Kansas health plan · 2026

Bronze Elite + PCP Saver · 43490KS0010005

Oscar Insurance Company offers this marketplace health insurance plan (Plan ID 43490KS0010005) 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: EPO CSR: Standard Bronze Off Exchange Plan Issuer: Oscar Insurance Company
Telehealth Data pending HSA eligible Yes Dental Not listed Vision Child
Pay / Manage Plan View issuer site

CMS AV Calculator output: 64.22% (35.78% member share on average). Learn about AV methodology.

2026 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

$290 – $1227

Before subsidies

Estimate after subsidies

Deductible

N/A

N/A

See deductible details

Max out-of-pocket

$10,600

$21200 per group

Review MOOP rules

Office visits

Primary care $50.00
Specialist $125.00
HSA Eligible

Drug tiers

Generic $3.00
Preferred brand $100.00 Copay after deductible

View formulary tiers

$401 / mo before subsidies

≈ $4812 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.

$1271 / mo before subsidies

≈ $15248 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.

$1539 / mo before subsidies

≈ $18466 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.

$978 / mo before subsidies

≈ $11736 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%

Emergency Room Services

$2,000.00

Durable Medical Equipment

50.00%

Advertisement

Enrollment guidance

Stay on top of 2026 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2026 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Kansas). 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.
  • Standard Bronze Off Exchange Plan 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%

Emergency Room Services

$2,000.00

Durable Medical Equipment

50.00%

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 43490KS0010005
Coverage year 2026
State Kansas
Issuer Oscar Insurance Company
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 43490KS0010005-00
Available variants

Standard Off Exchange Plan · 43490KS0010005-00

Standard On Exchange Plan · 43490KS0010005-01

Open to Indians below 300% FPL · 43490KS0010005-02

Open to Indians above 300% FPL · 43490KS0010005-03
Last plan update Tue, 28 Oct 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 Kansas 7213
PCPs in Kansas 724
Telehealth support Data pending
Nationwide providers 79371
7,213 doctors statewide 724 PCPs 28 OB/GYN

Provider network(s)

Providers Kansas All US states
All 7213 79371
PCP 724 1860
Allergy 2 5
OB/GYN 28 75
Dentists 2 18

Drug coverage overview

3,991 drugs tracked

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

Tier Covered drugs
GENERIC 2,197
NON-PREFERRED-BRAND 602
SPECIALTY-DRUGS 583
PREFERRED-GENERIC 320
ZERO-COST-SHARE-PREVENTIVE-DRUGS 214
NONPREFERRED-SPECIALTY-DRUGS 75
Prior authorization Drugs
Required 866
Not Required 3,125
Step therapy Drugs
Required 19
Not Required 3,972
Quantity limits Drugs
Has Limit 1,430
No Limit 2,561

Customer highlights

What stands out for members

  • Issuer: Oscar Insurance Company · Plan ID 43490KS0010005 · 2026 filing.
  • Disease management programs available: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 43490KS0010005-00 (Standard Off Exchange Plan) currently displayed.
Advertisement

Benefits

Covered services & limitations

Everyday care

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

Chiropractic Care

$125.00
Tier 1 in-network $125.00
Out-of-network 100.00%

Diabetes Education

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

Outpatient self-management training and education, including medical nutrition therapy, for insulin dependent diabetes, insulin-using diabetes, gestational diabetes and noninsulin using diabetes when provided by a certified, registered or licensed health care professional with expertise in diabetes and the diabetic (1) is treated at a program approved by the American Diabetes Association; (2) is treated by a person certified by the national certification board of diabetes educators; or (3) is, as to nutritional education, treated by a licensed dietitian pursuant to a treatment plan authorized by such healthcare professional.

Home Health Care Services

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Includes educational visits with a limit of three per year on educational visits.

Exclusions: Excludes services provided by a member of the Insured's immediate family; Provided by a person who normally lives in the Insured's home; or Which are Custodial/Maintenance care. The Company has the right to determine which services are Custodial/Maintenance care.

Laboratory Outpatient and Professional Services

$50.00
Tier 1 in-network $50.00
Out-of-network 100.00%

Exclusions: Diagnostic tests and evaluations are ordered, requested or performed solely for the purpose of resolving issues in the context of legal proceedings, including those concerning custody, visitation, termination of parental rights, civil damages or criminal actions.

Other Practitioner Office Visit (Nurse, Physician Assistant)

$50.00
Tier 1 in-network $50.00
Out-of-network 100.00%

Professional Providers include Physician Assistants. Registered Nurses qualify as Eligible Providers.

