Plan Details

98905OK0130047-00

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:	$2,000
Individual Out of Pocket Maximum:	$8,700
Office Visit Copay:	$30
Preferred Generics:	$15
Preferred Brand Name:	$30
Non-Preferred Brand Name:	$60
Individual Rx Deductible:	None
Preferred Specialty:	$250
Non-Preferred Specialty:	$250
Specialist Copay:	$60
Coinsurance:	25%^*

^*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.