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Oscar Health Insurance

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VIDEO Instructions on how to
ENROLL  ONLINE   direct,
Quotes & Enroll  Covered CA

Oscar’s Health Insurance focuses centers around the Internet and mobile applications. Another click and appointment options — a free doctor’s call or a visit to a primary care physician or specialist — are splashed on the screen with estimated costs. A consumer could expect to shell out a total of $200 in co-pays and typical prescriptions or tests for a visit to a specialist. Oscar offers an Exclusive Provider Organization plan, or EPO — a hybrid of the HMO and PPO models. Consumers, for example, receive no coverage out of network, but unlike an HMO they don’t need a primary care physician or a referral to see a specialist.   Providence Health & Services,  UCLA Health, St Joseph, HOAG, Huntington Memorial and USC Keck have signed on to Oscar’s network, giving it 19 hospitals and 11,000 MD’s in Los Angeles.  Orange County has 9 hospitals and 5,000 providers.

All plans are EPOs with Doctor on Call, Concierge, and Step Rewards for staying active. Even better, Oscar never requires referrals to see a specialist. This means you don’t need to book an appointment with a primary care provider just to get a permission slip, saving you time and money.

Classic plans

Classic plans have higher monthly premiums and lower annual deductibles than Simple plans. Most plans provide pre-deductible copays for routine care and drugs. All plans have either coinsurance or affordable copays after you hit your deductible.

Saver plans
(Non Standard)

Saver plans are low premium, high deductible plans. In California, these are plans that work alongside a Health Savings Account (HSA). With HSA compatible Saver plans, you pay the full negotiated rate for care out of your HSA until your reach your deductible. After that, Oscar pays 100% for any covered care.

Oscar’s Simple Plans
(Non Standard)

offer something different, they combine the deductible and Out of Pocket Maximum as one number.  The kicker, you still get pre-deductible benefits.  For example, you have a $4,500 deductible and MOOP on the Gold Simple plan, however you can go to the doctor, get your labs and x-rays all at a flat co-pay prior to meeting your deductible.  Simple!

Jump to:

Oscar 2021 Individual Brochure

Steve's VIDEO Introduction to this webpage and the Oscar Brochure

oscar 2021 individual brochure

No #Rando 's

Oscar Billboard

Oscar Billboard

Get OSCAR Quotes & Enroll ONLINE

Appoint us as your Oscar Broker - No extra charge - 17 reasons why it's a good idea

Enroll and get quotes with Oscar - No extra charge for broker support

VIDEO Instructions on how to
ENROLL  ONLINE   direct,
Quotes & Enroll  Covered CA

Ask us a Question? FAQ's?
Appoint us as your Covered CA Broker - No Extra Charge

Pharmacy Rx Benefits 

Oscar Explanation of Coverage for #Rx

Holistic alternative for erectile dysfunction to Viagra?

See our FAQ section for more details on how Rx Coverage works.

#EPO vs HMO vs PPO?

EPO

All plans are EPOs Exclusive Provider Organization  with Doctor on Call, Concierge, and Step Rewards for staying active. Even better, Oscar never requires referrals to see a specialist. This means you don’t need to book an appointment with a primary care provider just to get a permission slip, saving you time and money.   See Page 5 of EOC Evidence of Coverage for more details. 

 

 

Choice of Physicians and Providers

This is an Exclusive Provider Organization (“EPO”) plan.

Services must be performed or supplies furnished by an In-Network Provider in order for benefits to be payable. Typically, there are no Benefits provided when using an Out-of-Network Provider and You may be responsible for the total amount billed by an Out-of-Network Provider. The only exceptions are:

● Services received by an Out-of-Network Provider as a result of a medical Emergency, Urgent Care Visit, or an Authorized Referral as defined in the
DEFINITIONS section; and
● Covered Services received at an In-Network Facility, at which, or as a result of which, the Member receives Covered Services from and Out-of-Network Provider. Authorized Referrals and Covered Services received under the second exception are provided at In-Network Cost Sharing.

To maximize Your benefits, be sure to confirm that the Provider (e.g. a Physician or Hospital) You wish to see is an In-Network Hospital or an In-Network Provider (for Providers other than Hospitals) under Your Plan. Services must be performed or supplies furnished by an In-Network Provider in order for benefits to be payable, unless one of the exceptions listed above apply.  2020 EOC *

 

Health Net Definitions of HMO, PPO, EPO, etc. 

Blue Cross Definition EPO

OSCAR #TeleMed

This is our “Main Page” on Telemed.  Not just Oscar but Telemed for ALL companies, in general.

 

Oscar covers Medically Necessary Covered Services offered through Telehealth by an In Network Provider subject to the terms and conditions of the their contracts with In Network Providers.   Telehealth Visits from certain Oscar-designated Telehealth Providers are covered in full.

