Benefit Explanation: Virtual visits with an Oscar Care 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.*
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
CoPay: $90.00
CoInsurance: Not Applicable
Covered: Covered
Prescription Drug Information
Preferred Brand Drugs
CoPay: $100.00
CoInsurance: Not Applicable
Covered: Covered
Non Preferred Brand Drugs
CoPay: Not Applicable
CoInsurance: 50.00% Coinsurance after deductible
Covered: Covered
Generic Drugs
CoPay: $0.00
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.
$0 unlimited visits with your Oscar Virtual Primary Care team. This plan gives you access to the Oscar Virtual Primary Care through your Oscar mobile app or online account. Visits with this team are unlimited and always $0—even if you haven’t hit your deductible.
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 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, drugs must be prescribed by your Oscar Care virtual 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
Inpatient Coverage
Hospital Services
CoPay: $2500.00 Copay per Day
CoInsurance: Not Applicable
Covered: Covered
Benefit Explanation: All usual Hospital services and supplies, including semiprivate room, intensive care, and coronary care units; Preauthorization is required. The per day copayment will apply for a maximum of 2 days.
Inpatient Services
CoPay: $350.00
CoInsurance: Not Applicable
Covered: Covered
Emergency and Urgent Care
Emergency Room
CoPay: $1,000.00
CoInsurance: Not Applicable
Covered: Covered
Urgent Care Facility
CoPay: $50.00
CoInsurance: Not Applicable
Covered: Covered
Maternity
Labor and Delivery Hospital Stay
CoPay: $2,500.00
CoInsurance: Not Applicable
Covered: Covered
Benefit Explanation: Will cover 48-hour hospital stay for uncomplicated vaginal delivery and 96-hour hospital stay for uncomplicated caesarean section. The per day copayment will apply for a maximum of 2 days.
1-817-813-4562, TTY 711
