Secure - 43490KS0010011 Health Insurance Plan

Oscar Insurance Company health insurance plan with the Plan ID 43490KS0010011. The plan is called Secure.

Health Insurance Plan ID 43490KS0010011
Health Insurance Plan Year 2023
State Kansas
Health Insurance Issuer Oscar Insurance Company
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 43490KS0010011-00
Provider Network(s) ['KSN001']
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Wed, 27 Mar 2024 12:10 GMT).

Providers Kansas All US States
All N/A N/A
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A
Available Variants of the Health Plan

Standard Off Exchange Plan - 43490KS0010011-00

Standard On Exchange Plan - 43490KS0010011-01

Last Plan Update Date Fri, 24 Feb 2023 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

Benefits of Secure Health Insurance Plan, 43490KS0010011-00

Benefit Covered In Network Out Of Network
Abortion for Which Public Funding is Prohibited
NO
Accidental Dental

Oral Surgical Services and Services for Accidental Injuries to Sound Natural Teeth, limited to: (1) Surgical procedures of the jaw and gums. (2) Removal of tumors and cysts of the jaws, cheeks, lips, tongue, roof and floor of the mouth. (3) Removal of exostoses (bony growths) of the jaw and hard palate. (4) Treatment of fractures and dislocations of the jaw and facial bones. (5) Surgical removal of impacted teeth. (6) Treatment of Sound Natural Teeth caused by an Accidental Injury. This includes replacement of Sound Natural Teeth lost due to the Accidental Injury. (7) Intra oral dental imaging services in connection with covered oral surgery if treatment begins within 30 days. (8) General anesthesia for covered oral surgery. (9) Cylindrical endosseous dental implants, mandibular staple implants, subperiosteal implants and the associated fixed and/or removable prosthetic appliance when provided because of an Accidental Injury. (10) Cylindrical endosseous dental implants, mandibular staple implants, subperiosteal implants andthe associated fixed and/or removable prosthetic appliances following surgical resection of either benign or malignant lesions (NOT including inflammatory lesions).

YES

$0.00 Copay after deductible

100.00%
Acupuncture
NO
Allergy Testing

Allergy testing and treatment.

YES

$0.00 Copay after deductible

100.00%
Bariatric Surgery
NO
Basic Dental Care - Adult
NO
Basic Dental Care - Child
NO
Chemotherapy
YES

0.00% Coinsurance after deductible

100.00%
Chiropractic Care
YES

$0.00 Copay after deductible

100.00%
Cosmetic Surgery
NO
Delivery and All Inpatient Services for Maternity Care

Also covers surrogate mother if there is a petition to adopt within 90 days of birth.

YES

$0.00 Copay after deductible

100.00%
Dental Check-Up for Children
NO
Diabetes Education

Outpatient self-management training and education, including medical nutrition therapy, for insulin dependent diabetes, insulin-using diabetes, gestational diabetes and noninsulin using diabetes when provided by a certified, registered or licensed health care professional with expertise in diabetes and the diabetic (1) is treated at a program approved by the American Diabetes Association; (2) is treated by a person certified by the national certification board of diabetes educators; or (3) is, as to nutritional education, treated by a licensed dietitian pursuant to a treatment plan authorized by such healthcare professional.

YES

$0.00 Copay after deductible

100.00%
Dialysis

Plan cover Hemodialysis.

YES

0.00% Coinsurance after deductible

100.00%
Durable Medical Equipment

Benefits are limited to the amount normally available for a basic (standard) item which allows necessary function. Basic (standard) medical equipment is equipment that provides the essential function required for the treatment or amelioration of the medical condition at a Medically Necessary level. Charges for deluxe or electrically operated medical equipment are not covered, beyond the extent allowed for basic (standard) items. Deluxe describes medical equipment that has enhancements that allow for additional convenience or use beyond that provided by basic (standard) equipment.

YES

0.00% Coinsurance after deductible

100.00%
Emergency Room Services
YES

$0.00 Copay after deductible

$0.00 Copay after deductible
Emergency Transportation/Ambulance

Emergency transportation/ambulance within 500 mile radius.

