INDIVIDUAL & FAMILY PLANS
Our plans are designed to cover essential health benefits including inpatient, outpatient, emergent, maternal, mental, behavioral, prescription drugs, lab tests, preventive, pediatric care services and much more.
Take control of your healthcare experience with our member benefits package. We can help you find the right doctor, access mental health services, find your secure medical information online, connect for a virtual visit, talk with a registered nurse or take advantage of your member discounts.
Individual Marketplace 2020 Flu Shot Incentive – A flu shot is an important part of maintaining your health. Receive a $100 Gift Card for each University of Utah Health Plans member who receives their flu shot between August 1 and December 31, 2020. Learn More >
Member Benefits
2021 On & Off Marketplace Benefit Highlights
| DESCRIPTION | GOLD COPAY | SILVER 2300 | SILVER COPAY | SILVER COPAY (OFF) | BRONZE 3 COPAY | BRONZE HSA | EXPANDED BRONZE | EXPANDED BRONZE HSA |
|---|---|---|---|---|---|---|---|---|
| FEATURES | ||||||||
| Annual Deductible (individual/family) | $1,500/$3,000 | $2,300/$4,600 | $3,500/$7,000 | $4,500/$9,000 | $7,800/$15,600 | $7,000/$14,000 | $5,650/$11,300 | $5,750/$11,500 |
| Prescription Drug Deductible (individual/family) | $500/$1,000 | $1,000/$2,000 | $2,000/$4,000 | Included with MD | Included with MD | Included with MD | $1,650/$3,300 | Included with MD |
| Annual Out-of-Pocket Maximum (individual/family) | $7,000/$14,000 | $8,300/$16,600 | $8,000/$16,000 | $8,150/$16,300 | $8,550/$17,100 | $7,000/$14,000 | $8,550/$17,100 | $7,000/$14,000 |
| BENEFITS | ||||||||
| Emergency and Urgent Care | ||||||||
| Emergency Room | $200 copay AD | $600 copay AD | $500 copay AD | $500 copay AD | 40% Co AD | 0% Co AD | 50% Co AD | 35% Co AD |
| Urgent Care | $25 copay DW | $35 copay DW | $30 copay DW | $30 copay DW | $45 copay/ first 3 visits then 40% AD | 0% Co AD | $50 copay DW | $30 copay AD |
| Office Visits | ||||||||
| Preventive Care/Screening/
Immunizations/Well-Child Visits/ Family Planning |
No Charge | |||||||
| Primary Care | $25 copay DW | $35 copay DW | $30 copay DW | $30 copay DW | $45 copay/ first 3 visits then 40% AD | 0% Co AD | $50 copay DW | $30 copay AD |
| Mental Health/Substance Abuse Services | $25 copay DW | $35 copay DW | $30 copay DW | $30 copay DW | $45 copay/ first 3 visits then 40% AD | 0% Co AD | $50 copay DW | $30 copay AD |
| Specialty Care | $40 copay DW | $60 copay DW | $75 copay DW | $75 copay DW | 40% Co AD | 0% Co AD | $80 copay AD | $50 copay AD |
| Other Practitioner Care | $40 copay DW | $60 copay DW | $75 copay DW | $75 copay DW | 40% Co AD | 0% Co AD | 50% Co AD | 35% Co AD |
