FEHB Member Guide
2019
FEDERAL EMPLOYEES— YOU SERVE US, LET US SERVE YOU. TABLE OF CONTENTS
3 Why SelectHealth®
4 We Can Help
7 Wellness Resources
9 SelectHealth MedSM
10 Preventive Care
12 SelectHealth Prescriptions®
13 My Health
14 HDHP Option Benefits
15 Standard Option Benefits
16 High Option Benefits
18 Participating Hospitals
19 InstacareSM and KidscareSM
20 2019 Rate Information Why SelectHealth
Our mission is Helping People Live the Healthiest Lives Possible®. For more than 30 years, we’ve been committed to helping members like you stay healthy, offering personalized service, and providing access to high-quality care. Our mission is the foundation of everything we do. Get to know us a little better.
WE'RE LOCAL. We live, work, and play in the same communities you do. When you call us, you’re talking to someone who lives in your community—or the one next to yours. We use the same providers and clinics you do. Isn’t it nice to know that the person picking up the phone is a neighbor?
WE WORK CLOSELY WITH INTERMOUNTAIN HEALTHCARE®. Our integration with Intermountain gives you access to your favorite doctors and facilities and offers more seamless service from SelectHealth. We're working together to help you live a healthy life.
OUR SERVICE IS SUPERIOR. We can answer your toughest questions and help you find the right doctor, clinic, or mental health provider for your needs. We can even schedule an appointment—no referral necessary. When you call us, a real person will pick up the phone in 20 seconds or less.
WE'RE PUTTING YOU IN CHARGE. We want you to have the resources to be your own health advocate. Our Medical Cost Estimator can help you plan ahead by telling you how much a service or procedure will cost. And My Health arms you with information about your benefits, year-to-date totals, claims, lab results, appointments, and more.
This is a brief description of the features of the SelectHealth® FEHB Plan. Before making a final decision, please read the Plan's Federal brochure (RI-73-865). All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure. These benefits are neither offered nor guaranteed under contract with the FEHB Program, but are made available to all Enrollees and family members who become Members of the SelectHealth Plan.
selecthealth.org/fehb 3 We Can Help
Health insurance doesn’t have to be complicated. We can help you with everything from understanding your benefits to finding the right doctor. Our customer service teams are dedicated to providing exceptional service.
MEMBER SERVICES We want to help you understand your insurance plan— when you have a question, give us a call. We also realize that life doesn’t always happen between nine and five, so we’re here late.
7 a.m. to 8 p.m., weekdays 9 a.m. to 2 p.m., Saturdays 844-345-FEHB
MEMBER ADVOCATES MY HEALTH CUSTOMER SERVICES We can help you find the right doctor for your needs. We’ll find No time for a call? Log in to the closest facility or doctor with the My Health and chat with us or request nearest available appointment, a call back at a time that’s more schedule appointments for you, convenient for you. and help you understand and maximize your benefits. selecthealth.org 800-515-2220
4 selecthealth.org/fehb YOUR FEHB ID CARD
You will receive a SelectHealth MedSM ID card that includes your member number, copay information, deductible, prescription drug rates, contact information, and much more. You may be required to show this card at your doctor's office to receive care. For this reason, we recommend carrying this card with you at all times to ensure you get the care you need, when you need it.
Your SelectHealth FEHB plan gives you access to the SelectHealth Med network in Utah, and MultiPlan or PHCS networks for emergency or urgent care services while outside of Utah.
*Your costs may differ from the sample card image.
In-Network Medical Benefits Pharmacy Benefits Medical Deductible: $2000 Formulary: RxSelect BIN: 800008 Preventive Care: 0% Primary Care: $25* Tier 1: $10* MED NETWORK ID: 800000000 Specialty Care: $40* Tier 2: 25%* Connect CareSM: $10* Tier 3: 50%* Urgent Care Clinic: $40* Tier 4: 20%* Emergency Room: $350* Jonathan Doe Tier 5: 20%* *After Medical Deductible SUBSCRIBER
Urgent or emergency care outside of Utah: Member Services: 800-538-5038 Find a Doctor: 800-515-2220 Federal P.O. Box 30192, Salt Lake City UT 84130-0192 Employee selecthealth.org
Refer to the front of your ID card for your Refer to the back of your ID card for SelectHealth SelectHealth member ID number, copay, deductible, contact information and your FEHB networks. and prescription costs.*
INTERMOUNTAIN CONNECT CARE® Healthcare on your schedule—no Connect Care is now lines, no waiting room. Connect only $10 for SelectHealth Care is a convenient way to talk to a provider about urgent medical FEHB Members! issues, no appointment necessary.
Only $10 for SelectHealth FEHB Members!* Download the app or visit intermountainconnectcare.org to get started. *Those on a high deductible health plan may pay up to $49 until deductible is met.
selecthealth.org/fehb 5 Wellness Resources
6 selecthealth.org/fehb Wellness Resources
We want you to live well, so we provide several resources to supplement plan benefits. From discounts to disease management, the SelectHealth Wellness program is designed to help you maintain and enjoy a healthy, happy lifestyle.
CARE MANAGEMENT The process is simple—no enrollment forms, fees, or payroll deductions—just great savings when you mention Our registered nurse care managers offer one-time or that you are a SelectHealth member and show your ID ongoing one-on-one support and help coordinate your card. To learn more, visit selecthealth.org/discounts. care. We provide educational materials, newsletters, and follow-up phone calls. For more information, TOBACCO CESSATION call Care Management at 800-442-5305. One of the most significant things a person can do to SELECTHEALTH HEALTHY BEGINNINGS® improve overall health is to quit smoking. We offer a free program called Quit for Life® that allows participants Our prenatal care program provides emotional support to progress at their own pace from home. For more and coaching for expectant mothers from a team of information, call 866-784-8454. nurse care managers. In addition to pregnancy and prenatal education materials and other over-the- THE WEIGH TO HEALTH® phone screenings, the program includes high-risk care Finding a balance of fitness and nutrition that works for management when needed. For more information, call your body is important for a lasting weight management Healthy BeginningsSM at 866-442-5052. program. The Intermountain Weigh to Health program is MEMBER DISCOUNTS for overweight adults who want to lose weight, improve their health, and feel better every day. We know that embracing a healthy lifestyle is easier when it costs less. As a SelectHealth member, you have access to discounts on everyday products and services that aren't generally covered by your plan, including:
>> Acupuncture >> Health clubs >> Massage therapy >> Hearing aids >> LASIK vision surgery
selecthealth.org/fehb 7 SelectHealth Med
New Layton Hospital 8 selecthealth.org/fehb SelectHealth Med
SelectHealth Med covers all of Utah's Intermountain Healthcare® hospitals, facilities, and physicians, in PRIMARY CARE PROVIDERS addition to thousands of contracted doctors. This A Primary Care Provider (PCP) sees patients for network also covers specialty care facilities like Primary common medical problems, performs routine Children’s Hospital and Huntsman Cancer Hospital for exams, and helps prevent or treat illness. You can cancer treatment. Plus, new in 2019 is the brand new trust a PCP to know your health history, be your Intermountain Layton Hospital. partner in preventive care, and help you find other doctors when you need them. Your Complete Care includes specialists, a free nurse line, online telehealth access through Connect Care, and INTERMOUNTAIN CONNECT CARE® pharmacies nationwide. Visit a provider 24/7 via live online video. Many plans cover this service for only $10, and you’ll Wondering whether your current doctor or neighborhood never pay more than $49 for the visit. clinic is part of the SelectHealth Med network? To find out, visit selecthealth.org/providers. Remember to filter INTERMOUNTAIN INSTACARE® your results by choosing SelectHealth Med from the What’s open late and costs less than the ER? network drop-down menu. Our InstaCare℠ and KidsCare℠ clinics. If you need urgent care, these are great options.
