Plan Details

CommunityCare PPO Platinum A Select

87698OK0090004-01

Plan Year:

2018

Individual Deductible:	$500
Individual Out of Pocket Maximum:	$1,700
Office Visit Copay:	$10
Out of Network Coinsurance:	50%*
Preferred Generics:	$15
Preferred Brand Name:	$40
Non-Preferred Brand Name:	$70
Specialty:	$160

^*Subject to the deductible.

Insure Oklahoma Qualified

Eligible for Small Business Health Care Tax Credits

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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