Oscar Health Insurance was founded in 2013 and designed as a tech-savvy, consumer focused health insurance company. Oscar provides an alternative to traditional health insurance companies in New York, California, and Texas.
Every health insurance plan is required to provide essential benefits, as defined by the Affordable Care Act. These essential benefits fall into ten categories of services:
The specific services offered within those categories may vary from state to state, but these categories represent the minimum that all health insurance plans are required to cover. No matter where you purchase your health insurance plan from – federal, state, or private marketplace – it must cover these ten essential benefits.
Plans may choose to cover additional services. State, federal, and private exchanges will give you the full list of the exact services each plan covers before you apply.
All Oscar plans offer free primary care visits, free generic drugs, and free laboratory tests. Oscar also aims to simplify plans by presenting them to consumers in plain English. Oscar also has some of the best designed apps in the health insurance market, with easy to use doctor search tools and a free Doctor On Call service that helps you with common illnesses without ever leaving your house. Additionally, all Oscar members receive a free Misfit fitness tracker. You can earn up to a dollar per day by reaching your step goal.
Prescriptions & Drugs
Oscar covers generic and brand name drugs that are on their formulary (also known as a drug list). All generic drugs are free for Oscar plan members. You can see if Oscar covers a specific drug by using their search tool. You can also view the entire 2016 formulary by visiting their forms page (select your state in the top right).
PolicyGenius offers anonymous, no-obligation shopping of all marketplace health insurance plans, as well as “off-exchange” plans that you won’t find on Healthcare.gov or the state marketplaces. You can browse all plans, and sort and filter those plans based on your preferences and budget.
Once you’ve selected a health insurance plan, enrolling in that plan is easy. You fill out a short online form, then complete the final step with a quick enrollment phone call with a licensed agent. On that call, the licensed agent will verify your identity, double-check eligibility and answer any questions you may have. For certain insurers, who don’t permit private brokers (like PolicyGenius) to enroll customers, you’ll have to enroll directly with the insurer or on your state’s marketplace (these plans will be noted).
After you enroll in a health insurance plan, you will get your membership materials (including your member ID card) and the first premium bill directly from the health insurance company. You are responsible for paying the bill to ensure that your coverage goes into effect, and to keep current on those payments.
Your health services provider should make a claim directly to Oscar for you. However, if that doesn’t happen or you visited a non-Oscar affiliated provider, you may need to make a claim yourself. To do so, print out the appropriate claim form (listed on the Oscar form page; choose your state in the top right) and follow the instructions on the form.