Plan Details

98905OK0130043-00

Plan Year:

2023

Gold Metal plans cover an estimated 80% of your medical and prescription drug costs. They also limit your annual out-of-pocket expenses.

Individual Deductible:	$1,100
Individual Out of Pocket Maximum:	$8,700
Office Visit Copay:	$30
Preferred Generics:	$15
Preferred Brand Name:	$45
Non-Preferred Brand Name:	$95^*
Individual Rx Deductible:	Integrated
Preferred Specialty:	$300^*
Non-Preferred Specialty:	$350^*
Specialist Copay:	$55
Coinsurance:	40%^*

First 3 telehealth visits at $0.

^*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: