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Bronze Classic

91908OK0010003
Expanded Bronze
PPO

Bronze Classic is an Expanded Bronze PPO plan by Oscar Insurance Company.

IMPORTANT: You are viewing the 2023 version of Bronze Classic 91908OK0010003. You can enroll in this plan if you qualify for special enrollment until the end of 2023.

Locations

Bronze Classic is offered in the following counties.

Plan Overview

This is a plan overview for 2023 version of Bronze Classic 91908OK0010003.
Insurer: Oscar Insurance Company
Network Type: PPO
Metal Type: Expanded Bronze
HSA Eligible?: No
Plan ID: 91908OK0010003

Cost-Sharing Overview

Bronze Classic offers the following cost-sharing.

Notes:

  • Some plans have separate cost-sharing for medical and drugs, while other plans offer combined cost-sharing. The cost-sharing amounts above are combined medical and drug costs unless otherwise noted.
  • You are viewing the standard version of this plan. Your costs may be lower depending on your income. Use the “get a quote” button below to see your estimated premium and out-of-pocket costs after assistance.
Ready to sign up for Bronze Classic?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

Plan Features

Bronze Classic offers the following features and referral requirements.

Wellness Program: No
Disease Program: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
Notice Pregnancy: No
Referral Specialist: No
Specialist Requiring Referral:
Plan Exclusions:
Child Only Option?: Allows Adult and Child-Only

Network Details

The following network details will help you understand what Bronze Classic covers when you are out of the service area or out of the country.

Out of Country Coverage: Yes
Out of Country Coverage Description: Emergency Services only.
Out of Service Area Coverage: Yes
Out of Service Area Coverage Description: Emergency and Urgent Services only.
National Network: No

Additional Benefits and Cost-Sharing

Bronze Classic includes the following benefits at the cost sharing rates listed below.