| Habilitative Care | 20% Co AD | $60 copay AD | 40% Co AD | 40% Co AD | 40% Co AD | 0% Co AD | 50% Co AD | 35% Co AD |
| Rehabilitative Care | 20% Co AD | $60 copay AD | 40% Co AD | 40% Co AD | 40% Co AD | 0% Co AD | 50% Co AD | 35% Co AD |
| Vision Services | ||||||||
| Adult Annual Routine Vision Exam | No Charge | |||||||
| Pediatric Vision Exam | No Charge | |||||||
| Corrective Lenses | No Charge | 0% Co AD | No Charge | 0% Co AD | ||||
| Prescription Drugs | ||||||||
| Formulary Generic Drugs | $15 copay DW | $15 copay DW | $15 copay DW | $15 copay DW | $30 copay DW | 0% Co AD | $30 copay DW | 35% Co AD |
| Formulary Preferred Brand Drugs | $30 copay DW | $30 copay DW | $30 copay DW | $30 copay DW | $45 copay DW | 0% Co AD | $50 copay DW | 35% Co AD |
| Formulary Non Preferred Brand Drugs | 50% Co AD | 25% Co AD | 50% Co AD | 50% Co AD | 50% Co AD | 0% Co AD | 50% Co AD | 35% Co AD |
| Specialty Drugs | 25% Co AD | 50% Co AD | 25% Co AD | 25% Co AD | 40% Co AD | 0% Co AD | 25% Co AD | 35% Co AD |
| Outpatient Hospital/Facility Services | ||||||||
| Laboratory Services | 20% Co AD | 50% Co AD | 40% Co AD | 40% Co AD | 40% Co AD | 0% Co AD | 50% Co AD | 35% Co AD |
| Radiology Services | 20% Co AD | 50% Co AD | 40% Co AD | 40% Co AD | 40% Co AD | 0% Co AD | 50% Co AD | 35% Co AD |
| Specialized Scanning Services (CT, MRI, PET Scans) | 20% Co AD | 50% Co AD | 40% Co AD | 40% Co AD | 40% Co AD | 0% Co AD | 50% Co AD | 35% Co AD |
| Medical / Surgical Services | 20% Co AD | 50% Co AD | 40% Co AD | 40% Co AD | 40% Co AD | 0% Co AD | 50% Co AD | 35% Co AD |
| Inpatient Hospital Services | ||||||||
| Medical/Surgical, Maternity Care, Mental Health, Substance Abuse, Skilled Nursing Care | 20% Co AD | 50% Co AD | 40% Co AD | 40% Co AD | 40% Co AD | 0% Co AD | 50% Co AD | 35% Co AD |
| Hospice Care | 20% Co AD | 50% Co AD | 40% Co AD | 40% Co AD | 40% Co AD | 0% Co AD | 50% Co AD | 35% Co AD |
| Transportation Assistance | ||||||||
| Emergency Transportation - Ambulance | $250 copay/ trip AD | 50% Co AD | $250 copay/ trip AD | $250 copay/ trip AD | 40% Co AD | 0% Co AD | 50% Co AD | 35% Co AD |
| Non-Emergency Medical and Non-Emergency Non-Medical Transportation to & from Medical Appointments | Not Covered | |||||||
| SUPPLEMENTAL BENEFITS | ||||||||
| MD Live 24/7 Telehealth | No Charge | 0% Co AD | No Charge | 0% Co AD | ||||
| Virtual Visits - Instant Online Care | No Charge | 0% Co AD | No Charge | 0% Co AD | ||||
| 24-Hour Nurse Line | No Charge | |||||||
| U Baby Care - Prenatal & Postnatal Care | No Charge | |||||||
| Tobacco Counseling, Smoking Cessation Program | No Charge | |||||||
2021 Cost Sharing Reduction (CSR) Plans
CSR Plans available through Marketplace Only.