YES

$0.00 Copay after deductible

$0.00 Copay after deductible
Eye Glasses for Children
YES

$0.00 Copay after deductible

100.00%
Gender Affirming Care
YES

$0.00 Copay after deductible

100.00%
Generic Drugs
YES

$0.00 Copay after deductible

100.00%
Habilitation Services

Supplementing with the federal definition of habilitative services: Health care services that help a person keep, learn, or improve skills and functioning for daily living. Examples include therapy for a child who is not walking or talking at the expected age. These services may include physical and occupational therapy, speech-language pathology and other services for people with disabilities in a variety of inpatient and/or outpatient settings.

YES

$0.00 Copay after deductible

100.00%
Hearing Aids
NO
Home Health Care Services

Includes educational visits with a limit of three per year on educational visits.

YES

$0.00 Copay after deductible

100.00%
Hospice Services
YES

0.00% Coinsurance after deductible

100.00%
Imaging (CT/PET Scans, MRIs)
YES

$0.00 Copay after deductible

100.00%
Infertility Treatment

Plan covers Diagnosis and treatment of cause of infertility. Benefits are available for covered services such as office visits, laboratory tests, and radiological studies to diagnose the cause of infertility. Benefits are also provided for the necessary treatment of the condition unless the treatment is identified as non-covered (see exclusions). For example, corrective surgical procedures, therapeutic injections, and drug therapy regimens (Pregnyl, Clomid, Clomiphene, Ovidrel, Gonal, Follistim and Cetrotide) are all covered services when medically necessary. Benefits are also available for tests, such as ultrasound, performed to monitor the effectiveness of the fertility drug therapy. Also for any necessary pregnancy testing performed as an integral part of the overall infertility treatment program. Benefits are excluded, however, for any procedures, tests, or other services that are exclusively provided to monitor the effectiveness of non-covered fertilization procedures.

YES

$0.00 Copay after deductible

100.00%
Infusion Therapy
YES

0.00% Coinsurance after deductible

100.00%
Inpatient Hospital Services (e.g., Hospital Stay)
YES

No Charge after deductible

100.00%
Inpatient Physician and Surgical Services
YES

$0.00 Copay after deductible

100.00%
Laboratory Outpatient and Professional Services
YES

$0.00 Copay after deductible

100.00%
Long-Term/Custodial Nursing Home Care
NO
Major Dental Care - Adult
NO
Major Dental Care - Child
NO
Mental/Behavioral Health Inpatient Services
YES

$0.00 Copay after deductible

100.00%
Mental/Behavioral Health Outpatient Services
YES

$0.00 Copay after deductible

100.00%
Non-Preferred Brand Drugs
YES

$0.00 Copay after deductible

100.00%
Nutritional Counseling
NO
Orthodontia - Adult
NO
Orthodontia - Child
NO
Other Practitioner Office Visit (Nurse, Physician Assistant)

Professional Providers include Physician Assistants. Registered Nurses qualify as Eligible Providers.

YES

$0.00 Copay after deductible

100.00%
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
YES

$0.00 Copay after deductible

100.00%
Outpatient Rehabilitation Services

Limit: 90.0 Days per Benefit Period

These therapies include but are not limited to PT, OT, and ST. Further, '(Rehab) services are covered only if they are expected to result in significant improvement in the Insured's condition. The Company, with appropriate medical consultation, will determine whether significant improvement has occurred'. 'Speech Therapy', limited to one service per day up to a maximum benefit of 90 daily services per Insured per Benefit Period. This limitation is not applicable to Mental Illness or Substance Use Disorders.

YES

$0.00 Copay after deductible

100.00%
Outpatient Surgery Physician/Surgical Services
YES

$0.00 Copay after deductible

100.00%
Preferred Brand Drugs
YES

$0.00 Copay after deductible

100.00%
Prenatal and Postnatal Care

Also covers surrogate mother if there is a petition to adopt within 90 days of birth.

