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Plan Details

CommunityCare PPO Gold 750 Select

87698OK0090017-01
Plan Year:
2016

Gold Metal plans cover an estimated 80% of your medical and prescription drug costs. They also limit your annual out-of-pocket expenses at a maximum level in case you have some very large claims. Individuals whose income is between 100%-400% of the Federal Poverty Level may be eligible for some premium subsidies, but only to the level that would have been provided if they had selected a Silver Plan. In addition, benefit enhancements in the form of lower deductibles and copayments are not available for individuals enrolled on the Gold Plan.

  • Covers approximately 80% of your covered medical and prescription drug costs.

Individual Deductible:$750
Individual Out of Pocket Maximum:$3,500
Office Visit Copay:$25
Out of Network Coinsurance:50%*
*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