EOBs for plan members are temporarily unavailable to view online. If you have questions about plan benefits, please contact the CommunityCare customer service team for assistance.

Attention: CommunityCare will be performing systems maintenance Friday, April 19th starting at 5 p.m. through midnight on Saturday, April 20th. Some online documents, tools and resources may be unavailable during this time. Thank you for your patience.

Plan Details

98905OK0180055-00

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^*
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.

Benefit Details

Directories

Additional Information

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

Plan Details

CommunityCare Bronze 219 Standard

Benefit Details

Directories

Additional Information

Essential Benefits