Oscar

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Prescription Drug Information

Inpatient Coverage

Emergency and Urgent Care

Major Dental Care

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Plan Overview

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

Office Visit

Primary Doctor	CoPay: $0.00 Copay after deductible CoInsurance: Not Applicable Covered: Covered Benefit Explanation: Virtual urgent care services from Oscar designated telemedicine providers are covered in full after the deductible has been met. First three (3) non-preventive visits are $0 and not subject to the deductible.
Specialist	CoPay: $0.00 Copay after deductible CoInsurance: Not Applicable Covered: Covered

Prescription Drug Information

Preferred Brand Drugs	CoPay: $0.00 Copay after deductible CoInsurance: Not Applicable Covered: Covered
Non Preferred Brand Drugs	CoPay: $0.00 Copay after deductible CoInsurance: Not Applicable Covered: Covered
Generic Drugs	CoPay: $0.00 Copay after deductible CoInsurance: Not Applicable Covered: Covered
Specialty Drugs	CoPay: $0.00 Copay after deductible CoInsurance: Not Applicable Covered: Covered

Inpatient Coverage

Hospital Services	CoPay: No Charge after deductible CoInsurance: Not Applicable Covered: Covered
Inpatient Services	CoPay: $0.00 Copay after deductible CoInsurance: Not Applicable Covered: Covered

Emergency and Urgent Care

Emergency Room	CoPay: $0.00 Copay after deductible CoInsurance: Not Applicable Covered: Covered
Urgent Care Facility	CoPay: $0.00 Copay after deductible CoInsurance: Not Applicable Covered: Covered

Maternity

Labor and Delivery Hospital Stay	CoPay: $0.00 Copay after deductible CoInsurance: Not Applicable Covered: Covered
Pre and Postnatal Office Visit	CoPay: Not Applicable CoInsurance: 0.00% Covered: Covered

Vision

Routine Eye Exams For Children

CoPay: $0.00 Copay after deductible
CoInsurance: Not Applicable
Covered: Covered
Limit Quantity: 1
Limit Unit : Exam(s) per Year

Major Dental Care

Routine Dental Checkups for Children	CoPay: Not Applicable CoInsurance: 0.00% Covered: Covered Limit Quantity: 2 Limit Unit : Exam(s) per Year
Basic Dental Care - Child	CoPay: Not Applicable CoInsurance: 0.00% Coinsurance after deductible Covered: Covered Limit Quantity: 2 Limit Unit : Exam(s) per Year
Major Dental Care - Child	CoPay: Not Applicable CoInsurance: 0.00% Coinsurance after deductible Covered: Covered

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