Secure - 69512MO0010011 Health Insurance Plan

Oscar Insurance Company health insurance plan with the Plan ID 69512MO0010011. The plan is called Secure.

Health Insurance Plan ID 69512MO0010011
Health Insurance Plan Year 2023
State Missouri
Health Insurance Issuer Oscar Insurance Company
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 69512MO0010011-00
Provider Network(s) ['MON001']
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 Missouri 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 - 69512MO0010011-00

Standard On Exchange Plan - 69512MO0010011-01

Last Plan Update Date Tue, 28 Feb 2023 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

Benefits of Secure Health Insurance Plan, 69512MO0010011-00

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

Limit: 3000.0 Dollars per Episode

Treatment must begin within 12 months of the injury.

YES

0.00% Coinsurance after deductible

100.00%
Acupuncture
NO
Allergy Testing
YES

0.00% Coinsurance 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

Chiropractic visits beyond 26 per benefit period require Prior Authorization.

YES

0.00% Coinsurance after deductible

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

0.00% Coinsurance after deductible

100.00%
Dental Check-Up for Children
NO
Diabetes Education
YES

0.00% Coinsurance after deductible

100.00%
Dialysis

Covered Services include dialysis treatments in an outpatient dialysis, or home dialysis and training for you and the person who will help you with home self-dialysis.

YES

0.00% Coinsurance after deductible

100.00%
Durable Medical Equipment
YES

0.00% Coinsurance after deductible

100.00%
Emergency Room Services
YES

0.00% Coinsurance after deductible

0.00% Coinsurance after deductible
Emergency Transportation/Ambulance
YES

0.00% Coinsurance after deductible

0.00% Coinsurance after deductible
Eye Glasses for Children

Limit: 1.0 Item(s) per Year

Covered lenses and frames each available at limit of one per year.

YES

0.00% Coinsurance after deductible

100.00%
Gender Affirming Care
YES

0.00% Coinsurance after deductible

100.00%
Generic Drugs
YES

0.00% Coinsurance after deductible

100.00%
Habilitation Services

Limit: 20.0 Visit(s) per Benefit Period

Habilitative services definition: 'help you keep, learn or improve skills and functioning for daily living.'

YES

0.00% Coinsurance after deductible

100.00%
Hearing Aids

Benefits include hearing aids provided to a newborn for initial amplification following a newborn hearing screening.

YES

0.00% Coinsurance after deductible

100.00%
Home Health Care Services

Limit: 100.0 Visit(s) per Benefit Period

To be eligible for benefits, you must essentially be confined to the home, as an alternative to a Hospital stay, and be physically unable to get needed medical services on an outpatient basis.

YES

0.00% Coinsurance after deductible

100.00%
Hospice Services
YES

0.00% Coinsurance after deductible

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

0.00% Coinsurance after deductible

100.00%
Infertility Treatment
NO
Infusion Therapy
YES

0.00% Coinsurance after deductible

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

0.00% Coinsurance after deductible

100.00%
Inpatient Physician and Surgical Services
YES

0.00% Coinsurance after deductible

100.00%
Laboratory Outpatient and Professional Services
YES

0.00% Coinsurance 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% Coinsurance after deductible

100.00%
Mental/Behavioral Health Outpatient Services
YES

0.00% Coinsurance after deductible

100.00%
Non-Preferred Brand Drugs
YES

0.00% Coinsurance after deductible

100.00%
Nutritional Counseling
YES

0.00% Coinsurance after deductible

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

0.00% Coinsurance after deductible

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

0.00% Coinsurance after deductible

100.00%
Outpatient Rehabilitation Services

Limit: 20.0 Visit(s) per Benefit Period

To be Covered Services, rehabilitation services must involve goals you can reach in a reasonable period of time. Benefits will end when treatment is no longer Medically Necessary and you stop progressing toward those goals.

YES

0.00% Coinsurance after deductible

100.00%
Outpatient Surgery Physician/Surgical Services
YES

0.00% Coinsurance after deductible

100.00%
Preferred Brand Drugs
YES

0.00% Coinsurance after deductible

100.00%
Prenatal and Postnatal Care
YES

0.00% Coinsurance 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% Coinsurance after deductible

100.00%
Private-Duty Nursing

Limit: 82.0 Visit(s) per Benefit Period

Private duty nursing services are a Covered Service only when given as part of the 'Home Care Services' benefit. Private Duty Lifetime Maximum: 164 visits In- and Out-of-Network combined.

YES

0.00% Coinsurance after deductible

100.00%
Prosthetic Devices

Benefits include the purchase, fitting, adjustments, repairs and replacements.

YES

0.00% Coinsurance after deductible

100.00%
Radiation
YES

0.00% Coinsurance after deductible

100.00%
Reconstructive Surgery

Benefits include reconstructive surgery to correct significant deformities caused by congenital or developmental abnormalities, illness, injury or an earlier treatment in order to create a more normal appearance.

YES

0.00% Coinsurance after deductible

100.00%
Rehabilitative Occupational and Rehabilitative Physical Therapy

Limit: 20.0 Visit(s) per Benefit Period

20 visit limit each for PT and OT.

YES

0.00% Coinsurance after deductible

100.00%
Rehabilitative Speech Therapy

Unlimited visits for speech therapy.

YES

0.00% Coinsurance after deductible

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

Limit: 1.0 Exam(s) per Benefit Period

YES

0.00% Coinsurance after deductible

100.00%
Routine Foot Care

Coverage is available if Medically Necessary.

YES

0.00% Coinsurance after deductible

100.00%
Skilled Nursing Facility

Limit: 150.0 Days per Benefit Period

Limit is for in-and out-of-network combined and includes rehab and outpatient day rehab.

YES

0.00% Coinsurance after deductible

100.00%
Specialist Visit
YES

0.00% Coinsurance after deductible

100.00%
Specialty Drugs
YES

0.00% Coinsurance after deductible

100.00%
Substance Abuse Disorder Inpatient Services
YES

0.00% Coinsurance after deductible

100.00%
Substance Abuse Disorder Outpatient Services
YES

0.00% Coinsurance after deductible

100.00%
Transplant
YES

0.00% Coinsurance after deductible

100.00%
Treatment for Temporomandibular Joint Disorders

Covered Services include removable appliances for TMJ repositioning and related surgery, medical care, and diagnostic services.

YES

0.00% Coinsurance after deductible

100.00%
Urgent Care Centers or Facilities
YES

0.00% Coinsurance after deductible

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

0.00% Coinsurance after deductible

100.00%
X-rays and Diagnostic Imaging
YES

0.00% Coinsurance after deductible

100.00%

Secure Health Insurance Plan Variant 69512MO0010011-00 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 MOF001
Formulary URL URL
HIOS Product ID 69512MO001
Import Date 2/28/2023 1:02
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 69512
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 MON001
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) 69512MO0010011-00
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 MOS001
Source Name HIOS
Plan ID 69512MO0010011
State Code MO
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, 69512MO0010011

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

Frequently Asked Questions(FAQ) about Secure, 69512MO0010011 Health Insurance Plan, 69512MO0010011

  • Does Secure Health Insurance Plan, 69512MO0010011 support Mail Ordering?

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

  • Does (69512MO0010011) Health Insurance Plan, Variant (69512MO0010011-00) 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 (69512MO0010011) Health Insurance Plan, Variant (69512MO0010011-00) have Out Of Country Coverage?

    Yes. Details: Emergency Services Only

    Does (69512MO0010011) Health Insurance Plan, Variant (69512MO0010011-00) have Out of Service Area Coverage?

    Yes. Details: Emergency and Urgent Services only

    Does (69512MO0010011) Health Insurance Plan, Variant (69512MO0010011-00) 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 (69512MO0010011-00) offer Disease Management Programs for Asthma?

    Yes, the Secure Health Insurance Plan Variant 69512MO0010011-00 offers Disease Management Program for Asthma.

    Does Secure Health Insurance Plan, Variant (69512MO0010011-00) offer Disease Management Programs for Heart disease?

    Yes, the Secure Health Insurance Plan Variant 69512MO0010011-00 offers Disease Management Program for Heart disease.

    Does Secure Health Insurance Plan, Variant (69512MO0010011-00) offer Disease Management Programs for Depression?

    Yes, the Secure Health Insurance Plan Variant 69512MO0010011-00 offers Disease Management Program for Depression.

    Does Secure Health Insurance Plan, Variant (69512MO0010011-00) offer Disease Management Programs for Diabetes?

    Yes, the Secure Health Insurance Plan Variant 69512MO0010011-00 offers Disease Management Program for Diabetes.

    Does Secure Health Insurance Plan, Variant (69512MO0010011-00) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the Secure Health Insurance Plan Variant 69512MO0010011-00 offers Disease Management Program for High blood pressure & high cholesterol.

    Does Secure Health Insurance Plan, Variant (69512MO0010011-00) offer Disease Management Programs for Low back pain?

    Yes, the Secure Health Insurance Plan Variant 69512MO0010011-00 offers Disease Management Program for Low back pain.

    Does Secure Health Insurance Plan, Variant (69512MO0010011-00) offer Disease Management Programs for Pregnancy?

    Yes, the Secure Health Insurance Plan Variant 69512MO0010011-00 offers Disease Management Program for Pregnancy.

    Does Secure Health Insurance Plan, Variant (69512MO0010011-00) offer Disease Management Programs for Weight loss programs?

    Yes, the Secure Health Insurance Plan Variant 69512MO0010011-00 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