Oscar Health Insurance
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 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 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
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!
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 *
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.
OSCAR Tele Med
1 page flyer
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 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 *
Links & Videos to help you get the most from Oscar
Concierge – reinventing customer service with a personalized team of 3 care guides and a nurse – for every member.
- Oscar App Demo Video
- Doctor on Call Demo Video
- Concierge – We can help you get care VIDEO
- Making Health Care more human VIDEO
- How to find MD’s in Oscar App VIDEO
- Oscar Playlist 19 videos, about 15 seconds each VIDEO
- Modern Technology for Modern Care VIDEO
Every Oscar member gets a dedicated team of care guides and a nurse. See how it works.
You can use the Oscar Provider Finder without logging in.
Other links mentioned in our mini webinar:
- Oscar Change of Broker
- How to set up Oscar Account?
- Oscar Create an account
- Oscar Log In
2021 Rate Sheet - but it's easier to get a quote - see links above