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CommunityCare Health Insurance Basics

What does CommunityCare offer?

CommunityCare HMO (Health Maintenance Organization): In an HMO, a member establishes a relationship with a primary care physician (PCP) who will manage and coordinate their health care needs. Coverage is provided in-network only - no compensation or application toward deductible is provided for out-of-network care, except in emergency situations. Prescription drug coverage is included in all CommunityCare HMO plans.

CommunityCare POS (Point of Service) ): This type of plan has the basic elements of an HMO health insurance plan with the additional benefit of allowing you to self-refer outside the provider network.

CommunityCare Life and Health PPO (Preferred Provider Organization) A PPO is a health insurance plan that offers both in-network and out-of-network benefits. We have a strong network of providers throughout Oklahoma, and provide national coverage to members who are located outside of Oklahoma.

Senior Health Plan CommunityCare is proud to offer Senior Health Plan, a program created especially for Medicare beneficiaries. Our Medicare Advantage plans include coverage for Medicare Part A and B, Part D (outpatient drug coverage) if needed, plus additional benefits.

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How do Copayments work?

A copayment (also called a copay) is a fixed amount you pay for a covered service. Copayments can vary for services within your plan, like drugs, lab tests, visits to specialists, etc.

 
What is a Deductible?

The amount you pay for covered health care services before your plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services. After you pay your deductible, you usually pay only a copayment or coinsurance for covered services.

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What does In-Network and Out-of-Network mean?

Utilizing health care providers contracted with your health plan is considered in network. When you seek care from a provider not contracted with your plan, this is referred to as out of network.

In-Network - Out-of-Network illustration
What is the difference between CommunityCare Select and Standard Networks?
Select Network

The CommunityCare Select Network is anchored by Saint Francis Health System and Ascension St. John in the greater Tulsa area and SSM Health St. Anthony and Norman Regional Health System in the greater Oklahoma City area.

Standard Network

The CommunityCare Standard Network includes all of the providers in the Select Network plus a broad network of providers across northeastern Oklahoma and the greater Oklahoma City area.

How does Coinsurance work?

Coinsurance is a percentage of the cost of a covered health care service you pay. For example, if your coinsurance is 20% for a covered service with an allowed amount of $100, you will pay $20

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When do I need to (and How do I) request Preauthorization?

If your PCP determines that you need more tests, specialty care or hospitalization, your PCP may send a referral to CommunityCare or your network’s referral center asking that the plan authorize those services. Your PCP and, when appropriate, your specialist will be notified of the referral decision and recommendations

What is the Out-Of-Pocket (OOP) limit?

The most you have to pay for covered services in a plan year. After you spend this amount on copayments and coinsurance for care and services, your health plan pays 100% of the costs of covered benefits.

Out of Pocket illustration
What does "Covered Services" mean?

Health care services that are covered benefits by your health plan. These services will count toward your deductible. After you pay your deductible, you usually pay only a copayment or coinsurance for covered services.

 
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