Plan Details

87698OK0110044-00

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:	$7,700
Individual Out of Pocket Maximum:	$8,700
Office Visit Copay:	$35
Out of Network Coinsurance:	70%^*
Preferred Generics:	$15
Preferred Brand Name:	$45^*
Non-Preferred Brand Name:	$95^*
Individual Rx Deductible:	$500
Preferred Specialty:	$300^*
Non-Preferred Specialty:	$350^*
OON Individual Deductible:	$17,400
OON Family Deductible:	$35,800
OON OOP Individual Deductible:	Unlimited
OON OOP Family Deductible:	Unlimited
OON Office Visit Copay:	70%^*
Specialist Copay:	$65
OON Specialist Copay:	70%^*
Coinsurance:	40%^*

^*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: