At a glace Medical Claim Submissio Basics Usual, Customary ad Reasoable Allowaces Deductibles, Coisurace ad Out-of-Pocket Maximums Coordiatio of Beefits Health Reserve Accout Claims Makig Oxford MyPla sm Work for You Claims Cotact Iformatio Do you eed to dowload a claim form? Log o to the Employer sectio of www.oxfordhealth.com ad click the Tools ad Resources tab. Forms ca be foud uder Practical Resources. www Sed all medical claim forms to: Sed all Oxford MyPla health reimbursemet Oxford accout claim forms to: Att: Claims Departmet Oxford P.O. Box 7082 Att: Oxford MyPla s m Claims Dept. Bridgeport, CT 06601-7082 P.O. Box 1021 Eatotow, NJ 07724 Do you have claims questios? Please call your Accout Maager or Cliet Services at 1-888-654-0065. E-mail: groupservices@oxfordhealth.com. The respose time is geerally withi 24 hours. www For Health Reserve Accout claims questios, call Oxford MyPla Special Services at 1-800-588-8621. For Health Savigs Accout claims questios, call us at 1-800-201-6953. 39
Medical Claim Submissio Basics Whe a Claim Form is Required There are cases whe members may be required to complete claim forms i order to receive reimbursemet, such as: Whe members have out-of-etwork coverage ad/or obtai care o a out-of-etwork basis Whe we are the secodary isurace carrier Whe members receive laboratory services from a o-participatig laboratory All covered charges for out-of-etwork medical treatmet are subject to a deductible, coisurace, ad usual, customary ad reasoable (UCR) limitatios, as stated i your Certificate of Coverage. The most commoly used claim form is the HCFA-1500 Health Isurace Claim Form. A image of the HCFA-1500 Health Isurace Claim Form ca be see o the ext page ad ca be dowloaded from www.oxfordhealth.com. www I-etwork Claims Whe members receive care o a i-etwork basis, there are usually o claim forms to complete. They simply show their ID card ad pay ay applicable cost shares (copaymets). Members of Freedom Pla Direct SM, Liberty Pla SM Direct, Oxford MyPla SM, ad Freedom Pla Value Optio SM have to meet a i-etwork deductible or pay i-etwork coisurace for certai i-etwork covered services. See your pla s Summary of Beefits for complete details regardig coverage. Out-of-Network Claims The member must complete a HCFA-1500 Health Isurace Claim Form, ad sed the claim form ad the origial provider ivoice to: Oxford Claims Departmet P.O. Box 7082 Bridgeport, CT 06601-7082 Filig Deadlies: Whe Claims Must be Submitted Commercial members have 180 days from the date of service to submit a claim to us. Filig deadlies are based o the claim s date of service. They are ot based o the date that the claim was mailed to or received by us. Claims that are filled i completely ad correctly are usually processed withi 10 to 15 busiess days. If you have ay questios regardig a particular claim submissio, please call Cliet Services at 1-888-654-0065. 40
What to Complete o a HCFA-1500 Claim Form for Out-of-Network Claims Required Claims Iformatio Box 1a. Isured s ID umber (idicate subscriber s Oxford ID umber) Box 2. Patiet s ame Boxes 9a d. Other isured s ame (oly complete sectio if patiet has other isurace) Boxes 4 7. Isured s ame, address ad telephoe umber (subscriber s cotact iformatio) Box 12. Sigature authorizig release of medical iformatio. Members who wat to receive paymet directly must sig Box 12 oly ad leave Box 13 blak. Box 13. Sigature authorizig assigmet of beefits (if applicable). Members who wat the paymet of medical beefits to go directly to the udersiged physicia or supplier of services must sig Box 13 i additio to Box 12 of the Claim Form. 41
What Should be Submitted with a HCFA-1500 Health Isurace Claim Form A origial, itemized bill must also be submitted with the claim form ad iclude the followig: Patiet s ame; Provider s ame; Provider s Federal Tax ID umber (FTIN); Member ID umber; Date of service; Type of service; Descriptio of service (CPT-4 code); Idividual charges for each service; ad Diagosis codes (ICD-9 codes). The diagosis codes must be icluded o the bill ad claim form. The bill must appear o the provider s billig letterhead. Balace Due or Balace Forward statemets will ot be accepted. If a pritable bill is ot available, the bottom portio of the HCFA-1500 Claim Form, (boxes 14-33) must be completed ad siged by the provider. Precertificatio Requiremets for Out-of-Network Claims (This sectio does ot apply to our i-etwork oly plas.) For all products that have out-of-etwork beefits, most services that require precertificatio o a i-etwork basis also require