Oscar Insurance Company of Florida health insurance plan with the Plan ID 40572FL0200011. The plan is called Secure.
Health Insurance Plan ID | 40572FL0200011 | ||||||||||||||||||
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Health Insurance Plan Year | 2025 | ||||||||||||||||||
State | Florida | ||||||||||||||||||
Health Insurance Issuer | Oscar Insurance Company of Florida | ||||||||||||||||||
Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
Health Insurance Plan Variant | 40572FL0200011-00 | ||||||||||||||||||
Provider Network(s) | PREFERRED | ||||||||||||||||||
In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 10 Dec 2024 06:32 GMT). |
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Available Variants of the Health Plan | |||||||||||||||||||
Last Plan Update Date | Fri, 18 Oct 2024 00:00 GMT | ||||||||||||||||||
Last Import Date | Tue, 10 Dec 2024 06:32 GMT |
Benefit | Covered | In Network | Out Of Network |
---|---|---|---|
Abortion for Which Public Funding is Prohibited
|
NO | ||
Accidental Dental
|
YES | No Charge after deductible |
100.00% |
Acupuncture
|
NO | ||
Allergy Testing
|
YES | No Charge after deductible |
100.00% |
Bariatric Surgery
|
NO | ||
Basic Dental Care - Adult
|
NO | ||
Basic Dental Care - Child
|
NO | ||
Chemotherapy
|
YES | No Charge after deductible |
100.00% |
Chiropractic Care
Limit: 35.0 Visit(s) per Benefit Period Combined limit for all outpatient therapy plus chiropractic. |
YES | No Charge after deductible |
100.00% |
Cosmetic Surgery
|
NO | ||
Delivery and All Inpatient Services for Maternity Care
Exclusions: Maternity services rendered to a covered person who is acting as a gestational surrogate are excluded. |
YES | No Charge after deductible |
100.00% |
Dental Check-Up for Children
|
NO | ||
Diabetes Education
|
YES | No Charge after deductible |
100.00% |
Dialysis
|
YES | No Charge after deductible |
100.00% |
Durable Medical Equipment
|
YES | No Charge after deductible |
100.00% |
Emergency Room Services
|
YES | No Charge after deductible |
No Charge after deductible |
Emergency Transportation/Ambulance
|
YES | No Charge after deductible |
No Charge after deductible |
Eye Glasses for Children
|
YES | No Charge after deductible |
100.00% |
Gender Affirming Care
|
NO | ||
Generic Drugs
|
YES | No Charge after deductible |
100.00% |
Habilitation Services
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 |
YES | No Charge after deductible |
100.00% |
Hearing Aids
|
NO | ||
Home Health Care Services
Limit: 20.0 Days per Benefit Period Exclusions: Part-time- Services limited to less than 8 hours a day, less than 40 hours a week. Intermittent- Services limited to each visit up to but not exceeding 2 hours a day. Excluded: Services rendered by an employee/operator of an adult congregate living facility, adult foster home, adult day care center, or a nursing facility. |
YES | No Charge after deductible |
100.00% |
Hospice Services
|
YES | No Charge after deductible |
100.00% |
Imaging (CT/PET Scans, MRIs)
|
YES | No Charge after deductible |
100.00% |
Infertility Treatment
|
NO | ||
Infusion Therapy
|
NO | ||
Inpatient Hospital Services (e.g., Hospital Stay)
|
YES | No Charge after deductible |
100.00% |
Inpatient Physician and Surgical Services
|
YES | No Charge after deductible |
100.00% |
Laboratory Outpatient and Professional Services
|
YES | No Charge after deductible |
100.00% |
Long-Term/Custodial Nursing Home Care
|
NO | ||
Major Dental Care - Adult
|
NO | ||
Major Dental Care - Child
|
NO | ||
Mental/Behavioral Health Inpatient Services
Exclusions: Exclusion of "inpatient (overnight) mental health services received in a residential treatment facility." |
YES | No Charge after deductible |
100.00% |
Mental/Behavioral Health Outpatient Services
Exclusions: Excludes services for psychological testing associated with the evaluation and diagnosis of learning disabilities or for mental retardation. 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. |
