Meet the Chronic Care Plan

Our special plan makes it easier to stay healthy with multiple chronic conditions.
Chronic care plan

Cardiovascular-kidney-metabolic (CKM) syndrome is a complex condition that includes cardiovascular disease, kidney disease, obesity and type 2 diabetes.¹ Oscar helps uncomplicate CKM care by providing a unique plan that supports multiple CKM-related services in a more affordable way. Oscar’s Silver Simple Chronic Care CKM Plan² can reduce the cost of services that treat CKM syndrome by at least 25%, including many cardio-metabolic conditions that fall within CKM syndrome.Where is this plan available?This plan is available in AZ, FL, GA, OH, and TX.
Plans

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

Healthy habits don’t go unnoticed around here. Oscar loves to celebrate your achievements and cheer you on along the way. Members enrolled in the Silver Simple Chronic Care CKM plan can earn:³
  • 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
You can also check our Perks page for additional rewards and incentives that may be available to you.
Chronic care plan

Frequently Asked Questions

    • This plan is available in AZ, FL, GA, OH, and TX.  In Georgia, the plan is named ‘Silver Simple Multicondition.’

    • 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.

    • Yes, this plan is especially designed to help members with cardiovascular-kidney-metabolic (CKM) syndrome save money and manage their condition.

    • 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
    • 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.
      You can also check our Perks page for additional rewards and incentives that may be available to you.
    • 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.
    • 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.

    • Please refer to any applicable expiration details provided at the time you receive a reward.

    • 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.
    • If you have not received your rewards, you can call your Care Team at (855) 672-2755.
Footnotes
¹Sources: Cleveland Clinic | What is CKM syndrome?Mass General Brigham | What is CKM Syndrome and Could You Have It?²This plan is available in AZ, FL, GA, OH, and TX. In Georgia, the plan is named 'Silver Simple Multicondition.’Source: 2024 Oscar internal analysis of average course of treatment for Diabetes, Pulmonary Related Conditions, CKM conditions. 25% savings is an average annual savings amount based on individual members who are on the base level Diabetes, Breathe Easy, Chronic Care CKM, or MultiCondition plans. Savings is an average for healthcare costs related to managing diabetes conditions, pulmonary related conditions, or multiple CKM conditions. Savings varies for members on Silver Cost Share reduction plans and Diabetes CSR150 plans. Note that treatment and costs for managing chronic conditions can vary widely and specific chronic condition plan names may vary by individual markets.Oscar Medical coverage is underwritten by Oscar Insurance Company located in New York, New York. Plans sold in New York are underwritten by Oscar Insurance Corporation located in New York, New York. Plans sold in Florida are underwritten by Oscar Insurance Company of Florida. Plans sold in New Jersey are underwritten by Oscar Garden State Insurance Corporation. Administrative Services for all plans provided by Oscar Management Corporation. Plans sold in Texas use policy and associated COC form numbers OSC-TX-IVL-HMO-EOC-2025-HIX OHIN-134128348; OSC-TX-IVL-HMO-EOC-2025 OHIN-134128297; GUIDED OSC-TX-IVL-HMO-GOLD-GUIDED-CARE-EOC-2025 OHIN-134128360; OSC-TX-IVL-EOC-2025 OHIN-134080911;OSC-TX-IVL-EOC-2025-HIX OHIN-134080906; OSC-TX-S-IVL-EOC-2025-HIX OHIN-134079760; OSC-TX-S-IVL-EOC-2025 OHIN-134079760. Plans sold in Virginia use policy and associated form numbers VA ON OSC-VA-IVL-EOC-2025-HIX OHIN-134065976; VA OFF OSC-VA-IVL-EOC-2025 OHIN-134065976.HMO products are offered by Oscar Insurance Corporation and Oscar Buckeye State Insurance Corporation in Ohio, Oscar Health Plan, Inc. in Arizona and Illinois, Oscar Health Plan of Pennsylvania, Inc in Pennsylvania, Oscar Health Plan of Georgia in Georgia, Oscar Health Plan of North Carolina, Inc. in North Carolina, Oscar Managed Care of South Florida, Inc. in Florida, Oscar Health Plan of New York, Inc. in New York, and Oscar Managed Care in Texas.All insurance policies and group benefit plans contain exclusions and limitations. For availability, costs, and complete details of coverage, contact a licensed agent or Oscar sales representative.³Benefits and rewards can vary by Plan, and certain restrictions apply.⁴Members must complete the flu vaccine and pneumonia vaccine in the same calendar year to earn the $25 reward.⁵The Active&Fit program is provided by American Specialty Health Fitness, Inc. a subsidiary of American Specialty Health Incorporated (ASH). Active&Fit is a federally registered trademark of ASH. Once Oscar receives the required eligible claims, 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.

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