What comes out of my pay?How much will I pay out of my own pocket?What is SimpleNexus contributing?What will I pay after I meet my deductible?Will my doctor be in-network?
Network Options: Select Med Network or Select Value Network
You’ve built a trusting relationship and you want to keep it. But, did you know that you can also save money by using an in-network provider? That’s why you will be able to choose a provider network that is right for you and your family’s health and wellbeing.
(800) 538-5038 | selecthealth.org
Medical Plans
High Deductible Health Plan – Select Med Network – HSA Eligible
This High Deductible Health Plan (HDHP) is supplemented by the contribution that SimpleNexus will make to your Health Savings Account. An important thing to know about the High Deductible Health Plan is that both the family deductible and out-of-pocket maximum are non-embedded. This means the family deductible and the out-of-pocket max could be met collectively, or by one family member. The deductible must be met in full before the plan coinsurance begins to pay, and the family out-of-pocket max must be satisfied in full before the plan will pay at 100% for all members.
Please note that the out-of-network deductible and out-of-pocket maximum are separate from the in-network deductible and out-of-pocket maximum — this means that any services provided by an out-of-network provider will not count towards your in-network deductible or out-of-pocket maximum.
The SelectHealth Med network is affordable and comprehensive. It is a statewide HMO that covers all of Utah, features 37 participating hospitals, and 7,500 participating physicians & providers. Remember: if you have a family member that lives outside of the network area, please contact Human Resources to explore your best options.
This High Deductible Health Plan (HDHP) is supplemented by the contribution that SimpleNexus will make to your Health Savings Account. An important thing to know about the High Deductible Health Plan is that both the family deductible and out-of-pocket maximum are non-embedded. This means the family deductible and the out-of-pocket max could be met collectively, or by one family member. The deductible must be met in full before the plan coinsurance begins to pay, and the family out-of-pocket max must be satisfied in full before the plan will pay at 100% for all members.
Please note that the out-of-network deductible and out-of-pocket maximum are separate from the in-network deductible and out-of-pocket maximum — this means that any services provided by an out-of-network provider will not count towards your in-network deductible or out-of-pocket maximum.
The SelectHealth Med network is affordable and comprehensive. It is a statewide HMO that covers all of Utah, features 37 participating hospitals, and 7,500 participating physicians & providers. Remember: if you have a family member that lives outside of the network area, please contact Human Resources to explore your best options.
High Deductible Health Plan – $2,000 Deductible
Select Med Network
Select Med Network
In-Network
Out-of-Network*
Annual Deductible
You pay up to
$2,000 per individual
$4,000 per family
$2,000 per individual
$4,000 per family
You pay up to
$4,000 per individual
$8,000 per family
$4,000 per individual
$8,000 per family
Coinsurance
You pay 20% AD
You pay 50% AD
Out-of-pocket Maximum
No more than
$4,000 per individual
$8,000 per family
$4,000 per individual
$8,000 per family
No more than
$8,000 per individual
$16,000 per family
$8,000 per individual
$16,000 per family
Preventive Services
You pay
$0 according to government guidelines
$0 according to government guidelines
Not
Covered
Covered
Office Visits
Primary Care
Specialist
Primary Care
Specialist
You pay
20% AD
20% AD
20% AD
20% AD
You pay
50% AD
50% AD
50% AD
50% AD
Mental Health Services
Office Visit
Inpatient
Office Visit
Inpatient
You pay
20% AD
20% AD
20% AD
20% AD
You pay
50% AD
50% AD
50% AD
50% AD
Emergency Services
Urgent Care
Emergency Room
Urgent Care
Emergency Room
You pay
20% AD
20% AD
20% AD
20% AD
You pay
50% AD
Covered as In-Network
50% AD
Covered as In-Network
Inpatient & Outpatient
Inpatient Hospital
Outpatient Surgery
Inpatient Hospital
Outpatient Surgery
You pay
20% AD
20% AD
20% AD
20% AD
You pay
50% AD
50% AD
50% AD
50% AD
Prescription Medication
Generic Brand / Preferred Brand / Non-preferred Brand / Specialty
Retail (30-day supply)
Mail Order (90-day supply)
Mail Order (90-day supply)
You pay $15 AD / $30 AD / $50 AD / $100 AD
You pay up to 2.5x Retail
You pay up to 2.5x Retail
Health Care Account
Health Savings Account (HSA)
AD: After Deductible
* Providers may charge more than the plan allows when you receive services out-of-network. It is recommended that you ask the out-of-network provider about their billed charges before planning care.