YES | No Charge after deductible |
100.00% |
Non-Preferred Brand Drugs
|
YES | No Charge after deductible |
100.00% |
Nutritional Counseling
Diabetes coverage includes "nutrition counseling"; home health services include "nutritional guidance" |
YES | No Charge after deductible |
100.00% |
Orthodontia - Adult
|
NO | ||
Orthodontia - Child
|
NO | ||
Other Practitioner Office Visit (Nurse, Physician Assistant)
|
YES | No Charge after deductible |
100.00% |
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
|
YES | No Charge after deductible |
100.00% |
Outpatient Rehabilitation Services
Limit: 35.0 Visit(s) per Benefit Period Combined limit for all outpatient therapy plus chiropractic. |
YES | No Charge after deductible |
100.00% |
Outpatient Surgery Physician/Surgical Services
|
YES | No Charge after deductible |
100.00% |
Preferred Brand Drugs
|
YES | No Charge after deductible |
100.00% |
Prenatal and Postnatal Care
|
YES | 0.00% |
100.00% |
Preventive Care/Screening/Immunization
|
YES | 0.00% |
100.00% |
Primary Care Visit to Treat an Injury or Illness
First three (3) non-preventive visits are $0 and not subject to the deductible. Cost share applies to both in-person and telemedicine services. |
YES | No Charge after deductible |
100.00% |
Private-Duty Nursing
|
NO | ||
Prosthetic Devices
|
YES | No Charge after deductible |
100.00% |
Radiation
|
YES | No Charge after deductible |
100.00% |
Reconstructive Surgery
Only for Breast reconstruction following a Mastectomy. |
YES | No Charge after deductible |
100.00% |
Rehabilitative Occupational and Rehabilitative Physical Therapy
Limit: 35.0 Visit(s) per Benefit Period Exclusions: If provided in an Inpatient setting, member must be able to actively participate in 2 rehabilitative therapies and be able to tolerate at least 3 hours per day of skilled Rehab services for at least 5 days a week. Member's condition must be likely to significantly improve. Inpatient rehab limit is 21 days. Combined limit for all outpatient therapy plus chiropractic. |
YES | No Charge after deductible |
100.00% |
Rehabilitative Speech Therapy
Limit: 35.0 Visit(s) per Benefit Period Combined limit for all outpatient therapy plus chiropractic. |
YES | No Charge after deductible |
100.00% |
Routine Dental Services (Adult)
|
NO | ||
Routine Eye Exam (Adult)
|
NO | ||
Routine Eye Exam for Children
|
YES | No Charge after deductible |
100.00% |
Routine Foot Care
|
NO | ||
Skilled Nursing Facility
Limit: 60.0 Days per Benefit Period |
YES | No Charge after deductible |
100.00% |
Specialist Visit
Cost share applies to both in-person and telemedicine services. |
YES | No Charge after deductible |
100.00% |
Specialty Drugs
|
YES | No Charge after deductible |
100.00% |
Substance Abuse Disorder Inpatient Services
Exclusions: Exclusion of "expenses for prolonged care and treatment of Substance Dependency in a specialized inpatient or residential treatment facility" |
YES | No Charge after deductible |
100.00% |
Substance Abuse Disorder Outpatient Services
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. |
YES | No Charge after deductible |
100.00% |
Transplant
|
YES | No Charge after deductible |
100.00% |
Treatment for Temporomandibular Joint Disorders
Exclusions: Services involving bones or joints of the jaw (e.g., Services to treat temporomandibular joint [TMJ] dysfunction) or facial region if, under accepted medical standards, such diagnostic Services are necessary to treat Conditions caused by congenital or developmental deformity, disease, or injury. Payment for splints for the treatment of temporomandibular joint ("TMJ") dysfunction is limited to one splint in a six-month period unless a more frequent replacement is determined by us to be Medically Necessary |
YES | No Charge after deductible |
100.00% |
Urgent Care Centers or Facilities
Virtual urgent care services provided by Oscar-designated virtual care providers are covered in full once the deductible has been met. |
