Meet the plan designed to support diabetes care

Frequently Asked Questions

• Where is this plan available?

  • This plan is available in GA, OH, TN, NC, KS, MO, IL (Choice network only), NE, and IA.

• Who is eligible for this plan?

  • The plan is eligible to all members in GA, OH, TN, NC, KS, MO, IL (Choice only), NE, IA. 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, Tier1a drugs) are not conditioned on a member having a specific chronic condition.

• Are the plans designed for people with Type 1 and Type 2 Diabetes?

  • Yes, these plans 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, these plans 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?
  • • Fully covered labs (including HbA1c screening, urinalysis, metabolic panel, lipid panel)
    • Fully covered eye and foot exams
    • $0 Tier 1a drugs
    • $0 Primary Care provider visits
    • $0 Behavioral health visits
    • $100 out-of-pocket maximum on insulin
• What insulin brands and DME manufacturers are included or covered?

  • Oscar's preferred insulin brand is Roche's Accu-check 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?
  • Accu-check is Oscar's preferred point of care blood glucose monitor. Continuous glucose monitoring (CGM) systems are also available to members through prior authorization. See here for Oscar's medical necessity criteria for Continual Glucose Monitors.
• Why does my ID card have a different plan name? (Diabetes Care Plan not listed)

  • You’ll see the plan listed on your ID card as "Simple Silver — for Diabetes".

• How do I get my supplies needed through the Diabetes Care Plan if I don't want to enroll with Livongo?
  • Members can manage their own diabetes care plan with the following:

    • Using the pharmacy benefits built into the plan to request refills as needed or getting meters, test strips, and insulin coverage —including Basaglar, Tresiba, Levemir, Humulin U-500, Fiap, and Novolin/Novolog.
    • Glucose monitors for point of care blood glucose testing and continuous glucose monitoring (CGM) devices. Accu-check is our preferred point of care blood glucose monitor. The devices are enabled by Bluetooth® and easily connect to the mySugr app.
    • Continuous glucose monitoring (CGM) systems through prior authorization. You can take a look at our medical necessity criteria for these at hioscar.com/medical/cg029.
• What rewards and incentives are included?
  • • Sign up for Livongo, our $0 Diabetes Management partner and receive $50 for activating the account.
    • Check in with your primary care physician for care coordination and receive a gift card.
    • Complete any two tests: hbA1c test, metabolic panel test, lipid test, UA (Urine Albumin) test, diabetic eye exam, to access on demand fitness by the American Specialty Health Fitness’ Active & Fit.
    • Regularly reach step goals in our app to earn $10 toward healthy groceries with Instacart.

    Note: Not all members enrolled in the Simple Silver - For Diabetes plan will be eligible to participate in the Rewards & Incentives program. Members who are not currently living with diabetes, are pre-diabetic, or living with gestational diabetes will not be eligible for the rewards and incentives program.
• How will Oscar know if I completed the actions for the rewards?

  • Once you have enrolled and activated Livongo within the first three months of an active plan, Livongo will share member engagement with Oscar to provide a $50 debit card to spend towards healthy groceries.

    For any preventative exam, annual wellness visit, or annual routine physical exam, the claim from your visit will serve as verification of completion and reload the original debit card with an additional $50 to spend towards groceries.

    In order to qualify for subsidized access to ASH Gyms and fitness classes, claims for any two of the following prescribed or ordered services will serve as verification of completion: HbA1c, metabolic, lipid, UA (Urine Albumin), or diabetic eye exam.

• Do my rewards expire?

  • Rewards expire at the end of your benefit year.

• 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.

• 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.