Plan Details

87698OK0110033-00

Plan Year:

2024

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

Individual Deductible:	$2,900
Individual Out of Pocket Maximum:	$7,050
Office Visit Copay:	$35^*
Out of Network Coinsurance:	50%^*
Preferred Generics:	$15^*
Preferred Brand Name:	$40^*
Non-Preferred Brand Name:	$95^*
Individual Rx Deductible:	Integrated
OON Individual Deductible:	$5,600
OON Family Deductible:	$16,800
OON OOP Individual Deductible:	Unlimited
OON OOP Family Deductible:	Unlimited
OON Office Visit Copay:	50%^*
Specialist Copay:	$45^*
OON 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: