In-network with Ascension St. John, Hillcrest, OSU Medical and Saint Francis (other providers are available in our network).
EOBs for plan members are temporarily unavailable to view online. If you have questions about plan benefits, please contact the CommunityCare customer service team for assistance.
Attention: CommunityCare will be performing systems maintenance Friday, April 19th starting at 5 p.m. through midnight on Saturday, April 20th. Some online documents, tools and resources may be unavailable during this time. Thank you for your patience.

Brokers

Medicare Brokers - Plans Overview

Choose the Senior Health Plan tab, the INTEGRIS Health Partners+ tab, or the CommunityCare Options to view the common benefits & copays for these plans. Included are the links to the specific additional benefits pages.

Deluxe

Medical and Medicare Part D Benefits
Premium
$0 per month
Maximum Out-of-Pocket
$5,300
Primary Care Physician
$0 copay per visit
Specialist
$40 copay per visit
Emergency Room
$90 copay per visit
Urgent Care
$40 copay per visit
Outpatient Hospital
$300 copay
Outpatient Rehabilitation
$20 copay per visit
Outpatient Diagnostic Services
$15-$150 copay, depending on the service
Hospital
$300 per day for days 1-7
DME
20%; 0 for CGM

Premier

Medical and Medicare Part D Benefits
Premium
$21.10 per month
Maximum Out-of-Pocket
$4,700
Primary Care Physician
$0 copay per visit
Specialist
$35 copay per visit
Emergency Room
$90 copay per visit
Urgent Care
$35 copay per visit
Outpatient Hospital
$250 copay
Outpatient Rehabilitation
$20 copay per visit
Outpatient Diagnostic Services
$0-$100 copay, depending on the service
Hospital
$245 per day for days 1-5
DME
20%; 0 for CGM

Choice

Medical Benefits Only
Premium
$0 per month
Maximum Out-of-Pocket
$5,300
Primary Care Physician
$0 copay per visit
Specialist
$35 copay per visit
Emergency Room
$90 copay per visit
Urgent Care
$35 copay per visit
Outpatient Hospital
$250 copay
Outpatient Rehabilitation
$20 copay per visit
Outpatient Diagnostic Services
$0-$100 copay, depending on the service
Hospital
$245 per day for days 1-5
DME
20%; 0 for CGM

Extra Benefits

Dental
$0 for two preventive visits; $1,500 comprehensive
Vision
$0 copay for eyewear up to $300 per year
OTC
$60 per quarter
Hearing Aids
Covered in Wallet
Wallet
Flex Card limit up to $350 for fitness, hearing aids, PERS, home & bathroom safety & non-Medicare DME
Dental
$0 for two preventive visits; $1,500 comprehensive
Vision
$0 copay for eyewear up to $300 per year
OTC
$60 per quarter
Hearing Aids
Covered in Wallet
Wallet
Flex Card limit up to $500 for fitness, hearing aids, PERS, home & bathroom safety & non-Medicare DME
Dental
$0 for two preventive visits; $1,500 comprehensive
Vision
$0 copay for eyewear up to $200 per year
OTC
$50 per quarter
Hearing Aids
Covered in Wallet
Wallet
Flex Card limit up to $500 for fitness, hearing aids, PERS, home & bathroom safety & non-Medicare DME

Part D

Tier 1 - Preferred Generic
$0 copay
Tier 2 - Generic
$5 copay
Tier 3 - Preferred Brand Name
$40 copay
Insulin Tier
$35
Tier 4 - Non-Preferred Drugs
$95 copay
Tier 5 - Specialty Tier
33% of the cost
Tier 1 - Preferred Generic
$0 copay
Tier 2 - Generic
$5 copay
Tier 3 - Preferred Brand Name
$40 copay
Insulin Tier
$35
Tier 4 - Non-Preferred Drugs
$95 copay
Tier 5 - Specialty Tier
33% of the cost
Tier 1 - Preferred Generic
N/A
Tier 2 - Generic
N/A
Tier 3 - Preferred Brand Name
N/A
Insulin Tier
N/A
Tier 4 - Non-Preferred Drugs
N/A
Tier 5 - Specialty Tier
N/A

Copays in GAP

Tier 1 - Preferred Generic
$0 copay
Tier 2 - Generic
$5 copay
Other Tiers
25%
Tier 1 - Preferred Generic
$0 copay
Tier 2 - Generic
$5 copay
Other Tiers
25%
Tier 1 - Preferred Generic
N/A
Tier 2 - Generic
N/A
Other Tiers
N/A

INTEGRIS Health Partners+ is owned by INTEGRIS Health and administered by CommunityCare.

The INTEGRIS Health Partners+ service area is: Canadian, Cleveland, Kingfisher, Lincoln, Logan, Oklahoma and Pottawatomie counties.

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