CommunityCare Catastrophic Select

98905OK0130024
Catastrophic
HMO

CommunityCare Catastrophic Select is a Catastrophic HMO plan by CommunityCare.

IMPORTANT: You are viewing the 2024 version of CommunityCare Catastrophic Select 98905OK0130024. You can enroll in this plan during open enrollment 2024, which starts November 1st and ends January 15th, 2023, in most states.

Locations

CommunityCare Catastrophic Select is offered in the following counties.

Plan Overview

This is a plan overview for 2024 version of CommunityCare Catastrophic Select 98905OK0130024.
Insurer: CommunityCare
Network Type: HMO
Metal Type: Catastrophic
HSA Eligible?: No
Plan ID: 98905OK0130024

Cost-Sharing Overview

CommunityCare Catastrophic Select 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 CommunityCare Catastrophic Select?

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

CommunityCare Catastrophic Select offers the following features and referral requirements.

Wellness Program: Yes
Disease Program: Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management
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 CommunityCare Catastrophic Select 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
Out of Service Area Coverage: Yes
Out of Service Area Coverage Description: Emergency Services
National Network: No

Additional Benefits and Cost-Sharing

CommunityCare Catastrophic Select 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
$35.00 Copay after deductible Not ApplicableNot Applicable 100.00%
Specialist Visit
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Other Practitioner Office Visit (Nurse, Physician Assistant)
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 100.00%
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Outpatient Surgery Physician/Surgical Services
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Hospice Services
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Routine Dental Services (Adult)
Not Covered
Infertility Treatment
Not Covered
Long-Term/Custodial Nursing Home Care
Not Covered
Private-Duty Nursing
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%85.0 Visit(s) per Year
Routine Eye Exam (Adult)
Not Covered
Urgent Care Centers or Facilities
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Home Health Care Services
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00% Must be medically necessary and is subject to prior authorization
Emergency Room Services
Covered
Not Applicable No Charge after deductibleNot Applicable No Charge after deductible
Emergency Transportation/Ambulance
Covered
Not Applicable No Charge after deductibleNot Applicable No Charge after deductible
Inpatient Hospital Services (e.g., Hospital Stay)
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Inpatient Physician and Surgical Services
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Bariatric Surgery
Not Covered
Except when medically necessary
Cosmetic Surgery
Not Covered
Skilled Nursing Facility
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%60.0 Visit(s) per Year Up to 60 treatment days per disability, per calendar year
Prenatal and Postnatal Care
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Delivery and All Inpatient Services for Maternity Care
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Mental/Behavioral Health Outpatient Services
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Mental/Behavioral Health Inpatient Services
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Substance Abuse Disorder Outpatient Services
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Substance Abuse Disorder Inpatient Services
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Generic Drugs
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Preferred Brand Drugs
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Non-Preferred Brand Drugs
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Specialty Drugs
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Outpatient Rehabilitation Services
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%60.0 Visit(s) per Year Up to 60 treatment days per disability, per calendar year. Combination of Physical Therapy, Occupational Therapy and Speech Therapy.
Habilitation Services
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%60.0 Visit(s) per Year Up to 60 treatment days per disability, per calendar year. Combination of Physical Therapy, Occupational Therapy and Speech Therapy.
Chiropractic Care
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Durable Medical Equipment
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Hearing Aids
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%1.0 Item(s) per 2 Years 1 hearing aid per ear every 48 months
Imaging (CT/PET Scans, MRIs)
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Preventive Care/Screening/Immunization
Covered
No Charge Not ApplicableNot Applicable 100.00%
Routine Foot Care
Not Covered
Acupuncture
Not Covered
Weight Loss Programs
Not Covered
Routine Eye Exam for Children
Covered
No Charge Not ApplicableNot Applicable 100.00%1.0 Visit(s) per Year
Eye Glasses for Children
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%1.0 Item(s) per Year 1 pair of standard lenses and frames or contacts per year
Dental Check-Up for Children
Not Covered
Rehabilitative Speech Therapy
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%60.0 Visit(s) per Year Up to 60 treatment days per disability, per calendar year. Combination of Physical Therapy, Occupational Therapy and Speech Therapy.
Rehabilitative Occupational and Rehabilitative Physical Therapy
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%60.0 Visit(s) per Year Up to 60 treatment days per disability, per calendar year. Combination of Physical Therapy, Occupational Therapy and Speech Therapy.
Well Baby Visits and Care
Covered
No Charge Not ApplicableNot Applicable 100.00%
Laboratory Outpatient and Professional Services
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
X-rays and Diagnostic Imaging
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Basic Dental Care – Child
Not Covered
Orthodontia – Child
Not Covered
Major Dental Care – Child
Not Covered
Basic Dental Care – Adult
Not Covered
Orthodontia – Adult
Not Covered
Major Dental Care – Adult
Not Covered
Abortion for Which Public Funding is Prohibited
Not Covered
Abortions are excluded, except as allowed by law to protect the life of the mother from imminent danger
Transplant
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Accidental Dental
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Dialysis
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Allergy Testing
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Chemotherapy
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Radiation
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00% Must be medically necessary and is subject to prior authorization
Diabetes Education
Covered
No Charge Not ApplicableNot Applicable 100.00%
Prosthetic Devices
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Infusion Therapy
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00% Must be medically necessary and is subject to prior authorization
Treatment for Temporomandibular Joint Disorders
Not Covered
Nutritional Counseling
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00%
Reconstructive Surgery
Covered
Not Applicable No Charge after deductibleNot Applicable 100.00% Surgery performed primarily to improve or alter the Member’s external appearance is excluded Covered in cases of mastectomies and medically necessary situations, and for medically necessary reconstructive surgery due to accidental injury, functional congenital defects, or deformities that are the result of treatment or illness that substantially impair bodily function.
Gender Affirming Care
Not Covered

Free Preventive Services

There is no copayment or coinsurance for any of the following CommunityCare Catastrophic Select 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 CommunityCare Catastrophic Select 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 CommunityCare Catastrophic Select?

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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