Service In-Network
Copay / Coinsurance
Out-of-Network
Copay / Coinsurance
Limits and Explanation
Primary Care Visit to Treat an Injury or Illness
Covered
$50.00 50.00% Coinsurance after deductible 50.00% Coinsurance after deductible One (1) non-preventive visit is $50 and not subject to the deductible. Virtual visits with an Oscar Care urgent 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 Urgent Care team.* Please refer to your plan documents for more information. *For these savings to apply, they must be prescribed by your Oscar Virtual Urgent Care provider under a Silver, Gold, or Platinum plan.
Specialist Visit
Covered
50.00% Coinsurance after deductible 50.00% Coinsurance after deductible
Other Practitioner Office Visit (Nurse, Physician Assistant)
Covered
50.00% Coinsurance after deductible 50.00% Coinsurance after deductible
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Covered
$1200.00 Copay after deductible 50.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services
Covered
$350.00 Copay after deductible 50.00% Coinsurance after deductible
Hospice Services
Covered
50.00% Coinsurance after deductible 50.00% Coinsurance after deductible
Routine Dental Services (Adult)
Infertility Treatment
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Covered
50.00% Coinsurance after deductible 50.00% Coinsurance after deductible85 Visit(s) per Benefit Period Pre-authorization required.
Routine Eye Exam (Adult)
Urgent Care Centers or Facilities
Covered
$75.00 50.00% Coinsurance after deductible
Home Health Care Services
Covered
50.00% Coinsurance after deductible 50.00% Coinsurance after deductible30 Visit(s) per Benefit Period
Emergency Room Services
Covered
50.00% Coinsurance after deductible 50.00% Coinsurance after deductible
Emergency Transportation/Ambulance
Covered
50.00% Coinsurance after deductible 50.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)
Covered
50.00% Coinsurance after deductible 50.00% Coinsurance after deductible
Inpatient Physician and Surgical Services
Covered
50.00% Coinsurance after deductible 50.00% Coinsurance after deductible
Bariatric Surgery
Cosmetic Surgery
Skilled Nursing Facility
Covered
50.00% Coinsurance after deductible 50.00% Coinsurance after deductible30 Days per Benefit Period
Prenatal and Postnatal Care
Covered
$0.00 50.00% Coinsurance after deductible
Delivery and All Inpatient Services for Maternity Care
Covered
50.00% Coinsurance after deductible 50.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services
Covered
50.00% Coinsurance after deductible 50.00% Coinsurance after deductible Benefits for the treatment of Mental Illness include treatments for drug addiction, substance abuse and alcoholism.
Mental/Behavioral Health Inpatient Services
Covered
50.00% Coinsurance after deductible 50.00% Coinsurance after deductible Benefits for the treatment of Mental Illness include treatments for drug addiction, substance abuse and alcoholism.
Substance Abuse Disorder Outpatient Services
Covered
50.00% Coinsurance after deductible 50.00% Coinsurance after deductible Benefits for the treatment of Mental Illness include treatments for drug addiction, substance abuse and alcoholism.
Substance Abuse Disorder Inpatient Services
Covered
50.00% Coinsurance after deductible 50.00% Coinsurance after deductible Benefits for the treatment of Mental Illness include treatments for drug addiction, substance abuse and alcoholism.
Generic Drugs
Covered
$3.00 100.00% Oscar is on a mission to make your prescriptions more affordable. That?s why your savings start on day 1 of your new plan. All Oscar members have access to 24/7 virtual urgent care services. Depending on your plan, if your Oscar Virtual Urgent Care provider prescribes any prescriptions on the Generics: Tier 1a or Generics: Tier 1b list during your visit, 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, they must be prescribed by your Oscar Virtual Urgent Care provider under a Silver, Gold, or Platinum plan. Virtual visits with other providers in Oscar?s network will not be free and the additional savings will not apply.
Preferred Brand Drugs
Covered
$250.00 Copay after deductible 100.00%
Non-Preferred Brand Drugs
Covered
50.00% Coinsurance after deductible 100.00%
Specialty Drugs
Covered
50.00% Coinsurance after deductible 100.00%
Outpatient Rehabilitation Services
Covered
50.00% Coinsurance after deductible 50.00% Coinsurance after deductible30 Days per Benefit Period
Habilitation Services
Covered
50.00% Coinsurance after deductible 50.00% Coinsurance after deductible25 Visit(s) per Benefit Period
Chiropractic Care
Covered
50.00% Coinsurance after deductible 50.00% Coinsurance after deductible
Durable Medical Equipment
Covered
50.00% Coinsurance after deductible 50.00% Coinsurance after deductible
Hearing Aids
Covered
50.00% Coinsurance after deductible 50.00% Coinsurance after deductible One hearing aid per ear every 48 months up to age 18.
Imaging (CT/PET Scans, MRIs)
Covered
50.00% Coinsurance after deductible 50.00% Coinsurance after deductible
Preventive Care/Screening/Immunization
Covered
$0.00 50.00% Coinsurance after deductible
Routine Foot Care
Acupuncture
Weight Loss Programs
Routine Eye Exam for Children
Covered
$0.00 50.00% Coinsurance after deductible1 Exam(s) per Year
Eye Glasses for Children
Covered
50.00% 50.00% Coinsurance after deductible1 Item(s) per Year
Dental Check-Up for Children
Not Covered
2 Visit(s) per Year
Rehabilitative Speech Therapy
Covered
50.00% Coinsurance after deductible 50.00% Coinsurance after deductible25 Visit(s) per Benefit Period Maximum of 25 Outpatient visits for Physical Therapy, Occupational Therapy and Speech Therapy (combined).
Rehabilitative Occupational and Rehabilitative Physical Therapy
Covered
50.00% Coinsurance after deductible 50.00% Coinsurance after deductible25 Visit(s) per Benefit Period Maximum of 25 Outpatient visits for Physical Therapy, Occupational Therapy and Speech Therapy (combined).
Well Baby Visits and Care
Covered
$0.00 50.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services
Covered
$10.00 Copay after deductible 50.00% Coinsurance after deductible
X-rays and Diagnostic Imaging
Covered
50.00% Coinsurance after deductible 50.00% Coinsurance after deductible
Basic Dental Care – Child
Not Covered
Orthodontia – Child
Not Covered
Major Dental Care – Child
Not Covered
Basic Dental Care – Adult
Orthodontia – Adult
Major Dental Care – Adult
Abortion for Which Public Funding is Prohibited
Transplant
Covered
50.00% Coinsurance after deductible 50.00% Coinsurance after deductible
Accidental Dental
Covered
$350.00 Copay after deductible 50.00% Coinsurance after deductible
Dialysis
Covered
$350.00 Copay after deductible 50.00% Coinsurance after deductible
Allergy Testing
Covered
50.00% Coinsurance after deductible 50.00% Coinsurance after deductible Issuer clarifies this is a covered benefit but stipulated under the Medical Policy and not written in the member materials.
Chemotherapy
Covered
$350.00 Copay after deductible 50.00% Coinsurance after deductible
Radiation
Covered
50.00% Coinsurance after deductible 50.00% Coinsurance after deductible
Diabetes Education
Covered
$0.00 50.00% Coinsurance after deductible
Prosthetic Devices
Covered
50.00% Coinsurance after deductible 50.00% Coinsurance after deductible
Infusion Therapy
Covered
50.00% Coinsurance after deductible 50.00% Coinsurance after deductible25 Visit(s) per Benefit Period Covered under Outpatient Therapy Services.
Treatment for Temporomandibular Joint Disorders
Nutritional Counseling
Covered
50.00% Coinsurance after deductible 50.00% Coinsurance after deductible Diabetes self-management training and training related to medical nutrition therapy.
Reconstructive Surgery
Covered
50.00% Coinsurance after deductible 50.00% Coinsurance after deductible Breast reconstruction or implantation or removal of breast prostheses is a Covered Service only when performed solely and directly as a result of mastectomy which is Medically Necessary.
Gender Affirming Care
Covered
50.00% Coinsurance after deductible 50.00% Coinsurance after deductible

Free Preventive Services

There is no copayment or coinsurance for any of the following Bronze Classic preventive services. This is true even if you haven’t met your yearly deductible.

Please note, these services are free only when delivered by a doctor or other provider in your plan’s network.

Additional Resources

Below are additional resources for Bronze Classic including the Summary of Benefits & Coverage (SBC), plan brochure, formulary link, and a link to the website to pay your monthly premium after you enroll.

Summary of Benefits: Summary of Benefits Link
Plan Brochure: Plan Brochure Link
Formulary: Formulary Link
Premium Payment Website: Premium Payment Link
Ready to sign up for Bronze Classic?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

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