Limit Quantity: 30
  • Limit Unit : Item(s) per Month
  • Benefit Explanation: Per Utah State Law, during calendar year 2022, the insulin prescription cap for a 30-day prescription supply of at least one insulin in each therapy category will $28.00
Generic Drugs
  • CoPay: $25.00
  • CoInsurance: Not Applicable
  • Covered: Covered
  • Limit Quantity: 30
  • Limit Unit : Item(s) per Month
Specialty Drugs
  • CoPay: Not Applicable
  • CoInsurance: 0.00% Coinsurance after deductible
  • Covered: Covered
  • Limit Quantity: 30
  • Limit Unit : Item(s) per Month

Inpatient Coverage

Hospital Services
  • CoPay: $1500.00 Copay per Day
  • CoInsurance: Not Applicable
  • Covered: Covered
Inpatient Services
  • CoPay: $65.00
  • CoInsurance: Not Applicable
  • Covered: Covered

Emergency and Urgent Care

Emergency Room
  • CoPay: Not Applicable
  • CoInsurance: 0.00% Coinsurance after deductible
  • Covered: Covered
Urgent Care Facility
  • CoPay: $30.00
  • CoInsurance: Not Applicable
  • Covered: Covered

Maternity

Labor and Delivery Hospital Stay
  • CoPay: $65.00
  • CoInsurance: Not Applicable
  • Covered: Covered
Pre and Postnatal Office Visit
  • CoPay: No Charge
  • CoInsurance: Not Applicable
  • Covered: Covered

Vision

Routine Eye Exams For Children
  • CoPay: No Charge
  • CoInsurance: Not Applicable
  • Covered: Covered
  • Limit Quantity: 1
  • Limit Unit : Visit(s) per Benefit Period

Major Dental Care

Routine Dental Checkups for Children
  • Covered: Not Covered
Routine Dental Checkups for Adults
  • Covered: Not Covered
Basic Dental Care - Adult
  • Covered: Not Covered
Basic Dental Care - Child
  • Covered: Not Covered
Major Dental Care - Adult
  • Covered: Not Covered
Major Dental Care - Child
  • Covered: Not Covered
Related Articles
You may be interested in these relevant articles from across the HealthMarkets.com network.
© 2021 HealthMarkets Insurance Agency. All rights reserved.
Attention: This website is operated by HealthMarkets Insurance Agency and is not the Health Insurance Marketplace® website. In offering this website, HealthMarkets Insurance Agency is required to comply with all applicable federal laws, including the standards established under 45 C.F.R. § 155.220(c) and (d) and standards established under 45 C.F.R. § 155.260 to protect the privacy and security of personally identifiable information. This website may not display all data on Qualified Health Plans (QHPs) being offered in your state through the Health Insurance Marketplace® website. To see all available data on Qualified Health Plan options in your state, go to the Health Insurance Marketplace® website at HealthCare.gov.
HealthMarkets Insurance Agency offers the opportunity to enroll in either QHPs or off-Marketplace coverage. Please visit HealthCare.gov for information on the benefits of enrolling in a QHP. Off-Marketplace coverage is not eligible for the cost savings offered for coverage through the Marketplaces.
1. HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency in all 50 states and DC. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in a health plan. No obligation to enroll. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.
2. HealthMarkets is ranked “Excellent” (5 out of 5 stars) by 92% of customers on Trustpilot: Based on 3,101 customer reviews on Trustpilot in the health insurance agency category as of 4/29/21. Learn more at www.trustpilot.com/review/healthmarkets.com
3. Premium subsidies vary by address and subject to eligibility. Those with incomes between 100% and 150% of the federal poverty level (FPL) may qualify for a zero-dollar premium silver plan (after tax credits). They may also qualify for a zero-dollar premium bronze plan (after tax credits). Cost sharing (deductibles and coinsurance) may be higher.
46513-HM-1020 46512-HM-0121
HealthMarkets Insurance Agency BBB Business Review
Verified Badge