Diabetes care you can count on

Frequently Asked Questions

• Where is this plan available?

  • This plan is available in FL, GA , IA, IL, KS, MO, NC, NE, OH-Cleveland, OK, TN, and TX. In TX, it’s called “Silver Simple Diabetes Guided Care.”

• Who is eligible for this plan?

  • This plan is available in FL, GA , IA, IL, KS, MO, NC, NE, OH-Cleveland, OK, TN, and TX. In TX, it’s called “Silver Simple Diabetes Guided Care.” Enrollment into the plan is not limited to diabetic members and the lower cost shares for non-diabetic related services and supplies (labs, PCP visits, Tier 1a drugs) are not restricted based on a member having a specific chronic condition.

• Is the plan designed for people with type 1 and type 2 diabetes?

  • Yes, this plan can help save money and manage the condition for people living with type 1 or type 2 diabetes. If you have pre-diabetes or gestational diabetes, this plan may offer reduced costs, but you will not be eligible to engage in the rewards and incentives program offerings for diabetic members.

• What benefits are included with the plan?
  • • $0 Labs (HbA1c screening, urinalysis, metabolic panel, lipid panel)
    • $0 Diabetic eye and foot exams
    • $0 Tier 1a drugs
    • $0 Primary care provider (PCP) visits
    • $0 Behavioral health visits
    • $100 Out-of-pocket monthly maximum on insulin
• What insulin brands and durable medical equipment (DME) manufacturers are included or covered in the plan?

  • Accu-Chek is Oscar's preferred brand for diabetic testing supplies (meters, test strips, lancets). Preferred insulins are Basaglar, Tresiba, Levemir, Humulin U-500, Fiap, and Novolin/Novolog products.

• Which glucose monitors are included?
  • Dexcom G6 and G7 are Oscar’s preferred continuous glucose monitors (CGM) and are also available to members through prior authorization. See here for Oscar's medical necessity criteria for CGMs. The devices are enabled by Bluetooth® and easily connect to the mySugr app.
• How do I get my diabetic testing supplies?

  • Use the pharmacy benefits built into the plan to request refills of diabetic testing supplies (meters, test strips, lancets) or insulin.

• What rewards and incentives are included?
  • Healthy habits don’t go unnoticed. With Oscar, members are eligible for rewards upon completion of qualifying activities. Members with type 1 and type 2 diabetes enrolled in the Silver Simple Diabetes plan can earn:

    • Up to $25 for reaching step goals in our app
    • $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.

    Members who are not currently living with diabetes, are pre-diabetic, or live with gestational diabetes are not eligible for these rewards and incentives. You can also check our Perks page for additional rewards and incentives that may be available to you.
• 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 (you’ll need to create an account if you don’t already have one). 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 for you.
• 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 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 take part in this Rewards and Incentives program, does it exclude me from any others 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.
• What is the difference between the Silver Simple Diabetes plan and WellDia?

  • The Silver Simple Diabetes plan is a medical plan option offered through Oscar that includes primary care, specialist care, $0 services, and more that are focused on supporting members living with type 1 or type 2 diabetes. This plan may also be a good fit for those with pre-diabetes or gestational diabetes.

    Members use the pharmacy benefits built into the plan to request refills of diabetic testing supplies (meters, test strips, lancets) or insulin.

    WellDia is Oscar’s diabetes management program, helping members manage their type 1 or type 2 diabetes and stay on top of regular blood glucose testing. WellDia members receive $0 test strips, lancets, and a new glucometer. WellDia is offered at no cost to you. You must be enrolled in an Oscar medical plan and have type 1 or type 2 diabetes to be eligible for WellDia.

• Can I enroll in the Silver Simple Diabetes plan and WellDia?

  • Yes, you can enroll in the Silver Simple Diabetes plan and WellDia. You must be enrolled in an Oscar medical plan and have type 1 or type 2 diabetes to enroll in WellDia.