Preventive Care/Screening/Immunization

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

Primary Care Visit to Treat an Injury or Illness

$50.00
Tier 1 in-network $50.00
Out-of-network 100.00%

Cost share applies to both in-person and telemedicine services.

Rehabilitative Occupational and Rehabilitative Physical Therapy

$125.00
Tier 1 in-network $125.00
Out-of-network 100.00%

Exclusions: Materials used for occupational therapy are excluded.

Rehabilitative Speech Therapy

$125.00
Tier 1 in-network $125.00
Out-of-network 100.00%

Limit: 90.0 Days per Benefit Period

Limited to one service per day up to a maximum benefit of 90 daily services per Insured per Benefit Period. This limitation is not applicable to Mental Illness or Substance Use Disorders

Specialist Visit

$125.00
Tier 1 in-network $125.00
Out-of-network 100.00%

Cost share applies to both in-person and telemedicine services.

Urgent Care Centers or Facilities

$75.00
Tier 1 in-network $75.00
Out-of-network 100.00%

Virtual urgent care services provided by Oscar-designated virtual care providers are covered in full.

X-rays and Diagnostic Imaging

$135.00
Tier 1 in-network $135.00
Out-of-network 100.00%

Exclusions: Diagnostic tests and evaluations are ordered, requested or performed solely for the purpose of resolving issues in the context of legal proceedings, including those concerning custody, visitation, termination of parental rights, civil damages or criminal actions.

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Delivery and All Inpatient Services for Maternity Care

$3,000.00
Tier 1 in-network $3,000.00
Out-of-network 100.00%

The per day copayment will apply for a maximum of two (2) days. Also covers surrogate mother if there is a petition to adopt within 90 days of birth. See plan documents for separate professional services cost shares.

Dialysis

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Plan cover Hemodialysis.

Durable Medical Equipment

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Benefits are limited to the amount normally available for a basic (standard) item which allows necessary function. Basic (standard) medical equipment is equipment that provides the essential function required for the treatment or amelioration of the medical condition at a Medically Necessary level. Charges for deluxe or electrically operated medical equipment are not covered, beyond the extent allowed for basic (standard) items. Deluxe describes medical equipment that has enhancements that allow for additional convenience or use beyond that provided by basic (standard) equipment

Exclusions: Items for comfort or convenience are not covered.\nIncluded within the definition of convenience items are: (a) Pieces of equipment used to provide exercise to functioning and non-functioning portions of the body when leased, purchased, or rented for use outside a recognized institutional facility. (b) Those pieces of equipment designed to provide the walking capability for individuals with nonfunctioning leg

Emergency Room Services

$2,000.00
Tier 1 in-network $2,000.00
Out-of-network $2,000.00

Emergency Transportation/Ambulance

$2,000.00
Tier 1 in-network $2,000.00
Out-of-network $2,000.00

Emergency transportation/ambulance within 500 mile radius.

Hospice Services

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Exclusions: Blood

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

$3000.00 Copay per Day
Tier 1 in-network $3000.00 Copay per Day
Out-of-network 100.00%

The per day copayment will apply for a maximum of two (2) days.

Exclusions: Blood

Inpatient Physician and Surgical Services

$350.00
Tier 1 in-network $350.00
Out-of-network 100.00%

Mental/Behavioral Health Inpatient Services

$3000.00 Copay per Day
Tier 1 in-network $3000.00 Copay per Day
Out-of-network 100.00%

The per day copayment will apply for a maximum of two (2) days.

Mental/Behavioral Health Outpatient Services

$125.00
Tier 1 in-network $125.00
Out-of-network 100.00%

The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.

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

$1,200.00
Tier 1 in-network $1,200.00
Out-of-network 100.00%

Outpatient Rehabilitation Services

$125.00
Tier 1 in-network $125.00
Out-of-network 100.00%

Limit: 90.0 Days per Benefit Period

These therapies include but are not limited to PT, OT, and ST. Further, Rehab Services are covered only if they are expected to result in significant improvement in the Insured's condition. The Company, with appropriate medical consultation, will determine whether significant improvement has occurred. Speech Therapy, limited to one service per day up to a maximum benefit of 90 daily services per Insured per Benefit Period. This limitation is not applicable to Mental Illness or Substance Use Disorders.

Exclusions: Excludes vocational rehabilitation; Cognitive therapy; social rehabilitation.

Outpatient Surgery Physician/Surgical Services

$350.00
Tier 1 in-network $350.00
Out-of-network 100.00%

Radiation

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Skilled Nursing Facility

$3000.00 Copay per Day
Tier 1 in-network $3000.00 Copay per Day
Out-of-network 100.00%

The per day copayment will apply for a maximum of two (2) days.