precertificatio o a out-of-etwork basis. If a member is receivig treatmet from a out-of-etwork provider, it is the member s resposibility to call Customer Service at 1-800-444-6222 or the umber o their ID card to precertify the procedures recommeded by the out-of-etwork provider. If medically ecessary services are ot available o a i-etwork basis, or a participatig provider caot be located withi the area, the our Medical Maagemet Departmet must precertify the services i order for coverage to be provided i-etwork, regardless of pla desig. Members, regardless of pla desig, who do ot receive precertificatio will be obligated to cover all charges or will be subject to a reductio of coverage. Please refer to your Certificate of Coverage for more details. How to Check o a Claim s Status Members ca check their claims: Olie at www.oxfordhealth.com by loggig o to the member sectio with their user ame ad password; www O Oxford Express (our voice iteractive phoe system) at 1-800-444-6222; or By callig our Customer Service Departmet at 1-800-444-6222 or at the umber o the back of their ID card. 42
Usual, Customary ad Reasoable Allowaces For most out-of-etwork medical procedures, we determie a usual, customary ad reasoable (UCR) allowace based o Health Isurace Associatio of America (HIAA) or other idustry data, Medicare fees, ad other factors. For each billed procedure, the UCR allowace represets the maximum amout we will reimburse or cosider applyig toward deductible ad coisurace paymets. More iformatio regardig the calculatio of your group s UCR levels ca be foud i the Certificate of Coverage ad Summary of Beefits. Please ote that UCR amouts are reviewed periodically ad ca chage without otice. Deductibles, Coisurace ad Out-of-Pocket Maximums Uderstadig Deductibles Whether your group offers plas with oly out-of-etwork deductibles or both i- ad out-of-etwork deductibles (Freedom Pla Direct SM, Liberty Pla SM Direct, Freedom Pla Value Optio SM, Oxford MyPla SM, Oxford Exclusive Pla SM, Oxford HSA Direct SM ad Oxford HSA Exclusive SM ) your employee s coverage will be subject to coisurace ad a out-of-pocket maximum oce the deductible is met. Members with sigle coverage: A sigle deductible is satisfied by icurrig covered services up to the amout of the deductible. Members with two-perso families: If the sum of the two sigle deductibles is less tha the total family deductible amout, the each idividual is oly resposible for meetig his or her sigle deductible before coisurace for out-of-etwork visits will apply to that idividual. Members with family coverage: A family deductible is satisfied whe a combiatio of applied idividual deductibles equals the family deductible. Ay combiatio of family members idividual deductibles ca satisfy the family deductible; however, o oe perso ca cotribute more tha his or her sigle deductible amout. See example below. This example ca be used to uderstad both i- ad out-of-etwork deductibles: i a family of four people, where the idividual deductible is $200 ad the family deductible is $500, the family deductible would be satisfied by the followig situatio i chroological order. Family Member #1 Icurs a bill for $300 The remaiig $100 is subject to their coisurace Family Member #2 Icurs a bill for $400 The remaiig $200 is subject to their coisurace Family Member #3 Icurs a bill for $200 The remaiig $100 is subject to their coisurace Meets $200 idividual deductible + Meets $200 idividual deductible = $400 of the $500 family deductible is met + $100 meets the etire family deductible = $500 family deductible is met Family Member #4 Icurs a bill for $300. The etire claim will be subject to their coisurace. 43
I-etwork Deductibles: I-etwork deductibles apply oly to employers who offer Freedom Pla Direct SM, Liberty Pla Direct s m, Freedom Pla Value Optio SM, Oxford MyPla SM, Oxford Exclusive Pla SM, Oxford HSA Direct SM ad Oxford HSA Exclusive SM. These plas also have a out-of-etwork deductible (see sectio below). The i-etwork ad out-of-etwork deductibles i these plas have to be satisfied idepedetly before medical bills are subject to either the i- or out-of-etwork coisurace. For example: Assume Joa has already satisfied her i-etwork deductible for this caledar year. Joa the icurs a bill from Dr. Bob, a i-etwork physicia. Dr. Bob bills us directly, ad the bill is subject to Joa s i-etwork coisurace. Now, Joa receives covered services from Dr. Smith, a out-of-etwork provider. Joa completes a HCFA-1500 Health Isurace Claim Form, ad submits the claim form ad the bill from Dr. Smith