Oscar Insurance Company
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Bronze Classic Standard - EPO

Plan summary
Get our guide to the Essential Health Benefits covered by this plan and all other Marketplace plans.
Monthly premium
Your premium is the amount you pay for health insurance each month.
Deductible
$7,500 per person
$7,500 per person
Your deductible is the amount you pay for healthcare services before your insurance starts helping you cover the cost.
Depending on the plan, some basic services (like doctor visits and prescriptions) may be covered before your deductible is met.
Out-of-pocket max
$9,200 per person
$18,400 per family
This is the most you will have to pay for healthcare services during your coverage period (typically 12 months).
After you spend this amount on deductibles, copayments, and coinsurance, your health insurance plan will pay the rest.
Note: monthly premiums don’t count towards your out-of-pocket max.
Network type
EPO
The type of network you choose (HMO, PPO, POS, or EPO) will determine which providers (doctors, pharmacies, hospitals, and specialist) you can see.
• HMO plans usually limit coverage to providers who are within the plan’s network, and require a doctor’s referral to see specialists.
• PPO plans usually cover some of the cost of out-of-network providers (but not as much as for in-network providers), and don’t require a doctor’s referral to see specialists.
• EPO is a managed care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan’s network (except in an emergency).
Metal tier
Expanded Bronze
Metal levels (which include bronze, silver, gold, and platinum) determine how you will split the cost of your healthcare services with your insurance carrier.
• Bronze plans have the lowest monthly premiums and the highest costs when you need care
• Silver plans have moderate monthly premiums and moderate costs when you need care.
• Gold plans have high monthly premiums and low costs when you need care.
• Platinum plans have the highest monthly premiums and the lowest costs when you need care.
Doctor visits
This can include any visits to your doctors (outside of regular checkups) within your plan's network.
Primary care visit
$50 copay
Cost share applies to in-person, telemedicine services, and online visits. Office Visits and Doctor Services Covered Services include: Office Visits for medical care (including second surgical opinions) to examine, diagnose, and treat an illness or injury, including surgery. Services are limited to routine care and treatment of common illnesses for adults and children. Home Visits for medical care to examine, diagnose, and treat an illness or injury. Please note that Doctor visits in the home are different than the Home Care Services benefit described earlier. Walk-In Doctor's Office for services limited to routine care and treatment of common illnesses for adults and children.
This is the amount you’re responsible for when receiving primary care services.
For example, this could be an appointment with your primary care provider for a routine checkup or screening.
Specialist visit
$100 copay
Cost share applies to both in-person and telemedicine services. Specialist Office Visit including office surgeries and second opinion.
This is the amount you’re responsible for when visiting a specialist (a medical professional who specializes in different types of diseases or conditions).
For example, a dermatologist, cardiologist, or pathologist.
Preventive care visit
No charge
Covers: (1) Services with an 'A' or 'B' rating from the United States Preventive Services Task Force; (2) Immunizations for children, adolescents, and adults recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention; (3) Preventive care and screenings for infants, children and adolescents as listed in the guidelines supported by the Health Resources and Services Administration (including infant hearing screening); (4) Preventive care and screening for women as listed in the guidelines supported by the Health Resources and Services Administration; and (5) Counseling services related to nutrition, and to smoking and tobacco use cessation. Prescription drugs that help you stop smoking or reduce your dependence on tobacco products are also covered preventive services. Smoking cessation products and over the counter nicotine replacement products (limited to nicotine patches and gum) are covered when obtained with a prescription. Additionally, state law requires coverage for routine screening mammograms and routine prostate specific antigen testing and digital rectal exams.
There are dozens of preventive care services available for free with every plan, including check-ups, counseling, screenings, and immunizations
To learn more, scroll down to the Free Preventive Care section below.
Emergency / Surgery
These are the costs you’re responsible for in the case of an emergency or surgery.
Urgent care
$75 copay
Virtual urgent care services provided by Oscar-designated virtual care providers are covered in full. Urgent care includes treatment at an Urgent Care Center for urgent but non-emergent care as described in Urgent Care Services. Often an urgent, rather than an Emergency, health problem exists. An urgent health problem is an unexpected illness or injury that calls for care that cannot wait until a regularly scheduled office visit. Urgent health problems are not life threatening and do not call for the use of an emergency room. Urgent health problems include earache, sore throat, and fever (not above 104 degrees). Benefits for urgent care include: Office visit, X-ray services, Care for broken bones, Tests such as flu, urinalysis, pregnancy test, rapid strep, Lab services, including allergy testing, Allergy shots/injections, Medical supplies, Advanced diagnostic imaging, Surgery, Prescription drug, Stitches for simple cuts, Draining an abscess. When temporarily out of the Service Area, Out-of-Network Urgent Care services are covered. In addition to applicable cost share, you may beresponsible for balance billing.
An urgent care center can be a convenient option if you have a non-life-threatening injury and your doctor is not available.
Urgent care is usually less expensive than going to the Emergency Room, and will usually have shorter wait times for non-life-threatening injuries.
Emergency room
50% coinsurance after deductible
Benefits are available in a Hospital emergency room or freestanding emergency Facility for services and supplies to treat the onset of symptoms for an Emergency
This is the amount you’re responsible for when receiving emergency room services.
Ambulance
50% coinsurance after deductible
Medically Necessary ambulance services are a Covered Service when one or more of the following criteria are met: You are transported by a state licensed vehicle that is designed, equipped, and used only to transport the sick and injured and staffed by Emergency Medical Technicians (EMT), paramedics, or other certified medical professionals. This includes ground, water, fixed wing, and rotary wing air transportation. Benefits are only available for air ambulance when it is not appropriate to use a ground or water ambulance. For ground ambulance, you are taken:, From your home, the scene of an accident or medical Emergency to a Hospital;, Between Hospitals, including when the carrier requires you to move from an out-of- network Hospital to an in-network Hospital; or, Between a Hospital and a Skilled Nursing Facility or other approved Facility. For air or water ambulance, you are taken:, From the scene of an accident or medical Emergency to a Hospital; Between Hospitals, including when the carrier requires you to move from an out-of- network Hospital to an in-network Hospital; or Between a Hospital and an approved Facility. Benefits also include medically necessary treatment of a sickness or injury by medical professionals from an ambulance service, even if you are not taken to a facility. Excludes: Air ambulance will not be covered if you are taken to a Facility that is not an acute care Hospital (such as a Skilled Nursing Facility), or if you are taken to a Physician’s office or your home. Coverage is not available for air ambulance transfers for the reason of being treated in a specific Hospital or by a specific Physician.
This is the amount you’re responsible for when receiving ambulatory services.
Hospital stay (facility)
50% coinsurance after deductible
Benefits for room, board, and nursing services include: a room with two or more beds; a private room when medically necessary for isolation and no isolation facilities are available; a room in an approved special care unit; meals, special diets; general nursing services; operating, childbirth, and treatment rooms and equipment; prescribed drugs; anesthesia, anesthesia supplies and services given by the hospital or other provider; medical and surgical dressings and supplies, casts, and splints; blood and blood products; diagnostic services. Includes coverage for general anesthesia and hospitalization services when determined by dentist and treating physician that such services are required to effectively and safely provide dental care for (i) children under the age of 5, (ii) covered persons who are severely disabled, or (iii) covered persons who have a medical condition that requires admission to a hospital or Outpatient surgery facility.
This is the amount you’re responsible for when using the facilities and equipment at a hospital.
Hospital stay (physician)
50% coinsurance after deductible
Includes medical care visits; intensive medical care when medically necessary; treatment for a health problem by a Doctor who is not your surgeon while you are in the Hospital for surgery; treatment by two or more Doctors during one Hospital stay when the nature or severity of your health problem calls for the skill of separate Doctors; a personal bedside exam by another Doctor when asked for by your Doctor; surgery and general anesthesia; professional charges to interpret diagnostic tests such as imaging, pathology reports, and cardiology. Surgeries and procedures to correct congenital abnormalities that cause functional impairment and congenital abnormalities in newborn children; other invasive procedures, such as angiogram, arteriogram, amniocentesis, tap or puncture of brain or spine; endoscopic exams, such as arthroscopy, bronchoscopy, colonoscopy, laparoscopy; treatment of fractures and dislocations; anesthesia and surgical support when medically necessary; medically necessary pre- operative and post-operative care. Medical benefits are limited to certain oral surgeries including: treatment of medically diagnosed cleft lip, cleft palate, or ectodermal dysplasia; maxillary or mandibular frenectomy when not related to a dental procedure; alveolectomy when related to tooth extraction; orthognathic surgery because of a medical condition or injury or for a physical abnormality that prevents normal function of the joint or bone and is medically necessary to attain functional capacity of the affected part; oral / surgical correction of accidental injuries; surgical services on the hard or soft tissue in the mouth when the main purpose is not to treat or help the teeth and their supporting structures; treatment of non-dental lesions, such as removal of tumors and biopsies; incision and drainage of infection of soft tissue not including odontogenic cysts or abscesses. Includes surgical treatment of injuries and illnesses of the eye.
