Plan Details

CommunityCare Gold 2 Standard

98905OK0180024-00

Plan Year:

2018

Individual Deductible:	$1,000
Individual Out of Pocket Maximum:	$3,000
Office Visit Copay:	$35
Preferred Generics:	$20
Preferred Brand Name:	$55
Non-Preferred Brand Name:	$75
Specialty:	$200*

^*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