Oscar

Silver Simple Diabetes

Prescription Drug Information

Inpatient Coverage

Emergency and Urgent Care

Major Dental Care

Links

Plan Overview

Combined Medical and Drug Deductible	Individual: $6,500.00 Family: $13000.0 Per Person: $6500.0
Combined Medical and Drug Out of Pocket Maximum	Individual: $8,550.00 Family: $17100.0 Per Person: $8550.0

Office Visit

Primary Doctor

CoPay: $0.00
CoInsurance: Not Applicable
Covered: Covered
Benefit Explanation: Cost share applies to both in-person and telemedicine services from in-network providers. Virtual primary care services provided by Oscar-designated virtual care providers are covered in full. Virtual pediatric primary care services are not available through Oscar Medical Group; these services should be obtained in-person from in-network providers.

Specialist

CoPay: $40.00
CoInsurance: Not Applicable
Covered: Covered
Benefit Explanation: Diabetic eye exams and diabetic foot exams are covered in full. Cost share applies to both in-person and telemedicine services from in-network providers.

Prescription Drug Information

Preferred Brand Drugs	CoPay: $75.00 Copay after deductible CoInsurance: Not Applicable Covered: Covered Exclusions: Excludes infertility services including medications.
Non Preferred Brand Drugs	CoPay: Not Applicable CoInsurance: 50.00% Coinsurance after deductible Covered: Covered Exclusions: Excludes infertility services including medications.
Generic Drugs	CoPay: $0.00 CoInsurance: Not Applicable Covered: Covered Exclusions: Excludes infertility services including medications.
Specialty Drugs	CoPay: Not Applicable CoInsurance: 50.00% Coinsurance after deductible Covered: Covered Exclusions: Excludes infertility services including medications.

Inpatient Coverage

Hospital Services	CoPay: Not Applicable CoInsurance: 50.00% Coinsurance after deductible Covered: Covered
Inpatient Services	CoPay: Not Applicable CoInsurance: 50.00% Coinsurance after deductible Covered: Covered

Emergency and Urgent Care

Emergency Room

CoPay: Not Applicable
CoInsurance: 50.00% Coinsurance after deductible
Covered: Covered

Maternity

Labor and Delivery Hospital Stay	CoPay: Not Applicable CoInsurance: 50.00% Coinsurance after deductible Covered: Covered
Pre and Postnatal Office Visit	CoPay: Not Applicable CoInsurance: 0.00% Covered: Covered

Vision

Routine Eye Exams for Children

CoPay: $0.00
CoInsurance: Not Applicable
Covered: Covered
Limit Quantity: 1
Limit Unit : Exam(s) per Year

Major Dental Care

Routine Dental Checkups for Children	Covered: Not Covered
Routine Dental Checkups for Adults	Covered: Not Covered