This is the amount you’re responsible for when receiving services provided by a physician, surgeon, medical doctor, or other specialist.
Outpatient procedure (facility)
50% after deductible
This is the amount you’re responsible for when using the equipment and facilities at a hospital.
Specifically, during a procedure that does not require overnight hospitalization.
Outpatient procedure (physician)
50% coinsurance after deductible
Includes coverage for blood and blood products, anesthesia and anesthesia supplies and services given by the Hospital or other Facility, medical and surgical dressings and supplies, casts, and splints. Includes coverage for general anesthesia and hospitalization services when determined by dentist and treating physician that such services are required to effectively and safely provide dental care for (i) children under the age of 5, (ii) covered persons who are severely disabled, or (iii) covered persons who have a medical condition that requires admission to a hospital or Outpatient surgery facility. Surgeries and procedures to correct congenital abnormalities that cause functional impairment and congenital abnormalities in newborn children; other invasive procedures, such as angiogram, arteriogram, amniocentesis, tap or puncture of brain or spine; endoscopic exams, such as arthroscopy, bronchoscopy, colonoscopy, laparoscopy; treatment of fractures and dislocations; anesthesia and surgical support when Medically Necessary; Medically Necessary pre-operative and post-operative care. Benefits are limited to certain oral surgeries including: treatment of medically diagnosed cleft lip, cleft palate, or ectodermal dysplasia; maxillary or mandibular frenectomy when not related to a dental procedure; alveolectomy when related to tooth extraction; orthognathic surgery because of a medical condition or injury or for a physical abnormality that prevents normal function of the joint or bone and is Medically Necessary to attain functional capacity of the affected part; oral / surgical correction of accidental injuries; surgical services on the hard or soft tissue in the mouth when the main purpose is not to treat or help the teeth and their supporting structures; treatment of non-dental lesions, such as removal of tumors and biopsies; incision and drainage of infection of soft tissue not including odontogenic cysts or abscesses. Includes surgical treatment of injuries and illnesses of the eye.
This is the amount you’re responsible for when receiving services provided by a physician, surgeon, or other specialist.
Specifically, during a procedure that does not require overnight hospitalization.
Physical rehabilitation
$50 copay
Includes treatment to restore a physically disabled persons ability to do activities of daily living, such as walking, eating, drinking, dressing, using the toilet, moving from a wheelchair to a bed, bathing, and therapy for tasks needed for the persons job. Also, includes the treatment by physical means to ease pain, restore health, and to avoid disability after an illness, injury, or loss of an arm or a leg by means of hydrotherapy, heat, physical agents, bio-mechanical and neuro-physiological principles and devices. Limit is combined for physical and occupational therapy. Limit applies separately to habilitative and rehabilitative services. Limit does not apply when received as part of hospice benefit, early intervention benefit, treatment of autism spectrum disorder, or mental health conditions or substance use disorder. Excludes: Non-covered providers include, but are not limited to, masseurs or masseuses (massage therapists), and physical therapist technicians
This includes physical and occupational therapy, speech pathology, and psychiatric rehabilitation services.
Pregnancy
Every ACA health insurance plan covers healthcare services provided before and after your child is born. Here is a breakdown of the costs associated with your plan.
Labor, delivery, hospital stay
50% coinsurance after deductible
Important Note About Maternity Admissions: Under federal law, benefits may not be limited for any Hospital length of stay for childbirth for the mother or newborn to less than 48 hours after vaginal birth, or less than 96 hours after a cesarean section (C-section). However, federal law as a rule does not stop the mothers or newborns attending Provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours, or 96 hours, as applicable. In any case, as provided by federal law, the carrier may not require a Provider to get authorization before prescribing a length of stay which is not more than 48 hours for a vaginal birth or 96 hours after a C- section. Inter-hospital Transfer of Mother with Infant Preauthorization is not required for the interhospital transfer of a newborn infant experiencing a life-threatening Emergency Medical Condition or the hospitalized mother of such newborn infant to accompany the infant. See plan documents for separate professional services cost shares. Includes services needed during a normal or complicated pregnancy and for services needed for a miscarriage. Covered maternity services include: pregnancy testing; professional and facility services for childbirth including use of the delivery room and care for normal deliveries, in a facility or the home including the services of an appropriately licensed nurse midwife; anesthesia services to provide partial or complete loss of sensation before delivery; routine nursery care for the newborn during the mothers normal hospital stay, including circumcision of a covered male dependent; allowed fetal screenings, which are genetic or chromosomal tests of the fetus.
This is the amount you will pay for your labor, delivery, and hospital stay.