HOSPITALS
PCP Intermountain hospitals span the state of Utah, offering a variety of care and services. Think Health Connect heart care, cancer treatment, transplant services, Answers Care women and newborns, and much more—you name it, they can treat it. YOUR SPECIALISTS When you need more than your PCP, our Emergency InstaCare Care COMPLETE network of specialists and surgeons can help— CARE and there are thousands to choose from. LOCAL CLINICS Intermountain community clinics and contracted Local Hospitals Clinics clinics are in your area, so you never have to drive far to get the care you need. Plus, some Specialists clinics have extended hours!
EMERGENCY CARE If you have an emergency, call 911 or go to the nearest hospital—we’ve got you covered anywhere you are.
INTERMOUNTAIN HEALTH ANSWERS® Our free nurse line is available 24/7 to ease your mind. Call 844-501-6600 about any condition.
selecthealth.org/fehb 9 Preventive Care
LITTLE OR NO COST TO YOU
Our plans cover preventive care 100%—that means no copay, deductible, or coinsurance. For services to be covered as preventive, your doctor must bill claims with preventive codes. If a preventive service identifies a condition that needs further testing or treatment, regular copays, coinsurance, and deductibles may apply.
HOW WE HELP
Our online resources give you access to immunization schedules, tips for better health, A little effort today can have big results and information about preventive care exams and tests. tomorrow. We encourage you to be We provide a newsletter that includes information on health, wellness, benefits, and pharmacy information. proactive about your health and get There is also a section dedicated to nutrition and fitness regular checkups and screenings. that features healthy recipes.
PREVENTIVE CARE
Regular preventive care exams can help maintain optimal For more information about your preventive health and detect and treat concerns early. We provide care benefits, see your Federal brochure, call information, schedules, reminder calls, and mailings to Member Services at 844-345-FEHB, or visit help you seek the appropriate examinations, selecthealth.org/fehb. immunizations, and tests.
10 selecthealth.org/fehb Adult Preventive Services >> Alcohol Misuse Screening Pediatric Preventive Services >> Hepatitis A (ages 18 and older) and Counseling (younger than age 18) >> Hepatitis B Laboratory Tests >> Hearing Screening Procedures/Counseling >> Meningitis (ages 65 and older) >> Complete Blood Count >> Well-Child Visit (preventive >> Varicella (CBC) >> Glaucoma Screening when billed on the following (including MMVR) >> Prostate Cancer Screening >> Sexually Transmitted schedule: birth; 2 to 4 days; >> Rotavirus (PSA) Infections Counseling 2 to 4 weeks; 2, 4, 6, 9, 12, >> Human Papillomavirus >> Diabetes Screening 15, and 18 months; ages 2, >> Dietary Counseling (HPV) (ages 9 to 26) >> Cholesterol Screening (only for certain diet-related 2½; once a year from ages 3 to 18) >> Gonorrhea Screening chronic diseases) >> Primary Care Tobacco >> Human Papillomavirus Immunizations (HPV) Testing (once every Use Intervention >> Influenza 3 years in women ages >> Eye Exam 30 and older) >> Tetanus or Tetanus, >> Developmental Testing >> Chlamydia Screening Diphtheria, and Obstetrical >> Newborn Hearing Screening Preventive Services >> Human Immunodeficiency Pertussis (Td, Tdap) (younger than age 1) Virus (HIV) Screening >> Pneumococcal These are specific to pregnant >> Hearing Screening >> Syphilis Screening >> Hepatitis A women. To determine which (ages 10 and younger) additional non-obstetrical services >> Tuberculosis (TB) Testing >> Meningitis >> Application of Fluoride may be considered preventive, >> Lead Screening >> Zoster (ages 60 and over) Varnish (younger than age 5) please refer to the Adult or >> BRCA 1 & 2 Testing (covered >> Human Papillomavirus Pediatric