2017 Individual and Family Plans
Oscar expanded the availability of their health plans to San Francisco County, Region 4. They will maintain offering plans in Los Angeles and Orange counties, Regions 16 and18. They will offer on-exchange plans through Covered California and off-exchange plans as well.
Oscar Hospital Network
Los Angeles County
- Providence St. Joseph Medical Center
- Providence Holy Cross Medical Center
- Providence Little Company of Mary Medical Center -Torrance
- Providence Little Company of Mary Medical Center -San Pedro
- Providence Tarzana Medical Center
- Providence St. John’s Health Center
- Good Samaritan Hospital
- Huntington Memorial Hospital
- Henry Mayo Newhall Memorial Hospital
- UCLA Medical Center – Santa Monica
- UCLA Medical Center – Ronald Reagan
Orange County
- St. Joseph Hospital of Orange
- St. Jude Medical Center
- Hoag Memorial Hospital Presbyterian
- Mission Hospital Regional Medical Center – Main
- Mission Hospital Regional Medical Center – Laguna Beach
Bay Area
- O’Connor Hospital
- Saint Louise Regional Hospital
- Seton Medical Center
- Seton Coastside
- Sequoia Hospital
- UCSF Medical Center at Mission Bay
- UCSF Medical Center at Mount Zion
- UCSF Medical Center at Parnassus
- One Medical Center
Medical Groups
- UCLA Medical Center
- St. Joseph Hoag Health
- UCSF Hill Physicians Group
Oscar Doctor, Hospital, Drug Search
Oscar 2017 Plan Guide
Oscar Provider Network
Oscar Concierge Team
California Enrollment Form
Get A Quote for an Oscar Health Plan
Oscar health plans will be offered in part of Region 16 (southwest Los Angeles County) and all of Orange County (Region 18) in 2016. They will be offering plans through Covered California and off-exchange directly from Oscar. As of mid-November Oscar was still adding documents and consumer information for 2016 open enrollment. I’ll update this page as more material becomes available.
Exclusive Provider Organization
All of Oscar’s health plans are Exclusive Provider Organizations (EPO). The big difference between an EPO and a PPO (Preferred Provider Organization) is that there is no out-of-network coverage. All health plan covered benefits must be administered by in-network providers for the member to either receive cost sharing and have the expenses accrue to any deductible and annual maximum out-of-pocket amount. There is no out-of-network coverage.
California Regions Plan Map with plans by county
2016 Oscar Participating Hospital List
- Providence St. Joseph Medical Center
- Providence Holy Cross Medical Center
- Providence Little Company of Mary Medical Center – Torrance
- Providence Little Company of Mary Medical Center – San Pedro
- Providence Tarzana Medical Center
- Providence St. John’s Health Center
- Good Samaritan Hospital
- St. Joseph Hospital of Orange
- St. Jude Medical Center
- Hoag Memorial Hospital Presbyterian
- Mission Hospital Regional Medical Center – Main
- Mission Hospital Regional Medical Center – Laguna Beach
- Huntington Memorial Hospital
- Henry Mayo Newhall Memorial Hospital
- UCLA Medical Center – Santa Monica
- UCLA Medical Center – Ronald Reagan
Integrated mobile applications
Many health plans are offering virtual doctor visits by phone and mobile applications to keep track of health information. But instead of having third party administrators of these features Oscar has it built into their mobile platform. Feature such as –
- Doctor on Call
- Misfit Flash fitness tracker, earned points can turn into money
- Mobile device doctor search feature
- Online history and tracking of office visits, prescriptions, claims and payment
Standard Benefit Design Plans
Standard benefit design plans conform to the specified health plans for Covered California. They include the Minimum Coverage, Bronze 60, Silver 70, Gold 80 and Platinum 90 plans. They can be purchased either through Covered California with premium tax credit subsidy or directly from Oscar with no subsidy. One special note is that Gold and Platinum plans offer cost sharing more like an HMO. In other words, instead of the member’s responsibility for high cost services equaling a coinsurance percentage (such as 20% or 10%), Oscar has set copayments for many specific health care services. This should greatly reduce consumer surprises when they get the invoice from the hospital and physicians.
