Plan Details

CommunityCare PPO Bronze C19 Select

87698OK0090035-00
Plan Year:
2020

Bronze Metal plans cover an estimated 60% of your medical and prescription drug costs. They limit your annual out-of-pocket expenses. Bronze plans are the least expensive of all the "metal plans." Bronze plans do not qualify as creditable coverage.

Individual Deductible:$8,150
Individual Out of Pocket Maximum:$8,150
Office Visit Copay:$35
Out of Network Coinsurance:30%*
Preferred Generics:$0*
Preferred Brand Name:$0*
Non-Preferred Brand Name:$0*
Individual Rx Deductible:Integrated
Preferred Specialty:$0*
Non-Preferred Specialty:$0*
First 3 primary care visits have a $35 co-payment and are not subject to the deductible.
*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
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