Oscar Insurance Company

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Combined Medical and Drug Deductible	Individual: $9,200.00 Family: $18400 Per Person: $9200
Combined Medical and Drug Out of Pocket Maximum	Individual: $9,200.00 Family: $18400 Per Person: $9200

Primary Doctor

CoPay: No Charge after deductible
CoInsurance: Not Applicable
Covered: Covered
Benefit Explanation: First three (3) non-preventive visits are $0 and not subject to the deductible. Cost share applies to both in-person and telemedicine services. Your PCP provides your primary health care, orders lab tests and x-rays, prescribes medicines or therapies and arranges hospitalization when necessary. Your PCP may be a family practitioner, a general practitioner, an internal medicine specialist, a pediatrician, an obstetrician/gynecologist, a nurse practitioner or a physician assistant.You may choose to seek services from a Participating Provider without referral from your PCP at any time

Specialist

CoPay: No Charge after deductible
CoInsurance: Not Applicable
Covered: Covered
Benefit Explanation: Cost share applies to both in-person and telemedicine services. Referral care is care provided by a Health Professional or Physician other than your PCP. You may request a second medical opinion from a Participating Specialist Provider who has skills and training substantially similar to those of the Physician making the original treatment recommendation without Prior Approval. If there are no Participating Providers with the skills and training needed to provide a second opinion on the proposed treatment, we may Cover a second medical opinion from a Non-Participating Specialist Provider. Prior Approval from Priority Health is required before the second opinion is obtained. Any tests, procedures, treatments or surgeries recommended by the consulting Provider must be performed by a Participating Provider unless we approve the services in advance.

Preferred Brand Drugs	CoPay: No Charge after deductible CoInsurance: Not Applicable Covered: Covered Benefit Explanation: Prescription Drugs and Supplies, Drugs and supplies that are prescribed and received during a Covered inpatient stay are Covered as medical benefits.drugs for cancer therapy and the reasonable cost of administering them are Covered.
Non Preferred Brand Drugs	CoPay: No Charge after deductible CoInsurance: Not Applicable Covered: Covered Benefit Explanation: Prescription Drugs and Supplies, Drugs and supplies that are prescribed and received during a Covered inpatient stay are Covered as medical benefits.drugs for cancer therapy and the reasonable cost of administering them are Covered.
Generic Drugs	CoPay: No Charge after deductible CoInsurance: Not Applicable Covered: Covered Benefit Explanation: Prescription Drugs and Supplies, Drugs and supplies that are prescribed and received during a Covered inpatient stay are Covered as medical benefits.drugs for cancer therapy and the reasonable cost of administering them are Covered.
Specialty Drugs	CoPay: No Charge after deductible CoInsurance: Not Applicable Covered: Covered Benefit Explanation: Prescription Drugs and Supplies, Drugs and supplies that are prescribed and received during a Covered inpatient stay are Covered as medical benefits.drugs for cancer therapy and the reasonable cost of administering them are Covered.

Hospital Services	CoPay: No Charge after deductible CoInsurance: Not Applicable Covered: Covered Benefit Explanation: (a) Hospital Inpatient Care. Hospital and long term acute inpatient services and supplies including services performed by Physicians and Health Professionals, room and board, general nursing care, drugs administered while you are confined as an inpatient, and related services and supplies.
Inpatient Services	CoPay: No Charge after deductible CoInsurance: Not Applicable Covered: Covered Benefit Explanation: (a) Hospital Inpatient Care. Hospital and long term acute inpatient services and supplies including services performed by Physicians and Health Professionals, room and board, general nursing care, drugs administered while you are confined as an inpatient, and related services and supplies.

Emergency Room	CoPay: No Charge after deductible CoInsurance: Not Applicable Covered: Covered Benefit Explanation: Medical Emergency care and Urgent Care services are Covered.
Urgent Care Facility	CoPay: No Charge after deductible CoInsurance: Not Applicable Covered: Covered Benefit Explanation: Virtual urgent care services provided by Oscar-designated virtual care providers are covered in full once the deductible has been met. Medical Emergency care and Urgent Care services are Covered under this Certificate.

Labor and Delivery Hospital Stay

CoPay: No Charge after deductible
CoInsurance: Not Applicable
Covered: Covered
Benefit Explanation: Covered Services(a) Hospital and Provider care. Services and supplies furnished by a Hospital or Provider for prenatal care, including genetic testing, postnatal care, Hospital delivery, and care for the Complications of Pregnancy. The mother and Newborn have the right to an inpatient stay of no less than 48 hours following a normal vaginal delivery or no less than 96 hours following a cesarean section. If the mother and her attending Physician agree, the mother and the Newborn may be discharged from the Hospital sooner. (b) Newborn child care. A Newborn child (including necessary care and treatment of medically diagnosed congenital defects and birth abnormalities) for the first 31 days from birth. Telephone assessment and home visits by a registered nurse shortly after the date of the mother's discharge for evaluation of the mother, Newborn and family. These services are only available if your Provider identifies a medical need. (d) Maternity education programs

Pre and Postnatal Office Visit

CoPay: Not Applicable
CoInsurance: 0.00%
Covered: Covered
Benefit Explanation: Covered Services(a) Hospital and Provider care. Services and supplies furnished by a Hospital or Provider for prenatal care, including genetic testing, postnatal care, Hospital delivery, and care for the Complications of Pregnancy. The mother and Newborn have the right to an inpatient stay of no less than 48 hours following a normal vaginal delivery or no less than 96 hours following a cesarean section. If the mother and her attending Physician agree, the mother and the Newborn may be discharged from the Hospital sooner. (b) Newborn child care. A Newborn child (including necessary care and treatment of medically diagnosed congenital defects and birth abnormalities) for the first 31 days from birth. Telephone assessment and home visits by a registered nurse shortly after the date of the mother's discharge for evaluation of the mother, Newborn and family. These services are only available if your Provider identifies a medical need. (d) Maternity education programs

Routine Eye Exams for Children

Routine Dental Checkups for Children	Covered: Not Covered
Routine Dental Checkups for Adults	Covered: Not Covered