This information is designed to help you choose a benefit plan for 2022 only. Please refer to the Plan Documents provided by the carrier for information regarding coverage, limitations and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
* Providers may charge more than the plan allows when you receive services out-of-network. It is recommended that you ask the out-of-network provider about their billed charges before planning care.
This information is designed to help you choose a benefit plan for 2022 only. Please refer to the Plan Documents provided by the carrier for information regarding coverage, limitations and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
Tax Considerations
In general, you pay for medical coverage before federal, state, and social security taxes are withheld, so you pay less in taxes. Please note that domestic partner contributions are regulated by the IRS and generally must be made on an after-tax basis. Similarly, the company contribution toward the cost of domestic partner coverage and his/her dependents is taxable income to you. Contact your tax advisor for more details on how this tax treatment applies to your specific situation.
In general, you pay for medical coverage before federal, state, and social security taxes are withheld, so you pay less in taxes. Please note that domestic partner contributions are regulated by the IRS and generally must be made on an after-tax basis. Similarly, the company contribution toward the cost of domestic partner coverage and his/her dependents is taxable income to you. Contact your tax advisor for more details on how this tax treatment applies to your specific situation.
Select Med HDHP Premiums
Total Monthly
Premium
Premium
SimpleNexus
Monthly Cost
Monthly Cost
Employee
Monthly Cost
Monthly Cost
Employee Per
Pay Period Cost
Pay Period Cost
Employee (EE) Only
$391.60
$360.30
$31.30
$15.65
EE + Spouse / Domestic Partner
$881.20
$810.70
$70.50
$35.25
EE + Child(ren)
$842.00
$774.60
$67.40
$33.70
EE + Family
$1,214.10
$1,117.00
$97.10
$48.55
SimpleNexus HSA Contributions
Annual
Contribution
Contribution
Per Pay Period
Contribution
Contribution
Employee (EE) Only
$750
$31.25
EE + Spouse / Domestic Partner
$1,000
$41.67
EE + Child(ren)
$1,250
$52.08
EE + Family
$1,250
$52.08
High Deductible Health Plan – Select Value Network – HSA Eligible
This High Deductible Health Plan (HDHP) is supplemented by the contribution that SimpleNexus will make to your Health Savings Account. An important thing to know about the High Deductible Health Plan is that both the family deductible and out-of-pocket maximum are non-embedded. This means the family deductible and the out-of-pocket max could be met collectively, or by one family member. The deductible must be met in full before the plan coinsurance begins to pay, and the family out-of-pocket max must be satisfied in full before the plan will pay at 100% for all members.
The SelectHealth Value network is a highly integrated regional network that features 11 participating hospitals and 5,800 participating physicians & providers. Though this network is smaller and does not offer out-of-network coverage, it is considered to be the best value available in Utah. The Select Value network is only available in the following counties:
This High Deductible Health Plan (HDHP) is supplemented by the contribution that SimpleNexus will make to your Health Savings Account. An important thing to know about the High Deductible Health Plan is that both the family deductible and out-of-pocket maximum are non-embedded. This means the family deductible and the out-of-pocket max could be met collectively, or by one family member. The deductible must be met in full before the plan coinsurance begins to pay, and the family out-of-pocket max must be satisfied in full before the plan will pay at 100% for all members.
The SelectHealth Value network is a highly integrated regional network that features 11 participating hospitals and 5,800 participating physicians & providers. Though this network is smaller and does not offer out-of-network coverage, it is considered to be the best value available in Utah. The Select Value network is only available in the following counties:
- Box Elder County
- Cache County
- Davis County
- Iron County
- Morgan County
- Salt Lake County
- Summit County
- Tooele County
- Utah County
- Wasatch County
- Washington County
- Weber County
Remember: in the event of an emergency, even if you are outside of the covered area, your services will be covered as if in-network.
High Deductible Health Plan – $2,000 Deductible
Select Value Network
Select Value Network
In-Network Only
Annual Deductible
You pay up to
$2,000 per individual
$4,000 per family
$2,000 per individual
$4,000 per family
Coinsurance
You pay 20% AD
Out-of-pocket Maximum
No more than
$4,000 per individual
$8,000 per family
$4,000 per individual
$8,000 per family
Preventive Services
You pay
$0 according to government guidelines
$0 according to government guidelines
Office Visits
Primary Care
Specialist
Primary Care
Specialist
You pay
20% AD
20% AD
20% AD
20% AD
Mental Health Services
Office Visit
Inpatient
Office Visit
Inpatient
You pay
20% AD
20% AD
20% AD
20% AD
Emergency Services
Urgent Care
Emergency Room
Urgent Care
Emergency Room
You pay
20% AD
20% AD
20% AD
20% AD
Inpatient & Outpatient
Inpatient Hospital
Outpatient Surgery
Inpatient Hospital
Outpatient Surgery
You pay
20% AD
20% AD
20% AD
20% AD
Prescription Medication
Generic Brand / Preferred Brand / Non-preferred Brand / Specialty
Retail (30-day supply)
Mail Order (90-day supply)
Mail Order (90-day supply)
You pay $15 AD / $30 AD / $50 AD / $100 AD
You pay up to 2.5x Retail
You pay up to 2.5x Retail
Health Care Account
Health Savings Account (HSA)
AD: After Deductible
This information is designed to help you choose a benefit plan for 2022 only. Please refer to the Plan Documents provided by the carrier for information regarding coverage, limitations and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
This information is designed to help you choose a benefit plan for 2022 only. Please refer to the Plan Documents provided by the carrier for information regarding coverage, limitations and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
Tax Considerations
In general, you pay for medical coverage before federal, state, and social security taxes are withheld, so you pay less in taxes. Please note that domestic partner contributions are regulated by the IRS and generally must be made on an after-tax basis. Similarly, the company contribution toward the cost of domestic partner coverage and his/her dependents is taxable income to you. Contact your tax advisor for more details on how this tax treatment applies to your specific situation.
In general, you pay for medical coverage before federal, state, and social security taxes are withheld, so you pay less in taxes. Please note that domestic partner contributions are regulated by the IRS and generally must be made on an after-tax basis. Similarly, the company contribution toward the cost of domestic partner coverage and his/her dependents is taxable income to you. Contact your tax advisor for more details on how this tax treatment applies to your specific situation.
Select Value HDHP Premiums
Total Monthly
Premium
Premium
SimpleNexus
Monthly Cost
Monthly Cost
Employee
Monthly Cost
Monthly Cost
Employee Per
Pay Period Cost
Pay Period Cost
Employee (EE) Only
$360.30
$360.30
$0.00
$0.00
EE + Spouse / Domestic Partner
$810.70
$810.70
$0.00
$0.00
EE + Child(ren)
$774.60
$774.60
$0.00
$0.00
EE + Family
$1,117.00
$1,117.00
$0.00
$0.00
SimpleNexus HSA Contributions
Annual
Contribution
Contribution
Per Pay Period
Contribution
Contribution
Employee (EE) Only
$750
$31.25
EE + Spouse / Domestic Partner
$1,000
$41.67
EE + Child(ren)
$1,250
$52.08
EE + Family
$1,250
$52.08
Traditional Health Plan – Select Med Network
An important thing to know about the Traditional plan is that it’s embedded for both the family deductible and out-of-pocket maximum. This means that on a family plan each covered member must meet their individual deductible before coinsurance begins for that covered member and each covered member has an individual out-of-pocket maximum that must be met before the plan will cover 100% of eligible costs.
The SelectHealth Med network is affordable and comprehensive. It is a statewide HMO that covers all of Utah, features 37 participating hospitals, and 7,500 participating physicians & providers. Remember: if you have a family member that lives outside of the network area, please contact Human Resources to explore your best options.
An important thing to know about the Traditional plan is that it’s embedded for both the family deductible and out-of-pocket maximum. This means that on a family plan each covered member must meet their individual deductible before coinsurance begins for that covered member and each covered member has an individual out-of-pocket maximum that must be met before the plan will cover 100% of eligible costs.
The SelectHealth Med network is affordable and comprehensive. It is a statewide HMO that covers all of Utah, features 37 participating hospitals, and 7,500 participating physicians & providers. Remember: if you have a family member that lives outside of the network area, please contact Human Resources to explore your best options.