Prescriptions
Prescription coverage and cost is usually based on a tiered structure. These tiers are determined by generic, brand, or speciality drugs.
Generic
$25 copay
Covers prescription legend drugs from either a Retail Pharmacy or the PBMs Home Delivery Pharmacy; self-administered injectable drugs; specialty drugs; self-injectable insulin and supplies and equipment used to administer insulin; insulin $50 limit/30-day supply; self-administered contraceptives, including oral contraceptive drugs, self-injectable contraceptive drugs, contraceptive patches, and contraceptive rings. Certain contraceptives are covered under the 'Preventive Care' benefit. Includes coverage for special food products or supplements when prescribed by a Doctor when medically necessary; Flu Shots (including administration). Inpatient or IV therapy drugs used in the treatment of cancer pain will not be denied on the basis that the dosage exceeds the recommended dosage of the pain-relieving agent, if prescribed in compliance with established statutes pertaining to patients with intractable cancer pain. Excludes: The following are not covered:, Refills after one year after date of original prescription, Infertility Drugs, Drugs that do not need a Prescription, Fluoride treatments, Items covered as DME, Lost or stolen drugs, Drugs not approved by USFDA, Drugs to treat sexual dysfunction, Weight loss drugs
This is the amount you will pay for a generic drug prescription.
Brand
$50 copay after deductible
Covers prescription legend drugs from either a Retail Pharmacy or the PBMs Home Delivery Pharmacy; self-administered injectable drugs; specialty drugs; self-injectable insulin and supplies and equipment used to administer insulin; insulin $50 limit/30-day supply; self-administered contraceptives, including oral contraceptive drugs, self-injectable contraceptive drugs, contraceptive patches, and contraceptive rings. Certain contraceptives are covered under the 'Preventive Care' benefit. Includes coverage for special food products or supplements when prescribed by a Doctor when medically necessary; Flu Shots (including administration). Inpatient or IV therapy drugs used in the treatment of cancer pain will not be denied on the basis that the dosage exceeds the recommended dosage of the pain-relieving agent, if prescribed in compliance with established statutes pertaining to patients with intractable cancer pain. Excludes: The following are not covered:, Refills after one year after date of original prescription, Infertility Drugs, Drugs that do not need a Prescription, Fluoride treatments, Items covered as DME, Lost or stolen drugs, Drugs not approved by USFDA, Drugs to treat sexual dysfunction, Weight loss drugs
This is the amount you will pay for a brand name drug prescription.
Non-preferred Brand
$100 copay after deductible
Covers prescription legend drugs from either a Retail Pharmacy or the PBMs Home Delivery Pharmacy; self-administered injectable drugs; specialty drugs; self-injectable insulin and supplies and equipment used to administer insulin; insulin $50 limit/30-day supply; self-administered contraceptives, including oral contraceptive drugs, self-injectable contraceptive drugs, contraceptive patches, and contraceptive rings. Certain contraceptives are covered under the 'Preventive Care' benefit. Includes coverage for special food products or supplements when prescribed by a Doctor when medically necessary; Flu Shots (including administration). Inpatient or IV therapy drugs used in the treatment of cancer pain will not be denied on the basis that the dosage exceeds the recommended dosage of the pain-relieving agent, if prescribed in compliance with established statutes pertaining to patients with intractable cancer pain. Excludes: The following are not covered:, Refills after one year after date of original prescription, Infertility Drugs, Drugs that do not need a Prescription, Fluoride treatments, Items covered as DME, Lost or stolen drugs, Drugs not approved by USFDA, Drugs to treat sexual dysfunction, Weight loss drugs
This is the amount you will pay for a non-preferred brand name drug prescription.
Specialty
$500 copay after deductible
Covers prescription legend drugs from either a Retail Pharmacy or the PBMs Home Delivery Pharmacy; self-administered injectable drugs; specialty drugs; self-injectable insulin and supplies and equipment used to administer insulin; insulin $50 limit/30-day supply; self-administered contraceptives, including oral contraceptive drugs, self-injectable contraceptive drugs, contraceptive patches, and contraceptive rings. Certain contraceptives are covered under the 'Preventive Care' benefit. Includes coverage for special food products or supplements when prescribed by a Doctor when medically necessary; Flu Shots (including administration). Inpatient or IV therapy drugs used in the treatment of cancer pain will not be denied on the basis that the dosage exceeds the recommended dosage of the pain-relieving agent, if prescribed in compliance with established statutes pertaining to patients with intractable cancer pain. Excludes: The following are not covered:, Refills after one year after date of original prescription, Infertility Drugs, Drugs that do not need a Prescription, Fluoride treatments, Items covered as DME, Lost or stolen drugs, Drugs not approved by USFDA, Drugs to treat sexual dysfunction, Weight loss drugs
This is the amount you will pay for a speciality drug prescription.
