Oklahoma health plan · 2025

Blue Preferred Bronze PPO℠ Standard · 87571OK0350191

Blue Cross Blue Shield of Oklahoma offers this marketplace health insurance plan (Plan ID 87571OK0350191) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Expanded Bronze Plan type: PPO CSR: Zero Cost Sharing Plan Variation Issuer: Blue Cross Blue Shield of Oklahoma
Telehealth Data pending HSA eligible No Dental Not listed Vision Child
Pay / Manage Plan View issuer site

CMS AV Calculator output: 100.00% (0.00% member share on average). Learn about AV methodology.

2025 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$411 – $1612

Before subsidies

Estimate after subsidies

Deductible

$0

$0 per group

See deductible details

Max out-of-pocket

$0

$0 per group

Review MOOP rules

Office visits

Primary care $0.00, 0.00%
Specialist $0.00, 0.00%
HSA Not eligible

Drug tiers

Generic $0.00, 0.00%
Preferred brand $0.00, 0.00%

View formulary tiers

$563 / mo before subsidies

≈ $6757 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$1784 / mo before subsidies

≈ $21412 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$2161 / mo before subsidies

≈ $25932 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$1373 / mo before subsidies

≈ $16480 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

$0.00, 0.00%

Emergency Room Services

$0.00, 0.00%

Durable Medical Equipment

$0.00, 0.00%

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Enrollment guidance

Stay on top of 2025 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2025 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Oklahoma). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • Zero Cost Sharing Plan Variation plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

$0.00, 0.00%

Emergency Room Services

$0.00, 0.00%

Durable Medical Equipment

$0.00, 0.00%

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 87571OK0350191
Coverage year 2025
State Oklahoma
Issuer Blue Cross Blue Shield of Oklahoma
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 87571OK0350191-02
Available variants

Standard Off Exchange Plan · 87571OK0350191-00

Standard On Exchange Plan · 87571OK0350191-01

Open to Indians below 300% FPL · 87571OK0350191-02

Open to Indians above 300% FPL · 87571OK0350191-03
Last plan update Sat, 11 Jan 2025 00:00 GMT
Last HealthPorta import Tue, 02 Dec 2025 06:13 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in Oklahoma 24261
PCPs in Oklahoma 3062
Telehealth support Data pending
Nationwide providers 27429
24,261 doctors statewide 3,062 PCPs 83 OB/GYN

Provider network(s)

Providers Oklahoma All US states
All 24261 27429
PCP 3062 3546
Allergy 8 8
OB/GYN 83 91
Dentists 64 279

Drug coverage overview

3,938 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
GENERIC 2,304
SPECIALTY 899
NON-PREFERRED-BRAND 735
Prior authorization Drugs
Required 935
Not Required 3,003
Step therapy Drugs
Required 28
Not Required 3,910
Quantity limits Drugs
Has Limit 1,661
No Limit 2,277

Customer highlights

What stands out for members

  • Issuer: Blue Cross Blue Shield of Oklahoma · Plan ID 87571OK0350191 · 2025 filing.
  • Disease management programs available: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 87571OK0350191-02 (Open to Indians below 300% FPL) currently displayed.
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Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Limit: 25.0 Visit(s) per Benefit Period

Limit is combination of Speech Therapy, Occupational Therapy, Physical Therapy, and Muscle Manipulations.

Exclusions: nan

Diabetes Education

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Home Health Care Services

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Limit: 30.0 Visit(s) per Benefit Period

nan

Exclusions: nan

Laboratory Outpatient and Professional Services

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Member cost share may increase when using a Hospital-based facility for these services. See benefit booklet for details.

Exclusions: nan

Other Practitioner Office Visit (Nurse, Physician Assistant)

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Preventive Care/Screening/Immunization

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Primary Care Visit to Treat an Injury or Illness

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Rehabilitative Occupational and Rehabilitative Physical Therapy

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Limit: 25.0 Visit(s) per Benefit Period

Limit is combination of Speech Therapy, Occupational Therapy, Physical Therapy, and Muscle Manipulations.

Exclusions: nan

Rehabilitative Speech Therapy

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Limit: 25.0 Visit(s) per Benefit Period

Limit is combination of Speech Therapy, Occupational Therapy, Physical Therapy, and Muscle Manipulations.

Exclusions: nan

Specialist Visit

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Urgent Care Centers or Facilities

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

X-rays and Diagnostic Imaging

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Member cost share may increase when using a Hospital-based facility for these services. See benefit booklet for details.

Exclusions: nan

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Delivery and All Inpatient Services for Maternity Care

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Childbirth/delivery professional services are subject to your Medical EHB Deductible/Maximum Out of Pocket for Medical EHB benefits, if applicable.