to us. Sice Joa has ot satisfied her out-of-etwork deductible, the bill will be applied to her out-of-etwork deductible. Please ote: Members are oly resposible for their i-etwork deductible ad coisurace whe receivig covered i-etwork services. Participatig physicias ad other participatig providers are ot permitted to balace-bill the member for ay amout above the provider s cotracted rate. Out-of-Network Deductibles: Most billed amouts for covered services from a out-of-etwork provider are subject to a deductible, coisurace, ad UCR. The member is resposible for ay amout billed over the UCR. Prior Carrier Deductibles (New Groups Oly) We will provide credit for deductibles paid to previous carriers uder the followig coditios: We will hoor ay prior deductibles paid to aother health pla betwee Jauary 1 ad the effective date of your ew policy; Deductible credit will oly be give for the caledar year i which your policy first became effective ad is oly available to ew groups; Deductibles will be credited i amouts equal to those applied to the previous health pla; ad If our deductibles are higher tha those of the previous pla, our deductible must be satisfied before beefits are paid. New hires to your compay are ot eligible for a deductible credit from their previous employer s medical pla. Credit for deductibles is available oly to employees who were erolled uder the health pla that your group had before coverage bega. 44
How to Receive Credit for Previous Carrier Deductibles We will ot obtai deductible iformatio from your previous carrier. This is the resposibility of the member. To obtai credit for deductibles paid to a previous carrier, members should: Obtai Explaatio of Beefits forms from the previous carrier showig the amouts of the deductibles applied; Complete a Prior Carrier Deductible Form (members ca dowload this form o www.oxfordhealth.com or call Customer Service to request the form); ad www Withi 60 days of your policy s effective date, submit these forms to: Oxford Att: Deductible Credit Ceter P.O. Box 7081 Bridgeport, CT 06601-7081 Uderstadig Coisurace ad Out-of-Pocket Maximums The basic priciples for coisurace ad out-of-pocket maximums ca be applied to plas that have i- ad/or out-of-etwork beefits. Members erolled i plas that have both i- ad out-of-etwork deductibles ad coisurace eed to satisfy the i- ad out-of-etwork deductibles, coisurace, ad out-of-pocket maximums idepedetly. Oce a member s deductible is met, claims will be reimbursed subject to coisurace up to the out-of-pocket maximum specified i the Summary of Beefits. The deductible ad coisurace percetages applied to the member s claims are ot based o billed charges. They are based o either the i-etwork provider s cotracted rate (i-etwork charges oly) or o the charges deemed usual, customary ad reasoable (UCR) by us (out-of-etwork charges oly). Oly the cotracted rate or UCR amout is applied to the member s deductible. Oce the member s deductible has bee met, the the coisurace percetage of the cotracted rate or UCR is applied to the out-of-pocket maximum. Please ote (out-of-etwork oly): The member is always resposible for payig ay charges above the UCR amout for out-of-etwork providers. See Usual, Customary ad Reasoable Allowaces. A member s out-of-pocket maximum represets the amout of moey i deductible ad coisurace that a idividual ad/or family must pay before claims are reimbursed by us at 100 percet of the cotracted rate (i-etwork charges oly) or UCR allowaces (out-of-etwork charges oly). Members should refer to the Summary of Beefits for their coisurace percetage ad out-of-pocket maximum. 45
The iformatio i the followig two examples are based o this member profile. Sigle deductible: $200 Sigle out-of-pocket maximum: $1,200 Family deductible: $500 Family out-of-pocket maximum: $3,000 Coisurace: 80%/20% Deductible + coisurace = Out-of-pocket maximum Example #1 illustrates how the followig istace ca be applied durig a i- or out-of-etwork situatio. Teri receives a bill for $100 from Dr. Smith. The cotracted rate (i-etwork) or UCR (out-of-etwork) for that procedure is $75. Assumig that Teri has met her applicable sigle deductible of $200, the we are resposible for 80% of the cotracted rate or UCR (80% x $75 = $60). Teri is resposible for 20% of the cotracted rate or UCR (20% x $75 = $15). For out-of-etwork plas oly: Teri is also resposible for the differece betwee the billed amout ad the UCR ($100 75 = $25). I-etwork Out-of-Network Billed amout $ 100 $ 100 Cotracted rate/ucr $ 75 $ 75 We pay 80% coisurace (80% x $75) $ 60 $ 60 20% coisurace amout (20% x $75) $ 15 $ 15 Amout above UCR (out-of-etwork oly) N/A ($100 $75)+$ 25 Total amout Teri owes Dr. Smith $ 15 $ 40 Sigle out-of-pocket maximum $1,200 $ 1,200 Accumulated deductible + coisurace ($200 + $15) $ 215 $ 215 Remaiig out-of-pocket maximum $ 985 $ 985 46
Example #2 illustrates how the followig istace ca be applied durig a i- or out-of-etwork situatio. Teri icurs a secod bill from Dr. Smith for $8,000. The cotracted rate or UCR is equal to the billed amout. We pay 80% of the cotracted rate or UCR (80% x $8,000= $6,400). Agai, Teri is resposible for 20% of the cotracted rate or UCR. For out-of-etwork plas oly: Teri is also resposible for the differece betwee the billed amout ad the UCR ($8,000 $8,000 = $0). Sice the amout owed to Dr. Smith exceeds Teri s out-of-pocket maximum, she is resposible oly for the remaiig $985 of her out-of-pocket maximum, ad we are resposible for the $615 differece. Now that Teri has met her out-of-pocket maximum (deductible + coisurace), we are resposible, from this poit forward, for 100% of the cotracted rate for all i-etwork procedures, or UCR for all out-of-etwork procedures or visits icurred for that caledar year. Teri is still resposible for amouts above the UCR. I-etwork Out-of-Network Remaiig out-of-pocket maximum $ 1,985 $ 1,985 Secod billed amout from Dr. Smith $ 8,000 $ 8,000 Cotracted rate/ucr $ 8,000 $ 8,000 We pay 80% coisurace (80% x $8,000) $ 6,400 $ 6,400 Teri pays 20% coisurace (20% x $8,000) $ 1,600 $ 1,600 Amout above UCR (out-of-etwork oly) N/A ($8,000 $8,000)+ $ 0 Total amout Teri owes Dr. Smith $ 1,600 $ 1,600 Remaiig out-of-pocket maximum Teri eeds to meet $ 1,985 $ 1,985 Teri s 20% coisurace amout - $ 1,600 - $ 1,600 Remaiig out-of-pocket maximum $ 0 $ 0 (Teri has ow met her out-of-pocket maximum) Teri has met her out-of-pocket maximum, ad we pay the remaiig $615 to Dr. Smith ($1,600 $985) $ 1,615 $ 1,615 Teri pays Dr. Smith $ 1,985 $ 1,985 Importat Poits to Remember: The member s deductible ad coisurace are reset to zero at the begiig of every caledar year for most groups. Members with out-of-etwork coverage will remai resposible for the coisurace level of the UCR util his or her out-of-pocket maximum or the family out-of-pocket maximum for that caledar year is met. Members with out-of-etwork coverage are always resposible for ay differece betwee the UCR ad billed amout, regardless of whether the out-of-pocket maximum has bee met. 47
Coordiatio of Beefits (COB) If a spouse or depedet becomes a member while also covered by aother health isurer, oe isurer will be cosidered primary, while the other will be cosidered secodary. All claims must first be evaluated by the primary health isurace carrier before they are submitted to the secodary carrier. It is essetial for us to kow about ay duplicate coverage iformatio, eve if it is for oly oe family member. COB questioaires are mailed to members who fail to adequately complete the other carrier questio o the Member Erollmet Form. Please see your Certificate of Coverage for specific details regardig our coordiatio of beefits policies with other isurers. Oxford as the Secodary Health Isurace Carrier Whe we are the secodary carrier for a member, all claims for health care services must first be evaluated by the primary isurer before beefits will be cosidered. This icludes all claims that are covered by: Aother health isurace compay Auto isurace Workers compesatio isurace For example, a member s spouse is isured by both us ad XYZ Health. XYZ Health is the primary carrier, ad we are the secodary carrier. The member s spouse receives treatmet from a dermatologist. First, the claim must be processed by XYZ Health. The, a Explaatio of Beefits from XYZ Health eeds to be submitted to us, alog with a itemized bill, for us to determie paymet. Determiig the Secodary Health Isurace Carrier If a perso is covered by more tha oe pla, we make a determiatio of which pla is primary based o criteria that may iclude the isured s status as either subscriber, spouse/parter, or depedets, their marital status ad the presece of a divorce/court decree ad date of birth. I additio, if the other carrier is Medicare, criteria may iclude their workig status as either workig, retired or disabled ad the size of the group. Please refer to your Certificate of Coverage for more iformatio. 48
Submittig a Claim Whe Oxford is the Secodary Health Isurace Carrier I order for us to cosider a claim as the secodary isurer, members should attach a Explaatio of Beefits (EOB) from the primary isurer, alog with a completed HCFA-1500 Claim Form ad origial provider ivoice. For istructios o how to complete a claim form, see the sectio, What to Complete o a HCFA-1500 Claim Form. Health Reserve Accout Claims The followig sectio oly applies to employers who have Oxford MyPla SM. Importat Note: The Oxford MyPla SM Health Reserve Accout is based o a health reimbursemet arragemet (HRA), which is subject to the requiremets of the Iteral Reveue Code. Groups may wat to cosult a tax advisor regardig these accouts. Neither Oxford Health Isurace, Ic., Oxford Beefit Maagemet SM (OBM) or ay other affiliate of Oxford Health Plas, LLC shall act as a fiduciary for the employer group. Iformatio i this documet is subject to chage without otice. Oxford MyPla SM Coverage Oxford MyPla covers i-etwork prevetive care at 100%, with o deductible. Oxford MyPla has a deductible for both i- ad out-of-etwork services. Geerally, this deductible applies to all covered services, uless your pla icludes a office visit copaymet. If your pla has i-etwork deductibles for most services, members will eed to pay attetio to what type of care is eeded ad how much it will cost. Members are i charge of where ad whe they access care ad whe they icur out-of-pocket expeses. Oxford MyPla Health Reserve Accout The Health Reserve Accout helps members pay for covered out-of-pocket expeses that fall uder the deductible or coisurace provisios of their pla. Uderstadig what health care really costs is a key compoet of the Oxford MyPla. After members receive care, they will receive a detailed EOB report that shows exactly how much their care costs, ad calculates how much is covered uder the deductible. Members will use the EOB to apply for reimbursemet from their Health Reserve Accout. Sice they will be drawig o either their Health Reserve Accout or persoal fuds util they meet the deductible limit, they will wat to cotrol their spedig carefully. After exhaustig the Health Reserve Accout fuds, members are resposible for the remaiig deductible. The employer is solely resposible for fudig the Health Reserve Accout. Oxford MyPla i Actio To help you better uderstad how the Health Reserve Accout works, we have created two member profiles ad outlied typical medical expeses. Member experieces ad cost shares may be differet from the examples ad will be based o their specific choices ad pla desig. These figures are for illustrative purposes oly. 49
Example #1 Jae Smith is sigle ad livig i Tarrytow. Oxford MyPla deductible (sigle): $1,000 Health Reserve Accout: $500 Jae sees a i-etwork allergist. The allergist seds the claim to us as he/she ormally would. We adjudicate the claim, approvig the cotracted rate of $135. We sed a EOB to both Jae ad her allergist statig that $135 has bee applied to Jae s deductible. Jae has two choices for usig her Health Reserve Accout: 1. She may assig paymet from her Health Reserve Accout directly to her allergist. By sedig her EOB to us, she will geerate a $135 paymet from her Health Reserve Accout to her allergist. 2. She ca pay her allergist the $135 directly, ad submit a Oxford My Pla Health Reserve Accout Claim Form to us, alog with her EOB ad a receipt from the allergist. This will geerate a $135 paymet from the Health Reserve Accout directly to Jae. We will debit the Health Reserve Accout, leavig a balace of $365 for future expeses. Jae has participated i the actual health care cost trasactio but, because of the Health Reserve Accout, she has ot icurred ay out-of-pocket expese. Example #2 Eddie Lopez is married with two childre ad lives i Quees. Oxford MyPla deductible (family): $2,000 Health Reserve Accout: $1,000 Eddie s so Joh cuts his figer, ad it looks like he ll eed stitches. Eddie does t kow if he should go to the urget care ceter or the hospital emergecy room (ER) just aroud the corer. Because his Oxford MyPla has a i-etwork deductible, he kows his Health Reserve Accout will cover his costs, up to the first $1,000. Eddie realizes that Joh is i o immediate dager. Because he kows that visits to urget care ceters typically cost less tha visits to the ER, Eddie decides to take his so to the urget care ceter. We adjudicate the claim from the urget care ceter at $145, sed a EOB to both parties, ad apply $145 to Eddie s deductible. Eddie may choose to assig the paymet directly to the urget care ceter, or make a paymet himself ad submit the receipt with the EOB ad claim form to us for reimbursemet. Eddie s Oxford MyPla Health Reserve Accout balace is adjusted to $855. Eddie has take a first step at uderstadig how health care decisios ca impact his Health Reserve Accout. Eddie has become a more egaged health care cosumer. Ad by choosig the more efficiet care choice, he has used his Health Reserve Accout dollars wisely ad has t icurred out-of-pocket costs. 50
