Texas health plan · 2026

Silver Simple PCP Saver Guided Care · 20069TX0510125

Oscar Insurance Company offers this marketplace health insurance plan (Plan ID 20069TX0510125) 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 Insurance Company
Telehealth Data pending HSA eligible No Dental Not listed Vision Child
Pay / Manage Plan View issuer site

CMS AV Calculator output: 94.05% (5.95% 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

$449 – $1759

Before subsidies

Estimate after subsidies

Deductible

$0

$0 per group

See deductible details

Max out-of-pocket

$1,850

$3700 per group

Review MOOP rules

Office visits

Primary care $5.00
Specialist $10.00
HSA Not eligible

Drug tiers

Generic $0.00
Preferred brand $30.00

View formulary tiers

$615 / mo before subsidies

≈ $7374 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.

$1947 / mo before subsidies

≈ $23369 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.

$2358 / mo before subsidies

≈ $28301 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.

$1499 / mo before subsidies

≈ $17986 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

20.00%

Durable Medical Equipment

20.00%

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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 Texas). 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

20.00%

Durable Medical Equipment

20.00%

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 20069TX0510125
Coverage year 2026
State Texas
Issuer Oscar Insurance Company
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 20069TX0510125-06
Available variants

Standard Off Exchange Plan · 20069TX0510125-00

Standard On Exchange Plan · 20069TX0510125-01

Open to Indians below 300% FPL · 20069TX0510125-02

Open to Indians above 300% FPL · 20069TX0510125-03

73% AV Silver Plan · 20069TX0510125-04

87% AV Silver Plan · 20069TX0510125-05

94% AV Silver Plan · 20069TX0510125-06
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 Texas 57258
PCPs in Texas 6761
Telehealth support Data pending
Nationwide providers 62688
57,258 doctors statewide 6,761 PCPs 311 OB/GYN

Provider network(s)

Providers Texas All US states
All 57258 62688
PCP 6761 7532
Allergy 23 24
OB/GYN 311 344
Dentists 25 29

Drug coverage overview

3,948 drugs tracked

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

Tier Covered drugs
GENERIC 2,210
NON-PREFERRED-BRAND 594
SPECIALTY-DRUGS 581
PREFERRED-GENERIC 281
ZERO-COST-SHARE-PREVENTIVE-DRUGS 212
NONPREFERRED-SPECIALTY-DRUGS 70
Prior authorization Drugs
Required 857
Not Required 3,091
Step therapy Drugs
Required 17
Not Required 3,931
Quantity limits Drugs
Has Limit 1,406
No Limit 2,542

Customer highlights

What stands out for members

  • Issuer: Oscar Insurance Company · Plan ID 20069TX0510125 · 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 20069TX0510125-06 (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

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

Limit: 35.0 Visit(s) per Year

Limited to combined 35 visits per year, including Chiropractic.

Diabetes Education

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

Home Health Care Services

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Limit: 60.0 Visit(s) per Year

Exclusions: Benefits will not be provided for Home Health Care for Food or home delivered meals; Social case work or homemaker services; Services provided primarily for Custodial Care; Transportation services; Home Infusion Therapy; and Durable medical equipment.

Laboratory Outpatient and Professional Services

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Other Practitioner Office Visit (Nurse, Physician Assistant)

$5.00
Tier 1 in-network $5.00
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

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

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

Rehabilitative Occupational and Rehabilitative Physical Therapy

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Rehabilitative Speech Therapy

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Specialist Visit

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

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

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Delivery and All Inpatient Services for Maternity Care

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Will cover 48-hour hospital stay for uncomplicated vaginal delivery and 96-hour hospital stay for uncomplicated cesarean section.

Dialysis

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Durable Medical Equipment

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Exclusions: Durable medical equipment not provided for Home Health Care. Rental covered under medical/surgical. Excluded from pharmacy benefits, but permitted for diabetes and self-administered injections. Female contraception and breast pumps covered under medical/surgical benefits.

Emergency Room Services

20.00%
Tier 1 in-network 20.00%
Out-of-network 20.00%

Emergency Transportation/Ambulance

20.00%
Tier 1 in-network 20.00%
Out-of-network 20.00%

Hospice Services

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Preauthorization is required.