| Plans available through Marketplace Only | SILVER COPAY 73% CSR | SILVER COPAY 87% CSR | SILVER COPAY 94% CSR | SILVER 2300 73% CSR | SILVER 2300 87% CSR | SILVER 2300 94% CSR |
|---|---|---|---|---|---|---|
| FEATURES | ||||||
| Annual Deductible (individual/family) | $3,000/$6,000 | $400/$800 | $0/$0 | $2,300/$4,600 | $400/$800 | $0/$0 |
| Prescription Drug Deductible (individual/family) | $500/$1,000 | $150/$300 | $0/$0 | $500/$1,000 | $200/$400 | $0/$0 |
| Annual Out-of-Pocket Maximum (individual/family) | $6,550/$13,100 | $2,850/$5,700 | $1,600/$3,200 | $6,500/$13,000 | $2,850/$5,700 | $1,500/$3,000 |
| BENEFITS | ||||||
| Emergency and Urgent Care | ||||||
| Emergency Room | $250 copay AD | $250 copay AD | $100 copay AD | $500 copay AD | $250 copay AD | $100 copay AD |
| Urgent Care | $30 copay DW | $10 copay DW | $10 copay DW | $30 copay DW | $20 copay DW | $10 copay DW |
| Office Visits | ||||||
| Preventive Care/Screening/
Immunizations/Well-Child Visits/ Family Planning |
No Charge | |||||
| Primary Care | $30 copay DW | $10 copay DW | $10 copay DW | $30 copay DW | $20 copay DW | $10 copay DW |
| Mental Health/Substance Abuse Services | $30 copay DW | $10 copay DW | $10 copay DW | $30 copay DW | $20 copay DW | $10 copay DW |
| Specialty Care | $60 copay DW | $30 copay DW | $20 copay DW | $60 copay DW | $35 copay DW | $15 copay DW |
| Other Practitioner Care | $60 copay DW | $30 copay DW | $20 copay DW | $60 copay DW | $35 copay DW | $15 copay DW |
| Habilitative Care | 30% Co AD | 25% Co AD | 10% Co AD | $60 copay AD | $35 copay AD | $15 copay AD |
| Rehabilitative Care | 30% Co AD | 25% Co AD | 10% Co AD | $60 copay AD | $35 copay AD | $15 copay AD |
| Vision Services | ||||||
| Adult Annual Routine Vision Exam | No Charge | |||||
| Pediatric Vision Exam | No Charge | |||||
| Corrective Lenses | No Charge | |||||
| Prescription Drugs | ||||||
| Formulary Generic Drugs | $15 copay DW | $15 copay DW | $10 copay DW | $15 copay DW | $15 copay DW | $10 copay DW |
| Formulary Preferred Brand Drugs | $30 copay DW | $30 copay DW | $25 copay DW | $30 copay DW | $30 copay DW | $25 copay DW |
| Formulary Non Preferred Brand Drugs | 50% Co AD | 50% Co AD | 50% Co AD | 25% Co AD | 15% Co AD | 5% Co AD |
| Specialty Drugs | 25% Co AD | 20% Co AD | 20% Co AD | 50% Co AD | 25% Co AD | 15% Co AD |
| Outpatient Hospital/Facility Services | ||||||
| Laboratory Services | 30% Co AD | 25% Co AD | 10% Co AD | 50% Co AD | 20% Co AD | 10% Co AD |
| Radiology Services | 30% Co AD | 25% Co AD | 10% Co AD | 50% Co AD | 20% Co AD | 10% Co AD |
| Specialized Scanning Services (CT, MRI, PET Scans) | 30% Co AD | 25% Co AD | 10% Co AD | 50% Co AD | 20% Co AD | 10% Co AD |
| Medical / Surgical Services | 30% Co AD | 25% Co AD | 10% Co AD | 50% Co AD | 20% Co AD | 10% Co AD |
| Inpatient Hospital Services | ||||||
| Medical/Surgical, Maternity Care, Mental Health, Substance Abuse, Skilled Nursing Care | 30% Co AD | 25% Co AD | 10% Co AD | 50% Co AD | 20% Co AD | 10% Co AD |
| Hospice Care | 30% Co AD | 25% Co AD | 10% Co AD | 50% Co AD | 20% Co AD | 10% Co AD |
| Transportation Assistance | ||||||
| Emergency Transportation - Ambulance | $250 copay/trip AD | $250 copay/trip AD | $250 copay/trip AD | 50% Co AD | 50% Co AD | 50% Co AD |
| Non-Emergency Medical and Non-Emergency Non-Medical Transportation to & from Medical Appointments | Not Covered | |||||
| SUPPLEMENTAL BENEFITS | ||||||
| MD Live 24/7 Telehealth | No Charge | |||||
| Virtual Visits - Instant Online Care | No Charge | |||||
| 24-Hour Nurse Line | No Charge | |||||
| U Baby Care - Prenatal & Postnatal Care | No Charge | |||||
| Tobacco Counseling, Smoking Cessation Program | No Charge | |||||
