Plan Details

98905OK0270009-00

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:	$5,500
Individual Out of Pocket Maximum:	$8,000
Office Visit Copay:	$25
Out of Network Coinsurance:	70%^*
Preferred Generics:	$15
Preferred Brand Name:	$45
Non-Preferred Brand Name:	50%
Individual Rx Deductible:	Integrated
Preferred Specialty:	50%^*
Non-Preferred Specialty:	50%^*
OON Individual Deductible:	$8,500
OON Family Deductible:	$18,100
OON OOP Individual Deductible:	Unlimited
OON OOP Family Deductible:	Unlimited
OON Office Visit Copay:	70%^*
Specialist Copay:	$55
OON Specialist Copay:	70%^*
Coinsurance:	15%^*

^*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: