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SelectHealth Med Benchmark Platinum Native American Plan
Your SelectHealth Med Benchmark Platinum Zero Cost Sharing plan provides exceptional coverage with access to the Med network, SelectHealth’s largest statewide network connecting you to Intermountain Health hospitals, specialists, and primary care providers across Utah. This Native American plan has no deductible and no cost sharing for covered in-network medical care, including primary care, specialists, urgent care, hospital services, prescriptions, and more. Virtual visits are also available at no charge, making it easy to get convenient care when you need it. Preventive services and children’s eye exams are fully covered, and members can take advantage of SelectHealth’s wellness resources, member discounts, and convenient tools for managing care and prescriptions. With the broad reach of the Med network and $0 cost sharing on covered services, this plan offers outstanding access to care throughout Utah.
Carrier
SelectHealth
Plan Year
2027
Plan State
Utah
Deductible
$0
Individual
$0
Family
Maximum Out of Pocket
$0
Individual
$0
Family
Doctor Visits
Knowing what you’ll pay when you visit the doctor is an important part of choosing the right health insurance plan, especially if you or your family regularly use primary care, specialists, or mental health services. Many plans offer a copay, which is a set dollar amount you pay for a covered visit—for example, a $40 copay means you pay $40 for that visit and the insurance company pays the rest. If a service says “after deductible,” it means you generally pay the full negotiated cost of that care until you have met your plan’s deductible, and then the insurance company begins sharing the cost as outlined by the plan. Understanding whether your regular doctor visits have a simple copay or are subject to the deductible can make a big difference in how much you spend on healthcare throughout the year. Below, you can see what this plan charges for some of the most commonly used doctor visits.
Primary Care Visit
No charge
Specialty Care Visit
No charge
Mental Health Visit
No charge
Virtual Visits*
No charge
*Virtual visits may only cover specific types of services like primary care visits or mental health visits. Please check the full summary of benefits or with your local agent to verify coverage.
Emergency and Urgently Needed Services
Knowing the difference between urgent care and the emergency room can help you get the right care while also avoiding unnecessary medical expenses. Urgent care is generally best for medical problems that need attention quickly but are not life-threatening, such as minor injuries, infections, fevers, or illnesses when your regular doctor isn’t available. The emergency room (ER) is designed for serious or potentially life-threatening situations, such as severe injuries, difficulty breathing, chest pain, or other medical emergencies. Your cost for either type of care will depend on your health plan. A copay is a set amount you pay for the visit, for example, a $75 for urgent care or $500 for an ER visit. If the benefit says “after deductible,” you generally pay the plan’s negotiated cost until your deductible has been met, and then your insurance begins sharing the cost according to the plan benefits. Because ER care can be much more expensive than urgent care, understanding these benefits can help you know what to expect when you need care unexpectedly.
Urgent Care Visit
No charge
Emergency Room Visit
No charge
Ground Ambulance
No charge
Prescription Coverage
Prescription drugs are usually divided into different tiers, and the tier your medication falls into helps determine how much you will pay at the pharmacy. Depending on the health plan, you may see Tier 1 through Tier 4 or 5, or categories such as preferred generic, generic, preferred brand, non-preferred brand, and specialty drugs. Preferred generic medications are typically the lowest-cost option and include many of the common prescriptions people take regularly. Generic drugs may cost a little more, while preferred brand-name drugs are medications the insurance company has negotiated better pricing for. Non-preferred brand drugs generally have higher costs, and specialty medications are usually the most expensive and are often used to treat more complex medical conditions. Below, we show the cost for preferred generic prescriptions, since this is where many commonly used medications fall. If you take a medication in another tier and want to know what it will cost, ask one of our local agents to look it up for you, or you can review the plan’s full Summary of Benefits below for additional prescription cost-sharing information.
Preferred Generic
No charge
Extra Benefits for Children
Many health insurance plans include additional dental and vision benefits for children under age 18, helping families manage the cost of important routine care. Depending on the plan, pediatric benefits may include services like dental exams, cleanings, eye exams, glasses, and other covered dental or vision care. The amount the plan pays and your out-of-pocket costs can vary, so it’s important to review the specific benefits of each plan. If the health plan you are considering does not include pediatric dental or vision coverage, ask one of our local Utah Avenue Insurance agents about adding a separate dental or vision plan so your child can have the additional coverage they need.
Children's Eye Exam
No charge
Children's Glasses
No charge
Children's Dental Check Up
Not covered
Full Summary of Benefits and Helpful Links
Official plan documents, including the Summary of Benefits and Coverage (SBC) and insurance policy, provide more detailed information about how your health plan works, including deductibles, copays, coinsurance, covered services, and other important benefits. You can also use the provider search links to check which doctors, specialists, hospitals, and other healthcare facilities participate in the plan’s network. We recommend reviewing these resources when comparing plans so you can better understand your coverage, expected costs, and whether the doctors and facilities you prefer are included.
Helpful Links
Schedule a consultation with a local health insurance agent
Insurance doesn’t have to be confusing, and you don’t have to figure it out on your own. Our local Utah Avenue Insurance agents are here to help you compare your options, understand your benefits, and find coverage that fits your healthcare needs and your budget. We can help with Marketplace and private health insurance, Medicare Advantage and Medicare Supplements, dental, vision, life insurance, accident coverage, and more. Meet with us in person, virtually, or over the phone—whatever is easiest for you. Best of all, there is no cost to work with one of our agents, so schedule your consultation today and let us help you find the right coverage with confidence.
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The plan benefits, costs, copays, deductibles, networks, and other information shown on this page are provided for general informational purposes and may change. Utah Avenue Insurance makes every effort to provide accurate and up-to-date information; however, the insurance carrier’s official policy documents, Summary of Benefits and Coverage (SBC), and other plan documents will always govern your coverage. Provider networks and prescription drug formularies may also change, so we recommend verifying your doctors, hospitals, and medications before enrolling. If you have questions about a benefit or cost, please contact a Utah Avenue Insurance agent and we’ll be happy to help you review the plan details.