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Plan Details

98905OK0320003-00

Plan Year:

2024

Platinum Metal plans cover an estimated 90% of your medical and prescription drug costs. They also limit your annual out-of-pocket expenses. Platinum Plans are the most expensive of all the "metal plans."

Individual Deductible:	$1,000
Individual Out of Pocket Maximum:	$3,000
Office Visit Copay:	$25
Preferred Generics:	$10
Preferred Brand Name:	$45
Non-Preferred Brand Name:	$95
Individual Rx Deductible:	None
Preferred Specialty:	$300
Non-Preferred Specialty:	$350
Specialist Copay:	$50
Coinsurance:	20%

Benefit Details

Directories

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

Plan Details

CommunityCare Platinum 419 HMO One

Benefit Details

Directories

Additional Information

Essential Benefits