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Plan Details

CommunityCare Silver 1622 HMO One

98905OK0320012-00
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:$3,000
Individual Out of Pocket Maximum:$8,100
Office Visit Copay:$20*
Preferred Generics:$15*
Preferred Brand Name:$40*
Non-Preferred Brand Name:20%*
Individual Rx Deductible:Integrated
Preferred Specialty:20%*
Non-Preferred Specialty:20%*
Specialist Copay:$35*
Coinsurance:20%*
*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