Oscar

Gold Elite Saver Plus

Prescription Drug Information

Inpatient Coverage

Emergency and Urgent Care

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Plan Overview

Medical Deductible	Individual: $0 Family: $0 Per Person: $0
Prescription Drug Deductible	Individual: $200 Family: $400 Per Person: $200
Medical Out-of-Pocket Maximum	Individual: $7,900 Family: $15,800 Per Person: $7,900
Drug Out-of-Pocket Maximum	Individual: Included in Medical Family: Included in Medical Per Person: Included in Medical

Office Visit

Primary Doctor	Standard: $0 Copay
Specialist	Standard: $25 Copay

Prescription Drug Information

Preferred Brand Drugs	Standard: $75 Copay after deductible
Non Preferred Brand Drugs	Standard: $250 Copay after deductible
Generic Drugs	Standard: $3 Copay
Specialty Drugs	Standard: $550 Copay after deductible

Inpatient Coverage

Hospital Services	Standard: $1000 Copay per day
Inpatient Services	Standard: $200 Copay

Emergency and Urgent Care

Emergency Room

Standard: $500 Copay