Surgery must be medically necessary. Not all procedures classified as weight reduction surgery are covered. Prior approval for weight reduction surgery is required.

Limit: 1.0 Item(s) per Benefit Period

Preferred generic drugs are covered in full.

Exclusions: Limitations and exclusions do apply.

Treatment for Autism with speech therapy, occupational therapy, or physical therapy is covered. Use of Applied Behavior Analysis for the treatment of Autism is not covered.

Care (generally in a home setting) for patients who are terminally ill and who have a life expectancy of six months or less. Hospice respite care has a quantity limit of 15 inpatient days and 15 outpatient days per lifetime. Hospice respite care must be used in increments of not more than five days at a time.

Intravenous administration of nutrients, antibiotics, and other drugs and fluids when provided in the home (home infusion therapy).

Labs (HbA1c screening, urinalysis, metabolic panel, lipid panel) to manage diabetes are covered in full.

Exclusions: Excludes: certain disorders related to early childhood, such as academic underachievement disorder, communication disorders, such as stuttering and stammering, ABA services.

Exclusions: Excludes: certain disorders related to early childhood, such as academic underachievement disorder, communication disorders, such as stuttering and stammering, ABA services.

The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.

Cost share applies to both in-person and telemedicine services.

Plan refers to home skilled nursing as private duty nursing. Home skilled nursing is intended to provide a safe transition from other levels of care when medically necessary, to provide teaching to caregivers for ongoing care, or to provide short-term treatments that can be safely administered in the home setting.

Limit: 1.0 Exam(s) per Benefit Period

Diabetic eye exams and diabetic foot exams are covered in full. Cost share applies to both in-person and telemedicine services.

Exclusions: Excludes treatment received in a residential treatment facility, except the acute level of care described in plan document.

Exclusions: Excludes treatment received in a residential treatment facility, except the acute level of care described in plan document.

The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.

Exclusions: Limitations and exclusions do apply.

Transplants are subject to Case Management.

Exclusions: Excludes: dental extractions, dental restorations, or orthodontic treatment for temporomandibular joint disorders

Virtual urgent care services provided by Oscar-designated virtual care providers are covered in full.

Covered for child through age 7.