Silver Elite Saver Plus

69512MO0010030
Silver
EPO

Silver Elite Saver Plus is a Silver EPO plan by Oscar Insurance Company.

Locations

Silver Elite Saver Plus is offered in the following counties.

Plan Overview

This is a plan overview for 2025 version of Silver Elite Saver Plus 69512MO0010030.
Insurer: Oscar Insurance Company
Network Type: EPO
Metal Type: Silver
HSA Eligible?: No
Plan ID: 69512MO0010030

Cost-Sharing Overview

Silver Elite Saver Plus 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 Silver Elite Saver Plus?

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

Silver Elite Saver Plus offers the following features and referral requirements.

Wellness Program: No
Disease Program: Asthma, Heart Disease, Depression, Diabetes, Pregnancy
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 Silver Elite Saver Plus 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

Silver Elite Saver Plus 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
$60.00 Not ApplicableNot Applicable 100.00% Cost share applies to both in-person and telemedicine services.
Specialist Visit
Covered
$100.00 Not ApplicableNot Applicable 100.00% Cost share applies to both in-person and telemedicine services.
Other Practitioner Office Visit (Nurse, Physician Assistant)
Covered
$60.00 Not ApplicableNot Applicable 100.00%
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Covered
Not Applicable 50.00%Not Applicable 100.00%
Outpatient Surgery Physician/Surgical Services
Covered
Not Applicable 50.00%Not Applicable 100.00%
Hospice Services
Covered
Not Applicable 50.00%Not Applicable 100.00%
Routine Dental Services (Adult)
Not Covered
Infertility Treatment
Not Covered
Fertility treatments such as artificial insemination and in-vitro fertilization are not a Covered Service. Covered Services include diagnostic tests to find the cause of infertility and services to treat the underlying medical conditions that cause infertility
Long-Term/Custodial Nursing Home Care
Not Covered
Private-Duty Nursing
Covered
$100.00 Not ApplicableNot Applicable 100.00%82.0 Visit(s) per Benefit Period Private Duty Nursing Services excluded if given in a Hospital or Skilled Nursing Facility. Private duty nursing services are a Covered Service only when given as part of the “Home Care Services” benefit. Private Duty Lifetime Maximum: 164 visits In- and Out-of-Network combined.
Routine Eye Exam (Adult)
Not Covered
Urgent Care Centers or Facilities
Covered
$50.00 Not ApplicableNot Applicable 100.00% Virtual urgent care services provided by Oscar-designated virtual care providers are covered in full.
Home Health Care Services
Covered
$100.00 Not ApplicableNot Applicable 100.00%100.0 Visit(s) per Benefit Period To be eligible for benefits, you must essentially be confined to the home, as an alternative to a Hospital stay, and be physically unable to get needed medical services on an outpatient basis
Emergency Room Services
Covered
Not Applicable 50.00%Not Applicable 50.00%
Emergency Transportation/Ambulance
Covered
Not Applicable 50.00%Not Applicable 50.00%
Inpatient Hospital Services (e.g., Hospital Stay)
Covered
Not Applicable 50.00%Not Applicable 100.00%
Inpatient Physician and Surgical Services
Covered
Not Applicable 50.00%Not Applicable 100.00%
Bariatric Surgery
Not Covered
Cosmetic Surgery
Not Covered
Skilled Nursing Facility
Covered
Not Applicable 50.00%Not Applicable 100.00%150.0 Days per Benefit Period Limit is for in-and out-of-network combined and includes rehab and outpatient day rehab.
Prenatal and Postnatal Care
Covered
Not Applicable 0.00%Not Applicable 100.00%
Delivery and All Inpatient Services for Maternity Care
Covered
Not Applicable 50.00%Not Applicable 100.00%
Mental/Behavioral Health Outpatient Services
Covered
$60.00 Not ApplicableNot Applicable 100.00%
Mental/Behavioral Health Inpatient Services
Covered
Not Applicable 50.00%Not Applicable 100.00%
Substance Abuse Disorder Outpatient Services
Covered
$60.00 Not ApplicableNot Applicable 100.00%
Substance Abuse Disorder Inpatient Services
Covered
Not Applicable 50.00%Not Applicable 100.00%
Generic Drugs
Covered
$3.00 Not ApplicableNot Applicable 100.00%
Preferred Brand Drugs
Covered
$125.00 Not ApplicableNot Applicable 100.00%
Non-Preferred Brand Drugs
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00%
Specialty Drugs
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00%
Outpatient Rehabilitation Services
Covered
$60.00 Not ApplicableNot Applicable 100.00%20.0 Visit(s) per Benefit Period To be Covered Services, rehabilitation services must involve goals you can reach in a reasonable period of time. Benefits will end when treatment is no longer Medically Necessary and you stop progressing toward those goals.
