Oscar

Silver Simple- For Diabetes (Choice) ($0 Virtual Primary Care + $0 Diabetic Labs + Insulin Discounts + $0 Foot and Eye Exams)

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Plan Overview

Combined Medical and Drug Deductible	Individual: $6,450 Family: $12,900 Per Person: $6,450
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
CoInsurance: Not Applicable
Covered: Covered
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: $40.00
CoInsurance: Not Applicable
Covered: Covered
Benefit Explanation: Diabetic eye exam and diabetic foot exams are covered in full.

Prescription Drug Information

Preferred Brand Drugs	CoPay: $75.00 Copay after deductible CoInsurance: Not Applicable Covered: Covered Benefit Explanation: Covered prescription insulin drugs are limited to a $100 copayment maximum per 30-day supply.
Non Preferred Brand Drugs	CoPay: Not Applicable CoInsurance: 50.00% Coinsurance after deductible Covered: Covered Benefit Explanation: Covered prescription insulin drugs are limited to a $100 copayment maximum per 30-day supply.
Generic Drugs	CoPay: $0.00 CoInsurance: Not Applicable Covered: Covered Benefit Explanation: Covered prescription insulin drugs are limited to a $100 copayment maximum per 30-day supply. 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 Benefit Explanation: Covered prescription insulin drugs are limited to a $100 copayment maximum per 30-day supply.

Inpatient Coverage

Hospital Services	CoPay: Not Applicable CoInsurance: 50.00% Coinsurance after deductible Covered: Covered Benefit Explanation: All usual Hospital services and supplies, including semiprivate room, intensive care, and coronary care units; Preauthorization is required.
Inpatient Services	CoPay: Not Applicable CoInsurance: 50.00% Coinsurance after deductible Covered: Covered

Emergency and Urgent Care

Emergency Room	CoPay: Not Applicable CoInsurance: 50.00% Coinsurance after deductible Covered: Covered
Urgent Care Facility	CoPay: $75.00 CoInsurance: Not Applicable Covered: Covered

Maternity

Labor and Delivery Hospital Stay	CoPay: Not Applicable CoInsurance: 50.00% Coinsurance after deductible Covered: Covered Benefit Explanation: Will cover 48-hour hospital stay for uncomplicated vaginal delivery and 96-hour hospital stay for uncomplicated caesarean section.
Pre and Postnatal Office Visit	CoPay: Not Applicable CoInsurance: 0.00% Covered: Covered

Vision

Routine Eye Exams For Children

CoPay: $0.00
CoInsurance: Not Applicable
Covered: Covered

Major Dental Care

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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Silver Simple- For Diabetes (Choice) ($0 Virtual Primary Care + $0 Diabetic Labs + Insulin Discounts + $0 Foot and Eye Exams)

Plan Overview

Office Visit

Prescription Drug Information

Inpatient Coverage

Emergency and Urgent Care

Maternity

Vision

Major Dental Care

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