Preventive Services lists. once per lifetime for Laboratory Tests (HPV) (ages 9 to 26) high-risk individuals who >> Newborn Metabolic Laboratory Tests meet criteria) Contraception Screening >> Iron Deficiency Anemia >> Hepatitis B Virus (HBV) (younger than age 1) Screening Screening (covered for Most contraceptives are covered >> Diabetes Screening high-risk individuals who as a preventive service under >> Human Immunodeficiency meet criteria) your pharmacy benefits. Virus (HIV) Screening >> Urine Study to Detect >> Hepatitis C Virus (HCV) >> Cervical Cap with >> PKU Screening Asymptomatic Bacteriuria Screening (ages 48 and Spermicide (younger than age 1) (first prenatal visit or at 12 to 16 weeks gestation) older or high-risk individuals >> Diaphragm with Spermicide >> Thyroid >> Rubella Screening who meet criteria) >> Emergency Contraception (younger than age 1) Procedures (Ella, Plan B) >> Sickle Cell Disease >> Rh(D) Incompatibility Screening >> Pap Test >> Female Condom Screening (younger than age 1) >> Hepatitis B Infection >> Lung Cancer Screening >> Implantable Rod (between ages 55 and 80) Immunizations Screening (at first >> IUDs prenatal visit) >> Screening Mammogram >> Generic Oral Contraceptives (As recommended by the >> Colon Cancer Screening >> Gonorrhea Screening (Combined Pill, Progestin CDC/ACIP) >> Chlamydia Screening >> Abdominal Aortic Aneurysm Only, or Extended/ >> Measles, Mumps, Screening (males only, once Continuous Use) Rubella (MMR) >> Syphilis Screening between ages 65 and 75) >> Patch >> Diphtheria, Tetanus, Breastfeeding Supplies >> Bone Density/DEXA (once Pertussis (Dtap, DT, DTP) every two years in women >> Shot/Injection and Support ages 60 and older) (Depo-Provera) >> Haemophilus Infuenzae >> Breast Pump, Electronic >> Permanent Sterilization >> Spermicide Type B (Hib, DtaP-Hib-IPV, AC or DC (one per birth) DTP-Hib, Dtap-Hib) Procedures (such as tubal >> Sponge with Spermicide >> Lactation Class (one per ligations/vasectomies) >> Surgical Sterilization for >> Hepatitis B (HepB) birth at a SelectHealth- Examinations/Counseling Women (Tubal Ligation) >> Polio (OPV, IPV, approved facility) >> Physical Exam >> Surgical Sterilization DtaP-Hep-LPV) Implant for Women >> Tobacco Use Counseling >> Influenza >> Vaginal Contraceptive Ring >> Pneumococcal
This information is subject to change at any time and additional limitations may apply. To verify if your service or supply is considered preventive, call Member Services at 844-345-FEHB.
selecthealth.org/fehb 11 Know Before You Fill
COMPARE DRUG PRICES IN MY HEALTH CONVENIENT PHARMACY ACCESS
Log in to My Health to search for covered medications, compare drug prices, and see other information about your prescriptions and benefits. My Health also has INTERMOUNTAIN information about any special requirements, like step HOME DELIVERY PHARMACY therapy or preauthorization, which you and/or your Get your prescriptions delivered for FREE. doctor may need to complete before you can fill a Register online at prescription. If you ever have questions about drugs intermountainrx.org with special requirements, call Member Services or call 855-779-3960. at 844-345-FEHB.
SAVE MONEY WITH LOWER-TIER DRUGS The list of drugs covered by your plan is RxSelect®. INTERMOUNTAIN Your member materials and ID card indicate which drug SPECIALTY PHARMACY list you have, and searchable versions are available on our website. If you take specialty drugs or self-injectables, the Specialty Pharmacy offers the Your drug list has four tiers of coverage. Each tier corresponds to a copay, deductible, or coinsurance convenience of FREE home delivery. As of amount (the amount you pay when you get drugs at the January 1, 2019 use of Intermountain Specialty pharmacy). Look for generics and lower tier alternatives Pharmacy is required for tier 4 drugs. to pay less for effective medications.
>> $ Tier 1 – Lowest Cost (mostly generic drugs) >> $$ Tier 2 – Higher Cost (generic and brand-name drugs) RETAIL 90® >> $$$ Tier 3 – Highest Cost (mostly brand-name drugs) Get a 90-day supply of your maintenance >> $$$$ Tier 4 – Injectable Drugs and Specialty Medications medications at a participating Retail 90 pharmacy—and pay less in most cases.
YOUR LOCAL PHARMACY
From major national chains to the corner drug store, you can get your prescriptions filled pretty much anywhere. Search for participating pharmacies at selecthealth.org.
12 selecthealth.org/fehb My Health – Everything At Your Fingertips
My Health can be accessed from your mobile device or computer by visiting selecthealth.org. Once you log in, click the SelectHealth icon or link and enjoy being an informed healthcare consumer.
MEDICAL COST ESTIMATOR
Get an estimate for common healthcare services. For example, find out ahead of time how much to plan for when having a baby, including charges for the facility, provider, and anesthesiologist, if applicable. Bundling these numbers together, we’ll estimate how much your plan will cover and what you will pay.
HEALTHCARE INFORMATION
Get lab results, faster—many providers upload them directly to My Health. Keep track of appointments, view records, message Intermountain Healthcare doctors, and much more.
CHAT WITH US
No time for a phone call? Use our secure chat feature to talk with Member Services online. Whether you need to know if your medication will be covered or how much a doctor’s bill was, chat can help.
MESSAGE YOUR DOCTOR
With a few clicks you can send a message to your Intermountain doctor about your last visit, recent lab results, or questions about your new prescription.
selecthealth.org/fehb 13 HDHP Option Benefits This is a summary of the features of the SelectHealth Plan. Before making a final decision, please read the Plan’s Federal brochure RI 73-865. All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure.
HDHP OPTION BENEFITS YOU PAY $1,500 per person, per calendar year; Deductible $3,000 Self Plus One or Self & Family, per calendar year Protection against catastrophic costs $5,000 per person, per calendar year; $10,000 per Self Plus One or Self (out-of-pocket maximum)* and Family enrollment, per calendar year MEDICAL SERVICES PROVIDED BY PHYSICIANS $0 preventive exam; $20 primary care after deductible; $30 specialist after Services provided in office deductible, $20 Intermountain KidsCare after deductible; $30 urgent care and Intermountain InstaCare after deductible SERVICES PROVIDED BY A HOSPITAL $150 per day up to $750 per admission, after deductible; Inpatient $0 after deductible (professional fees) Outpatient $150 per day after deductible MATERNITY Physician $0 after deductible Hospital $100 per admission copay, after deductible EMERGENCY BENEFITS In-area/out-of-area emergency room $200 copay after deductible MENTAL HEALTH AND CHEMICAL DEPENDENCY
$20 per office visit, after deductible Mental health and substance use treatment $150 per day for outpatient services, after deductible $150 per day up to $750 per admission, after deductible
PRESCRIPTION DRUGS Tier 1 $7 after deductible Tier 2 $25 after deductible Retail pharmacy (30-day supply) Tier 3 $50 after deductible Tier 4 30% after deductible Our preferred HSA vendor Tier 1 $7 after deductible is HealthEquity®. Please visit Mail order (90-day supply) Tier 2 $50 after deductible Tier 3 $150 after deductible healthequity.com for more Injectable drugs and specialty medications 30% after deductible information about an HSA. (in provider's office) Dental care No benefit Vision care $0 preventive exam; $30 specialist after deductible; eyewear is not covered
*Covered medical and pharmacy expenses are included in the out-of-pocket maximum.
2019 RATE INFORMATION: These rates do not apply to all Enrollees. If you are in a special enrollment category, please refer to the FEHB Program website or contact the agency or Tribal Employer HDHP OPTION that maintains your health benefits enrollment.
Non-Postal Premium Postal Premium
TYPE OF Biweekly Monthly Biweekly ENROLLMENT Enrollment Category 1 Category 2 Gov’t Share Your Share Gov’t Share Your Share Code Your Share Your Share HDHP Option WX1 175.47 58.49 380.18 126.73 56.15 48.55 Self Only HDHP Option WX3 399.92 133.30 866.48 288.83 127.97 110.64 Self Plus One HDHP Option WX2 399.92 133.30 866.48 288.83 127.97 110.64 Self and Family
14 selecthealth.org/fehb Standard Option Benefits This is a summary of the features of the SelectHealth Plan. Before making a final decision, please read the Plan’s Federal brochure RI 73-865. All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure.
STANDARD OPTION BENEFITS YOU PAY $250 per person, per calendar year; Deductible $500 Self Plus One or Self & Family, per calendar year Protection against catastrophic costs $5,500 per person, per calendar year; $11,000 per Self Plus One (out-of-pocket maximum)* or Self and Family enrollment, per calendar year MEDICAL SERVICES PROVIDED BY PHYSICIANS $0 preventive exam; $25 primary care; Services provided in office $35 specialist; $20 Intermountain KidsCare; $35 urgent care and Intermountain InstaCare SERVICES PROVIDED BY A HOSPITAL 15% per admission (facility charges) after deductible; Inpatient 15% (professional fees) after deductible Outpatient 15% after deductible MATERNITY Physician $0 Hospital $200 per admission copay EMERGENCY BENEFITS In-area/out-of-area emergency room $200 copay after deductible MENTAL HEALTH AND CHEMICAL DEPENDENCY
$25 per office visit Mental health and substance use treatment 15% for outpatient services, after deductible 15% per inpatient admit, after deductible
PRESCRIPTION DRUGS Tier 1 $5 Tier 2 $40 Retail pharmacy (30-day supply) Tier 3 50% after deductible, up to $250 Tier 4 30% after deductible Tier 1 $5 Mail order (90-day supply) Tier 2 $80 Tier 3 50% after deductible Injectable drugs and specialty medications (in provider's office) 30% after deductible Dental care No benefit Vision care $0 preventive exam; $35 specialist; eyewear is not covered
*Covered medical and pharmacy expenses are included in the out-of-pocket maximum. 2019 RATE INFORMATION: These rates do not apply to all Enrollees. If you are in a special enrollment category, please refer to the FEHB Program website or contact the agency or Tribal Employer STANDARD OPTION that maintains your health benefits enrollment.
Non-Postal Premium Postal Premium TYPE OF Biweekly Monthly Biweekly ENROLLMENT Enrollment Category 1 Category 2 Gov’t Share Your Share Gov’t Share Your Share Code Your Share Your Share
Standard Option SF4 214.34 71.45 464.41 154.80 68.59 59.30 Self Only
Standard Option SF6 488.51 162.84 1,058.45 352.81 156.32 135.16 Self Plus One
Standard Option SF5 488.51 162.84 1,058.45 352.81 156.32 135.16 Self and Family
selecthealth.org/fehb 15 High Option Benefits This is a summary of the features of the SelectHealth Plan. Before making a final decision, please read the Plan’s Federal brochure RI 73-865. All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure.
HIGH OPTION BENEFITS YOU PAY Deductible $0 Protection against catastrophic costs $5,000 per person, per calendar year; $10,000 per Self Plus (out-of-pocket maximum)* One or Self and Family enrollment, per calendar year MEDICAL SERVICES PROVIDED BY PHYSICIANS $0 preventive exam; $15 primary care; Services provided in office $25 specialist; $15 Intermountain KidsCare; $25 urgent care and Intermountain InstaCare® SERVICES PROVIDED BY A HOSPITAL $250 per admission copay (facility charges); Inpatient 10% (professional fees) Outpatient 10% MATERNITY Physician $0 Hospital $200 per admission copay EMERGENCY BENEFITS In-area/out-of-area emergency room $175 copay MENTAL HEALTH AND CHEMICAL DEPENDENCY $15 per office visit Mental health and substance use treatment 10% for outpatient services $250 per inpatient admit PRESCRIPTION DRUGS Tier 1 $5 Tier 2 $25 Retail pharmacy (30-day supply) Tier 3 $50 Tier 4 30% Tier 1 $5 Mail order (90-day supply) Tier 2 $50 Tier 3 50% Injectable drugs and specialty medications (in provider’s office) 30% Dental care No benefit Vision care $0 preventive exam; $25 specialist; eyewear is not covered *Covered medical and pharmacy expenses are included in the out-of-pocket maximum.
These rates do not apply to all Enrollees. If you are in a special enrollment category, 2019 RATE INFORMATION: please refer to the FEHB Program website or contact the agency or Tribal Employer HIGH OPTION that maintains your health benefits enrollment.
Non-Postal Premium Postal Premium TYPE OF Biweekly Monthly Biweekly ENROLLMENT Enrollment Category 1 Category 2 Gov’t Share Your Share Gov’t Share Your Share Code Your Share Your Share
High Option SF1 230.18 251.88 498.72 545.74 248.68 239.09 Self Only
High Option SF3 492.27 606.44 1,066.59 1,313.95 599.60 579.09 Self Plus One
High Option SF2 525.32 573.39 1,138.19 1,242.35 566.09 544.21 Self and Family
16 selecthealth.org/fehb When you enroll with SelectHealth, you’ll have access to the SelectHealth Med network in Utah. If you are traveling and need urgent or emergency care, call Member Services at 844-345-FEHB.
Coverage in Utah
INSIDE THE SERVICE AREA
HOW IT WORKS When you’re in Utah, use the SelectHealth Med network to receive in-network benefits.
SelectHealth Member Advocates SelectHealth Member Advocates® are available during extended hours to help you find FINDING A the right doctor or other provider for your needs. They can even help schedule an PROVIDER appointment. To contact Member Advocates, call 800-515-2220 weekdays, from 7:00 a.m. to 8:00 p.m., and Saturdays, from 9:00 a.m. to 2:00 p.m. To access the online provider directory, visit selecthealth.org/fehb.
Outside of Utah Members may save money on out-of-area services by using BrightPath and St. Luke's Health Partners in Idaho, or by using Multiplan or PHCS providers and TRAVELING facilities when outside of Utah and Idaho. OUTSIDE THE In an effort to reduce out-of-pocket expenses for emergencies, SelectHealth has an SERVICE AREA arrangement with these providers who have agreed to accept an allowed amount for covered services. If possible, use these providers and facilities for urgent or emergency care.
Dependent children who live outside the service area will receive in-network benefits for covered services when they use SelectHealth Med providers in Utah, and MultiPlan or PHCS outside of Utah. Members must inform SelectHealth (through a dependent address OUT-OF-AREA change form) if they have a dependent residing outside the service area in order to DEPENDENT receive this coverage. To access this form, please visit selecthealth.org/fehb. Otherwise, COVERAGE service access outside the service area is limited to only those services that meet the definition of urgent or emergency care. Federal employees, annuitants, and spousal dependents are not eligible for this extended out-of-area coverage. For the definition of eligible dependent children, please refer to FEHB Facts in your Federal Brochure.
Always present your ID card when visiting providers or facilities. The logos on the card give you access to these providers.
selecthealth.org/fehb 17 In-Network Hospitals and Facilities Intermountain InstaCare and KidsCare Clinics SelectHealth FEHB members have access to Intermountain Healthcare’s nationally recognized facilities and contracted hospitals. All of the facilities meet our high-quality standards.
