Plan Details

CommunityCare PPO Platinum C19 Select

87698OK0090026-00
Plan Year:
2019

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:$1,000
Individual Out of Pocket Maximum:$3,000
Office Visit Copay:$20
Out of Network Coinsurance:50%*
Preferred Generics:$15
Preferred Brand Name:$40
Non-Preferred Brand Name:$70
Preferred Specialty:$160
Non-Preferred Specialty:$210
*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