Habilitation Services
Covered
$60.00 Not ApplicableNot Applicable 100.00%20.0 Visit(s) per Benefit Period ABA for autism only covered through age 18. Habilitative services definition: “help you keep, learn or improve skills and functioning for daily living.”
Chiropractic Care
Covered
$100.00 Not ApplicableNot Applicable 100.00% Chiropractic visits beyond 26 per benefit period require Prior Authorization
Durable Medical Equipment
Covered
Not Applicable 50.00%Not Applicable 100.00% Non-Medically Necessary enhancements to standard equipment and devices.
Hearing Aids
Covered
Not Applicable 50.00%Not Applicable 100.00% Not covered for adults aged 19 and older Benefits include hearing aids provided to a newborn for initial amplification following a newborn hearing screening. Limited to 1 hearing aid per ear, every 4 years, for children through age 18.
Imaging (CT/PET Scans, MRIs)
Covered
Not Applicable 50.00%Not Applicable 100.00%
Preventive Care/Screening/Immunization
Covered
Not Applicable 0.00%Not Applicable 100.00%
Routine Foot Care
Covered
$100.00 Not ApplicableNot Applicable 100.00% Coverage is only available if Medically Necessary Coverage is available if Medically Necessary.
Acupuncture
Not Covered
Weight Loss Programs
Not Covered
Routine Eye Exam for Children
Covered
$0.00 Not ApplicableNot Applicable 100.00%1.0 Exam(s) per Benefit Period
Eye Glasses for Children
Covered
Not Applicable 50.00%Not Applicable 100.00%1.0 Item(s) per Year Covered lenses and frames each available at limit of one per year
Dental Check-Up for Children
Not Covered
Rehabilitative Speech Therapy
Covered
$60.00 Not ApplicableNot Applicable 100.00% Unlimited visits for speech therapy.
Rehabilitative Occupational and Rehabilitative Physical Therapy
Covered
$60.00 Not ApplicableNot Applicable 100.00%20.0 Visit(s) per Benefit Period 20 visit limit each for PT and OT.
Well Baby Visits and Care
Covered
Not Applicable 0.00%Not Applicable 100.00%
Laboratory Outpatient and Professional Services
Covered
$50.00 Not ApplicableNot Applicable 100.00%
X-rays and Diagnostic Imaging
Covered
$100.00 Not ApplicableNot 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
Benefits include only services for a “therapeutic abortion,” which is an abortion performed to save the life of the mother. Public funding is not prohibited when an abortion is performed to save the life of the mother.
Transplant
Covered
Not Applicable 50.00%Not Applicable 100.00%
Accidental Dental
Covered
Not Applicable 50.00%Not Applicable 100.00%3000.0 Dollars per Episode Treatment must begin within 12 months of the injury
Dialysis
Covered
Not Applicable 50.00%Not Applicable 100.00% Covered Services include dialysis treatments in an outpatient dialysis, or home dialysis and training for you and the person who will help you with home self- dialysis
Allergy Testing
Covered
$100.00 Not ApplicableNot Applicable 100.00%
Chemotherapy
Covered
Not Applicable 50.00%Not Applicable 100.00%
Radiation
Covered
Not Applicable 50.00%Not Applicable 100.00%
Diabetes Education
Covered
$0.00 Not ApplicableNot Applicable 100.00%
Prosthetic Devices
Covered
Not Applicable 50.00%Not Applicable 100.00% Benefits include the purchase, fitting, adjustments, repairs and replacements
Infusion Therapy
Covered
Not Applicable 50.00%Not Applicable 100.00%
Treatment for Temporomandibular Joint Disorders
Covered
Not Applicable 50.00%Not Applicable 100.00% Covered Services do not include fixed or removable appliances that involve movement or repositioning of the teeth, repair of teeth (fillings), or prosthetics (crowns, bridges, dentures) Covered Services include removable appliances for TMJ repositioning and related surgery, medical care, and diagnostic services.
Nutritional Counseling
Covered
$60.00 Not ApplicableNot Applicable 100.00%
Reconstructive Surgery
Covered
Not Applicable 50.00%Not Applicable 100.00% Benefits include reconstructive surgery to correct significant deformities caused by congenital or developmental abnormalities, illness, injury or an earlier treatment in order to create a more normal appearance.
Gender Affirming Care
Not Covered

Free Preventive Services

There is no copayment or coinsurance for any of the following Silver Elite Saver Plus 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 Silver Elite Saver Plus 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 Silver Elite Saver Plus?

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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