Exclusions: nan

Dialysis

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Durable Medical Equipment

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Emergency Room Services

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Emergency Transportation/Ambulance

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Emergency Transportation/Ambulance is covered when your condition is such that an ambulance is necessary. Benefits will not be provided for long distance trips or for use of an ambulance because it is more convenient than other transportation when rendered in connection with a covered Inpatient admission or covered Emergency Accident Care or covered Emergency Medical Care or if it does not meet the definition of Medically Necessary for non-emergency medical situations. Benefits will not be provided for long distance trips. See benefit book for details.

Exclusions: nan

Hospice Services

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Inpatient Hospital Services (e.g., Hospital Stay)

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Inpatient Physician and Surgical Services

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Mental/Behavioral Health Inpatient Services

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Member cost share may increase when using a setting other than office.

Exclusions: nan

Mental/Behavioral Health Outpatient Services

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Member cost share may increase when using a setting other than office.

Exclusions: nan

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Member cost share may increase when using a Hospital-based facility for these services. See benefit booklet for details.

Exclusions: nan

Outpatient Rehabilitation Services

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Limit: 25.0 Visit(s) per Benefit Period

Limit is combination of Speech Therapy, Occupational Therapy, Physical Therapy, and Muscle Manipulations.

Exclusions: nan

Outpatient Surgery Physician/Surgical Services

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Radiation

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Skilled Nursing Facility

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Limit: 30.0 Days per Benefit Period

nan

Exclusions: nan

Substance Abuse Disorder Inpatient Services

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Member cost share may increase when using a setting other than office.

Exclusions: nan

Substance Abuse Disorder Outpatient Services

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Member cost share may increase when using a setting other than office.

Exclusions: nan

Transplant

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

Coverage details pending

nan

Exclusions: nan

Hearing Aids

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

1 hearing aid per ear (2 hearing aids) every 48 months for any covered member.

Exclusions: nan

Major Dental Care - Child

Coverage details pending

nan

Exclusions: nan

Prenatal and Postnatal Care

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

First prenatal visit is subject to the Office Visit charge. All subsequent prenatal care is covered under delivery for maternity care.

Exclusions: nan

Routine Eye Exam for Children

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Limit: 1.0 Visit(s) per Benefit Period

When purchasing Out of Network, reimbursements are available. See benefit book for details

Exclusions: nan

Well Baby Visits and Care

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Certain generic drugs may have a higher cost share amount than is listed on this page. When prescription drugs are bought from an out of network pharmacy additional charges may apply. See benefit book for details.

Exclusions: Coverage for certain agents or medication categories may also be excluded. These include, but are not limited to: Weight Loss, Sexual Dysfunction, OTC Equivalents, Fertility and Compounds. Any drug not found on the drug list is not covered. See benefit book for further details.

Non-Preferred Brand Drugs

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

When prescription drugs are bought from an out of network pharmacy additional charges may apply. You may be responsible for paying the difference between the cost of a brand name drug and generic drug, if a generic was also available. See benefit book for details.

Exclusions: Coverage for certain agents or medication categories may also be excluded. These include, but are not limited to: Weight Loss, Sexual Dysfunction, OTC Equivalents, Fertility and Compounds. Any drug not found on the drug list is not covered. See benefit book for further details.

Preferred Brand Drugs

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

When prescription drugs are bought from an out of network pharmacy additional charges may apply. You may be responsible for paying the difference between the cost of a brand name drug and generic drug, if a generic was also available. See benefit book for details.

Exclusions: Coverage for certain agents or medication categories may also be excluded. These include, but are not limited to: Weight Loss, Sexual Dysfunction, OTC Equivalents, Fertility and Compounds. Any drug not found on the drug list is not covered. See benefit book for further details.

Specialty Drugs

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Certain specialty drugs may have a higher cost share amount than is listed on this page. If prescription drugs are bought from an out of network pharmacy additional charges may apply. You may be responsible for paying the difference between the cost of a brand name drug and generic drug, if a generic was also available. See benefit book for details.

Exclusions: Coverage for certain agents or medication categories may also be excluded. These include, but are not limited to: Weight Loss, Sexual Dysfunction, OTC Equivalents, Fertility and Compounds. Any drug not found on the drug list is not covered. See benefit book for further details.

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Basic Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Dental Check-Up for Children

Coverage details pending

nan

Exclusions: nan

Infusion Therapy

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Member cost share may increase when using a Hospital-based facility for these services. See benefit booklet for details.

Exclusions: nan

Major Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Nutritional Counseling

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Covered when medically necessary

Exclusions: nan

Orthodontia - Adult

Coverage details pending

nan

Exclusions: nan

Orthodontia - Child

Coverage details pending

nan

Exclusions: nan

Prosthetic Devices

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Routine Dental Services (Adult)

Coverage details pending

nan

Exclusions: nan

Weight Loss Programs

Coverage details pending

nan

Exclusions: nan

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

nan

Exclusions: nan

Acupuncture

Coverage details pending

nan

Exclusions: nan

Allergy Testing

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

When services are provided in an office setting, cost shares may vary. Please see benefit booklet for details.

