Bronze Classic- Standard - 91908OK0010050 Health Insurance Plan
Oscar Insurance Company health insurance plan with the Plan ID 91908OK0010050. The plan is called Bronze Classic- Standard.
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 100.00% (we converted the output of AV Calculator to percentage to compare with data provided by Issuer, it shows the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 0.00% of the costs of all covered benefits (according to the AV Calculator by CMS.gov). More information about AV Calculator methodology.
| Health Insurance Plan ID | 91908OK0010050 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Oklahoma | ||||||||||||||||||
| Health Insurance Issuer | Oscar Insurance Company | ||||||||||||||||||
| Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 91908OK0010050-02 | ||||||||||||||||||
| Provider Network(s) | ['OKN001'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 16 Apr 2024 06:19 GMT). |
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| Available Variants of the Health Plan | Standard Off Exchange Plan - 91908OK0010050-00 Standard On Exchange Plan - 91908OK0010050-01 |
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| Last Plan Update Date | Fri, 24 Feb 2023 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 16 Apr 2024 06:19 GMT |
Benefits of Bronze Classic- Standard Health Insurance Plan, 91908OK0010050-02
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Abortion for Which Public Funding is Prohibited
|
NO | ||
| Accidental Dental
|
YES | $0.00 |
0.00% |
| Acupuncture
|
NO | ||
| Allergy Testing
Issuer clarifies this is a covered benefit but stipulated under the Medical Policy and not written in the member materials. |
YES | $0.00 |
0.00% |
| Bariatric Surgery
|
NO | ||
| Basic Dental Care - Adult
|
NO | ||
| Basic Dental Care - Child
|
NO | ||
| Chemotherapy
|
YES | $0.00 |
0.00% |
| Chiropractic Care
|
YES | $0.00 |
0.00% |
| Cosmetic Surgery
|
NO | ||
| Delivery and All Inpatient Services for Maternity Care
|
YES | $0.00 |
0.00% |
| Dental Check-Up for Children
Limit: 2.0 Visit(s) per Year |
NO | ||
| Diabetes Education
|
YES | $0.00 |
0.00% |
| Dialysis
|
YES | $0.00 |
0.00% |
| Durable Medical Equipment
|
YES | $0.00 |
0.00% |
| Emergency Room Services
|
YES | $0.00 |
$0.00 |
| Emergency Transportation/Ambulance
|
YES | $0.00 |
$0.00 |
| Eye Glasses for Children
Limit: 1.0 Item(s) per Year |
YES | $0.00 |
0.00% |
| Gender Affirming Care
|
YES | $0.00 |
0.00% |
| Generic Drugs
|
YES | $0.00 |
100.00% |
| Habilitation Services
Limit: 25.0 Visit(s) per Benefit Period |
YES | $0.00 |
0.00% |
| Hearing Aids
One hearing aid per ear every 48 months. |
YES | $0.00 |
0.00% |
| Home Health Care Services
Limit: 30.0 Visit(s) per Benefit Period |
YES | $0.00 |
0.00% |
| Hospice Services
|
YES | $0.00 |
0.00% |
| Imaging (CT/PET Scans, MRIs)
|
YES | $0.00 |
0.00% |
| Infertility Treatment
|
NO | ||
| Infusion Therapy
Limit: 25.0 Visit(s) per Benefit Period Covered under Outpatient Therapy Services. |
YES | $0.00 |
0.00% |
| Inpatient Hospital Services (e.g., Hospital Stay)
|
YES | $0.00 |
0.00% |
| Inpatient Physician and Surgical Services
|
YES | $0.00 |
0.00% |
| Laboratory Outpatient and Professional Services
|
YES | $0.00 |
0.00% |
| Long-Term/Custodial Nursing Home Care
|
NO | ||
| Major Dental Care - Adult
|
NO | ||
| Major Dental Care - Child
|
NO | ||
| Mental/Behavioral Health Inpatient Services
Benefits for the treatment of Mental Illness include treatments for drug addiction, substance abuse and alcoholism. |
YES | $0.00 |
0.00% |
| Mental/Behavioral Health Outpatient Services
Benefits for the treatment of Mental Illness include treatments for drug addiction, substance abuse and alcoholism. |
YES | $0.00 |
0.00% |
| Non-Preferred Brand Drugs
|
YES | $0.00 |
100.00% |
| Nutritional Counseling
Diabetes self-management training and training related to medical nutrition therapy. |
YES | $0.00 |
0.00% |
| Orthodontia - Adult
|
NO | ||
| Orthodontia - Child
|
NO | ||
| Other Practitioner Office Visit (Nurse, Physician Assistant)
|
YES | $0.00 |
0.00% |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
|
YES | $0.00 |
0.00% |
| Outpatient Rehabilitation Services
Limit: 30.0 Days per Benefit Period |
YES | $0.00 |
0.00% |
| Outpatient Surgery Physician/Surgical Services
|
YES | $0.00 |
0.00% |
| Preferred Brand Drugs
|
YES | $0.00 |
100.00% |
| Prenatal and Postnatal Care
|
YES | $0.00 |
0.00% |
| Preventive Care/Screening/Immunization
|
YES | $0.00 |
0.00% |
| Primary Care Visit to Treat an Injury or Illness
Virtual visits with an Oscar Care urgent care provider are unlimited and always $0?even if you haven?t hit your deductible. Depending on your plan, many prescriptions and labs will also cost you $0, if they?re ordered by your Oscar Virtual Urgent Care team.* Please refer to your plan documents for more information. *For these savings to apply, they must be prescribed by your Oscar Virtual Urgent Care provider under a Silver, Gold, or Platinum plan. |
YES | $0.00 |
0.00% |
| Private-Duty Nursing
Limit: 85.0 Visit(s) per Benefit Period Pre-authorization required. |
YES | $0.00 |
0.00% |
| Prosthetic Devices
|
YES | $0.00 |
0.00% |
| Radiation
|
YES | $0.00 |
0.00% |
| Reconstructive Surgery
Breast reconstruction or implantation or removal of breast prostheses is a Covered Service only when performed solely and directly as a result of mastectomy which is Medically Necessary. |
YES | $0.00 |
0.00% |
| Rehabilitative Occupational and Rehabilitative Physical Therapy
Limit: 25.0 Visit(s) per Benefit Period Maximum of 25 Outpatient visits for Physical Therapy, Occupational Therapy and Speech Therapy (combined). |
YES | $0.00 |
0.00% |
| Rehabilitative Speech Therapy
Limit: 25.0 Visit(s) per Benefit Period Maximum of 25 Outpatient visits for Physical Therapy, Occupational Therapy and Speech Therapy (combined). |
YES | $0.00 |
0.00% |
| Routine Dental Services (Adult)
|
NO | ||
| Routine Eye Exam (Adult)
|
NO | ||
| Routine Eye Exam for Children
Limit: 1.0 Exam(s) per Year |
YES | $0.00 |
0.00% |
| Routine Foot Care
|
NO | ||
| Skilled Nursing Facility
Limit: 30.0 Days per Benefit Period |
YES | $0.00 |
0.00% |
| Specialist Visit
|
YES | $0.00 |
0.00% |
| Specialty Drugs
|
YES | $0.00 |
100.00% |
| Substance Abuse Disorder Inpatient Services
Benefits for the treatment of Mental Illness include treatments for drug addiction, substance abuse and alcoholism. |
YES | $0.00 |
0.00% |
| Substance Abuse Disorder Outpatient Services
Benefits for the treatment of Mental Illness include treatments for drug addiction, substance abuse and alcoholism. |
YES | $0.00 |
0.00% |
| Transplant
|
YES | $0.00 |
0.00% |
| Treatment for Temporomandibular Joint Disorders
|
NO | ||
| Urgent Care Centers or Facilities
|
YES | $0.00 |
0.00% |
| Weight Loss Programs
|
NO | ||
| Well Baby Visits and Care
|
YES | $0.00 |
0.00% |
| X-rays and Diagnostic Imaging
|
YES | $0.00 |
0.00% |
$0 Cost Share ($0 Primary Care + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan Variant 91908OK0010050-02 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 1 |
| Begin Primary Care Cost-Sharing After Number Of Visits | 0 |
| Begin Primary Care Deductible Coinsurance After Number Of Copays | 0 |
| Business Year | 2023 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Zero Cost Sharing Plan Variation |
| Dental Only Plan | No |
| Design Type | Design 1 |
| Disease Management Programs Offered | Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs |
| EHB Percent of Total Premium | 1 |
| First Tier Utilization | 100% |
| Formulary ID | OKF001 |
| Formulary URL | URL |
| HIOS Product ID | 91908OK001 |
| Import Date | 2/24/2023 1:01 |
| Limited Cost Sharing Plan Variation - Estimated Advanced Payment | $0.00 |
| Inpatient Copayment Maximum Days | 0 |
| HSA Eligible | No |
| New/Existing Plan | New |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer ID | 91908 |
| Issuer Marketplace Marketing Name | Oscar Insurance Company |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Expanded Bronze |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | OKN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Emergency Services only. |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Emergency and Urgent Services only. |
| Plan Brochure | URL |
| Plan Effective Date | 1/1/2023 |
| Plan Expiration Date | 12/31/2023 |
| Plan ID (Standard Component ID with Variant) | 91908OK0010050-02 |
| Plan Marketing Name | Bronze Classic- Standard |
| Plan Type | PPO |
| Plan Variant Marketing Name | $0 Cost Share ($0 Primary Care + $0 Virtual Urgent Care Visits with Select Providers) |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $0 |
| SBC Scenario, Having a Baby, Limit | $0 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $0 |
| SBC Scenario, Having Diabetes, Deductible | $0 |
| SBC Scenario, Having Diabetes, Limit | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | OKS001 |
| Source Name | HIOS |
| Plan ID | 91908OK0010050 |
| State Code | OK |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group | per group not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person | per person not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual | Not Applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group | per group not applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person | per person not applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 0.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group | $0 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person | $0 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $0 |
| Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group | $0 per group |
| Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person | $0 per person |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | $0 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group | $0 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $0 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $0 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group | per group not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person | per person not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | Not Applicable |
| Unique Plan Design | No |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
| Wellness Program Offered | No |
Copay & Coinsurance of Bronze Classic- Standard Health Insurance Plan, 91908OK0010050
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about Bronze Classic- Standard, 91908OK0010050 Health Insurance Plan, 91908OK0010050
-
Does Bronze Classic- Standard Health Insurance Plan, 91908OK0010050 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (91908OK0010050) Health Insurance Plan, Variant (91908OK0010050-02) offer Disease Management Programs?
Does (91908OK0010050) Health Insurance Plan, Variant (91908OK0010050-02) have Out Of Country Coverage?
Does (91908OK0010050) Health Insurance Plan, Variant (91908OK0010050-02) have Out of Service Area Coverage?
Does (91908OK0010050) Health Insurance Plan, Variant (91908OK0010050-02) offer Disease Management Programs?
Does $0 Cost Share ($0 Primary Care + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan, Variant (91908OK0010050-02) offer Disease Management Programs for Asthma?
Does $0 Cost Share ($0 Primary Care + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan, Variant (91908OK0010050-02) offer Disease Management Programs for Heart disease?
Does $0 Cost Share ($0 Primary Care + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan, Variant (91908OK0010050-02) offer Disease Management Programs for Depression?
Does $0 Cost Share ($0 Primary Care + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan, Variant (91908OK0010050-02) offer Disease Management Programs for Diabetes?
Does $0 Cost Share ($0 Primary Care + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan, Variant (91908OK0010050-02) offer Disease Management Programs for High blood pressure & high cholesterol?
Does $0 Cost Share ($0 Primary Care + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan, Variant (91908OK0010050-02) offer Disease Management Programs for Low back pain?
Does $0 Cost Share ($0 Primary Care + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan, Variant (91908OK0010050-02) offer Disease Management Programs for Pregnancy?
Does $0 Cost Share ($0 Primary Care + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan, Variant (91908OK0010050-02) offer Disease Management Programs for Weight loss programs?
Disclaimer: This is based on the import(Date: Tue, 16 Apr 2024 06:19 GMT) of the data from Healthcare Issuers listed by CMS. While we make every effort to ensure that data is accurate, you should assume all results are unvalidated. Source: CMS.gov, HealthPorta HEALTHCARE MRF API