YES | No Charge after deductible |
100.00% |
Weight Loss Programs
|
NO | ||
Well Baby Visits and Care
|
YES | 0.00% |
100.00% |
X-rays and Diagnostic Imaging
|
YES | No Charge after deductible |
100.00% |
Plan Attribute | Value |
---|---|
Begin Primary Care Cost-Sharing After Number Of Visits | 3 |
Begin Primary Care Deductible Coinsurance After Number Of Copays | 0 |
Business Year | 2025 |
Child-Only Offering | Allows Adult and Child-Only |
Composite Rating Offered | No |
CSR Variation Type | Standard Catastrophic Off Exchange Plan |
Dental Only Plan | No |
Design Type | Not Applicable |
Disease Management Programs Offered | Asthma, Heart Disease, Depression, Diabetes, Pregnancy |
EHB Percent of Total Premium | 1.0 |
First Tier Utilization | 100% |
Formulary ID | FLF031 |
Formulary URL | URL |
HIOS Product ID | 40572FL020 |
Import Date | 2024-10-18 01:02:01 |
Limited Cost Sharing Plan Variation - Estimated Advanced Payment | $0.00 |
Inpatient Copayment Maximum Days | 0 |
HSA Eligible | No |
New/Existing Plan | Existing |
Notice Required for Pregnancy | No |
Is a Referral Required for Specialist? | No |
Issuer ID | 40572 |
Issuer Marketplace Marketing Name | Oscar Insurance Company of Florida |
Market Coverage | Individual |
Medical Drug Deductibles Integrated | Yes |
Medical Drug Maximum Out of Pocket Integrated | Yes |
Metal Level | Catastrophic |
Multiple In Network Tiers | No |
National Network | No |
Network ID | FLN001 |
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 |
Plan Brochure | URL |
Plan Effective Date | 2025-01-01 |
Plan Expiration Date | 2025-12-31 |
Plan ID (Standard Component ID with Variant) | 40572FL0200011-00 |
Plan Marketing Name | Secure |
Plan Type | EPO |
Plan Variant Marketing Name | Secure |
QHP/Non QHP | Both |
SBC Scenario, Having a Baby, Coinsurance | $0 |
SBC Scenario, Having a Baby, Copayment | $0 |
SBC Scenario, Having a Baby, Deductible | $9,200 |
SBC Scenario, Having a Baby, Limit | $0 |
SBC Scenario, Having Diabetes, Coinsurance | $0 |
SBC Scenario, Having Diabetes, Copayment | $0 |
SBC Scenario, Having Diabetes, Deductible | $5,400 |
SBC Scenario, Having Diabetes, Limit | $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 | $2,800 |
SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
Service Area ID | FLS002 |
Source Name | HIOS |
Plan ID | 40572FL0200011 |
State Code | FL |
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 |
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group | per group not applicable |
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person | per person not applicable |
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 0.00% |
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group | $18400 per group |
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person | $9200 per person |
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $9,200 |
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group | per group not applicable |
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person | per person not applicable |
Combined Medical and Drug EHB Deductible, Out of Network, Individual | Not Applicable |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group | $18400 per group |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $9200 per person |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $9,200 |
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 |
Unique Plan Design | No |
URL for Enrollment Payment | URL |
URL for Summary of Benefits & Coverage | URL |
Wellness Program Offered | No |
Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Disclaimer: This is based on the import(Date: Tue, 10 Dec 2024 06:32 GMT) of the data from Healthcare Issuers listed by CMS. While we make every effort to ensure that data is accurate, you should assume all results are unvalidated. Source: CMS.gov, HealthPorta HEALTHCARE MRF API