Off-Exchange Plans
Oscar offers a variety of different off-exchange plans that don’t conform to the standard benefit design, but still meet the actuarial values necessary for the respective metal tiers. There is a noticeable lack of cost sharing responsibilities such as coinsurance and copayments.
From the Oscar comparison plan guide:
Why aren’t there copays here?
With our Simple plans, you pay for covered services up to your deductible. After that, Oscar pays for everything.
No copays. No coinsurance.
Simple Series of Oscar plans
The Bronze Simple plan does have copays for labs and generic drugs. The Simple+ Silver, Gold and Platinum have copayments for specialist visits and urgent care. However, Tier 1 generic drugs are $0 cost all the Simple and Simple+ plans excluding the Bronze offering. Another interesting aspect of the Simple series of plans is that there is a $0 copay for primary care visits, OBGYN, and mental health visits for the Silver through Platinum plans.
- Get a quote for a California 2016 Oscar Health Plan
Evidence of Coverage
Oscar has two Evidence of Coverage (EOC) documents. One for On-Exchange or plan sold through Covered California that are Standard Benefit Design plan. This On-Exchange plans can also be purchased directly from Oscar. The other EOC are for their Non-Standard benefit design plans and are sold exclusive from Oscar.
Oscar EOC Non Stnd OffEx 2016 (1.0 MiB)
Oscar EOC On Exchng 2016 Standard (1.0 MiB)
Oscar Plan highlights
These are short one page marketing flyer that give the highlights of the plan benefits. There are three groups of Oscar plans-
- Standard benefit design plans sold through Covered California and directly from Oscar
- Non-standard Simple series of plans only offered through Oscar
- Non-standard Simple PLUS series of plans only offered through Oscar
Standard On and Off Exchange Plans
Bronze EPO Plan 2016 (60 KiB)
Gold EPO Plan 2016 (58 KiB)
Min Coverage EPO Plan 2016 (56 KiB)
Platinum EPO Plan 2016 (58 KiB)
Silver 70 EPO Plan 2016 (59 KiB)
Non-Standard Simple and Plus Series of Plans, Off-Exchange
Plus
Bronze Simple EPO Plan 2016 (57 KiB)
Gold Simple EPO Plan 2016 (57 KiB)
Platinum Simple EPO Plan 2016 (57 KiB)
Silver Simple EPO Plan 2016 (57 KiB)
Summary of Benefits and Coverage
Standard benefit design plans On and Off exchange
Gold EPO SBC 2016 (471 KiB)
Min Coverage SBC 2016 (477 KiB)
Platinum EPO SBC 2016 (470 KiB)
Silver 70 EPO SBC 2016 (475 KiB)
Silver 73 EPO SBC 2016 (476 KiB)
Silver 87 EPO SBC 2016 (476 KiB)
Silver 94 EPO SBC 2016 (475 KiB)
Non-standard plans Simple and Simple Plus series, Off-Exchange
- Plus
Bronze Simple EPO SBC 2016 (476 KiB)
Gold Simple EPO SBC 2016 (472 KiB)
Platinum Simple EPO SBC 2016 (472 KiB)
Silver Simple EPO SBC 2016 (472 KiB)
Oscar drug lists, hospitals, enrollment forms, plus
- EOC
- Plans_Covered_California
- Plans_Off_Exchange
- SBC_Covered_California
- SBC_Off_Exchange
18393a MaintenanceDrugList 10262015 (85 KiB)
Disabled Dependent Form CA (62 KiB)
Facility-claim-form (149 KiB)
HIPAA Authorization Form (112 KiB)
Member Rights And Responsibilites CA (66 KiB)
Misfit Overview (NY,NJ,TX,CA) (80 KiB)
Oscar Consumer Brochure (834 KiB)
Oscar Participating Hospital List (41 KiB)
Paper Enrollment Form 2016 Oscar (131 KiB)
Plan By Plan Comparison (185 KiB)
Provider-claim-form (1.2 MiB)
SEP 2016 OffEx Paper App (131 KiB)
Introductory video on Oscar through Covered California