Diagnostics / Labs / Imaging
This is the amount you're responsible for when receiving blood work, tests, or x-rays your doctor may need for diagnosing.
X-rays
50% coinsurance after deductible
Diagnostic Imaging Services and Electronic Diagnostic Tests, X-rays / regular imaging services, Radiology (including mammograms), ultrasound or nuclear medicine, Electrocardiograms (EKG), Electroencephalography (EEG), Echocardiograms, Hearing and vision tests for a medical condition or injury (not for screenings or preventive care), Tests ordered before a surgery or admission. Advanced Imaging Services, Benefits are also available for advanced imaging services, which include but are not limited to:, CT scan, CTA scan, Magnetic Resonance Imaging (MRI), Magnetic Resonance Angiography (MRA), Magnetic Resonance spectroscopy (MRS), Nuclear Cardiology, PET scans, PET/CT Fusion scans, QCT Bone Densitometry
This is the amount you’re responsible for when having an x-ray.
Imaging (CT/PET/MRI)
50% coinsurance after deductible
X-rays / regular imaging services, Radiology (including mammograms), ultrasound or nuclear medicine, Electrocardiograms (EKG), Electroencephalography (EEG), Echocardiograms Hearing and vision tests for a medical condition or injury (not for screenings or preventive care), Tests ordered before a surgery or admission. Advanced Imaging Services Benefits are also available for advanced imaging services, which include but are not limited to:, CT scan, CTA scan, Magnetic Resonance Imaging (MRI). Magnetic Resonance Angiography (MRA), Magnetic Resonance spectroscopy (MRS), Nuclear Cardiology, PET scans, PET/CT Fusion scans, QCT Bone Densitometry, Diagnostic CT Colonography. Single photon emission computed tomography (SPECT) scans
This is the amount you’re responsible for when having an MRI, CET, PET scan.
Blood work
50% coinsurance after deductible
Diagnostic Laboratory and Pathology Services
This is the amount you’re responsible for when receiving blood work.
Mental health
Under the Affordable Care Act, all Marketplace plans are required to cover behavioral health treatment, mental and behavioral health inpatient services, as well as substance use treatment.
Outpatient services
$50 copay
Includes treatment in an outpatient department of a hospital and office visits, individual psychotherapy, group psychotherapy, psychological testing and medication management visits. Services may be received by a psychiatrist, psychologist, neuropsychologist, licensed clinical social worker (L.C.S.W.), clinical nurse specialist, licensed marriage and family therapist (L.M.F.T.), licensed professional counselor (L.P.C) or any agency licensed by the state to give these services that must be covered by law.
This is the amount you’re responsible for when you have a procedure that does not require overnight hospitalization.
Psychiatric hospital stay
50% coinsurance after deductible
Includes services in a hospital or any facility required to be covered by state law. Inpatient benefits include individual psychotherapy, group psychotherapy, psychological testing, counseling with family members to assist with the patients diagnosis and treatment, convulsive therapy, detoxification, and rehabilitation
This is the amount you’re responsible for when you’re admitted or receiving treatment at a psychiatric hospital.
The Affordable Care Act requires that all health insurance plans cover preventive care for free. Preventive care services focus on managing and maintaining your health before something becomes serious. This includes routine check-ups, counseling, screenings, and immunizations. Grab our free guide to preventive care to refer back to later.
Abdominal aortic aneurysm one-time screening
For men of specified ages who have ever smoked
Free
Alcohol misuse screening and counseling
To prevent cardiovascular disease for men and women of certain ages
Free
Free
Free
Cholesterol screening
For adults of certain ages or at higher risk
Free
Colorectal cancer screening
For adults over 50
Free
Free
Diabetes (Type 2) screening
For adults with high blood pressure
Free
Diet counseling
For adults at higher risk for chronic disease
Free
Hepatitis B screening
For people at high risk
Free
Hepatitis C screening
For adults at increased risk, and one time for everyone born 1945 – 1965
Free
HIV screening
For everyone ages 15 to 65, and other ages at increased risk
Free
Free
Free
Free
Free
Free
Free
Free
Free
Free
Free
Free
Free
Free
Free
Lung cancer screening
For adults 55 - 80 at high risk for lung cancer
Free
Free
Free
Syphilis screening
For adults at higher risk and all pregnant women
Free
Tobacco Use screening
For all adults and cessation interventions for tobacco users
Free
Official documents
If you'd like to see the official documents from the health insurance company, we've provided links to those here.
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