Secure (Choice) - 11574IL0010011 Health Insurance Plan
Oscar Health Plan, Inc. health insurance plan with the Plan ID 11574IL0010011. The plan is called Secure (Choice).
| Health Insurance Plan ID | 11574IL0010011 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Illinois | ||||||||||||||||||
| Health Insurance Issuer | Oscar Health Plan, Inc. | ||||||||||||||||||
| Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 11574IL0010011-00 | ||||||||||||||||||
| Provider Network(s) | ['ILN001'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 30 Apr 2024 06:06 GMT). |
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| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Wed, 22 Feb 2023 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 30 Apr 2024 06:06 GMT |
Benefits of Secure (Choice) Health Insurance Plan, 11574IL0010011-00
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Abortion for Which Public Funding is Prohibited
|
YES | $0.00 Copay after deductible |
100.00% |
| Accidental Dental
|
YES | $0.00 Copay after deductible |
100.00% |
| Acupuncture
|
NO | ||
| Allergy Testing
|
YES | $0.00 Copay after deductible |
100.00% |
| Bariatric Surgery
|
YES | $0.00 Copay after deductible |
100.00% |
| Basic Dental Care - Adult
|
NO | ||
| Basic Dental Care - Child
|
NO | ||
| Chemotherapy
|
YES | 0.00% Coinsurance after deductible |
100.00% |
| Chiropractic Care
Limit: 25.0 Visit(s) per Benefit Period |
YES | $0.00 Copay after deductible |
100.00% |
| Cosmetic Surgery
Cosmetic surgery for the correction of the congenital deformities or for conditions resulting from accidental injuries, scars, tumors or disease is covered. |
YES | $0.00 Copay after deductible |
100.00% |
| Delivery and All Inpatient Services for Maternity Care
|
YES | $0.00 Copay after deductible |
100.00% |
| Dental Check-Up for Children
|
NO | ||
| Diabetes Education
Services must be rendered by a physician, or duly certified, or licensed health care professional with expertise in diabetes management. |
YES | $0.00 Copay after deductible |
100.00% |
| Dialysis
|
YES | 0.00% Coinsurance after deductible |
100.00% |
| Durable Medical Equipment
|
YES | 0.00% Coinsurance after deductible |
100.00% |
| Emergency Room Services
|
YES | $0.00 Copay after deductible |
$0.00 Copay after deductible |
| Emergency Transportation/Ambulance
|
YES | $0.00 Copay after deductible |
$0.00 Copay after deductible |
| Eye Glasses for Children
Limit: 1.0 Item(s) per Benefit Period |
YES | $0.00 Copay after deductible |
100.00% |
| Gender Affirming Care
|
YES | $0.00 Copay after deductible |
100.00% |
| Generic Drugs
|
YES | $0.00 Copay after deductible |
100.00% |
| Habilitation Services
Treatment must be medically necessary and therapeutic and not investigational. |
YES | $0.00 Copay after deductible |
100.00% |
| Hearing Aids
Limit: 2.0 Visit(s) per 3 Years Benefits are for bone anchored hearing aids. Quantity limit applies to hearing aids for children. |
YES | 0.00% Coinsurance after deductible |
100.00% |
| Home Health Care Services
|
YES | $0.00 Copay after deductible |
100.00% |
| Hospice Services
|
YES | 0.00% Coinsurance after deductible |
100.00% |
| Imaging (CT/PET Scans, MRIs)
|
YES | $0.00 Copay after deductible |
100.00% |
| Infertility Treatment
Limitations vary based on procedures. |
YES | 0.00% Coinsurance after deductible |
100.00% |
| Infusion Therapy
|
YES | 0.00% Coinsurance after deductible |
100.00% |
| Inpatient Hospital Services (e.g., Hospital Stay)
|
YES | 0.00% Coinsurance after deductible |
100.00% |
| Inpatient Physician and Surgical Services
|
YES | $0.00 Copay after deductible |
100.00% |
| Laboratory Outpatient and Professional Services
Benefit provided for outpatient services and when these services are related to surgery or medical care. |
YES | $0.00 Copay 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
|
YES | $0.00 Copay after deductible |
100.00% |
| Mental/Behavioral Health Outpatient Services
|
YES | $0.00 Copay after deductible |
100.00% |
| Non-Preferred Brand Drugs
|
YES | $0.00 Copay after deductible |
100.00% |
| Nutritional Counseling
|
YES | $0.00 Copay after deductible |
100.00% |
| Orthodontia - Adult
|
NO | ||
| Orthodontia - Child
|
NO | ||
| Other Practitioner Office Visit (Nurse, Physician Assistant)
|
YES | $0.00 Copay after deductible |
100.00% |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
|
YES | $0.00 Copay after deductible |
100.00% |
| Outpatient Rehabilitation Services
Maintenance therapies not covered. |
YES | $0.00 Copay after deductible |
100.00% |
| Outpatient Surgery Physician/Surgical Services
|
YES | $0.00 Copay after deductible |
100.00% |
| Preferred Brand Drugs
|
YES | $0.00 Copay after deductible |
100.00% |
| Prenatal and Postnatal Care
|
YES | $0.00 Copay after deductible |
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. Virtual urgent care visits with Oscar designated telemedicine providers are covered in full after the deductible has been met. |
YES | $0.00 Copay after deductible |
100.00% |
| Private-Duty Nursing
|
YES | $0.00 Copay after deductible |
100.00% |
| Prosthetic Devices
|
YES | 0.00% Coinsurance after deductible |
100.00% |
| Radiation
|
YES | 0.00% Coinsurance after deductible |
100.00% |
| Reconstructive Surgery
Only includes benefits for mastectomy-related services. |
YES | $0.00 Copay after deductible |
100.00% |
| Rehabilitative Occupational and Rehabilitative Physical Therapy
Maintenance Speech Therapy is not covered. |
YES | $0.00 Copay after deductible |
100.00% |
| Rehabilitative Speech Therapy
When rendered for the treatment of psychosocial speech delay, behavioral problems (including impulsive behavior and impulsivity syndrome) attention disorder, conceptual handicap or mental retardation, except as may be provided under this Certificate for Autism Spectrum Disorder(s). |
YES | $0.00 Copay after deductible |
100.00% |
| Routine Dental Services (Adult)
|
NO | ||
| Routine Eye Exam (Adult)
|
NO | ||
| Routine Eye Exam for Children
Limit: 1.0 Exam(s) per Benefit Period |
YES | $0.00 Copay after deductible |
100.00% |
| Routine Foot Care
Only covered for persons diagnosed with diabetes. |
YES | $0.00 Copay after deductible |
100.00% |
| Skilled Nursing Facility
|
YES | 0.00% Coinsurance after deductible |
100.00% |
| Specialist Visit
|
YES | $0.00 Copay after deductible |
100.00% |
| Specialty Drugs
|
YES | $0.00 Copay after deductible |
100.00% |
| Substance Abuse Disorder Inpatient Services
|
YES | $0.00 Copay after deductible |
100.00% |
| Substance Abuse Disorder Outpatient Services
|
YES | $0.00 Copay after deductible |
100.00% |
| Transplant
|
YES | $0.00 Copay after deductible |
100.00% |
| Treatment for Temporomandibular Joint Disorders
|
YES | 0.00% Coinsurance after deductible |
100.00% |
| Urgent Care Centers or Facilities
|
YES | $0.00 Copay after deductible |
100.00% |
| Weight Loss Programs
|
NO | ||
| Well Baby Visits and Care
|
YES | $0.00 Copay after deductible |
100.00% |
| X-rays and Diagnostic Imaging
Benefit provided for outpatient services and when these services are related to surgery or medical care. |
YES | $0.00 Copay after deductible |
100.00% |
Secure (Choice) Health Insurance Plan Variant 11574IL0010011-00 Attributes
| 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 | 2023 |
| 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, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs |
| EHB Percent of Total Premium | 0.998104 |
| First Tier Utilization | 100% |
| Formulary ID | ILF001 |
| Formulary URL | URL |
| HIOS Product ID | 11574IL001 |
| Import Date | 2/22/2023 20:01 |
| 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? | Yes |
| Issuer ID | 11574 |
| Issuer Marketplace Marketing Name | Oscar Health Plan, Inc. |
| 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 | ILN001 |
| 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 | 1/1/2023 |
| Plan Expiration Date | 12/31/2023 |
| Plan ID (Standard Component ID with Variant) | 11574IL0010011-00 |
| Plan Marketing Name | Secure (Choice) |
| Plan Type | HMO |
| Plan Variant Marketing Name | Secure (Choice) |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $9,100 |
| 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 | ILS001 |
| Source Name | SERFF |
| Specialist Requiring a Referral | All Specialist Providers |
| Plan ID | 11574IL0010011 |
| State Code | IL |
| 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 | $18200 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person | $9100 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $9,100 |
| 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 | $18200 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $9100 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $9,100 |
| 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 |
Copay & Coinsurance of Secure (Choice) Health Insurance Plan, 11574IL0010011
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about Secure (Choice), 11574IL0010011 Health Insurance Plan, 11574IL0010011
-
Does Secure (Choice) Health Insurance Plan, 11574IL0010011 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (11574IL0010011) Health Insurance Plan, Variant (11574IL0010011-00) offer Disease Management Programs?
Does (11574IL0010011) Health Insurance Plan, Variant (11574IL0010011-00) have Out Of Country Coverage?
Does (11574IL0010011) Health Insurance Plan, Variant (11574IL0010011-00) have Out of Service Area Coverage?
Does (11574IL0010011) Health Insurance Plan, Variant (11574IL0010011-00) offer Disease Management Programs?
Does Secure (Choice) Health Insurance Plan, Variant (11574IL0010011-00) offer Disease Management Programs for Asthma?
Does Secure (Choice) Health Insurance Plan, Variant (11574IL0010011-00) offer Disease Management Programs for Heart disease?
Does Secure (Choice) Health Insurance Plan, Variant (11574IL0010011-00) offer Disease Management Programs for Depression?
Does Secure (Choice) Health Insurance Plan, Variant (11574IL0010011-00) offer Disease Management Programs for Diabetes?
Does Secure (Choice) Health Insurance Plan, Variant (11574IL0010011-00) offer Disease Management Programs for High blood pressure & high cholesterol?
Does Secure (Choice) Health Insurance Plan, Variant (11574IL0010011-00) offer Disease Management Programs for Low back pain?
Does Secure (Choice) Health Insurance Plan, Variant (11574IL0010011-00) offer Disease Management Programs for Pregnancy?
Does Secure (Choice) Health Insurance Plan, Variant (11574IL0010011-00) offer Disease Management Programs for Weight loss programs?
Disclaimer: This is based on the import(Date: Tue, 30 Apr 2024 06:06 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