Plan Details

98905OK0130025-00

Plan Year:

2023

Silver Metal plans cover an estimated 70% of your medical and prescription drug costs. They limit your annual out-of-pocket expenses.

Individual Deductible:	$5,000
Individual Out of Pocket Maximum:	$9,100
Office Visit Copay:	$30
Preferred Brand Name:	$45
Non-Preferred Brand Name:	$95^*
Individual Rx Deductible:	Integrated
Preferred Specialty:	$300^*
Non-Preferred Specialty:	$350^*
Specialist Copay:	$50
Coinsurance:	30%^*

^*Subject to the deductible.

Benefit Details

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

CommunityCare is proudly owned by two of the region’s premier health systems. Other physicians and providers are available in our network.