Oscar Insurance Company

Bronze Elite- $0 Ded+Specialist Saver ($3 Drugs + $0 Virtual Care)

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Medical Deductible	Individual: $0 Family: $0 Per Person: $0
Prescription Drug Deductible	Individual: $7,700 Family: $15,400 Per Person: $7,700
Combined Medical and Drug Out of Pocket Maximum	Individual: $8,700 Family: $17,400 Per Person: $8,700

Primary Doctor

CoPay: $60.00
CoInsurance: Not Applicable
Covered: Covered
Benefit Explanation: Virtual visits with an Oscar Care urgent care provider are unlimited and always $0—even if you haven’t hit your deductible. Depending on your plan, many prescriptions and labs will also cost you $0, if they’re ordered by your Oscar Virtual Urgent Care team.* Please refer to your plan documents for more information. *For these savings to apply, they must be prescribed by your Oscar Virtual Urgent Care provider under a Silver or Gold plan.

Specialist

CoPay: $50.00
CoInsurance: Not Applicable
Covered: Covered
Benefit Explanation: First two (2) non-preventive visits combined for specialist care, mental health, or substance use office visits are $50 and not subject to deductible. Subsequent visits are $125 and not subject to deductible.

Preferred Brand Drugs	CoPay: $250.00 CoInsurance: Not Applicable Covered: Covered
Non Preferred Brand Drugs	CoPay: Not Applicable CoInsurance: 50.00% Coinsurance after deductible Covered: Covered
Generic Drugs	CoPay: $3.00 CoInsurance: Not Applicable Covered: Covered Benefit Explanation: Oscar is on a mission to make your prescriptions more affordable. That’s why your savings start on day 1 of your new plan. All Oscar members have access to 24/7 virtual urgent care services. Depending on your plan, if your Oscar Virtual Urgent Care provider prescribes any prescriptions on the Generics: Tier 1a or Generics: Tier 1b list during your visit, those prescriptions will be free.* Generics: Tier 1a: Drugs on this list will never cost you more than $3, no matter who prescribes them. Check to see if your prescriptions are on the $3 Prescription List at https://www.hioscar.com/prescriptions/3-dollar-list Prescriptions included in Generics: Tier 1b will always cost you less than $30, no matter who prescribes them—even if you haven’t hit your deductible. Find out which Tiers the drugs you take are on at www.hioscar.com/search *For these savings to apply, they must be prescribed by your Oscar Virtual Urgent Care provider under a Silver or Gold plan. Virtual visits with other providers in Oscar’s network will not be free and the additional savings will not apply.
Specialty Drugs	CoPay: Not Applicable CoInsurance: 50.00% Coinsurance after deductible Covered: Covered

Hospital Services	CoPay: $3000.00 Copay per Day CoInsurance: Not Applicable Covered: Covered Benefit Explanation: The per day copayment will apply for a maximum of 2 days.
Inpatient Services	CoPay: $350.00 CoInsurance: Not Applicable Covered: Covered

Emergency Room	CoPay: $1,000.00 CoInsurance: Not Applicable Covered: Covered Benefit Explanation: First visit is $1,000 and not subject to deductible. Subsequent visits are $1500 and not subject to deductible.
Urgent Care Facility	CoPay: $75.00 CoInsurance: Not Applicable Covered: Covered

Labor and Delivery Hospital Stay	CoPay: $3,000.00 CoInsurance: Not Applicable Covered: Covered Benefit Explanation: The per day copayment will apply for a maximum of 2 days.
Pre and Postnatal Office Visit	CoPay: Not Applicable CoInsurance: 0.00% Covered: Covered

Routine Eye Exams For Children

Routine Dental Checkups for Children	CoPay: Not Applicable CoInsurance: 0.00% Covered: Covered Limit Quantity: 2 Limit Unit : Visit(s) per Year
Basic Dental Care - Child	CoPay: Not Applicable CoInsurance: 20.00% Covered: Covered
Major Dental Care - Child	CoPay: Not Applicable CoInsurance: 50.00% Covered: Covered

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