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

Plan Details

CommunityCare Silver 1519 Select

98905OK0130027-00
Plan Year:
2023

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

Individual Deductible:$2,900
Individual Out of Pocket Maximum:$7,050
Office Visit Copay:$35*
Preferred Generics:$15*
Preferred Brand Name:$40*
Non-Preferred Brand Name:$95*
Individual Rx Deductible:Integrated
Preferred Specialty:$300*
Non-Preferred Specialty:$350*
Specialist Copay:$45*
Coinsurance:20%*
*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