YES

$0.00 Copay after deductible

100.00%
Preventive Care/Screening/Immunization
YES

$0.00

100.00%
Primary Care Visit to Treat an Injury or Illness

First three (3) non-preventive visits are $0 and not subject to the deductible. Virtual urgent care visits with Oscar designated telemedicine providers are covered in full after the deductible has been met.

YES

$0.00 Copay after deductible

100.00%
Private-Duty Nursing
YES

$0.00 Copay after deductible

100.00%
Prosthetic Devices

Benefits are limited to the amount normally available for a basic (standard) appliance which allows necessary function. Basic (standard) medical devices or appliances are those that provide the essential function required for the treatment or amelioration of the medical condition at a Medically Necessary level.

YES

0.00% Coinsurance after deductible

100.00%
Radiation
YES

0.00% Coinsurance after deductible

100.00%
Reconstructive Surgery

Cosmetic and reconstructive are generally excluded, but excepted from this exclusion are: a. Cosmetic or reconstructive repair of an Accidental Injury.; b. Reconstructive breast surgery in connection with a Medically Necessary mastectomy that resulted from a medical illness or injury. This includes reconstructive surgery on a breast on which a mastectomy was not performed in order to produce a symmetrical appearance.; c. Repair of congenital abnormalities and hereditary complications or conditions, limited to: (1) Cleft lip or palate. (2) Birthmarks on head or neck. (3) Webbed fingers or toes. (4) Supernumerary fingers or toes.; d. Reconstructive services performed on structures of the body to improve/restore impairments of bodily function resulting from disease, trauma, congenital or developmental anomalies or previous therapeutic processes. For purposes of this provision, the term 'cosmetic' means procedures and related services performed to reshape structures of the body in order to alter the individual's appearance.

YES

$0.00 Copay after deductible

100.00%
Rehabilitative Occupational and Rehabilitative Physical Therapy
YES

$0.00 Copay after deductible

100.00%
Rehabilitative Speech Therapy

Limit: 90.0 Days per Benefit Period

Limited to one service per day up to a maximum benefit of 90 daily services per Insured per Benefit Period. This limitation is not applicable to Mental Illness or Substance Use Disorders.

YES

$0.00 Copay after deductible

100.00%
Routine Dental Services (Adult)
NO
Routine Eye Exam (Adult)
NO
Routine Eye Exam for Children
YES

$0.00 Copay after deductible

100.00%
Routine Foot Care

Covered when systemic conditions such as metabolic, neurologic, or peripheral vascular disease exists and results in medically significant circulatory deficits or decreased sensation to the foot.

YES

$0.00 Copay after deductible

100.00%
Skilled Nursing Facility
YES

No Charge after deductible

100.00%
Specialist Visit
YES

$0.00 Copay after deductible

100.00%
Specialty Drugs
YES

$0.00 Copay after deductible

100.00%
Substance Abuse Disorder Inpatient Services
YES

$0.00 Copay after deductible

100.00%
Substance Abuse Disorder Outpatient Services
YES

$0.00 Copay after deductible

100.00%
Transplant

Benefits are provided for the following human organ transplants: Cornea; heart; heart-lung; kidney; pancreas; liver; lung (whole or lobar, single or double); small intestine; and multivisceral transplants.

YES

$0.00 Copay after deductible

100.00%
Treatment for Temporomandibular Joint Disorders
YES

0.00% Coinsurance after deductible

100.00%
Urgent Care Centers or Facilities
YES

$0.00 Copay after deductible

100.00%
Weight Loss Programs
NO
Well Baby Visits and Care
YES

$0.00 Copay after deductible

100.00%
X-rays and Diagnostic Imaging
YES

$0.00 Copay after deductible

100.00%

Secure Health Insurance Plan Variant 43490KS0010011-00 Attributes

Plan Attribute Value
Begin Primary Care Cost-Sharing After Number Of Visits 3
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 Standard Catastrophic Off Exchange Plan
Dental Only Plan No
Design Type Not Applicable
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 KSF001
Formulary URL URL
HIOS Product ID 43490KS001
Import Date 2/24/2023 20:01
Limited Cost Sharing Plan Variation - Estimated Advanced Payment $0.00
Inpatient Copayment Maximum Days 0
HSA Eligible No
New/Existing Plan Existing
Notice Required for Pregnancy No
Is a Referral Required for Specialist? No
Issuer ID 43490
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 Catastrophic
Multiple In Network Tiers No
National Network No
Network ID KSN001
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) 43490KS0010011-00
Plan Marketing Name Secure
Plan Type EPO
Plan Variant Marketing Name Secure
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $0
SBC Scenario, Having a Baby, Copayment $0
SBC Scenario, Having a Baby, Deductible $9,100
SBC Scenario, Having a Baby, Limit $0
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $0
SBC Scenario, Having Diabetes, Deductible $5,400
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 $2,800
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID KSS001
Source Name SERFF
Plan ID 43490KS0010011
State Code KS
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 $18200 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $9100 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $9,100
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group per group not applicable
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person per person not applicable
Combined Medical and Drug EHB Deductible, Out of Network, Individual Not Applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group $18200 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $9100 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $9,100
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 Secure Health Insurance Plan, 43490KS0010011

Drug Tier Pharmacy Type Copay amount Copay option Coinsurance rate Coinsurance option Mail Order

Frequently Asked Questions(FAQ) about Secure, 43490KS0010011 Health Insurance Plan, 43490KS0010011

  • Does Secure Health Insurance Plan, 43490KS0010011 support Mail Ordering?

    Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.

  • Does (43490KS0010011) Health Insurance Plan, Variant (43490KS0010011-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs

    Does (43490KS0010011) Health Insurance Plan, Variant (43490KS0010011-00) have Out Of Country Coverage?

    Yes. Details: Emergency Services Only

    Does (43490KS0010011) Health Insurance Plan, Variant (43490KS0010011-00) have Out of Service Area Coverage?

    Yes. Details: Emergency and Urgent Services only

    Does (43490KS0010011) Health Insurance Plan, Variant (43490KS0010011-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs

    Does Secure Health Insurance Plan, Variant (43490KS0010011-00) offer Disease Management Programs for Asthma?

    Yes, the Secure Health Insurance Plan Variant 43490KS0010011-00 offers Disease Management Program for Asthma.

    Does Secure Health Insurance Plan, Variant (43490KS0010011-00) offer Disease Management Programs for Heart disease?

    Yes, the Secure Health Insurance Plan Variant 43490KS0010011-00 offers Disease Management Program for Heart disease.

    Does Secure Health Insurance Plan, Variant (43490KS0010011-00) offer Disease Management Programs for Depression?

    Yes, the Secure Health Insurance Plan Variant 43490KS0010011-00 offers Disease Management Program for Depression.

    Does Secure Health Insurance Plan, Variant (43490KS0010011-00) offer Disease Management Programs for Diabetes?

    Yes, the Secure Health Insurance Plan Variant 43490KS0010011-00 offers Disease Management Program for Diabetes.

    Does Secure Health Insurance Plan, Variant (43490KS0010011-00) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the Secure Health Insurance Plan Variant 43490KS0010011-00 offers Disease Management Program for High blood pressure & high cholesterol.

    Does Secure Health Insurance Plan, Variant (43490KS0010011-00) offer Disease Management Programs for Low back pain?

    Yes, the Secure Health Insurance Plan Variant 43490KS0010011-00 offers Disease Management Program for Low back pain.

    Does Secure Health Insurance Plan, Variant (43490KS0010011-00) offer Disease Management Programs for Pregnancy?

    Yes, the Secure Health Insurance Plan Variant 43490KS0010011-00 offers Disease Management Program for Pregnancy.

    Does Secure Health Insurance Plan, Variant (43490KS0010011-00) offer Disease Management Programs for Weight loss programs?

    Yes, the Secure Health Insurance Plan Variant 43490KS0010011-00 offers Disease Management Program for Weight loss programs.

 

Disclaimer: This is based on the import(Date: Wed, 27 Mar 2024 12:10 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