Oscar Bronze Simple RX Copay ($3 Prescription List + Free 24/7 Plan Details for 2021- HealthPocket

Oscar Bronze Simple RX Copay ($3 Prescription List + Free 24/7

$270.67/mo

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Zip Code80219
Applicant9/17/1986 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameOscar Bronze Simple RX Copay ($3 Prescription List + Free 24/7
Plan IDhhs-44559CO0010001
Plan Year2021
Insurance ProviderOscar Insurance Company
Metal LevelExpanded Bronze
Plan TypeEPO
Deductible$8,550
Out-of-Pocket Maximum$8,550
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$0 Copay after deductible
Specialist Visit$0 Copay after deductible
Laboratory Outpatient and Professional Services$0 Copay after deductible
X-rays and Diagnostic Imaging$0 Copay after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans$0 Copay after deductible
Deductible - Family$17100 per group
Out-of-Pocket Maximum - Family$17100 per group

Prescription drug coverage

Generic Drugs$25 Copay
Preferred Brand Drugs$300 Copay
Non-Preferred Brand Drugs$500 Copay
Specialty Drugs$700 Copay

Access to doctors and hospitals

Provider directory URLhttp://www.hioscar.com/search
Does this plan have access to a national provider network?No
Is a referral required to see a Specialist?Not Covered
Does this plan cover services outside plan service area?Yes - Emergency and Urgent Services Only.
Does this plan cover services outside the country?Yes - Emergency Services Only.

Hospital services

Emergency Room Services$0 Copay after deductible
Inpatient Hospital Services (e.g., Hospital Stay)$0 Copay per Stay after deductible
Inpatient Physician and Surgical Services$0 Copay after deductible
Emergency Transportation or Ambulance Service$0 Copay after deductible

Maternity

Prenatal and Postnatal CareNot Applicable
Delivery and all inpatient services for maternity care$0 Copay after deductible

Mental Health

Mental/Behavioral Health Outpatient Services$0 Copay after deductible
Mental/Behavioral Health Inpatient Services$0 Copay after deductible
Substance use disorder outpatient services$0 Copay after deductible
Substance use disorder inpatient services$0 Copay after deductible

Medical Management Programs

Does this plan offer disease managment programs?Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
Does this plan offer a wellness program?Not Covered

Vision Coverage

Routine Eye Exam for ChildrenIncluded
Eye Glasses for ChildrenIncluded
Routine Eye Exam for AdultsNot Covered

Child Dental Coverage

Child Dental Coverage - Routine Dental CareIncluded
Child Dental Coverage - Basic Dental CareIncluded
Child Dental Coverage - OrthodontiaNot Covered
Child Dental Coverage - Major Dental CareIncluded

Adult Dental Coverage

Adult Dental Coverage - Routine Dental CareNot Covered
Adult Dental Coverage - Basic Dental CareNot Covered
Adult Dental Coverage - OrthodontiaNot Covered
Adult Dental Coverage - Major Dental CareNot Covered

Exclusions and Limitations

More Included BenefitsOther Practitioner Office Visit (Nurse, Physician Assistant)
Preventive Care/Screening/Immunization
Bariatric Surgery
Hearing Aids
Infertility Treatment
Private-Duty Nursing
Imaging (CT/PET Scans, MRIs)
Outpatient Surgery Physician/Surgical Services
Urgent Care Centers or Facilities
Inpatient Physician and Surgical Services
Durable Medical Equipment
Hospice Services
Dental Check-Up for Children
Applied Behavior Analysis Based Therapies
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Nutritional Counseling
Prosthetic Devices
Radiation
Reconstructive Surgery
Transplant
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Prosthetics: Legs and Arms
Telehealth PCP
Telehealth Specialist
Intensive Outpatient for Substance Use Disorder
Mental/Behavioral Health Prenatal Care
Partial Hospitalization for Mental/Behavioral Health
Partial Hospitalization for Substance Use Disorder
Postpartum Mental/Behavioral Health
Postpartum Substance Use Disorder
Residential Day Treatment for Mental/Behavioral Health
Residential Day Treatment for Substance Use Disorder
Substance Use Disorder Prenatal Care
Telehealth Mental/Behavioral Health
Telehealth Substance Use Disorder
Autism Spectrum Disorders - Assessment and Evaluation Services
Intensive Outpatient for Mental/Behavioral Health
More Limited BenefitsSkilled Nursing Facility
Home Health Care Services
Outpatient Rehabilitation Services
Habilitation Services
Chiropractic Care
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
Rehabilitative Occupational Therapy
Rehabilitative Physical Therapy
More Excluded BenefitsAcupuncture
Cosmetic Surgery
Weight Loss Programs
Routine Foot Care
Abortion for Which Public Funding is Prohibited
Accidental Dental
Long-Term/Custodial Nursing Home Care
PremiumPlan NameDeductible
from $231Oscar Secure (Free 24/7 Virtual Visits + Free Personal Care Tea$8,550.00Select
from $231Anthem Catastrophic Pathway Essentials HMO 8550$8,550.00Select
from $233KP Select CO Catastrophic$8,550.00Select
from $256Anthem Catastrophic PPO 8550$8,550.00Select
from $261Anthem Bronze Pathway Essentials HMO 8550$8,550.00Select
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  • Phone Number
    (303) 935-9142
  • Office Locations
    1930 S Federal Blvd
    Denver, CO 80219
1930 S Federal Blvd Denver CO, 80219

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HealthPocket.com is a free information source. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. While on our site, if you click on a plan or link, you may be directed to one of our partners who offers health insurance products. HealthPocket, Inc. is part of the Benefytt Technologies, Inc. family of companies.