Florida health plan · 2026

Silver Simple Chronic Care CKM · 21525FL0020010

Oscar Health Maintenance Organization of Florida offers this marketplace health insurance plan (Plan ID 21525FL0020010) 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: Silver Plan type: HMO CSR: 94% AV Level Silver Plan Issuer: Oscar Health Maintenance Organization of Florida
Telehealth Data pending HSA eligible No Dental Not listed Vision Child
Pay / Manage Plan View issuer site

Issuer actuarial value: 94.36%. Expect to pay roughly 5.64% of covered costs out of pocket, based on issuer reporting.

CMS AV Calculator output: 94.27% (5.73% 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

$394 – $2185

Before subsidies

Estimate after subsidies

Deductible

$0

$0 per group

See deductible details

Max out-of-pocket

$1,500

$3000 per group

Review MOOP rules

Office visits

Primary care $0.00
Specialist $5.00
HSA Not eligible

Drug tiers

Generic $0.00
Preferred brand $15.00

View formulary tiers

$568 / mo before subsidies

≈ $6812 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.

$1881 / mo before subsidies

≈ $22570 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.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$2344 / mo before subsidies

≈ $28126 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.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$1383 / mo before subsidies

≈ $16598 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

30.00%

Durable Medical Equipment

30.00%

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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 Florida). 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.
  • 94% AV Level Silver 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

30.00%

Durable Medical Equipment

30.00%

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 21525FL0020010
Coverage year 2026
State Florida
Issuer Oscar Health Maintenance Organization of Florida
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 21525FL0020010-06
Available variants

Standard Off Exchange Plan · 21525FL0020010-00

Standard On Exchange Plan · 21525FL0020010-01

Open to Indians below 300% FPL · 21525FL0020010-02

Open to Indians above 300% FPL · 21525FL0020010-03

73% AV Silver Plan · 21525FL0020010-04

87% AV Silver Plan · 21525FL0020010-05

94% AV Silver Plan · 21525FL0020010-06
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 Florida 62864
PCPs in Florida 7636
Telehealth support Data pending
Nationwide providers 128355
62,864 doctors statewide 7,636 PCPs 297 OB/GYN

Provider network(s)

Providers Florida All US states
All 62864 128355
PCP 7636 8925
Allergy 31 33
OB/GYN 297 319
Dentists 17 19

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 2,227
NON-PREFERRED-BRAND 635
SPECIALTY-DRUGS 567
PREFERRED-GENERIC 281
ZERO-COST-SHARE-PREVENTIVE-DRUGS 212
NONPREFERRED-SPECIALTY-DRUGS 69
Prior authorization Drugs
Required 860
Not Required 3,131
Step therapy Drugs
Required 19
Not Required 3,972
Quantity limits Drugs
Has Limit 1,441
No Limit 2,550

Customer highlights

What stands out for members

  • Issuer: Oscar Health Maintenance Organization of Florida · Plan ID 21525FL0020010 · 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 21525FL0020010-06 (94% AV Silver Plan ) currently displayed.
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Benefits

Covered services & limitations

Everyday care

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

Chiropractic Care

$5.00
Tier 1 in-network $5.00
Out-of-network 100.00%

Limit: 35.0 Visit(s) per Benefit Period

Combined limit for all outpatient therapy plus chiropractic.

Diabetes Education

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

Home Health Care Services

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

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.

Laboratory Outpatient and Professional Services

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

Labs (HbA1c screening, urinalysis, metabolic panel, lipid panel) are covered in full.

Other Practitioner Office Visit (Nurse, Physician Assistant)

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

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

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

Virtual primary care services provided by Oscar-designated virtual care providers are covered in full. Virtual pediatric primary care services are not available through Oscar Medical Group; these services should be obtained in-person from in-network providers. Cost share applies to both in-person and telemedicine services.

Rehabilitative Occupational and Rehabilitative Physical Therapy

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

Limit: 35.0 Visit(s) per Benefit Period

Combined limit for all outpatient therapy plus chiropractic.

Rehabilitative Speech Therapy

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

Limit: 35.0 Visit(s) per Benefit Period

Combined limit for all outpatient therapy plus chiropractic.

Specialist Visit

$5.00
Tier 1 in-network $5.00
Out-of-network 100.00%

Qualified visits for cardiology, pulmonology, and endocrinology are covered in full. Diabetic eye exams and diabetic foot exams are covered in full. Cost share applies to both in-person and telemedicine services.

Urgent Care Centers or Facilities

$30.00
Tier 1 in-network $30.00
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

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

Delivery and All Inpatient Services for Maternity Care

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

Exclusions: Maternity services rendered to a covered person who is acting as a gestational surrogate are excluded.