Substance Abuse Disorder Inpatient Services

$3000.00 Copay per Day
Tier 1 in-network $3000.00 Copay per Day
Out-of-network 100.00%

The per day copayment will apply for a maximum of two (2) days.

Substance Abuse Disorder Outpatient Services

$125.00
Tier 1 in-network $125.00
Out-of-network 100.00%

The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.

Transplant

$3,000.00
Tier 1 in-network $3,000.00
Out-of-network 100.00%

Benefits are provided for the following human organ transplants: Cornea; heart; heart-lung; kidney; pancreas; liver; lung (whole or lobar, single or double); small intestine; and multivisceral transplants.

Exclusions: There is no coverage hereunder for any transplant not specifically listed as covered or for supplies or services provided directly for or relative to human organ transplants not specifically listed as covered.

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Hearing Aids

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Major Dental Care - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Prenatal and Postnatal Care

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

Also covers surrogate mother if there is a petition to adopt within 90 days of birth.

Routine Eye Exam for Children

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

One (1) refraction visit per Benefit Period. Limit does not apply to all other medically necessary eye exams

Well Baby Visits and Care

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

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$3.00
Tier 1 in-network $3.00
Tier 2 in-network $30.00
Out-of-network 100.00%

Non-Preferred Brand Drugs

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Preferred Brand Drugs

$100.00 Copay after deductible
Tier 1 in-network $100.00 Copay after deductible
Out-of-network 100.00%

Specialty Drugs

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Exclusions: Coverage for Specialty Prescription Drugs will be limited to a supply sufficient for 34 consecutive days of therapy.

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

$350.00
Tier 1 in-network $350.00
Out-of-network 100.00%

Oral Surgical Services and Services for Accidental Injuries to Sound Natural Teeth, limited to: (1) Surgical procedures of the jaw and gums. (2) Removal of tumors and cysts of the jaws, cheeks lips, tongue, roof and floor of the mouth. (3) Removal of exostoses (bony growths) of the jaw and hard palate. (4) Treatment of fractures and dislocations of the jaw and facial bones. (5) Surgical removal of impacted teeth. (6) Treatment of Sound Natural Teeth caused by an Accidental Injury. This includes replacement of Sound Natural Teeth lost due to the Accidental Injury. (7) Intra oral dental imaging services in connection with covered oral surgery if treatment begins within 30 days. (8) General anesthesia for covered oral surgery. (9) Cylindrical endosseous dental implants, mandibular staple implants, subperiosteal implants and the associated fixed and/or removable prosthetic appliance when provided because of an Accidental Injury. (10) Cylindrical endosseous dental implants, mandibular staple implants, subperiosteal implants and the associated fixed and/or removable prosthetic appliances following surgical resection of either benign or malignant lesions (NOT including inflammatory lesions).

Basic Dental Care - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Dental Check-Up for Children

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Infusion Therapy

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Major Dental Care - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Nutritional Counseling

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Orthodontia - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Orthodontia - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Prosthetic Devices

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Benefits are limited to the amount normally available for a basic (standard) appliance which allows necessary function. Basic (standard) medical devices or appliances are those that provide the essential function required for the treatment or amelioration of the medical condition at a Medically Necessary level.

Exclusions: (1) Benefits are not provided for eyeglasses and contact lenses. Exception: Benefits are available for the initial eyeglasses/contacts following surgery for cataracts, aphakia, or pseudophakia, or an Insured under 12 years of age is eligible for subsequent eyeglasses/contacts following cataract surgery when there is a minimum change of .25 diopter. (2) Benefits are not provided for hearing aids, hair prosthesis or dental appliances including plates, bridges, prostheses or braces. (3) Benefits are not provided for items of wearing apparel except coverage is available for two postmastectomy bras per Insured per Benefit Period. A post-mastectomy bra is a bra that is specifically designed and intended to support single or bilateral breast prostheses. (4) Benefits are limited to the allowable amount for a basic/standard appliance which provides the essential function(s) required for the treatment or amelioration of the medical condition. (5) Charges for deluxe or electrically operated appliances or devices are not covered beyond the allowable amount for basic/standard appliances. Deluxe describes medical devices or appliances that have enhancements that allow for additional convenience or use beyond that provided by a basic/standard device or appliance. (6) Benefits are not provided for custom or over-the- counter orthotic devices, appliances including shoe inserts.

Routine Dental Services (Adult)

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Weight Loss Programs

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Acupuncture

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Allergy Testing

$125.00
Tier 1 in-network $125.00
Out-of-network 100.00%

Allergy testing and treatment.

