Meet the Chronic Care Plan
What’s included in this plan?
This plan includes the following cost-saving features:- $0 pulmonologist, endocrinologist, and cardiologist visits
- $0 pulmonary and cardiac rehabilitation
- $0 PCP and behavioral health visits
- $0 oxygen, COPD, and cardiological drugs
- $0 Tier 1a preferred generic prescriptions on Exchange Plans
- $3 Tier 1a preferred generic prescriptions on Off-Exchange Plans
- $100 out-of-pocket monthly maximum on insulin
Stay on top of your health and get rewarded
- Up to $25 for reaching step goals in the Oscar app
- $25 for getting flu and pneumonia vaccines⁴
- $50 toward healthy groceries when you complete an annual wellness exam
- Access to gyms and on-demand fitness by the American Specialty Health Fitness’ Active&Fit program by completing any two routine services: hbA1c test, metabolic panel test, lipid test, UA (Urine Albumin) test, or diabetic eye exam.⁵
Frequently Asked Questions
- Where is this plan available?
This plan is available in AZ, FL, GA, OH, and TX. In Georgia, the plan is named ‘Silver Simple Multicondition.’
- Who is eligible for this plan?
The plan is eligible to all members in AZ, FL, GA, OH, and TX. Enrollment into the plan is not limited to members with cardiovascular disease, kidney disease, obesity, and type 2 diabetes. The lower cost shares for CKM related services are not conditioned on a member having a specific chronic condition.
- Is the plan designed for people with CKM?
Yes, this plan is especially designed to help members with cardiovascular-kidney-metabolic (CKM) syndrome save money and manage their condition.
- What benefits are included?
- The Silver Simple Chronic Care CKM plan includes the following plan benefits:
- $0 endocrinologist visits
- $0 pulmonologist visits
- $0 cardiologist visits
- $0 pulmonary and cardiac rehabilitation
- $0 PCP visits
- $0 behavioral health visits
- $0 oxygen
- $0 COPD and cardiological drugs
- $0 Tier 1a preferred generic Rx on Exchange Plans
- $3 Tier 1a preferred generic Rx on Off-Exchange Plans
- $100 out-of-pocket monthly maximum on insulin
- What rewards and incentives are included?
- Our Silver Simple Chronic Care CKM plan rewards you for treating yourself right. And, we’ll cheer you on along the way. Oscar Members are eligible for rewards upon completion of qualifying activities. Members enrolled in the Silver Simple Chronic Care CKM plan can earn:
- Up to $25 for reaching step goals in our app
- $25 for getting flu and pneumonia vaccines
- $50 toward healthy groceries when you complete an annual wellness exam
- Access to gyms and on-demand fitness by the American Specialty Health Fitness’ Active&Fit program by completing any two routine services: hbA1c test, metabolic panel test, lipid test, UA (Urine Albumin) test, or diabetic eye exam.
- How do I participate in the steps reward?
- Download the Oscar app for iOS or Android, open the app, and select the Steps icon in your quick links to start earning. The app automatically syncs with Apple Health or Google Fit. If you (or anyone else on your plan) are unable to participate in step tracking, call us at (855) 672-2755. We'll work with you to find a wellness program that you can be rewarded for, too.
- How will Oscar know if I completed the actions for the rewards and incentives?
Once you have reached your step goals, you will be sent a gift card up to $25.
Once you’ve completed your flu and pneumonia vaccines, the claim from your visit(s) will serve as verification of completion and you will be sent a $25 gift card.
Once you complete your annual wellness exam, the claim from your visit will serve as verification of completion and you will be sent a $50 debit card to spend towards healthy groceries, good at over 62,000 retailers.
Claims from any two of the following prescribed or ordered services will serve as verification of completion in order to qualify for subsidized access to the American Specialty Health Fitness’ Active&Fit program: HbA1c, metabolic, lipid, UA (Urine Albumin), or diabetic eye exam. You’ll enjoy access to gyms and on-demand health classes through the remainder of the plan year, as long as you stay on the same plan.
- Do my rewards expire?
Please refer to any applicable expiration details provided at the time you receive a reward.
- If I participate in earning rewards and incentives with this plan, am I excluded from earning other rewards and incentives offered with my Oscar plan?
- No, it does not exclude you from other rewards and incentives programs. Check our Perks page for additional rewards and incentives that may be available to you.
- I have not received my rewards yet, who should I contact?
- If you have not received your rewards, you can call your Care Team at (855) 672-2755.