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Plan Details

98905OK0170058-00

Plan Year:

2015

Individual Deductible:	$4,500
Individual Out of Pocket Maximum:	$6,600
Office Visit Copay:	$25

Benefit Details

Summary of Benefits and Coverage (SBC)
Medical and Prescription Drug Benefits

Directories

Provider and Pharmacy Directory

Additional Information

Formulary
Member Handbook
Glossary of Health Coverage and Medical Terms

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 Silver 4500 Classic

Benefit Details

Directories

Additional Information

Essential Benefits