Oscar Health Insurance 2020 Updates
In 2020 Oscar will be entering many new markets throughout the country. While the Oscar Health NY small business market was granted a larger than usual increase this year, they remain competitive in the NY small group market.
There will be no changes to their networks this year, as they are still offering products on their Circle and Circle Plus networks. Below is a quick recap the difference between the 2 networks:
Oscar Circle Network:
this is the new name for the Original Oscar network which EXCLUDES:
- Winthrop (only change for 2020 as they were acquired by the NYU health system)
- All Northwell facilities and providers
- Memorial Sloan Kettering
- WestMed Doctor group
This network boasts 27K Providers, 30 Hospitals and 250 Urgent Care Centers
**No access to Walgreens, Rite Aid and Duane Reade pharmacies**
Oscar Circle Plus Network:
This will include all the Circle providers and facilities PLUS the following providers:
- Northwell Health System
- Memorial Sloan Kettering
- WestMed Doctor group
*Out of Area coverage with the Multiplan network. Just as a reminder, Oscar requires that no more than 20% of their employees live outside of the Oscar service area*
This network boasts 48.5k Providers, 51 Hospitals and 298 Urgent Care Centers
Oscar’s network is bi-state, in NY members will have access to the Oscar network of their choosing and in NJ members will have access to QualCare.
Pharmacy: CVS Caremark
Quest: Preferred Lab
A new vendor has been introduced this year in the NYC area ONLY, The service is called Capsule. This is a FREE pharmacy delivery program. Scripts are delivered straight to the members home within approx. 2 hours. This is keeping in tune with their easy member access approach. Coupled with their state-of-the-art Doctor on call program that can be found either by using the members online account or the Oscar app, members can send a message to a provider or request a call from a doctor in as little as 15 minutes. This is a free service that is unlimited and available 24/7. Members can also use Doctor on call Nationally.
For 2020 there have been no major changes to their portfolio. They have discontinued 4 plans which did not have much membership:
- Oscar Circle & Circle Plus Silver $2700. At renewal groups enrolled on this plan will be mapped to the Silver 3000 plan
- Oscar Circle & Circle Plus Gold $1500. At renewal groups enrolled on this plan will be mapped to the Gold 1000 plan
- Oscar Circle & Circle Plus Silver $7900. At renewal groups enrolled on this plan will be mapped to the Silver 4500 plan
- Oscar Circle & Circle Plus Gold $5000. At renewal groups enrolled on this plan will be mapped to the Gold 1250 plan
New to the Oscar Health portfolio this year is a richer Platinum offering. In addition, both of the Oscar Health networks are available via Healthpass as well.
Underwriting Guidelines have not changed. Oscar still requires 51% enrollment after valid waivers. Valid waivers are Medicare, Medicaid, Spousal, VA, Parental, Individual and any other Employer Sponsored coverage thru another carrier. They do also allow for class carve outs. Oscar also allows for Ghost plans (no enrollment needed).
Let us know if you wish to get a quote.