Makig Oxford MyPla s m Work for You How Oxford MyPla Medical Claims Work Geerally, members will ot pay the provider at the time of service (certai plas iclude copaymet provisios for physicia office visits). After a member s office visit, the doctor or other provider will submit a claim to us. Here s what happes ext: We adjudicate the claim ad determie which amouts should be applied to the deductible, coisurace, or other beefits. We sed a Explaatio of Beefits (EOB) to the provider ad to the member explaiig how much the member owes the provider, if applicable. The i-etwork provider will the bill the member for ay amouts due uder their deductible ad coisurace. Out-of-etwork claims are differet. The out-of-etwork claim will be adjudicated by us, ad the approved charges may be reduced based o the member s usual, customary ad reasoable (UCR) level of reimbursemet. The member may still owe the provider charges beyod the deductible ad coisurace charges outlied o their EOB. Charges above the UCR are ot eligible for reimbursemet from the member s Health Reserve Accout. How Members Use Oxford MyPla Health Reserve Accout to Pay Claims After receivig care, members will receive a EOB from us that illustrates which charges may be applied to their deductible or coisurace. The deductible amouts are eligible for reimbursemet from their Health Reserve Accout. Here s what members ca do: Optio 1: Automatic Paymet to the Provider The member submits the EOB ad a Oxford MyPla SM Health Reserve Accout Claim Form to the Oxford MyPla address listed o the form. A sample of the form ca be see o the followig page. The member selects the Assigatio of Paymet box o the form to idicate that he/she wats the paymet to go directly to the provider. All forms are available at www.oxfordhealth.com. www We will sed paymet for all eligible expeses (up to the remaiig Health Reserve Accout balace) directly to the provider. The member will receive a statemet cofirmig that this paymet has bee made. Optio 2: Pay the Provider ad Get Reimbursed After receivig a EOB from us, the provider will sed the member a bill for the approved charges, which should match the amout idicated o the EOB. The member should pay the provider the approved amout. The member should keep a copy of the bill ad get a receipt from the provider. The member should submit the EOB, the receipt, ad a Oxford MyPla Health Reserve Accout Claim Form to the Oxford MyPla address as idicated o the form. We will sed paymet for all eligible expeses (up to the remaiig Health Reserve Accout balace) directly to the member. 51
Oxford MyPla Health Reserve Accout Claim Form Importat thigs to remember: Members eed to idicate i the Assigatio of Paymet box to whom the paymet should be set. Members eed to submit a copy of their EOB ad a receipt (if they are askig to be reimbursed) with the claim form. 52
What Expeses are Eligible for Reimbursemet? The Oxford MyPla s m Health Reserve Accout may be used to reimburse all covered charges applied to the deductible or applicable coisurace costs. Members should refer to their Summary of Beefits for iformatio specific to their pla. What Expeses are Not Eligible for Reimbursemet? The Oxford MyPla Health Reserve Accout does ot reimburse moey spet o the followig services: Pharmacy copaymets or deductibles Out-of-etwork charges i excess of the allowed amout Deied claims Detal, visio, or other services ot covered by the isured s health pla Office visit copaymets (where applicable) How Pharmacy Claims Work Most Oxford MyPla pla desigs iclude pharmacy coverage. That pharmacy coverage is idepedet from the medical beefits, ad may iclude a separate deductible. Pharmacy charges are ot eligible for reimbursemet uder the medical deductible. Our pharmacy plas provide may icetives to use cost-effective medicatios, ad deductibles are geerally more moderate tha medical deductibles. Cosult the Certificate of Coverage for full pharmacy beefit details. How Members Get Iformatio o Deductibles or Oxford MyPla Health Reserve Accout Balaces The Oxford MyPla Special Services team is available durig busiess hours to give members iformatio regardig their balace. The toll-free phoe umber for Oxford MyPla Special Services ca be foud o the member ID card, or members ca call 1-800-588-8621. 53