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SelectHealth

Med Catastrophic 8700

Plan Overview

Combined Medical and Drug Deductible
  • Individual: $8,700.00
  • Family: $17,400
  • Per Person: $8,700
Combined Medical and Drug Out of Pocket Maximum
  • Individual: $8,700.00
  • Family: $17,400
  • Per Person: $8,700

Office Visit

Primary Doctor
  • CoPay: $35.00 Copay with deductible
  • CoInsurance: No Charge after deductible
  • Covered: Covered
Specialist
  • CoPay: No Charge after deductible
  • CoInsurance: Not Applicable
  • Covered: Covered

Prescription Drug Information

Preferred Brand Drugs
  • CoPay: Not Applicable
  • CoInsurance: No Charge after deductible
  • Covered: Covered
Non Preferred Brand Drugs
  • CoPay: Not Applicable
  • CoInsurance: No Charge after deductible
  • Covered: Covered
Generic Drugs
  • CoPay: No Charge after deductible
  • CoInsurance: Not Applicable
  • Covered: Covered
  • Benefit Explanation: There is an additional tier which includes selected generic and brand name drugs for $10 above the generic tier.
Specialty Drugs
  • CoPay: Not Applicable
  • CoInsurance: No Charge after deductible
  • Covered: Covered

Inpatient Coverage

Hospital Services
  • CoPay: Not Applicable
  • CoInsurance: No Charge after deductible
  • Covered: Covered
Inpatient Services
  • CoPay: Not Applicable
  • CoInsurance: No Charge after deductible
  • Covered: Covered

Emergency and Urgent Care

Emergency Room
  • CoPay: No Charge after deductible
  • CoInsurance: Not Applicable
  • Covered: Covered
Urgent Care Facility
  • CoPay: No Charge after deductible
  • CoInsurance: Not Applicable
  • Covered: Covered

Maternity

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

Vision

Routine Eye Exams For Children
  • CoPay: No Charge
  • CoInsurance: No Charge
  • Covered: Covered
  • Limit Quantity: 1
  • Limit Unit : Visit(s) per Year

Major Dental Care

Routine Dental Checkups for Children
  • CoPay: No Charge after deductible
  • CoInsurance: Not Applicable
  • Covered: Covered
  • Limit Quantity: 2
  • Limit Unit : Visit(s) per Year
Routine Dental Checkups for Adults
  • Covered: Not Covered
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