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Plan Details

CommunityCare PPO Gold D Standard

87698OK0110006-00
Plan Year:
2017
Individual Deductible:$2,500
Individual Out of Pocket Maximum:$3,500
Office Visit Copay:$20
Out of Network Coinsurance:50%*
Preferred Generics:$15
Preferred Brand Name:$40
Non-Preferred Brand Name:$70
Specialty:$160*
*Subject to the deductible
Click here to visit HealthCare.gov for a Rate Quote

Benefit Details

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Additional Information

Essential Benefits

All health plans in the exchanges are required to provide a minimum set of benefits which are termed essential benefits. These benefits include:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health services
  • Substance use disorder services
  • Prescription drug coverage
  • Rehabilitative and habilitative services and devices
  • Preventative and wellness services
  • Pediatric Services