Plan Details

87698OK0110030-00

Plan Year:

2023

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

Individual Deductible:	$5,000
Individual Out of Pocket Maximum:	$9,000
Office Visit Copay:	$30
Out of Network Coinsurance:	60%^*
Preferred Generics:	$15
Preferred Brand Name:	$45
Non-Preferred Brand Name:	50%
Individual Rx Deductible:	None
Preferred Specialty:	50%
Non-Preferred Specialty:	50%
OON Individual Deductible:	$10,000
OON Family Deductible:	$30,000
OON OOP Individual Deductible:	Unlimited
OON OOP Family Deductible:	Unlimited
OON Office Visit Copay:	60%^*
Specialist Copay:	$65
OON Specialist Copay:	60%^*
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: