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Plan Details

98905OK0320002-00

Plan Year:

2022

Platinum Metal plans cover an estimated 90% of your medical and prescription drug costs. They also limit your annual out-of-pocket expenses. Platinum Plans are the most expensive of all the "metal plans."

Individual Deductible:	$700
Individual Out of Pocket Maximum:	$3,000
Office Visit Copay:	$20
Preferred Generics:	$15
Preferred Brand Name:	$40
Non-Preferred Brand Name:	$70
Individual Rx Deductible:	None
Preferred Specialty:	$160
Non-Preferred Specialty:	$210

Benefit Details

Directories

Additional Information

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 Platinum 319 HMO One

Benefit Details

Directories

Additional Information

Essential Benefits