Plan Details

CommunityCare Platinum 219 HMO One

98905OK0320001-00

Plan Year:

2023

Platinum Metal plans cover an estimated 90% of your medical and prescription drug costs. They also limit your annual out-of-pocket expenses. Platinum Plans are the most expensive of all the "metal plans."

Individual Deductible:	$500
Individual Out of Pocket Maximum:	$3,000
Office Visit Copay:	$25
Preferred Generics:	$15
Preferred Brand Name:	$45
Non-Preferred Brand Name:	$95
Individual Rx Deductible:	None
Preferred Specialty:	$300
Non-Preferred Specialty:	$350
Specialist Copay:	$50
Coinsurance:	0%*

^*Subject to the deductible.

Insure Oklahoma Qualified

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