Salt Lake Area Alta View Hospital Huntsman Cancer Hospital Intermountain Medical Center
Logan Regional Hospital LDS Hospital Primary Children’s Hospital Bear River Valley Hospital Riverton Hospital TOSH®—The Orthopedic Specialty Hospital McKay-Dee Hospital Center
Davis Hospital & Med. Center
Layton Hospital
Park City Hospital Mountain West Med. Center Ashley Valley Med. Center
Heber Valley Med. Center American Fork Hospital
Orem Community Hospital Uintah Basin Med. Center
Utah Valley Hospital
Central Valley Med. Center MCH
Sanpete Valley Hospital Castleview Hospital Delta Community Hospital
Gunnison Valley Hospital
Fillmore Community Hospital
Sevier Valley Hospital
Milford Valley Memorial Hospital Moab Regional Hospital
Beaver Valley Hospital
San Juan Hospital Garfield Memorial Hospital
Blue Mountain Hospital Cedar City Hospital
Dixie Regional Med. Center (400 E. & River Rd. Campuses) Kane County Hospital
18 selecthealth.org/fehb Intermountain InstaCare and KidsCare Clinics
SelectHealth FEHB members have access to urgent care clinics owned by Intermountain Healthcare (shown on this map), as well as other participating clinics statewide.
InstaCare Hyde Park Logan Brigham City North Ogden InstaCare & KidsCare South Ogden Roy (Herefordshire)efor Syracuser Ogden KidsCare Layton (Northern Kaysville Utah) Salt Lake City Bountiful Holladay Murray Park City Tooele Sugar House (Memorial) Taylorsville Sandy West Jordan Sandy (Mountain View) Riverton (Southridge) Draper Saratoga Springs Highland North Orem American Fork Provo Springville Payson
To help you make informed choices about healthcare providers and clinics, our website contains information about participating providers, clinic quality scores, and patient satisfaction ratings. Visit selecthealth.org/fehb.
Cedar City
Hurricane
St. George (Sunset) St. George (River Road)
selecthealth.org/fehb 19 2019 Rate Information for the SelectHealth High, Standard, and High Deductible Health Plan Options
These rates do not apply to all Enrollees. If you are in a special enrollment category, please refer to the FEHB Program website or contact the agency or Tribal Employer which maintains your health benefits enrollment.
Non-Postal Premium Postal Premium
TYPE OF ENROLLMENT Biweekly Monthly Biweekly
Enrollment Gov’t Gov’t Category 1 Category 2 Your Share Your Share Code Share Share Your Share Your Share High Option SF1 230.18 251.88 498.72 545.74 248.68 239.09 Self Only High Option SF3 492.27 606.44 1,066.59 1,313.95 599.60 579.09 Self Plus One High Option SF2 525.32 573.39 1,138.19 1,242.35 566.09 544.21 Self and Family Standard Option SF4 214.34 71.45 464.41 154.80 68.59 59.30 Self Only Standard Option SF6 488.51 162.84 1,058.45 352.81 156.32 135.16 Self Plus One Standard Option SF5 488.51 162.84 1,058.45 352.81 156.32 135.16 Self and Family HDHP Option WX1 175.47 58.49 380.18 126.73 56.15 48.55 Self Only HDHP Option WX3 399.92 133.30 866.48 288.83 127.97 110.64 Self Plus One HDHP Option WX2 399.92 133.30 866.48 288.83 127.97 110.64 Self and Family
SelectHealth complies with applicable Federal civil rights laws and does not discriminate on the basis QUESTIONS? MEMBER SERVICES of race, color, national origin, age, disability, or sex. Contact us 844-345-FEHB ATENCIÓN: Si habla español, tiene a su disposición SELECTHEALTH WEBSITE servicios gratuitos de asistencia lingüística. Llame a selecthealth.org/fehb SelectHealth: 1-800-538-5038 (TTY: 711). 注意：如果您使用繁體中文，您可以免費獲得語 言援助服務。請致電 SelectHealth: 1-800-538-5038 (TTY: 711).
© 2018 Intermountain Healthcare and SelectHealth. All rights reserved. 15193730 10/18