Bariatric Surgery

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Cosmetic Surgery

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Eye Glasses for Children

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

Three (3) prescribed lenses and frames per Benefit Period. Contact lenses covered in lieu of glasses

Habilitation Services

$125.00
Tier 1 in-network $125.00
Out-of-network 100.00%

Supplementing with the federal definition of habilitative services: Health care services that help a person keep, learn, or improve skills and functioning for daily living. Examples include therapy for a child who is not walking or talking at the expected age. These services may include physical and occupational therapy, speech-language pathology and other services for people with disabilities in a variety of inpatient and/or outpatient settings.

Imaging (CT/PET Scans, MRIs)

$750.00
Tier 1 in-network $750.00
Out-of-network 100.00%

Exclusions: Diagnostic tests and evaluations are ordered, requested or performed solely for the purpose of resolving issues in the context of legal proceedings, including those concerning custody, visitation, termination of parental rights, civil damages or criminal actions.

Infertility Treatment

$1,200.00
Tier 1 in-network $1,200.00
Out-of-network 100.00%

Plan covers Diagnosis and treatment of cause of infertility. Benefits are available for covered services such as office visits, laboratory tests, and radiological studies to diagnose the cause of infertility. Benefits are also provided for the necessary treatment of the condition unless the treatment is identified as non- covered (see exclusions). For example, corrective surgical procedures, therapeutic injections, and drug therapy regimens (Pregnyl, Clomid, Clomiphene, Ovidrel, Gonal, Follistim and Cetrotide) are all covered services when medically necessary. Benefits are also available for tests, such as ultrasound, performed to monitor the effectiveness of the fertility drug therapy. Also for any necessary pregnancy testing performed as an integral part of the overall infertility treatment program. Benefits are excluded, however, for any procedures, tests, or other services that are exclusively provided to monitor the effectiveness of non-covered fertilization procedures.

Exclusions: Excludes In vitro fertilization, in vivo fertilization or any other medically-aided insemination procedure.

Long-Term/Custodial Nursing Home Care

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Private-Duty Nursing

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Exclusions: Excludes services provided by a member of the Insured's immediate family; Provided by a person who normally lives in the Insured's home; or Which are Custodial/Maintenance care. The Company has the right to determine which services are Custodial/Maintenance care.

Reconstructive Surgery

$3,000.00
Tier 1 in-network $3,000.00
Out-of-network 100.00%

Cosmetic and reconstructive are generally excluded, but excepted from this exclusion are: a. Cosmetic or reconstructive repair of an Accidental Injury. b. Reconstructive breast surgery in connection with a Medically Necessary mastectomy that resulted from a medical illness or injury. This includes reconstructive surgery on a breast on which a mastectomy was not performed in order to produce a symmetrical appearance. c. Repair of congenital abnormalities and hereditary complications or conditions, limited to: (1) Cleft lip or palate. (2) Birthmarks on head or neck. (3) Webbed fingers or toes. (4) Supernumerary fingers or toes. d. Reconstructive services performed on structures of the body to improve/restore impairments of bodily function resulting from disease, trauma, congenital or developmental anomalies or previous therapeutic processes. For purposes of this provision, the term "cosmetic" means procedures and related services performed to reshape structures of the body in order to alter the individual's appearance.

Routine Eye Exam (Adult)

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Routine Foot Care

$125.00
Tier 1 in-network $125.00
Out-of-network 100.00%

Covered when systemic conditions such as metabolic, neurologic, or peripheral vascular disease exists and results in medically significant circulatory deficits or decreased sensation to the foot.

Treatment for Temporomandibular Joint Disorders

$1,200.00
Tier 1 in-network $1,200.00
Out-of-network 100.00%

Exclusions: Phase II irreversible treatment; equilibration of occlusion, coronoplasty, occlusal adjustment; slides and/or photographs; non-prescription drugs, vitamins, nutrition supplements; stretching and other exercises; coolant sprays; moist heat therapy; hot packs; massage, either manual or by machine; acupuncture; cold packs; range of motion treatments; diet survey; nutrition counseling; rental or purchase of transcutaneous electrical nerve stimulators; office visits; periapical, bitewing and full-mouth radiographs; orthodontic treatment, including both fixed and removable appliances used for the purpose of moving teeth

Variant attributes

Bronze Elite + PCP Saver · Variant 43490KS0010005-00

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2026

CSR Variation Type

Standard Bronze Off Exchange Plan

HIOS Product ID

43490KS001

Metal Level

Expanded Bronze

Plan ID (Standard Component ID with Variant)

43490KS0010005-00

Plan Marketing Name

Bronze Elite + PCP Saver

Plan Variant Marketing Name

Bronze Elite + PCP Saver

Issuer & service area

Issuer-provided metadata for this variant.