Telehealth Visits can be requested through Oscar’s website, mobile application, and their  customer service line  1-855-672-2755.

hioscar.com/doctor-on-call 

hioscar.com/need-medical-advice-call-a-doctor-instead-of-your-mom

EOC – Evidence of Coverage.

Tele Med VIDEO Oscar

OSCAR Tele Med 
1 page flyer

My CPA’s thoughts & research on Telehealth 

Further clarification from Oscar:

  • Our Doctor on Call benefit is on all Oscar plans and include Oscar physicians that are board certified in your state.
  • These physicians are not specialists, they generally are listed as Internal Medicine, Primary Care, etc.
  • These doctors are not found on our website because there is no way to visit/select which doctor you speak to.
  • The physicians often service multiple states, as they are generally certified in multiple.
  • Personally, when I used the Doctor on Call benefit (at 11 pm) the doctor called me within 10 minutes.
  • If I called again today I would likely be speaking to a different physician.
  • I checked with Oscar circa 4.4.2019 and their Tel Med is just for an initial visit.  Check our Coronavirus page for updates on that.
  • doctor on demand.com

AB 744 – TeleHealth 

AB 744 will require contracts issued, amended or renewed after January 1, 2021 between a health care service plan and a health care provider to specify that the provider who delivers services appropriately through telehealth be reimbursed on the same basis and to the same extent that the plan would have had the same service been provided in-person.  The health plan cannot require the use of telehealth if the health care provider has determined that it is not appropriate nor does it limit the ability of the health plan and provider to negotiate the rate of reimbursement for a service. TeleHealth Resources.org *

Oscar #Member Portal Login

oscar member login


Links & Videos to help you get the most from Oscar

you tube videos

Concierge – reinventing customer service with a personalized team of 3 care guides and a nurse – for every member.

Every Oscar member gets a dedicated team of care guides and a nurse. See how it works.

Source – Oscar Broker Portal 

Our VIDEO  explaining all the webpages below.

You can use the Oscar Provider Finder without logging in.

Oscar Video Instructions to use provider finder

Other links mentioned in our mini webinar:

Steve Shorr
Website Video #Introduction

Steve Shorr video website introduction

Our webpages on our qualifications, reviews, testimonials, etc.

Contact Us & License Info

Our Webpage on Insurance Coverage for

COVID 19 

Visit our webpage on COVID 19

Matrix Metal Level Plans

Oscar Metal Level Plans

#Why Oscar?

Oscar forms & notices

OSCAR 

Forms, Evidence of Coverage, Grievances & Summary of benefits

2021 Rate Sheet - but it's easier to get a quote - see links above

OSCAR Rx & Doctor #Provider Finder 

Our main page on Oscar 

Oscar Pharmacy - Drug Finder

 

Oscar Network Options
Circle & Select
Los Angeles  *  San Francisco 

Oscar Network Options

Our web pages on UCLA & Cedars

 

Oscar Network Search Instructions

You Tube how to find MD

oscar find a doctor video

Child Pages

44 comments on “Oscar Health Insurance”

  1. 6 comments on “Pharmacy, Doctor & Provider Finder”

    Reply

  3. Hi Steve,

    Does Oscar cover anything while I’m in Portugal? Please let me know as I moved here in January and don’t think I’ll be going anywhere else anytime soon.

    I may need to cancel Oscar and sign up for a local plan here.

    Reply

        • Just got this bulletin

          COVID-19 has disrupted all of our lives in many different ways. We understand that even people who do not have symptoms may be experiencing mental and emotional hardship.

          Here’s how we’re helping Oscar members cope with the stress and emotional impact of the pandemic:

          1. Virtual mental health visits – We partner with Doctor on Demand https://www.doctorondemand.com/ to provide virtual therapy and online appointment scheduling. Your Oscar clients can sign up for an account here by using their Oscar ID number and selecting “Oscar” as the Health Plan option in the drop-down menu. Please note that Doctor on Demand is only for in-network Mental Health services, not Medical Services.

          2. Robust mental health network – We partner with Optum for mental and behavioral health benefits. Your Oscar clients can visit hioscar.com/member/benefits/mental-health to find an in-network mental health provider and more details on their mental health benefits.

          3. Emotional support helpline: 1-866-342-6892 – Optum offers a toll-free emotional support helpline that’s free of charge and open 24/7. It’s also available to anyone, so both you and your clients can use it and even share with family and friends.

          4. Sleep and stress reduction tools – We’ve teamed up with Calm to offer all Oscar members 40% off an annual subscription. Calm provides guided meditations and sleep stories to help manage anxiety, lower stress, and improve sleep. Your clients can claim this offer at hioscar.com/member/benefits/perks.

          We’ve created a dedicated webpage at hioscar.com/covid19/mental-health-resources that contains full details about all the mental health resources Oscar members have access to. Feel free to share this URL with your clients or learn more below.

          Reply

    • Here’s the evidence of coverage for the Oscar EPO Exclusive Provider Plans.

      Page 4

      Choice of Physicians and Providers

      This is an Exclusive Provider Organization (“EPO”) plan.

      Services must be performed or supplies furnished by an In-Network Provider (Search) in order for benefits to be payable. Typically, there are no Benefits provided when using an Out-of-Network Provider and You may be responsible for the total amount billed by an Out-of-Network Provider. The only exceptions are:

      [you can use] ● Services received by an Out-of-Network Provider as a result of a medical Emergency , Urgent Care Visit, or an Authorized Referral as defined in the DEFINITIONS section; and …

      Yes, I know these terms are confusing. Agents are not allowed to interpret or modify contracts… That’s why I have links to the actual policy. See that, it’s mandated to be written in plain English. Here’s my webpage on reading statutes, laws, Insurance Contracts, etc.

      Reply

      • What exactly do they cover for emergency?

        I think I’m best off looking into a global health plan, or something just in lisbon for now since no one is moving anytime soon.

        Reply

        • Emergency Services means, with respect to an Emergency Medical Condition or a
          Psychiatric Emergency Medical Condition:

          ● A medical screening, examination, and evaluation by a Physician and surgeon, or by other appropriate licensed persons under the supervision of a Physician and surgeon, to determine if an Emergency Medical Condition or Active Labor exists and, if it does, the care, treatment, and surgery, if within the scope of that person’s license, necessary to relieve or eliminate the Emergency Medical Condition, within the capability of the Facility.

          ● An additional screening, examination, and evaluation by a Physician, or other personnel to the extent permitted by applicable law and within the scope of their licensure and clinical privileges, to determine if a Psychiatric Emergency Medical Condition exists, and the care and treatment necessary to relieve or eliminate the Psychiatric Emergency Medical Condition, within the capability of the Facility.

          ● The care and treatment to relieve or eliminate a Psychiatric Emergency Medical Condition may include admission or transfer to a psychiatric unit within a general acute care Hospital, or to an acute psychiatric Hospital.

          Emergency Services and Care will not be covered if You did not require emergency services and care and You reasonably should have known that an emergency did not exist. EOC Page 16

          Note also, the State of CA mandate for Corona Virus testing at no deductible or co-pay.

          Many Insurance Companies will pay 100% of COVID 19 costs, even if you have Bronze Plan! I’m not sure if Oscar has joined them. Check here https://www.hioscar.com/covid19

          Reply

  4. 1 I am looking at Oscar EPO and L.A. Care 60 HMO plans.

    2 Oscar plan just says 40% after deductible.

    3 The visit fee is not given.

    4 Do you know the fee that is charged up to the 6000 deductible.

    5 Monthly cost is 90.42 per month.

    6 L.A. Care has $75 office visit for 1st 3 visits.

    7 No mention of how much after that.

    8 Been noticing fees are increasing (big surprise).

    9 I need the best plan available.

    10 Not sure of what my income will be next year.

    Reply

  7. Please send over:

    1. tele-med (sp?) info (I’m open to more shrinkage solutions, maybe I’ll use it, esp if the price is right!)

    2. Link so I can look up doctors and which plans they are officially part of.

    3. And my lingering question: I see from my taxes Form 8962 I’m paying back subsidies from last year.

    Can you help me get my brain around the math for what’s happening with each month/doctor visit appointment that passes while I’m still on the Blue Shied Silver 94 subsidized plan?

    4. When I decide on a plan, what happens next, do I go to that quotit link and Add to Cart and pay directly, or…?

    Reply

  8. Hi, Steve.
    Thanks, I’m all set with Oscar. I received a welcome letter and found instructions on making a web payment for my EPO 87 plan for Jan 1, 2018.

    I also set up the auto-pay recurring payments as well.

    Thanks for your help with the ACA insurance stuff here. Bye bye to Blue Shield of Calif. Their rates for the same PPO enhanced silver insurance were ridiculous.

    Oscar is a newer, startup company, so the competition for business is exactly what President Obama and Congress intended when they set up the ACA, among many other patient protections for those of us with pre-existing conditions.

    Thank you again,

    Reply

    • Covered CA right on their website – provider finder tells you that Oscar’s is better.

      The Covered California provider directory can help you select a health plan. The directory is updated monthly and may not be a current or complete list of the health plan’s providers.

      The health plan you select will have the most current provider directory. You may not have coverage or may have higher costs if you visit a provider who is not in your plan’s network. To avoid this, you must verify with your health plan if the provider is in-network before you seek care.

      Reply

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