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

Plan Details

CommunityCare Gold Standardized Select Plus

98905OK0130047-00
Plan Year:
2023

Gold Metal plans cover an estimated 80% of your medical and prescription drug costs. They also limit your annual out-of-pocket expenses.

Individual Deductible:$2,000
Individual Out of Pocket Maximum:$8,700
Office Visit Copay:$30
Preferred Generics:$15
Preferred Brand Name:$30
Non-Preferred Brand Name:$60
Individual Rx Deductible:None
Preferred Specialty:$250
Non-Preferred Specialty:$250
Specialist Copay:$60
Coinsurance:25%*
*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