Plan Details

CommunityCare Platinum Premier Standard

98905OK0180017-00

Plan Year:

2017

Individual Deductible:	$0
Individual Out of Pocket Maximum:	$1,400
Office Visit Copay:	$20
Preferred Generics:	$15
Preferred Brand Name:	$40
Non-Preferred Brand Name:	$70
Specialty:	$160

Insure Oklahoma Qualified

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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