Issuer ID

43490

Issuer Marketplace Marketing Name

Oscar Insurance Company

Market Coverage

Individual

Multiple In Network Tiers

Yes

National Network

No

Network ID

KSN001

Out of Country Coverage

Yes

Out of Country Coverage Description

Emergency Services Only

Out of Service Area Coverage

Yes

Out of Service Area Coverage Description

Emergency and Urgent Services Only

Service Area ID

KSS001

State Code

KS

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

0.6422406578445979

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

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

50.00%

Drug EHB Deductible, In Network (Tier 2), Default Coinsurance

50.00%

Inpatient Copayment Maximum Days

2

Medical Drug Deductibles Integrated

No

Medical Drug Maximum Out of Pocket Integrated

Yes

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

50.00%

Medical EHB Deductible, In Network (Tier 2), Default Coinsurance

50.00%

SBC Scenario, Having a Baby, Coinsurance

$0

SBC Scenario, Having a Baby, Copayment

$4,100

SBC Scenario, Having a Baby, Deductible

$0

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$600

SBC Scenario, Having Diabetes, Deductible

$4,200

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$100

SBC Scenario, Treatment of a Simple Fracture, Copayment

$2,100

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

per group not applicable

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

per person not applicable

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

Not Applicable

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

$21200 per group

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

$10600 per person

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

$10,600

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Group

$21200 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Person

$10600 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual

$10,600

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

per group not applicable

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

per person not applicable

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

Not Applicable

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

KSF001

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$0

SBC Scenario, Having Diabetes, Limit

$0

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

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

per group not applicable

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

per person not applicable

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

Not Applicable

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

$14000 per group

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

$7000 per person

Drug EHB Deductible, In Network (Tier 1), Individual

$7,000

Drug EHB Deductible, In Network (Tier 2), Family Per Group

$14000 per group

Drug EHB Deductible, In Network (Tier 2), Family Per Person

$7000 per person

Drug EHB Deductible, In Network (Tier 2), Individual

$7,000

Drug EHB Deductible, Out of Network, Family Per Group

per group not applicable

Drug EHB Deductible, Out of Network, Family Per Person

per person not applicable

Drug EHB Deductible, Out of Network, Individual

Not Applicable

Dental Only Plan

No

Design Type

Not Applicable

Disease Management Programs Offered

Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol

EHB Percent of Total Premium

0.9992

First Tier Utilization

44%

Import Date

10/28/2025

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

Yes

New/Existing Plan

Existing

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

No

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

per group not applicable

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

per person not applicable

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

Not Applicable

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

$0 per group

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

$0 per person

Medical EHB Deductible, In Network (Tier 1), Individual

$0

Medical EHB Deductible, In Network (Tier 2), Family Per Group

$0 per group

Medical EHB Deductible, In Network (Tier 2), Family Per Person

$0 per person

Medical EHB Deductible, In Network (Tier 2), Individual

$0

Medical EHB Deductible, Out of Network, Family Per Group

per group not applicable

Medical EHB Deductible, Out of Network, Family Per Person

per person not applicable

Medical EHB Deductible, Out of Network, Individual

Not Applicable

Plan Effective Date

1/1/2026

Plan Expiration Date

12/31/2026

Plan Type

EPO

QHP/Non QHP

Both

Second Tier Utilization

56%

Source Name

SERFF

Plan ID

43490KS0010005

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 Kansas?

Bronze Elite + PCP Saver (43490KS0010005) is a Expanded Bronze EPO from Oscar Insurance Company in Kansas for the 2026 coverage year.

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

Does Bronze Elite + PCP Saver 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 Bronze Elite + PCP Saver HSA-eligible and does it include dental or vision coverage?

It is HSA-eligible, so you can pair it with a Health Savings Account to lower taxes.

Dental coverage is not listed for this plan.

Vision add-ons: Child.

Does Bronze Elite + PCP Saver 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 Bronze Elite + PCP Saver?

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

Is there out-of-country coverage for Bronze Elite + PCP Saver?

Yes, limited out-of-country coverage is available. Review the Summary of Benefits for reimbursement steps. Details: Emergency Services Only

Does Bronze Elite + PCP Saver cover care outside the service area?

Yes, you have limited out-of-area coverage. See the plan documents for referral and prior authorization rules. Details: Emergency and Urgent Services Only

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.
Issuer profile More plans
Open comparison tray

Add at least two plans to launch side-by-side comparisons.