Plan Details

CommunityCare PPO Bronze A19 Standard

87698OK0110034-00
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:$6,200
Individual Out of Pocket Maximum:$6,600
Office Visit Copay:$25*
Out of Network Coinsurance:60%*
Preferred Generics:$15*
Preferred Brand Name:$45*
Non-Preferred Brand Name:$95*
Individual Rx Deductible:Integrated
Preferred Specialty:$300*
Non-Preferred Specialty:$350*
*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