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Oxford Liberty Gold EPO

Oxford / United

Oxford Liberty Gold EPO — Deductible: $1,800 / $3,600; Max Out of Pocket: $8,000 / $16,000; Copay: $30 / $60 / $75; Coinsurance: 30% after deductible; Emergency Room: $500 copay.

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Monthly premiums

Member: $1,519.29/mo
Member & Children: $2,561.40/mo
Member & Spouse: $3,000.18/mo
Member & Family: $4,235.35/mo

Plan details

Deductible (Individual): $1,800
Deductible (Family): $3,600
Out-of-Pocket Max (Individual): $8,000
Out-of-Pocket Max (Family): $16,000
Coinsurance (In-Network): 30%
Primary Care Copay: $30
Specialist Copay: $60
Urgent Care Copay: $75
ER Copay: $500

Benefits

Deductible
$1,800 / $3,600
OON: Not Covered
Max Out of Pocket
$8,000 / $16,000
OON: Not Covered
Copay
$30 / $60 / $75
PCP / Specialist / Urgent Care
Coinsurance
30% after deductible
Emergency Room
$500 copay
In & out of network
Rx Coverage
$10 / $50 / $90
Generic / Preferred / Non-Preferred; $200 Rx ded (T2-T3)
Pregnancy
Covered
Mental Health
Covered
$30 outpatient; 30% inpatient
Hospital Admission
30% coinsurance
After deductible
Referrals
Not Required
Dependents
To Age 26
Coverage
Nationwide
Work Requirement
Work Required

Plan documents

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