2024 EOBs are now available online. Please contact Customer Service for EOBs prior to the current year.

Plan Details

CommunityCare PPO Bronze B19 Standard

87698OK0110035-00
Plan Year:
2023

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:$7,000
Individual Out of Pocket Maximum:$7,000
Office Visit Copay:0%*
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*
OON Individual Deductible:$14,000
OON Family Deductible:$28,000
OON OOP Individual Deductible:Unlimited
OON OOP Family Deductible:Unlimited
OON Office Visit Copay:30%*
Specialist Copay:0%*
OON Specialist Copay:30%*
Coinsurance:0%*
*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