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Plan Details

CommunityCare Gold 4 Classic

98905OK0170085-01
Plan Year:
2017
Individual Deductible:$1,250
Individual Out of Pocket Maximum:$4,750
Office Visit Copay:$20
Preferred Generics:$10
Preferred Brand Name:$30
Non-Preferred Brand Name:$75
Specialty:30%

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