Oscar

Silver Simple PCP Saver

Prescription Drug Information

Inpatient Coverage

Emergency and Urgent Care

Links

Plan Overview

Medical Deductible	Individual: $5,750 Family: $11,500 Per Person: $5,750
Prescription Drug Deductible	Individual: Included in Medical Family: Included in Medical Per Person: Included in Medical
Medical Out-of-Pocket Maximum	Individual: $8,600 Family: $17,200 Per Person: $8,600
Drug Out-of-Pocket Maximum	Individual: Included in Medical Family: Included in Medical Per Person: Included in Medical

Office Visit

Primary Doctor	Standard: $20 Copay
Specialist	Standard: $70 Copay

Prescription Drug Information

Preferred Brand Drugs	Standard: $100 Copay
Non Preferred Brand Drugs	Standard: 40% Coinsurance after deductible
Generic Drugs	Standard: $3 Copay
Specialty Drugs	Standard: 40% Coinsurance after deductible

Inpatient Coverage

Hospital Services	Standard: 40% Coinsurance after deductible
Inpatient Services	Standard: 40% Coinsurance after deductible

Emergency and Urgent Care

Emergency Room

Standard: 40% Coinsurance after deductible