Exclusions: nan

Bariatric Surgery

Coverage details pending

nan

Exclusions: nan

Cosmetic Surgery

Coverage details pending

Except when medically necessary.

Exclusions: nan

Eye Glasses for Children

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Limit: 1.0 Item(s) per Benefit Period

All frames will first apply towards the allowance. Discount will apply on remaining balance, after the allowance. See benefit book for details

Exclusions: nan

Gender Affirming Care

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Habilitation Services

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Limit: 25.0 Visit(s) per Benefit Period

Limit is combination of Speech Therapy, Occupational Therapy, Physical Therapy, and Muscle Manipulations.

Exclusions: nan

Imaging (CT/PET Scans, MRIs)

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Member cost share may increase when using a Hospital-based facility for these services. See benefit booklet for details.

Exclusions: nan

Infertility Treatment

Coverage details pending

nan

Exclusions: nan

Long-Term/Custodial Nursing Home Care

Coverage details pending

nan

Exclusions: nan

Private-Duty Nursing

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Limit: 85.0 Visit(s) per Benefit Period

nan

Exclusions: nan

Reconstructive Surgery

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Breast reconstruction or implantation or removal of breast prostheses is a Covered Service only when performed solely and directly as a result of mastectomy which is Medically Necessary.

Exclusions: nan

Routine Eye Exam (Adult)

Coverage details pending

nan

Exclusions: nan

Routine Foot Care

Coverage details pending

Covered when medically necessary

Exclusions: nan

Treatment for Temporomandibular Joint Disorders

Coverage details pending

nan

Exclusions: nan

Variant attributes

Blue Preferred Bronze PPO℠ Standard · Variant 87571OK0350191-02

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

Zero Cost Sharing Plan Variation

HIOS Product ID

87571OK035

Metal Level

Expanded Bronze

Plan ID (Standard Component ID with Variant)

87571OK0350191-02

Plan Marketing Name

Blue Preferred Bronze PPO℠ Standard

Plan Variant Marketing Name

Blue Preferred Bronze PPO℠ Standard

Issuer & service area

Issuer-provided metadata for this variant.

Issuer ID

87571

Issuer Marketplace Marketing Name

Blue Cross and Blue Shield of Oklahoma

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

Yes

Network ID

OKN009

Out of Country Coverage

Yes

Out of Country Coverage Description

This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.

Out of Service Area Coverage

No

Service Area ID

OKS029

State Code

OK

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

1.0

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

Yes

Medical Drug Maximum Out of Pocket Integrated

Yes

SBC Scenario, Having a Baby, Coinsurance

$0

SBC Scenario, Having a Baby, Copayment

$0

SBC Scenario, Having a Baby, Deductible

$0

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$0

SBC Scenario, Having Diabetes, Deductible

$0

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$0

SBC Scenario, Treatment of a Simple Fracture, Copayment

$0

SBC Scenario, Treatment of a Simple Fracture, Deductible

$0

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group

$0 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person

$0 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual

$0

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

0.00%

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group

$0 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person

$0 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$0

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group

$0 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person

$0 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

$0

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

OKF017

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$60

SBC Scenario, Having Diabetes, Limit

$20

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

0

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Dental Only Plan

No

Design Type

Design 1

Disease Management Programs Offered

Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy

EHB Percent of Total Premium

1.0

First Tier Utilization

100%

Import Date

2025-01-11 00:01:52

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

Existing

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

No

Plan Effective Date

2025-01-01

Plan Expiration Date

2025-12-31

Plan Type

PPO

QHP/Non QHP

Both

Source Name

HIOS

Plan ID

87571OK0350191

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group

$0 per group

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person

$0 per person

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual

$0

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group

$0 per group

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person

$0 per person

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual

$0

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group

$0 per group

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person

$0 per person

Combined Medical and Drug EHB Deductible, Out of Network, Individual

$0

Unique Plan Design

No

Wellness Program Offered

No

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in Oklahoma?

Blue Preferred Bronze PPO℠ Standard (87571OK0350191) is a Expanded Bronze PPO from Blue Cross Blue Shield of Oklahoma in Oklahoma for the 2025 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does Blue Preferred Bronze PPO℠ Standard support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is Blue Preferred Bronze PPO℠ Standard HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental coverage is not listed for this plan.

Vision add-ons: Child.

Does Blue Preferred Bronze PPO℠ Standard support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with Blue Preferred Bronze PPO℠ Standard?

The issuer lists disease management resources for: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy.

Is there out-of-country coverage for Blue Preferred Bronze PPO℠ Standard?

Yes, limited out-of-country coverage is available. Review the Summary of Benefits for reimbursement steps. Details: This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.

Does Blue Preferred Bronze PPO℠ Standard cover care outside the service area?

No, the issuer indicates out-of-service-area care is not covered except for emergencies.

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
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