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NY 2023 All UHC Oxford Plan Details SBC

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Platinum:

None Gated means you can visit any Specialist doctor without a referral.

5/15 ($5 Copay for PCP/family doctor visits, $15 Copay for specialist doctor visits)

PPO covers out-of-network doctors.

EPO does not cover out-of-network doctors.

The 3 Doctor network Oxford Health uses are Freedom, Liberty & Metro.

Platinum-NY FREEDOM None Gated 5/15 100 PPO 2023

Platinum-NY FREEDOM None Gated 20/40 100 EPO 2023

Platinum-NY P FREEDOM None Gated 5/15 100 EPO 2023

Platinum-NY P FREEDOM None Gated 20/40 100 PPO 2023

Platinum-NY P FREEDOM None Gated 20/40 100 PPO FAIR 2023

Platinum-NY P METRO Gated 15/25 100 EPO 2023

Platinum-NY P LIBERTY Gated 10/25 250 90 EPO LA 23 Contract

Platinum-NY P LIBERTY None Gated 5/35 500 100 EPO 23 Contract

Gold:

HNY Application

Gold-NY (HNY) Healthy New York G MTRO GT 25-40 1250 80 EPO 23 Contract

Gold-NY G LBTY NG 30-60 2000 70 EPO 23 Contract

Gold-NY G MTRO NG 25-40 1250 80 EPO ME 23 Contract

Gold-NY G FRDM NG 30-60 2250 70 EPO 23 Contract

Gold-NY G FRDM NG 25-50 100 EPO ZD 23 Contract

Gold-NY G LBTY NG 1500 90 EPO HSA 23 Contract

Gold-NY G LBTY NG 20-40 2000 80 EPO 23 Contract

Gold-NY G FRDM NG 1750 100 EPO HSA 23 Contract

Gold-NY G LBTY NG 25-50 100 EPO ZD 23 Contract

Gold-NY G LBTY GT 30-60 1250 100 EPO 23 Contract

Gold-NY G FRDM NG 15-35 1750 90 EPO 23 Contract

Gold-NY G FRDM NG 25-40 1750 80 EPO 23 Contract

Gold-NY G FRDM NG 25-40 1500 80 PPO 23 Contract

Gold-NY G FRDM NG 50-50 1000 90 EPO 23 Contract

Gold-NY G FRDM NG 1500_90 PPO HSA 23

Gold-NY G FRDM NG 1500 90 EPO HSA 23 Contract

 

Silver:

NY S LBTY NG 40-80 3250 60 EPO 23 Contract

NY S FRDM NG 40-80 3250 60 EPO 23 Contract

NY S LBTY NG 30-75 4000 50 EPO 23 Contract

NY S MTRO GT 30-80 3750 60 EPO 23 Contract

NY S FRDM NG 30-60 2250 70 PPO HSA 23 Contract

NY S LBTY GT 30-60 4500 50 EPO 23 Contract

NY S FRDM NG 40-80 3250 60 PPO 23 Contract

NY S MTRO NG 30-80 3750 60 EPO ME 23 Contract

NY S MTRO GT 35-50 4000 70 EPO HSA 23 Contract

NY S MTRO NG 50-100 100 EPO ZD 23 Contract

NY S LBTY NG 4000 80 EPO HSA 23 Contract

NY S LBTY NG 50-100 100 EPO ZD 23 Contract

NY S LBTY NG 25-45 5000 50 EPO 23 Contract

NY S LBTY NG 40-80 5000 60 EPO 23 Contract

NY S FRDM NG 50-100 100 EPO ZD 23 Contract

NY S FRDM NG 2500 60 EPO HSA 23 Contract

NY S MTRO GT 40-80 3250 60 EPO 23 Contract

NY S FRDM NG 30-60 3000 80 EPO HSA 23 Contract

Bronze:

Bronze-NY B FRDM NG 5000 50 EPO HSA 23 Contract

Bronze-NY B LBTY NG 7000 100 EPO HSA 23 Contract

Bronze-NY B MTRO GT 7000 100 EPO HSA 23 Contract

Bronze-NY B LBTY NG 25-75 5750 70 EPO HSA 23 Contract

Bronze-NY B LBTY NG 30-60 6750 80 PPO HSA 23 Contract

Bronze-NY B MTRO GT 40-75 6500 50 EPO HSA 23 Contract