Silver Classic - 77739MI0070006 Health Insurance Plan

Oscar Insurance Company health insurance plan with the Plan ID 77739MI0070006. The plan is called Silver Classic.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 87.07% (we converted the output of AV Calculator to percentage to compare with data provided by Issuer, it shows the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 12.93% of the costs of all covered benefits (according to the AV Calculator by CMS.gov). More information about AV Calculator methodology.

Health Insurance Plan ID 77739MI0070006
Health Insurance Plan Year 2023
State Michigan
Health Insurance Issuer Oscar Insurance Company
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 77739MI0070006-05
Provider Network(s) ['MIN001']
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 20 Feb 2024 05:55 GMT).

Providers Michigan All US States
All N/A N/A
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A
Available Variants of the Health Plan

Standard Off Exchange Plan - 77739MI0070006-00

Standard On Exchange Plan - 77739MI0070006-01

Open to Indians below 300% FPL - 77739MI0070006-02

Open to Indians above 300% FPL - 77739MI0070006-03

73% AV Silver Plan - 77739MI0070006-04

87% AV Silver Plan - 77739MI0070006-05

94% AV Silver Plan - 77739MI0070006-06

Last Plan Update Date Tue, 28 Feb 2023 00:00 GMT
Last Import Date Tue, 20 Feb 2024 05:55 GMT

Benefits of Silver Classic Health Insurance Plan, 77739MI0070006-05

Benefit Covered In Network Out Of Network
Abortion for Which Public Funding is Prohibited
NO
Accidental Dental
NO
Acupuncture
NO
Allergy Testing
YES

$40.00

100.00%
Bariatric Surgery

Limit: 1.0 Procedure(s) per Lifetime

YES

30.00%

100.00%
Basic Dental Care - Adult
NO
Basic Dental Care - Child
NO
Chemotherapy
YES

30.00%

100.00%
Chiropractic Care

Limit: 30.0 Visit(s) per Year

Limit combined with OT and PT.

YES

$40.00

100.00%
Cosmetic Surgery
NO
Delivery and All Inpatient Services for Maternity Care
YES

30.00%

100.00%
Dental Check-Up for Children
NO
Diabetes Education
YES

$0.00

100.00%
Dialysis
YES

30.00%

100.00%
Durable Medical Equipment
YES

30.00%

100.00%
Emergency Room Services
YES

$750.00

$750.00
Emergency Transportation/Ambulance
YES

$750.00

$750.00
Eye Glasses for Children

Limit: 1.0 Item(s) per Year

YES

50.00%

100.00%
Gender Affirming Care
YES

30.00%

100.00%
Generic Drugs

Oscar is on a mission to make your prescriptions more affordable. That?s why your savings start on day 1 of your new plan. All Oscar members have access to 24/7 virtual urgent care services. Depending on your plan, if your Oscar Virtual Urgent Care provider prescribes any prescriptions on the Generics: Tier 1a or Generics: Tier 1b list during your visit, those prescriptions will be free.* Generics: Tier 1a: Drugs on this list will never cost you more than $3, no matter who prescribes them. Check to see if your prescriptions are on the $3 Prescription List at https://www.hioscar.com/prescriptions/3-dollar-list Prescriptions included in Generics: Tier 1b will always cost you less than $30, no matter who prescribes them?even if you haven?t hit your deductible. Find out which Tiers the drugs you take are on at www.hioscar.com/search *For these savings to apply, they must be prescribed by your Oscar Virtual Urgent Care provider under a Silver, Gold, or Platinum plan. Virtual visits with other providers in Oscar?s network will not be free and the additional savings will not apply.

YES

Tier 1: $3.00

Tier 2: $20.00

100.00%
Habilitation Services

Limit: 30.0 Visit(s) per Year

Yearly limits: PT and OT: 30 visits, Speech: 30 visits.

YES

$40.00

100.00%
Hearing Aids
NO
Home Health Care Services
YES

$40.00

100.00%
Hospice Services

Coverage includes inpatient and outpatient hospice care.

