Oscar Introduces Small Group Plans To California

Oscar offers small group employer plans for employees who live or work in Los Angeles or Orange counties.

Oscar now has small group plans available for employers in Los Angeles and Orange counties. The 2018 small group Oscar plans builds from their network and plan administration of health insurance for individuals and families which launched in California in 2015. The Oscar small group plans will have a very similar look as their individual family plans with similar network and features.

Oscar Small Group EPO Plans For Los Angeles & Orange Counties

The Oscar EPO network does not require a referral to see a primary care physician or specialist. But there is no coverage for any out-of-network providers like you might find with a PPO plan. Similar to their individual and family plans, the employer group plans will have a member concierge team and included Doctor on Call for telephone consultations. All plans include pediatric dental benefits and there is an optional infertility rider.

Standard And Classic Health Plans Offered

The health plan line-up includes the standard small group benefit design metal tier plans and a mix of what Oscar calls “Classic” and “Saver” benefit designs. The Classic and Saver benefit designs will have lower premiums because the members have a higher maximum out-of-pocket amount or a coinsurance percentage. For example, the standard Silver 70 EPO plan has a $7,000 maximum out-of-pocket amount and 20% coinsurance after the $2,000 deductible is met. Some of the Classic Silver plans can have a $7,350 maximum out-of-pocket amount and either 30% or 50% coinsurance. However, the Classic Silver plans will have some copayments for specific health care services or prescription drugs that are lower than the standard Silver 70 plan design.

Employers can offer up to three Oscar small group health plans to their employees. The employer must make at a 50% or $100 contribution to the employee’s premium. The employer does not have to make a contribution towards the premium for the employee’s spouse or dependents. If the employer replaces an existing small group plan, Oscar will credit prior calendar year deductible if valid Evidence of Billing statements from the prior carrier are provided within 60 days of the group implementation.

The Oscar EPO hospital network includes

Los Angeles County

• Foothill Presbyterian Hospital
• Inter-Community Hospital
• Queen of the Valley Hospital
• Keck Hospital of USC
• USC Norris Comprehensive Cancer Center and Hospital
• USC Verdugo Hills Hospital
• Children’s Hospital Los Angeles
• Good Samaritan Hospital
• Henry Mayo Newhall Hospital
• Huntington Memorial Hospital
• Providence Holy Cross Medical Center
• Providence Little Company of Mary Medical Center – San Pedro
• Providence Little Company of Mary Medical Center – Torrance
• Providence Saint John’s Health Center
• Providence Saint Joseph Medical Center
• Providence Tarzana Medical Center
• UCLA Medical Center – Ronald Reagan
• UCLA Medical Center – Santa Monica Angeles

Orange County

• Hoag Memorial Hospital Presbyterian – Irvine
• Hoag Memorial Hospital Presbyterian – Newport Beach
• Mission Hospital Regional Medical Center – Laguna Beach
• Mission Hospital Regional Medical Center – Main
• St. Joseph Hospital of Orange
• St. Jude Medical Center

Plus San Antonio Regional Hospital in San Bernardino

Oscar Small Group Eligibility

To be eligible for the Oscar small group plans the employer must have 1 to 100 full-time equivalent employees with 51% of those employees in California. At least one W-2 employee who is not an owner or spouse of an owner. The group must have been in existence for at least 4 weeks.  Eligible employees must live or work in Oscar’s small group service areas of Los Angeles or Orange counties. Other conditions apply, please see the underwriting guidelines below or contact me, Kevin Knauss, at 916-521-7216.

Oscar Small Group Documents, Applications, Rates