Bronze Classic PCP Saver Plus Rx Copay (Select)

Health Insurance Plan Details (2025 Plan)

by Oscar Health Plan, Inc.

Monthly Premium

HMO
$ubsidy
Bronze
Deductible
$8,500 /yr
Max Out-of-Pocket
$9,100 /yr

Details

Deductible (per individual) $8,500 /yr
Deductible (per family) $17,000 /yr
Max Out-of-Pocket (per individual) $9,100 /yr
Max Out-of-Pocket (per family) $18,200 /yr
Drug Deductible (per individual) Included in Medical
Drug Deductible (per family) Included in Medical
Drug Max Out-of-Pocket (per individual) Included in Medical
Drug Max Out-of-Pocket (per family) Included in Medical
Plan Type HMO
Includes Child Dental? No
Includes Adult Dental? No
Medical Services
Preventive Care No Charge
Primary Care Visit No Charge
Specialist Visit 50% Coinsurance after deductible
Emergency Room 50% Coinsurance after deductible
Inpatient Facility 50% Coinsurance after deductible
Inpatient Physician 50% Coinsurance after deductible
Drug Costs
Generic Drugs $3 Copay
Preferred Brand Drugs $500 Copay
Non-preferred Brand Drugs $650 Copay
Specialty Drugs $750 Copay

Plan Documents

Summary of Benefits and Coverage SBC doc
Provider Directory Doctor lookup
Drug Formulary List drug list

* Figures shown are only for in-network medical costs

** Please check with insurance company if Copay and Coinsurance rates are before or after the deductible


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