YES

30.00%

100.00%
Imaging (CT/PET Scans, MRIs)
YES

30.00%

100.00%
Infertility Treatment

Underlying causes only.

YES

30.00%

100.00%
Infusion Therapy
YES

30.00%

100.00%
Inpatient Hospital Services (e.g., Hospital Stay)
YES

30.00%

100.00%
Inpatient Physician and Surgical Services
YES

30.00%

100.00%
Laboratory Outpatient and Professional Services
YES

Tier 1: $10.00

Tier 2: $25.00

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

30.00%

100.00%
Mental/Behavioral Health Outpatient Services
YES

$40.00

100.00%
Non-Preferred Brand Drugs
YES

50.00%

100.00%
Nutritional Counseling

Limit: 6.0 Visit(s) per Year

Dietician Services.

YES

$10.00

100.00%
Orthodontia - Adult
NO
Orthodontia - Child
NO
Other Practitioner Office Visit (Nurse, Physician Assistant)
YES

$10.00

100.00%
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
YES

30.00%

100.00%
Outpatient Rehabilitation Services

Limit: 30.0 Visit(s) per Year

PT/OT/Chiro - combined visits per contract year; 30 ST per contract year; 30 cardiac/pulmonary visits per contract year.

YES

$40.00

100.00%
Outpatient Surgery Physician/Surgical Services
YES

30.00%

100.00%
Preferred Brand Drugs
YES

$75.00

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

Virtual visits with an Oscar Care urgent care provider are unlimited and always $0?even if you haven?t hit your deductible. Depending on your plan, many prescriptions and labs will also cost you $0, if they?re ordered by your Oscar Virtual Urgent Care team.* Please refer to your plan documents for more information. *For these savings to apply, they must be prescribed by your Oscar Virtual Urgent Care provider under a Silver, Gold, or Platinum plan.

YES

$10.00

100.00%
Private-Duty Nursing
NO
Prosthetic Devices
YES

30.00%

100.00%
Radiation
YES

30.00%

100.00%
Reconstructive Surgery
YES

30.00%

100.00%
Rehabilitative Occupational and Rehabilitative Physical Therapy

Limit: 30.0 Visit(s) per Year

Combined with chiro.

YES

$40.00

100.00%
Rehabilitative Speech Therapy

Limit: 30.0 Visit(s) per Year

YES

$40.00

100.00%
Routine Dental Services (Adult)
NO
Routine Eye Exam (Adult)
NO
Routine Eye Exam for Children

Limit: 1.0 Exam(s) per Year

YES

$0.00

100.00%
Routine Foot Care
NO
Skilled Nursing Facility

Limit: 45.0 Days per Year

YES

30.00%

100.00%
Specialist Visit
YES

$40.00

100.00%
Specialty Drugs
YES

50.00%

100.00%
Substance Abuse Disorder Inpatient Services
YES

30.00%

100.00%
Substance Abuse Disorder Outpatient Services
YES

$40.00

100.00%
Transplant
YES

30.00%

100.00%
Treatment for Temporomandibular Joint Disorders

Coverage includes medical care or services to treat dysfunction or TMJS resulting from a medical cause or injury, Office visits for medical evaluation and treatment, X-rays of the temporomandibular joint including contrast studies, but not dental X-rays, Myofunctional therapy and Surgery to the temporomandibular joint, such as condylectomy, meniscectomy, arthrotomy, and arthrocentesis.

YES

30.00%

100.00%
Urgent Care Centers or Facilities
YES

$40.00

100.00%
Weight Loss Programs
YES 100.00%
Well Baby Visits and Care
YES

$0.00

100.00%
X-rays and Diagnostic Imaging
YES

$50.00

100.00%

Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan Variant 77739MI0070006-05 Attributes

Plan Attribute Value
AV Calculator Output Number 0.870670035
Begin Primary Care Cost-Sharing After Number Of Visits 0
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 87% AV Level Silver 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 1
First Tier Utilization 20%
Formulary ID MIF001
Formulary URL URL
HIOS Product ID 77739MI007
Import Date 2/28/2023 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? No
Issuer ID 77739
Issuer Marketplace Marketing Name Oscar Insurance Company
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Silver
Multiple In Network Tiers Yes
National Network No
Network ID MIN001
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) 77739MI0070006-05
Plan Marketing Name Silver Classic
Plan Type EPO
Plan Variant Marketing Name Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers)
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $2,700
SBC Scenario, Having a Baby, Copayment $200
SBC Scenario, Having a Baby, Deductible $0
SBC Scenario, Having a Baby, Limit $0
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $1,800
SBC Scenario, Having Diabetes, Deductible $0
SBC Scenario, Having Diabetes, Limit $0
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $100
SBC Scenario, Treatment of a Simple Fracture, Copayment $1,400
SBC Scenario, Treatment of a Simple Fracture, Deductible $0
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Second Tier Utilization 80%
Service Area ID MIS001
Source Name SERFF
Plan ID 77739MI0070006
State Code MI
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 30.00%
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, In Network (Tier 2), Default Coinsurance 30.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Group $0 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Person $0 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Individual $0
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 $5800 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $2900 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $2,900
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Group $5800 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Person $2900 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual $2,900
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 Silver Classic Health Insurance Plan, 77739MI0070006

Drug Tier Pharmacy Type Copay amount Copay option Coinsurance rate Coinsurance option Mail Order

Frequently Asked Questions(FAQ) about Silver Classic, 77739MI0070006 Health Insurance Plan, 77739MI0070006

  • Does Silver Classic Health Insurance Plan, 77739MI0070006 support Mail Ordering?

    Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.

  • Does (77739MI0070006) Health Insurance Plan, Variant (77739MI0070006-05) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs

    Does (77739MI0070006) Health Insurance Plan, Variant (77739MI0070006-05) have Out Of Country Coverage?

    Yes. Details: Emergency Services Only

    Does (77739MI0070006) Health Insurance Plan, Variant (77739MI0070006-05) have Out of Service Area Coverage?

    Yes. Details: Emergency and Urgent Services only

    Does (77739MI0070006) Health Insurance Plan, Variant (77739MI0070006-05) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs

    Does Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan, Variant (77739MI0070006-05) offer Disease Management Programs for Asthma?

    Yes, the Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan Variant 77739MI0070006-05 offers Disease Management Program for Asthma.

    Does Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan, Variant (77739MI0070006-05) offer Disease Management Programs for Heart disease?

    Yes, the Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan Variant 77739MI0070006-05 offers Disease Management Program for Heart disease.

    Does Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan, Variant (77739MI0070006-05) offer Disease Management Programs for Depression?

    Yes, the Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan Variant 77739MI0070006-05 offers Disease Management Program for Depression.

    Does Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan, Variant (77739MI0070006-05) offer Disease Management Programs for Diabetes?

    Yes, the Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan Variant 77739MI0070006-05 offers Disease Management Program for Diabetes.

    Does Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan, Variant (77739MI0070006-05) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan Variant 77739MI0070006-05 offers Disease Management Program for High blood pressure & high cholesterol.

    Does Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan, Variant (77739MI0070006-05) offer Disease Management Programs for Low back pain?

    Yes, the Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan Variant 77739MI0070006-05 offers Disease Management Program for Low back pain.

    Does Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan, Variant (77739MI0070006-05) offer Disease Management Programs for Pregnancy?

    Yes, the Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan Variant 77739MI0070006-05 offers Disease Management Program for Pregnancy.

    Does Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan, Variant (77739MI0070006-05) offer Disease Management Programs for Weight loss programs?

    Yes, the Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan Variant 77739MI0070006-05 offers Disease Management Program for Weight loss programs.

 

Disclaimer: This is based on the import(Date: Tue, 20 Feb 2024 05:55 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