Plan Details

CommunityCare PPO Silver A20 Standard

87698OK0110039-00
Plan Year:
2020

Silver Metal plans cover an estimated 70% of your medical and prescription drug costs. They limit your annual out-of-pocket expenses.

Individual Deductible:$7,000
Individual Out of Pocket Maximum:$8,000
Office Visit Copay:$30
Out of Network Coinsurance:30%*
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
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