Oscar Health Plan

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	Bronze 60 EPO
Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. (Individual/Family)	$6,300
Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services (Individual/Family)	$6,800
Doctor Visit
Primary Care Office Visit	First 3 visits at $75 copay before deductible
Specialty Care Office Visit	$105 copay before deductible
Other Practitioner Office Visit	$75 copay beore deductible
Preventive Care/Screening/Immunization	No charge
Tests
Lab Tests	$40 copay
X-Rays and Diagnostic Imaging	100% coinsurance after deductible
Imaging (CT/PET Scans, MRIs)	100% coinsurance after deductible
Drugs
Tier 1 (Most Generic Drugs)	100% coinsurance after deductible
Tier 2 (Preferred Brand Drugs)	100% coinsurance after deductible
Tier 3 (Non-Preferred Brand Drugs)	100% coinsurance after deductible
Tier 4 (Specialty Drugs)	100% coinsurance after deductible
Outpatient Services
Outpatient Facility Fee	100% coinsurance after deductible
Outpatient Surgery Physician/Surgical Services	100% coinsurance after deductible
Outpatient Services Office Visits	100% coinsurance after deductible
ER & Urgent Care
Emergency Room Facility Fee	100% coinsurance after deductible
Emergency Transportation	100% coinsurance after deductible
Urgent Care	$75 copay before deductible
Emergency Room Professional Fee	No charge
Hospital
Inpatient Hospital Services	100% coinsurance after deductible
Inpatient Physician and Surgical Services	100% coinsurance after deductible
Mental/Behavioral Health
Mental/Behavioral Health Inpatient Facility Fee	$75 copay before deductible
Mental/Behavioral Health Inpatient Professional Fee	100% coinsurance after deductible
Substance Use Disorder Outpatient Services	$75 copay before deductible
Pregnancy
Prenatal Care	No charge
Delivery and Maternity Care Inpatient Facility Fee	100% coinsurance after deductible
Delivery and Maternity Care Inpatient Professional Fee	100% coinsurance after deductible
Other Special Needs
Home Health Care Services	100% coinsurance after deductible
Outpatient Rehabilitation Services	$75 copay
Skilled Nursing Facility	100% coinsurance after deductible
Durable Medical Equipment	100% coinsurance after deductible
Hospice Services	No Charge
Acupuncture	$75 copay before deductible
Rehabilitative Speech Therapy	$75 copay
Rehabilitative Occupational and Rehabilitative Physical Therapy	$75 copay
Well Baby Visits and Care	No charge
Allergy Testing	$105 copay before deductible
Diabetes Education	No charge
Nutritional Counseling	Not covered
Children’s Vision
Eye Exam for Children	No charge
Eyeglasses for Children	No charge
Children’s Dental
Child Filling – One Surface	$25 copay
Child Dental Checkup	No charge
Child Root Canal – Molar	$300 copay
Child Medically Necessary Orthodontia	$1,000 copay

	Silver 70 EPO
Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. (Individual/Family)	$2,500
Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services (Individual/Family)	$6,800
Doctor Visit
Primary Care Office Visit	$35 copay
Specialty Care Office Visit	$70 copay
Other Practitioner Office Visit	$35 copay
Preventive Care/Screening/Immunization	No charge
Tests
Lab Tests	$35 copay
X-Rays and Diagnostic Imaging	$70 copay
Imaging (CT/PET Scans, MRIs)	$300 copay
Drugs
Tier 1 (Most Generic Drugs)	$15 copay
Tier 2 (Preferred Brand Drugs)	$55 copay after deductible
Tier 3 (Non-Preferred Brand Drugs)	$80 copay after deductible
Tier 4 (Specialty Drugs)	20% coinsurance after deductible
Outpatient Services
Outpatient Facility Fee	20% coinsurance
Outpatient Surgery Physician/Surgical Services	20% coinsurance
Outpatient Services Office Visits	20% coinsurance
ER & Urgent Care
Emergency Room Facility Fee	$350 copay
Emergency Transportation	$250 copay after deductible
Urgent Care	$35 copay
Emergency Room Professional Fee	No charge
Hospital
Inpatient Hospital Services	20% coinsurance after deductible
Inpatient Physician and Surgical Services	20% coinsurance after deductible
Mental/Behavioral Health Inpatient Facility Fee	$35 copay
Mental/Behavioral Health Inpatient Professional Fee	20% coinsurance after deductible
Substance Use Disorder Outpatient Services	$35 copay
Pregnancy
Prenatal Care	No charge
Delivery and Maternity Care Inpatient Facility Fee	20% coinsurance after deductible
Delivery and Maternity Care Inpatient Professional Fee	20% coinsurance after deductible
Other Special Needs
Home Health Care Services	$45 copay
Outpatient Rehabilitation Services	$35 copay
Skilled Nursing Facility	20% coinsurance after deductible
Durable Medical Equipment	20% coinsurance
Hospice Services	No Charge
Acupuncture	$35 copay
Rehabilitative Speech Therapy	$35 copay
Rehabilitative Occupational and Rehabilitative Physical Therapy	$75 copay
Well Baby Visits and Care	No charge
Allergy Testing	$70 copay
Diabetes Education	No charge
Nutritional Counseling	Not covered
Children’s Vision
Eye Exam for Children	No charge
Eyeglasses for Children	No charge
Children’s Dental
Child Filling – One Surface	$25 copay
Child Dental Checkup	No charge
Child Root Canal – Molar	$300 copay
Child Medically Necessary Orthodontia	$1,000 copay

	Gold 80 EPO
Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. (Individual/Family)	$0
Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services (Individual/Family)	$6,750
Doctor Visit
Primary Care Office Visit	$30 copay
Specialty Care Office Visit	$55 copay
Other Practitioner Office Visit	$30 copay
Preventive Care/Screening/Immunization	No charge
Tests
Lab Tests	$35 copay
X-Rays and Diagnostic Imaging	$55 copay
Imaging (CT/PET Scans, MRIs)	20% coinsurance
Drugs
Tier 1 (Most Generic Drugs)	$15 copay
Tier 2 (Preferred Brand Drugs)	$55 copay
Tier 3 (Non-Preferred Brand Drugs)	$75 copay
Tier 4 (Specialty Drugs)	20% coinsurance
Outpatient Services
Outpatient Facility Fee	20% coinsurance
Outpatient Surgery Physician/Surgical Services	20% coinsurance
Outpatient Services Office Visits	20% coinsurance
ER & Urgent Care
Emergency Room Facility Fee	$325 copay
Emergency Transportation	$250 copay
Urgent Care	$30 copay
Emergency Room Professional Fee	No charge
Hospital
Inpatient Hospital Services	20% coinsurance
Inpatient Physician and Surgical Services	20% coinsurance
Mental/Behavioral Health Inpatient Facility Fee	20% coinsurance
Mental/Behavioral Health Inpatient Professional Fee	20% coinsurance
Substance Use Disorder Outpatient Services	$30 copay
Pregnancy
Prenatal Care	No charge
Delivery and Maternity Care Inpatient Facility Fee	20% coinsurance
Delivery and Maternity Care Inpatient Professional Fee	20% coinsurance
Other Special Needs
Home Health Care Services	20% coinsurance
Outpatient Rehabilitation Services	$30 copay
Skilled Nursing Facility	20% coinsurance
Durable Medical Equipment	20% coinsurance
Hospice Services	No Charge
Acupuncture	$30 copay
Rehabilitative Speech Therapy	$30 copay
Rehabilitative Occupational and Rehabilitative Physical Therapy	$30 copay
Well Baby Visits and Care	No charge
Allergy Testing	$55 copay
Diabetes Education	No charge
Nutritional Counseling	Not covered
Children’s Vision
Eye Exam for Children	No charge
Eyeglasses for Children	No charge
Children’s Dental
Child Filling – One Surface	$25 copay
Child Dental Checkup	No charge
Child Root Canal – Molar	$300 copay
Child Medically Necessary Orthodontia	$1,000 copay

	Platinum 90 EPO
Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. (Individual/Family)	$0
Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services (Individual/Family)	$4,000
Doctor Visit
Primary Care Office Visit	$15 copay
Specialty Care Office Visit	$40 copay
Other Practitioner Office Visit	$15 copay
Preventive Care/Screening/Immunization	No charge
Tests
Lab Tests	$20 copay
X-Rays and Diagnostic Imaging	$40 copay
Imaging (CT/PET Scans, MRIs)	10% coinsurance
Drugs
Tier 1 (Most Generic Drugs)	$5 copay
Tier 2 (Preferred Brand Drugs)	$15 copay
Tier 3 (Non-Preferred Brand Drugs)	$25 copay
Tier 4 (Specialty Drugs)	10% coinsurance
Outpatient Services
Outpatient Facility Fee	10% coinsurance
Outpatient Surgery Physician/Surgical Services	10% coinsurance
Outpatient Services Office Visits	10% coinsurance
ER & Urgent Care
Emergency Room Facility Fee	$150 copay
Emergency Transportation	$150 copay
Urgent Care	$15 copay
Emergency Room Professional Fee	No charge
Hospital
Inpatient Hospital Services	10% coinsurance
Inpatient Physician and Surgical Services	10% coinsurance
Mental/Behavioral Health Inpatient Facility Fee	10% coinsurance
Mental/Behavioral Health Inpatient Professional Fee	10% coinsurance
Substance Use Disorder Outpatient Services	$15 copay
Pregnancy
Prenatal Care	No charge
Delivery and Maternity Care Inpatient Facility Fee	10% coinsurance
Delivery and Maternity Care Inpatient Professional Fee	10% coinsurance
Other Special Needs
Home Health Care Services	10% coinsurance
Outpatient Rehabilitation Services	$15 copay
Skilled Nursing Facility	10% coinsurance
Durable Medical Equipment	10% coinsurance
Hospice Services	No Charge
Acupuncture	$15 copay
Rehabilitative Speech Therapy	$15 copay
Rehabilitative Occupational and Rehabilitative Physical Therapy	$15 copay
Well Baby Visits and Care	No charge
Allergy Testing	$40 copay
Diabetes Education	No charge
Nutritional Counseling	Not covered
Children’s Vision
Eye Exam for Children	No charge
Eyeglasses for Children	No charge
Children’s Dental
Child Filling – One Surface	$25 copay
Child Dental Checkup	No charge
Child Root Canal – Molar	$300 copay
Child Medically Necessary Orthodontia	$1,000 copay

	Minimum Coverage EPO
Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. (Individual/Family)	$7,150
Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services (Individual/Family)	$7,150
Doctor Visit
Primary Care Office Visit	First 3 visits at $0 copay before deductible
Specialty Care Office Visit	0% coinsurance after deductible
Other Practitioner Office Visit	$0 copay before deductible
Preventive Care/Screening/Immunization	No charge
Tests
Lab Tests	0% coinsurance after deductible
X-Rays and Diagnostic Imaging	0% coinsurance after deductible
Imaging (CT/PET Scans, MRIs)	0% coinsurance after deductible
Drugs
Tier 1 (Most Generic Drugs)	0% coinsurance after deductible
Tier 2 (Preferred Brand Drugs)	0% coinsurance after deductible
Tier 3 (Non-Preferred Brand Drugs)	0% coinsurance after deductible
Tier 4 (Specialty Drugs)	0% coinsurance after deductible
Outpatient Services
Outpatient Facility Fee	0% coinsurance after deductible
Outpatient Surgery Physician/Surgical Services	0% coinsurance after deductible
Outpatient Services Office Visits	0% coinsurance after deductible
ER & Urgent Care
Emergency Room Facility Fee	0% coinsurance after deductible
Emergency Transportation	0% coinsurance after deductible
Urgent Care	$0 copay before deductible
Emergency Room Professional Fee	No charge
Hospital
Inpatient Hospital Services	0% coinsurance after deductible
Inpatient Physician and Surgical Services	0% coinsurance after deductible
Mental/Behavioral Health Inpatient Facility Fee	0% coinsurance after deductible
Mental/Behavioral Health Inpatient Professional Fee	0% coinsurance after deductible
Substance Use Disorder Outpatient Services	$0 copay before deductible
Pregnancy
Prenatal Care	No charge
Delivery and Maternity Care Inpatient Facility Fee	0% coinsurance after deductible
Delivery and Maternity Care Inpatient Professional Fee	0% coinsurance after deductible
Other Special Needs
Home Health Care Services	0% coinsurance after deductible
Outpatient Rehabilitation Services	0% coinsurance after deductible
Skilled Nursing Facility	0% coinsurance after deductible
Durable Medical Equipment	0% coinsurance after deductible
Hospice Services	0% coinsurance after deductible
Acupuncture	$0 copay before deductible
Rehabilitative Speech Therapy	0% coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy	0% coinsurance after deductible
Well Baby Visits and Care	No charge
Allergy Testing	0% coinsurance after deductible
Diabetes Education	No charge
Nutritional Counseling	Not covered
Children’s Vision
Eye Exam for Children	No charge
Eyeglasses for Children	0% coinsurance after deductible
Children’s Dental
Child Filling – One Surface	0% coinsurance after deductible
Child Dental Checkup	No charge
Child Root Canal – Molar	0% coinsurance after deductible
Child Medically Necessary Orthodontia	0% coinsurance after deductible