Dialysis

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

Durable Medical Equipment

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

Oxygen is covered in full for members with COPD and other medical conditions that can be treated with long-term supportive oxygen therapy. Prior authorization for medical necessity may apply.

Emergency Room Services

30.00%
Tier 1 in-network 30.00%
Out-of-network 30.00%

Emergency Transportation/Ambulance

30.00%
Tier 1 in-network 30.00%
Out-of-network 30.00%

Hospice Services

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

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

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

Inpatient Physician and Surgical Services

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

Mental/Behavioral Health Inpatient Services

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

Exclusions: Exclusion of "inpatient (overnight) mental health services received in a residential treatment facility."

Mental/Behavioral Health Outpatient Services

$0.00
Tier 1 in-network $0.00
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.

Exclusions: Excludes services for psychological testing associated with the evaluation and diagnosis of learning disabilities or for mental retardation.

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

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

Outpatient Rehabilitation Services

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

Limit: 35.0 Visit(s) per Benefit Period

Cardiac and pulmonary rehab visits are covered in full. Combined limit for all outpatient therapy plus chiropractic.

Outpatient Surgery Physician/Surgical Services

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

Radiation

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

Skilled Nursing Facility

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

Limit: 60.0 Days per Benefit Period

Substance Abuse Disorder Inpatient Services

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

Exclusions: Exclusion of "expenses for prolonged care and treatment of Substance Dependency in a specialized inpatient or residential treatment facility"

Substance Abuse Disorder Outpatient Services

$0.00
Tier 1 in-network $0.00
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

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

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%

Routine Eye Exam for Children

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

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

$0.00
Tier 1 in-network $0.00
Tier 2 in-network $5.00
Out-of-network 100.00%

Common prescription generic statins, antiasthmatics, and bronchodilators (inhalers) are covered in full.

Non-Preferred Brand Drugs

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

Preferred Brand Drugs

$15.00
Tier 1 in-network $15.00
Out-of-network 100.00%

Specialty Drugs

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

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

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

30.00%
Tier 1 in-network 30.00%
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

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

Diabetes coverage includes "nutrition counseling"; home health services include "nutritional guidance"

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

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

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

$5.00
Tier 1 in-network $5.00
Out-of-network 100.00%

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

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

Habilitation Services

30.00%
Tier 1 in-network 30.00%
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)

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

Infertility Treatment

Coverage details pending

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

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

Coverage details pending

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

Reconstructive Surgery

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

Only for Breast reconstruction following a Mastectomy.

Routine Eye Exam (Adult)

Coverage details pending

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

Routine Foot Care

Coverage details pending

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

Treatment for Temporomandibular Joint Disorders

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

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

Variant attributes

Silver Simple Chronic Care CKM · Variant 21525FL0020010-06

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2026

CSR Variation Type

94% AV Level Silver Plan

HIOS Product ID

21525FL002

Metal Level

Silver

Plan ID (Standard Component ID with Variant)

21525FL0020010-06

Plan Marketing Name

Silver Simple Chronic Care CKM

Plan Variant Marketing Name

Silver Simple Chronic Care CKM CSR 150

Issuer & service area

Issuer-provided metadata for this variant.

Issuer Actuarial Value

94.36%

Issuer ID

21525

Issuer Marketplace Marketing Name

Oscar Health Maintenance Organization of Florida

Market Coverage

Individual

Multiple In Network Tiers

Yes

National Network

No

Network ID

FLN002

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

FLS006

State Code

FL

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

0.942684413

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

$1,500

SBC Scenario, Having a Baby, Copayment

$40

SBC Scenario, Having a Baby, Deductible

$0

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$500

SBC Scenario, Having Diabetes, Deductible

$0

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$800

SBC Scenario, Treatment of a Simple Fracture, Copayment

$10

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

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

30.00%

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

30.00%

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

$3000 per group

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

$1500 per person

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

$1,500

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

$3000 per group

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

$1500 per person

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

$1,500

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

FLF030

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

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

1

First Tier Utilization

44%

Import Date

10/28/2025

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

New

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

No

Plan Effective Date

1/1/2026

Plan Expiration Date

12/31/2026

Plan Type

HMO

QHP/Non QHP

Both

Second Tier Utilization

56%

Source Name

HIOS

Plan ID

21525FL0020010

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), 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), 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

Unique Plan Design

Yes

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 Florida?

Silver Simple Chronic Care CKM (21525FL0020010) is a Silver HMO from Oscar Health Maintenance Organization of Florida in Florida 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 Silver Simple Chronic Care CKM 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 Silver Simple Chronic Care CKM 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 Silver Simple Chronic Care CKM 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 Silver Simple Chronic Care CKM?

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

Is there out-of-country coverage for Silver Simple Chronic Care CKM?

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

Does Silver Simple Chronic Care CKM 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.
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