Oxford Metro Silver EPO
Oxford / United
Oxford Metro Silver EPO — Deductible: $3,750 / $7,500; Max Out of Pocket: $9,450 / $18,900; Copay: $30 / $80 / $80; Coinsurance: 40%; Emergency Room: 50% after deductible.
Monthly premiums
- Member
- $1,277.96/mo
- Member & Children
- $2,155.52/mo
- Member & Spouse
- $2,523.00/mo
- Member & Family
- $3,554.14/mo
Plan details
- Deductible (Individual)
- $3,750
- Deductible (Family)
- $7,500
- Out-of-Pocket Max (Individual)
- $9,450
- Out-of-Pocket Max (Family)
- $18,900
- Coinsurance (In-Network)
- 40%
- Primary Care Copay
- $30
- Specialist Copay
- $80
- Urgent Care Copay
- $80
Benefits
Deductible
$3,750 / $7,500
OON: Not Covered
Max Out of Pocket
$9,450 / $18,900
OON: Not Covered
Copay
$30 / $80 / $80
PCP / Specialist / Urgent Care
Coinsurance
40%
Emergency Room
50% after deductible
In & out of network
Rx Coverage
$10 / $65 / $95
Generic / Preferred / Non-Preferred; $200 Rx ded (T2-T3)
Pregnancy
Covered
Mental Health
Covered
$30 outpatient; 40% inpatient
Hospital Admission
40% coinsurance
After deductible
Referrals
Not Required
Dependents
To Age 26
Coverage
NY / NJ / CT
Metro network is tri-state only — must live in the area
Work Requirement
Work Required
Plan documents
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