CommunityCare DPC Silver $0 PCP

CommunityCare · 2027 plan year

Silver
Ind. deductible
$2,500
Family deductible
$5,000
Ind. OOP max
$12,000
Family OOP max
$24,000

Compare with other Silver plans in OK

Side by side: deductibles, out-of-pocket limits and copays.

More CommunityCare plans in OK

Monthly premiums by age

Rating Area 4 — the lowest-priced of the 3 areas this plan covers. Premiums differ by area.

AgeIndividualIndividual + tobacco
Under 15$462$462
21$604$724
30$685$822
40$771$926
50$1,078$1,294
60$1,638$1,966
64 and over$1,811$2,173

Live premium estimate

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Benefits & cost sharing

Primary Care

BenefitIn-network
Preventive Care/Screening/ImmunizationNo charge
Primary Care Visit to Treat an Injury or IllnessNo charge

Specialist

BenefitIn-network
Specialist Visit$75.00

Hospital

BenefitIn-network
Emergency Room Services50.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)50.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services50.00% Coinsurance after deductible
Urgent Care Centers or Facilities$100.00

Pharmacy

BenefitIn-network
Generic Drugs$25.00
Non-Preferred Brand Drugs$100.00
Preferred Brand Drugs$75.00
Specialty Drugs50.00% Coinsurance after deductible

Mental Health

BenefitIn-network
Mental/Behavioral Health Inpatient Services50.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient ServicesNo charge

Other

BenefitIn-network
Chemotherapy50.00% Coinsurance after deductible
Chiropractic Care$75.00
Cosmetic SurgeryNot covered
Delivery and All Inpatient Services for Maternity Care50.00% Coinsurance after deductible
Dental Check-Up for ChildrenNot covered
Diabetes EducationNo charge
Dialysis50.00% Coinsurance after deductible
Durable Medical Equipment50.00%
Emergency Transportation/Ambulance$50.00 Copay after deductible
Eye Glasses for Children50.00% Coinsurance after deductible
Basic Dental Care - AdultNot covered
Abortion for Which Public Funding is ProhibitedNot covered
Basic Dental Care - ChildNot covered
Accidental Dental50.00% Coinsurance after deductible
AcupunctureNot covered
Allergy Testing50.00% Coinsurance after deductible
Bariatric SurgeryNot covered
Habilitation Services$50.00
Hearing Aids50.00%
Home Health Care Services50.00% Coinsurance after deductible
Hospice ServicesNo charge
Imaging (CT/PET Scans, MRIs)50.00% Coinsurance after deductible
Infertility TreatmentNot covered
Infusion Therapy50.00% Coinsurance after deductible
Inpatient Physician and Surgical Services50.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services50.00% Coinsurance after deductible
Long-Term/Custodial Nursing Home CareNot covered
Major Dental Care - AdultNot covered
Major Dental Care - ChildNot covered
Nutritional Counseling50.00% Coinsurance after deductible
Orthodontia - AdultNot covered
Orthodontia - ChildNot covered
Other Practitioner Office Visit (Nurse, Physician Assistant)No charge
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)50.00% Coinsurance after deductible
Outpatient Rehabilitation Services$50.00
Prenatal and Postnatal CareNo charge
Private-Duty Nursing50.00% Coinsurance after deductible
Prosthetic Devices50.00% Coinsurance after deductible
Radiation50.00% Coinsurance after deductible
Reconstructive Surgery50.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy$50.00
Rehabilitative Speech Therapy$50.00
Routine Dental Services (Adult)Not covered
Routine Eye Exam (Adult)No charge
Routine Eye Exam for ChildrenNo charge
Routine Foot CareNot covered
Skilled Nursing Facility50.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services50.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient ServicesNo charge
Transplant50.00% Coinsurance after deductible
Treatment for Temporomandibular Joint DisordersNot covered
Weight Loss ProgramsNot covered
Well Baby Visits and CareNo charge
X-rays and Diagnostic Imaging50.00% Coinsurance after deductible

Plan rules

Service area

This plan covers 9 geographic areas.

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