If you receive a survey about your health care services, we hope you will take a few minutes to give us your feedback. Your opinion is important to us!
Important Note: For online premium payments, please only use CommunityCare verified payment portals to process transactions.

Plan Details

CommunityCare PPO Bronze A19 Standard

87698OK0110034-00
Plan Year:
2024

Bronze Metal plans cover an estimated 60% of your medical and prescription drug costs. They limit your annual out-of-pocket expenses. Bronze plans are the least expensive of all the "metal plans." Bronze plans do not qualify as creditable coverage.

Individual Deductible:$6,200
Individual Out of Pocket Maximum:$7,150
Office Visit Copay:$25*
Out of Network Coinsurance:60%*
Preferred Generics:$15*
Preferred Brand Name:$45*
Non-Preferred Brand Name:$95*
Individual Rx Deductible:Integrated
Preferred Specialty:$300*
Non-Preferred Specialty:$350*
OON Individual Deductible:$12,400
OON Family Deductible:$37,200
OON OOP Individual Deductible:Unlimited
OON OOP Family Deductible:Unlimited
OON Office Visit Copay:60%*
Specialist Copay:$50*
OON Specialist Copay:60%*
Coinsurance:50%*
*Subject to the deductible.

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