Oscar

Gold Simple ($0 Virtual Primary Care + $3 Drugs)

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Combined Medical and Drug Deductible	Individual: $2,000 Family: $4,000 Per Person: $2,000
Combined Medical and Drug Out of Pocket Maximum	Individual: $6,550 Family: $13,100 Per Person: $6,550

Primary Doctor

CoPay: $0.00
CoInsurance: Not Applicable
Covered: Covered
Benefit Explanation: Virtual visits with an Oscar Virtual Primary 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 Primary Care team.* You may also have access to $0 Tier 1 in-person PCP visits if your plan is issued in Miami-Dade or Broward counties. Please refer to your plan documents for more information. *For these savings to apply, they must be prescribed by your Oscar Virtual Primary Care provider under a Silver or Gold plan.

Specialist

Preferred Brand Drugs	CoPay: $75.00 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. Depending on your plan, if your Oscar Virtual Primary Care team prescribes you any prescriptions on the Generics: Tier 1a and Generics: Tier 1b list, those prescriptions will be $0.* 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, drugs must be prescribed by your Oscar Virtual Primary 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. Please refer to your plan documents for more information.
Specialty Drugs	CoPay: Not Applicable CoInsurance: 50.00% Coinsurance after deductible Covered: Covered

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 Room	CoPay: Not Applicable CoInsurance: 40.00% Coinsurance after deductible Covered: Covered
Urgent Care Facility	CoPay: $75.00 CoInsurance: Not Applicable Covered: Covered

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

Routine Eye Exams For Children

Routine Dental Checkups for Children	CoPay: Not Applicable CoInsurance: 0.00% Covered: Covered
Basic Dental Care - Child	CoPay: Not Applicable CoInsurance: 20.00% Coinsurance after deductible Covered: Covered
Major Dental Care - Child	CoPay: Not Applicable CoInsurance: 50.00% Coinsurance after deductible Covered: Covered

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