Oscar, a new health plan carrier to California, is slowly trickling out information on their individual and family plans for 2016. All of Oscars plans will be EPOs offered in parts of southwest Los Angeles County and all of Orange County.
They will be offering the standard benefit design health plans that can be purchased through Covered California with tax credits or directly from Oscar with no subsidies. Oscar will also offer seven off-exchange health plans that don’t follow the standard benefit design but meet the actuarial value for the metal tier they represent.
These off-exchange plans are grouped as either Simple or Simple +. In general, they are closer to a Health Savings Account where the members shoulder all the costs until the deductible is met. However, once the deductible is met with the Oscar Simple plan series, the member pays nothing for most covered health services.
Bronze Simple: $6,850 deductible is also the out-of-pocket maximum. Generic drugs and Quest Labs are each a $20 copayment. Two primary care visits are included at $20, then the full negotiated price is paid by the member after that.
Silver Simple: $5,900 deductible is also the out-of-pocket maximum.
Gold Simple: $3,000 deductible is also the out-of-pocket maximum.
Platinum Simple: $1,000 deductible is also the out-of-pocket maximum.
The Simple + Silver, Gold and Platinum have the same deductible and maximum out-of-pocket as the Simple plans, but they have $50 copayments for specialist visits, urgent care and preferred Brand Drugs. All generic drugs are $0 copay.
Oscar In-network Hospitals
2016 Participating Hospital List
- Providence St. Joseph Medical Center
- Providence Holy Cross Medical Center
- Providence Little Company of Mary Medical Center – Torrance
- Providence Little Company of Mary Medical Center – San Pedro
- Providence Tarzana Medical Center
- Providence St. John’s Health Center
- Good Samaritan Hospital
- St. Joseph Hospital of Orange
- St. Jude Medical Center
- Hoag Memorial Hospital Presbyterian
- Mission Hospital Regional Medical Center – Main
- Mission Hospital Regional Medical Center – Laguna Beach
- Huntington Memorial Hospital
- Henry Mayo Newhall Memorial Hospital
- UCLA Medical Center – Santa Monica
- UCLA Medical Center – Ronald Reagan
For more information on some of the plans and other Oscar documents as they are released visit Oscar California Health Plans