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Oxford Freedom Platinum EPO

Oxford / United

Oxford Freedom Platinum EPO — Deductible: $0; Max Out of Pocket: $3,250 / $6,500; Copay: $20 / $40 / $50; Coinsurance: 0%; Emergency Room: $250 copay.

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Monthly premiums

Member: $1,886.77/mo
Member & Children: $3,186.66/mo
Member & Spouse: $3,735.14/mo
Member & Family: $5,287.34/mo

Plan details

Deductible (Individual): $0
Deductible (Family): $0
Out-of-Pocket Max (Individual): $3,250
Out-of-Pocket Max (Family): $6,500
Coinsurance (In-Network): 0%
Primary Care Copay: $20
Specialist Copay: $40
Urgent Care Copay: $50
ER Copay: $250

Benefits

Deductible
$0
No deductible
Max Out of Pocket
$3,250 / $6,500
OON: Not Covered
Copay
$20 / $40 / $50
PCP / Specialist / Urgent Care
Coinsurance
0%
No coinsurance
Emergency Room
$250 copay
In & out of network
Rx Coverage
$5 / $35 / $70
Generic / Preferred / Non-Preferred; $100 Rx ded (T2-T3)
Pregnancy
Covered
Mental Health
Covered
$20 outpatient; $400/adm inpatient
Hospital Admission
$400 copay
Per admission
Referrals
Not Required
Dependents
To Age 26
Coverage
Nationwide
Work Requirement
Work Required

Plan documents

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