If you receive a survey about your health care services, we hope you will take a few minutes to give us your feedback. Your opinion is important to us!
Attention: CommunityCare will be performing systems maintenance Friday, September 19th starting at 5 p.m. through midnight on Saturday, September 20th. Some online documents, tools and resources may be unavailable during this time. Thank you for your patience.

Plan Details

CommunityCare Silver L21 HMO One

98905OK0320020-00
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:$7,700
Individual Out of Pocket Maximum:$8,700
Office Visit Copay:$35
Preferred Generics:$15
Preferred Brand Name:$45*
Non-Preferred Brand Name:$95*
Individual Rx Deductible:$500
Preferred Specialty:$300*
Non-Preferred Specialty:$350*
Specialist Copay:$65
Coinsurance:40%*
*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