Oscar

Silver Simple PCP Saver Guided Care

Prescription Drug Information

Inpatient Coverage

Emergency and Urgent Care

Major Dental Care

Links

Plan Overview

Combined Medical and Drug Deductible	Individual: $5,750.00 Family: $11500.0 Per Person: $5750.0
Combined Medical and Drug Out of Pocket Maximum	Individual: $8,750.00 Family: $17500.0 Per Person: $8750.0

Office Visit

Primary Doctor	CoPay: $10.00 CoInsurance: Not Applicable Covered: Covered Benefit Explanation: Cost share applies to both in-person and telemedicine services from in-network providers.
Specialist	CoPay: $80.00 CoInsurance: Not Applicable Covered: Covered Benefit Explanation: Cost share applies to both in-person and telemedicine services from in-network providers.

Prescription Drug Information

Preferred Brand Drugs	CoPay: $100.00 CoInsurance: Not Applicable Covered: Covered Exclusions: Excludes infertility services including medications.
Non Preferred Brand Drugs	CoPay: Not Applicable CoInsurance: 40.00% Coinsurance after deductible Covered: Covered Exclusions: Excludes infertility services including medications.
Generic Drugs	CoPay: $3.00 CoInsurance: Not Applicable Covered: Covered Exclusions: Excludes infertility services including medications.
Specialty Drugs	CoPay: Not Applicable CoInsurance: 40.00% Coinsurance after deductible Covered: Covered Exclusions: Excludes infertility services including medications.

Inpatient Coverage

Hospital Services	CoPay: Not Applicable CoInsurance: 40.00% Coinsurance after deductible Covered: Covered
Inpatient Services	CoPay: Not Applicable CoInsurance: 40.00% Coinsurance after deductible Covered: Covered

Emergency and Urgent Care

Emergency Room

CoPay: Not Applicable
CoInsurance: 40.00% Coinsurance after deductible
Covered: Covered

Maternity

Labor and Delivery Hospital Stay	CoPay: Not Applicable CoInsurance: 40.00% 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