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

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

All usual Hospital services and supplies, including semiprivate room, intensive care, and coronary care units; Preauthorization is required.

Inpatient Physician and Surgical Services

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Mental/Behavioral Health Inpatient Services

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Preauthorization is required.

Mental/Behavioral Health Outpatient Services

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

Preauthorization is required. 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)

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Outpatient Rehabilitation Services

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Limit: 35.0 Visit(s) per Year

Limited to combined 35 visits per year, including Chiropractic.

Outpatient Surgery Physician/Surgical Services

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Radiation

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Skilled Nursing Facility

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Limit: 25.0 Visit(s) per Year

Substance Abuse Disorder Inpatient Services

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Preauthorization is required.

Substance Abuse Disorder Outpatient Services

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

Certain services require preauthorization.\nThe 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

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Preauthorization is required.

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

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

To restore or correction of impaired speech or hearing loss.

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%

Non-Preferred Brand Drugs

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

Preferred Brand Drugs

$30.00
Tier 1 in-network $30.00
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

20.00%
Tier 1 in-network 20.00%
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

20.00%
Tier 1 in-network 20.00%
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

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Medically necessary foot orthotics are not subject to a calendar year maximum.

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

$10.00
Tier 1 in-network $10.00
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

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Limit: 35.0 Visit(s) per Year

Habilitative and rehabilitative limits cannot be combined for plans issued or renewed on or after January 1, 2017. Habilitation services includes autism services, and the benchmark plan does not impose age or maximums on autism coverage

Imaging (CT/PET Scans, MRIs)

20.00%
Tier 1 in-network 20.00%
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

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Examples of covered services include: Treatment provided for reconstructive surgery following cancer surgery; Reconstruction of the breast on which mastectomy has been performed.

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

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Though state law only mandates coverage for temporomandibular joint (TMJ) disorders for large group plans and HMOs, the benchmark plan covers TMJ. Therefore, it is considered part of the EHB package for Texas.

Exclusions: Excludes any non-surgical (dental restorations, orthodontics, or physical therapy) or non-diagnostic services or supplies (oral appliances, oral splints, oral orthotics, devices, or prosthetics) provided for the treatment of the temporomandibular joint and all adjacent or related muscles and nerves.

Variant attributes

Silver Simple PCP Saver Guided Care · Variant 20069TX0510125-06

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2026

CSR Variation Type

94% AV Level Silver Plan

HIOS Product ID

20069TX051

Metal Level

Silver

Plan ID (Standard Component ID with Variant)

20069TX0510125-06

Plan Marketing Name

Silver Simple PCP Saver Guided Care

Plan Variant Marketing Name

Silver Simple PCP Saver Guided Care CSR 150

Issuer & service area

Issuer-provided metadata for this variant.

Issuer ID

20069

Issuer Marketplace Marketing Name

Oscar Insurance Company

Market Coverage

Individual

Multiple In Network Tiers

Yes

National Network

No

Network ID

TXN002

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

TXS009

State Code

TX

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

0.9405032783614772

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

$1,900

SBC Scenario, Having a Baby, Copayment

$0

SBC Scenario, Having a Baby, Deductible

$0

SBC Scenario, Having Diabetes, Coinsurance

$20

SBC Scenario, Having Diabetes, Copayment

$800

SBC Scenario, Having Diabetes, Deductible

$0

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$500

SBC Scenario, Treatment of a Simple Fracture, Copayment

$20

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

20.00%

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

20.00%

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

$3700 per group

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

$1850 per person

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

$1,850

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

$3700 per group

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

$1850 per person

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

$1,850

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

TXF001

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?

Yes

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

Specialist Requiring a Referral

All specialists except Behavioral Health, Obstetrics and Gynecology, Cancer specialists, Transplant specialists and hospital / facility-based specialities (e.g., pathology) require a referral.

Plan ID

20069TX0510125

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

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 Texas?

Silver Simple PCP Saver Guided Care (20069TX0510125) is a Silver HMO from Oscar Insurance Company in Texas 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 PCP Saver Guided Care 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 PCP Saver Guided Care 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 PCP Saver Guided Care 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 PCP Saver Guided Care?

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 PCP Saver Guided Care?

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

Does Silver Simple PCP Saver Guided Care 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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