Traditional Health Plan – $1,000 Deductible
Select Med Network
Select Med Network
In-Network
Out-of-Network*
Annual Deductible
You pay up to
$1,000 per individual
$1,000 per member / $2,000 per family
$1,000 per individual
$1,000 per member / $2,000 per family
You pay up to
$2,000 per individual
$2,000 per member / $4,000 per family
$2,000 per individual
$2,000 per member / $4,000 per family
Coinsurance
You pay 20% AD
You pay 40% AD
Out-of-pocket Maximum
No more than
$4,000 per individual
$4,000 per member / $8,000 per family
$4,000 per individual
$4,000 per member / $8,000 per family
No more than
$8,000 per individual
$8,000 per member / $16,000 per family
$8,000 per individual
$8,000 per member / $16,000 per family
Preventive Services
You pay
$0 according to government guidelines
$0 according to government guidelines
Not
Covered
Covered
Office Visits
Primary Care
Specialist
Primary Care
Specialist
You pay
$25 copay
$35 copay
$25 copay
$35 copay
You pay
40% AD
40% AD
40% AD
40% AD
Mental Health Services
Office Visit
Inpatient
Office Visit
Inpatient
You pay
$25 copay
20% AD
$25 copay
20% AD
You pay
40% AD
40% AD
40% AD
40% AD
Emergency Services
Urgent Care
Emergency Room
Urgent Care
Emergency Room
You pay
$35 copay
$250 copay
$35 copay
$250 copay
You pay
40% AD
Covered as In-Network
40% AD
Covered as In-Network
Inpatient & Outpatient
Inpatient Hospital
Outpatient Surgery
Inpatient Hospital
Outpatient Surgery
You pay
20% AD
20% AD
20% AD
20% AD
You pay
40% AD
40% AD
40% AD
40% AD
Prescription Medication
Generic Brand / Preferred Brand / Non-preferred Brand / Specialty
Retail (30-day supply)
Mail Order (90-day supply)
Mail Order (90-day supply)
You pay $15 copay / $30 copay / $50 copay / $100 copay
You pay up to 2.5x Retail
You pay up to 2.5x Retail
AD: After Deductible
* Providers may charge more than the plan allows when you receive services out-of-network. It is recommended that you ask the out-of-network provider about their billed charges before planning care.
This information is designed to help you choose a benefit plan for 2022 only. Please refer to the Plan Documents provided by the carrier for information regarding coverage, limitations and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
* Providers may charge more than the plan allows when you receive services out-of-network. It is recommended that you ask the out-of-network provider about their billed charges before planning care.
This information is designed to help you choose a benefit plan for 2022 only. Please refer to the Plan Documents provided by the carrier for information regarding coverage, limitations and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
Tax Considerations
In general, you pay for medical coverage before federal, state, and social security taxes are withheld, so you pay less in taxes. Please note that domestic partner contributions are regulated by the IRS and generally must be made on an after-tax basis. Similarly, the company contribution toward the cost of domestic partner coverage and his/her dependents is taxable income to you. Contact your tax advisor for more details on how this tax treatment applies to your specific situation.
In general, you pay for medical coverage before federal, state, and social security taxes are withheld, so you pay less in taxes. Please note that domestic partner contributions are regulated by the IRS and generally must be made on an after-tax basis. Similarly, the company contribution toward the cost of domestic partner coverage and his/her dependents is taxable income to you. Contact your tax advisor for more details on how this tax treatment applies to your specific situation.
Select Med Traditional Premiums
Total Monthly
Premium
Premium
SimpleNexus
Monthly Cost
Monthly Cost
Employee
Monthly Cost
Monthly Cost
Employee Per
Pay Period Cost
Pay Period Cost
Employee (EE) Only
$473.50
$360.30
$113.20
$56.60
EE + Spouse / Domestic Partner
$1,065.50
$810.70
$254.80
$127.40
EE + Child(ren)
$1,018.10
$774.60
$243.50
$121.75
EE + Family
$1,468.00
$1,117.00
$351.00
$175.50
Traditional Health Plan – Select Value Network
An important thing to know about the Traditional plan is that it’s embedded for both the family deductible and out-of-pocket maximum. This means that on a family plan each covered member must meet their individual deductible before coinsurance begins for that covered member and each covered member has an individual out-of-pocket maximum that must be met before the plan will cover 100% of eligible costs.
The SelectHealth Value network is a highly integrated regional network that features 11 participating hospitals and 5,800 participating physicians & providers. Though this network is smaller and does not offer out-of-network coverage, it is considered to be the best value available in Utah. The Select Value network is only available in the following counties:
An important thing to know about the Traditional plan is that it’s embedded for both the family deductible and out-of-pocket maximum. This means that on a family plan each covered member must meet their individual deductible before coinsurance begins for that covered member and each covered member has an individual out-of-pocket maximum that must be met before the plan will cover 100% of eligible costs.
The SelectHealth Value network is a highly integrated regional network that features 11 participating hospitals and 5,800 participating physicians & providers. Though this network is smaller and does not offer out-of-network coverage, it is considered to be the best value available in Utah. The Select Value network is only available in the following counties:
- Box Elder County
- Cache County
- Davis County
- Iron County
- Morgan County
- Salt Lake County
- Summit County
- Tooele County
- Utah County
- Wasatch County
- Washington County
- Weber County
Remember: in the event of an emergency, even if you are outside of the covered area, your services will be covered as if in-network.
Traditional Health Plan – $1,000 Deductible
Select Value Network
Select Value Network
In-Network Only
Annual Deductible
You pay up to
$1,000 per individual
$1,000 per individual / $2,000 per family
$1,000 per individual
$1,000 per individual / $2,000 per family
Coinsurance
You pay 20% AD
Out-of-pocket Maximum
No more than
$4,000 per individual
$4,000 per individual / $8,000 per family
$4,000 per individual
$4,000 per individual / $8,000 per family
Preventive Services
You pay
$0 according to government guidelines
$0 according to government guidelines
Office Visits
Primary Care
Specialist
Primary Care
Specialist
You pay
$25 copay
$35 copay
$25 copay
$35 copay
Mental Health Services
Office Visit
Inpatient
Office Visit
Inpatient
You pay
$25 copay
20% AD
$25 copay
20% AD
Emergency Services
Urgent Care
Emergency Room
Urgent Care
Emergency Room
You pay
$35 copay
$250 copay
$35 copay
$250 copay
Inpatient & Outpatient
Inpatient Hospital
Outpatient Surgery
Inpatient Hospital
Outpatient Surgery
You pay
20% AD
20% AD
20% AD
20% AD
Prescription Medication
Generic Brand / Preferred Brand / Non-preferred Brand / Specialty
Retail (30-day supply)
Mail Order (90-day supply)
Mail Order (90-day supply)
You pay $15 copay / $30 copay / $50 copay / $100 copay
You pay up to 2.5x Retail
You pay up to 2.5x Retail
Health Care Account
Health Savings Account (HSA)
AD: After Deductible
This information is designed to help you choose a benefit plan for 2022 only. Please refer to the Plan Documents provided by the carrier for information regarding coverage, limitations and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
This information is designed to help you choose a benefit plan for 2022 only. Please refer to the Plan Documents provided by the carrier for information regarding coverage, limitations and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
Tax Considerations
In general, you pay for medical coverage before federal, state, and social security taxes are withheld, so you pay less in taxes. Please note that domestic partner contributions are regulated by the IRS and generally must be made on an after-tax basis. Similarly, the company contribution toward the cost of domestic partner coverage and his/her dependents is taxable income to you. Contact your tax advisor for more details on how this tax treatment applies to your specific situation.
In general, you pay for medical coverage before federal, state, and social security taxes are withheld, so you pay less in taxes. Please note that domestic partner contributions are regulated by the IRS and generally must be made on an after-tax basis. Similarly, the company contribution toward the cost of domestic partner coverage and his/her dependents is taxable income to you. Contact your tax advisor for more details on how this tax treatment applies to your specific situation.
Select Value Traditional Premiums
Total Monthly
Premium
Premium
SimpleNexus
Monthly Cost
Monthly Cost
Employee
Monthly Cost
Monthly Cost
Employee Per
Pay Period Cost
Pay Period Cost
Employee (EE) Only
$435.60
$360.30
$75.30
$37.65
EE + Spouse / Domestic Partner
$980.20
$810.70
$169.50
$84.75
EE + Child(ren)
$936.60
$774.60
$162.00
$81.00
EE + Family
$1,350.60
$1,117.00
$233.60
$116.80
