Oxford Freedom Silver EPO (HSA)
Oxford / United
Oxford Freedom Silver EPO (HSA) — Deductible: $2,500 / $5,000; Max Out of Pocket: $8,000 / $16,000; Copay: $0 / $0; Coinsurance: 40% after deductible; Emergency Room: 50% after deductible.
Monthly premiums
- Member
- $1,354.74/mo
- Member & Children
- $2,280.58/mo
- Member & Spouse
- $2,665.61/mo
- Member & Family
- $3,768.05/mo
Plan details
- Deductible (Individual)
- $2,500
- Deductible (Family)
- $5,000
- Out-of-Pocket Max (Individual)
- $8,000
- Out-of-Pocket Max (Family)
- $16,000
- Coinsurance (In-Network)
- 40%
Benefits
Deductible
$2,500 / $5,000
OON: Not Covered
Max Out of Pocket
$8,000 / $16,000
OON: Not Covered
Copay
$0 / $0
PCP / Specialist — after ded & coinsurance
Coinsurance
40% after deductible
Emergency Room
50% after deductible
In & out of network
Rx Coverage
$10 / $40 / $80
Generic / Preferred / Non-Preferred; after plan ded
Pregnancy
Covered
Mental Health
Covered
40% after ded, in & outpatient
Hospital Admission
40% coinsurance
After deductible
Referrals
Not Required
Dependents
To Age 26
HSA Compatible
Yes
High-deductible design
Coverage
Nationwide
Work Requirement
Work Required
Plan documents
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