- Types of Plans Offered
- Member Resources
- Unique Features
- Customer Service
Types of Plans Offered
Oscar takes both on- and off-exchange individual plans in all states in which it operates, plus small business plans in New York, New Jersey, and Tenessee. Oscar offers several different plan types: EPOs, HSA-compatible plans, and self-funded options. Oscar does not currently serve Medicaid or Medicare customers.
The perks of EPO plans are that you do not need a referral to see a specialist, and you can use any doctor or hospital within the EPO network. However, EPOs (similar to HMOs) have no benefits for out-of-network facilities, except in emergencies.
There are four kinds of Oscar Plans: Classic plans, Simple plans, Saver plans, and Backup plans. All Oscar Plans have free Doctor on Call telemedicine services, rewards for steps tracking, an Oscar Concierge team, and pre-deductible preventive care benefits.
Oscar Classic plans match the general plan structures of most of the plans you see in the individual insurance market.
Oscar Simple plans are easier to understand because you only have one dollar amount to remember because all covered services are free after you hit your deductible. This is because the deductible is set at the same level as the maximum out of pocket amount. (Note: Care that happens pre-deductible requires a copay, coinsurance, or full payment by consumers.)
Oscar Saver plans are HSA-compatible plans with a low monthly premium and higher dedictible. Members use funds out of their HSA to pay for health care throughout the year.
Oscar Backup plans are a low premium, high deductible option designed for healthier people who was to save on upfront medical costs.
Oscar does not include dental or vision insurance in their plans, except for children under the age of 18.
Members have several resources to glean information from. Before becoming a member, you have access to a free premium quote on Oscar's website or by phone. With this tool, you answer a few questions about yourself (zip code, age, how many people you want to cover) as well as your expected medical needs in the next year, which will help direct you to the most cost-efficient plan. You then are able to see all Oscar's plans, costs (including government subsidies if you qualify), benefits, and recommended options.
Once you pay your first bill, Oscar will send you a welcome kit, which includes your ID card(s), an in-depth look at your free perks and benefits, as well as your Schedule of Benefits and Coverage. It also has a "Health Care Cheat Sheet" to help break down all the details of your plan.
There is also Doctor on Call, which is a telemedicine service that lets members talk to a doctor 24/7 for free over the phone. This service is especially convenient for getting medical advice when you don't want to take a trip to the doctor's office. According to Oscar, 91% of all Doctor on Call visits end in a resolution without the caller needing an in-person doctor visit. In this sense, Oscar delivers on its emphasis on technology to make customers' experience more convenient.
Lastly, Oscar offers a web account and mobile app to its customers. These allow members to search for health professionals covered by Oscar's plans, abook appointments with select providers, and view detailed doctor credential information and reviews to find the one(s) best suited to handle their specific needs. Members can call or message their Concierge team by simply clicking a button within the app. This app also provides members with a "Health Timeline", which contains their personal medical information and history such as appointments, prescriptions, lab results, and billing information.
Oscar has unqiue features that vary from other competitors. One of these is the fast registration process. Because the company prides themselves on simplicity, they've taken a lot of steps to remove the complication from health plans, registrations processes, customer service, and more.
Each member is assigned to a Concierge team and a registered nurse, which allows specialized service to Oscar's customers. They team can assist with finding doctors, booking appointments, coordinating care for complex or chronic medical issues, provide clinical guidance, and resolve billing or reimbusement issues.
Instead of casting a wide net and contracting with every health care provider, Oscar has developed a curated network of medical groups and doctors in each of its service areas, esuring a tighter integration and higher quality outcome for members. Additionally, they use data science and complex modeling to assess network coverage, provider quality, and service volume to improve their offerings.
Oscar also provides rewards to customers who reach their step goals. Customers track their steps using the health apps that come with iPhones and Androids. When they reach their daily step goals, they can receive up to $100 in Amazon gift cards per year.
Oscar provides phone support from 8 a.m.-8 p.m. Monday-Friday local time in each of its markets, and 9 a.m.-5 p.m. on weekends. When you call or secure message Oscar you are connected to a Concierge team. This unique model provides customers with additional support. Each Concierge team consists of a care guides and a registered nurse.
In addition, due to the nurse's experience on the team, they can also handle clinical questions, including assessing a member's needs and connecting them with the proper type of doctor to address their needs. Concierge teams proactively reach out to members if they visit the ER or hospital unexpectedly to make sure they are okay and that they have done all the follow ups the doctors requested. Because they're familiar with you and use Oscar's powerful backend systems to see your history instantaneously, there is never a need to be passed off to another department.