Oscar

Bronze Simple HSA

Prescription Drug Information

Inpatient Coverage

Emergency and Urgent Care

Links

Plan Overview

Medical Deductible	Individual: $5,000 Family: $10,000 Per Person: $5,000
Prescription Drug Deductible	Individual: Included in Medical Family: Included in Medical Per Person: Included in Medical
Medical Out-of-Pocket Maximum	Individual: $7,450 Family: $14,900 Per Person: $7,450
Drug Out-of-Pocket Maximum	Individual: Included in Medical Family: Included in Medical Per Person: Included in Medical

Office Visit

Primary Doctor	Standard: $40 Copay after deductible
Specialist	Standard: $90 Copay after deductible

Prescription Drug Information

Preferred Brand Drugs	Standard: $200 Copay after deductible
Non Preferred Brand Drugs	Standard: 50% Coinsurance after deductible
Generic Drugs	Standard: $3 Copay after deductible
Specialty Drugs	Standard: 50% Coinsurance after deductible

Inpatient Coverage

Hospital Services	Standard: 50% Coinsurance after deductible
Inpatient Services	Standard: 50% Coinsurance after deductible

Emergency and Urgent Care

Emergency Room

Standard: 50% Coinsurance after deductible