Plan Details

CommunityCare PPO Gold 1500 Select

87698OK0090007-01

Plan Year:

2015

Individual Deductible:	$1,500
Individual Out of Pocket Maximum:	$3,500
Office Visit Copay:	$10
Out of Network Coinsurance:	60%*

^*Subject to the deductible.

Eligible for Small Business Health Care Tax Credits

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