F Silver PPO 40-70 Non-Gated OHI CNT by Oxford
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Plan Information
- Plan Name
- F Silver PPO 40-70 Non-Gated OHI CNT
- Insurance Company
- Oxford
In Network Benefits
- Office Co-pay
- $40
- Specialist Co-pay
- $70
- Hospital Co-pay
- 30% after deductible
- Emergency Room
- $500
- Referrals Needed
- No
- Rx: Generic/Brand/High Brand
- $15(deductible waived)/$45/$75 after $100 deductible
- In-Network Co-Insurance
- 30%
- Max Out of Pocket (single/family)
- $6,850/$13,700
Out Of Network Benefits
- Deductible (single/family)
- $4,000/$8,000
- Co-Insurance
- 50%
- Out of Pocket Max (single/family)
- $10,000/$20,000
Other Benefits
- Vision/Dental
- Pediatric Vision and Dental
- Renewal Date
- Calendar/Annual
- HSA Eligible
- No
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