Community - Community Health Choice HMO Silver 004

Texas, 2017

  • Plan Type

    HMO

  • Metal Tier

    Silver

  • Out of Pocket Maximum

    $7,150

  • Deductible

    $1,500

Enroll Now
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Call (855) 866-5590 to speak with a licensed agent about a new health plan.

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Cost Sharing Benefits (In Network)

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductible (Individual) $1,500
Deductible (Family) $3,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,150
Out of Pocket Maximum (Family) $14,300

Doctor Visits

Primary Care Visit $30 Copay after deductible
Specialist Visit $50 Copay after deductible
Inpatient Facility $500 Copay per day after deductible
Inpatient Physician $50 Copay after deductible
Emergency Room Services $500 Copay after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) $500 Copay after deductible
Laboratory Outpatient and Professional Services $30 Copay after deductible
X-Ray and Diagnostic Imaging $30 Copay after deductible

Health Management Programs

Asthma Available
Depression Available
Diabetes Available
Heart Disease Not available
High Blood Pressure / High Cholesterol Not available
Lower Back Pain Not available
Pain Management Not available
Pregnancy Available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient $500 Copay per day after deductible
Mental / Behavioral Health Outpatient $50 Copay after deductible
Rehabilitative Speech Therapy $50 Copay after deductible
Rehabilitative Occupational & Physical Therapy $50 Copay after deductible
Outpatient Facility $200 Copay after deductible
Outpatient Surgery $200 Copay after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx Data Not Available
Non Preferred Brand Rx Data Not Available
Specialty Drugs

73% Cost Sharing Benefits

Households with incomes between 200% to 250% of FPL qualify for the following cost sharing benefits for this silver plan. To understand how cost sharing reductions work and how they work for you see our article about Obamacare Cost Sharing Reduction Discounts

Deductibles and Cost Sharing

Deductible (Individual) $1,250
Deductible (Family) $2,500
Out of Pocket Maximum (Individual) $5,700
Out of Pocket Maximum (Family) $11,400

Doctor Visits

Primary Care Physician $30 Copay after deductible
Specialists $50 Copay after deductible
Emergency Room $500 Copay after deductible
Inpatient Facility $500 Copay per day after deductible
Inpatient Physician $50 Copay after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

87% Cost Sharing Benefits

Households with incomes between 150% to 200% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $0
Deductible (Family) $0
Out of Pocket Maximum (Individual) $2,350
Out of Pocket Maximum (Family) $4,700

Doctor Visits

Primary Care Physician
Specialists
Emergency Room
Inpatient Facility $300 Copay per day
Inpatient Physician

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

94% Cost Sharing Benefits

Households with incomes between 138% to 150% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $0
Deductible (Family) $0
Out of Pocket Maximum (Individual) $1,000
Out of Pocket Maximum (Family) $2,000

Doctor Visits

Primary Care Physician
Specialists
Emergency Room
Inpatient Facility $200 Copay per day
Inpatient Physician

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

Other Plans in Texas

Plan Community Health Choice HMO Gold 005 Deductible $500 Coinsurance Not applicable Out of Pocket $5,000
Plan Community Health Choice HMO Bronze 003 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Community Health Choice HMO Silver 002 Deductible $0 Coinsurance Not applicable Out of Pocket $7,150
Plan KelseyCare powered by Community Health Choice HMO 006 Deductible $0 Coinsurance Not applicable Out of Pocket $5,000
Plan Community Health Choice HMO Gold 001 Deductible $0 Coinsurance Not applicable Out of Pocket $5,000
Plan KelseyCare powered by Community Health Choice HMO 007 Deductible $0 Coinsurance Not applicable Out of Pocket $7,150
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Cost Sharing Benefits (In Network)

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductible (Individual) $1,500
Deductible (Family) $3,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,150
Out of Pocket Maximum (Family) $14,300

Doctor Visits

Primary Care Visit $30 Copay after deductible
Specialist Visit $50 Copay after deductible
Inpatient Facility $500 Copay per day after deductible
Inpatient Physician $50 Copay after deductible
Emergency Room Services $500 Copay after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) $500 Copay after deductible
Laboratory Outpatient and Professional Services $30 Copay after deductible
X-Ray and Diagnostic Imaging $30 Copay after deductible

Health Management Programs

Asthma Available
Depression Available
Diabetes Available
Heart Disease Not available
High Blood Pressure / High Cholesterol Not available
Lower Back Pain Not available
Pain Management Not available
Pregnancy Available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient $500 Copay per day after deductible
Mental / Behavioral Health Outpatient $50 Copay after deductible
Rehabilitative Speech Therapy $50 Copay after deductible
Rehabilitative Occupational & Physical Therapy $50 Copay after deductible
Outpatient Facility $200 Copay after deductible
Outpatient Surgery $200 Copay after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx Data Not Available
Non Preferred Brand Rx Data Not Available
Specialty Drugs

73% Cost Sharing Benefits

Households with incomes between 200% to 250% of FPL qualify for the following cost sharing benefits for this silver plan. To understand how cost sharing reductions work and how they work for you see our article about Obamacare Cost Sharing Reduction Discounts

Deductibles and Cost Sharing

Deductible (Individual) $1,250
Deductible (Family) $2,500
Out of Pocket Maximum (Individual) $5,700
Out of Pocket Maximum (Family) $11,400

Doctor Visits

Primary Care Physician $30 Copay after deductible
Specialists $50 Copay after deductible
Emergency Room $500 Copay after deductible
Inpatient Facility $500 Copay per day after deductible
Inpatient Physician $50 Copay after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

87% Cost Sharing Benefits

Households with incomes between 150% to 200% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $0
Deductible (Family) $0
Out of Pocket Maximum (Individual) $2,350
Out of Pocket Maximum (Family) $4,700

Doctor Visits

Primary Care Physician
Specialists
Emergency Room
Inpatient Facility $300 Copay per day
Inpatient Physician

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

94% Cost Sharing Benefits

Households with incomes between 138% to 150% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $0
Deductible (Family) $0
Out of Pocket Maximum (Individual) $1,000
Out of Pocket Maximum (Family) $2,000

Doctor Visits

Primary Care Physician
Specialists
Emergency Room
Inpatient Facility $200 Copay per day
Inpatient Physician

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

Other Plans in Texas

Plan Community Health Choice HMO Gold 005 Deductible $500 Coinsurance Not applicable Out of Pocket $5,000
Plan Community Health Choice HMO Bronze 003 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Community Health Choice HMO Silver 002 Deductible $0 Coinsurance Not applicable Out of Pocket $7,150
Plan KelseyCare powered by Community Health Choice HMO 006 Deductible $0 Coinsurance Not applicable Out of Pocket $5,000
Plan Community Health Choice HMO Gold 001 Deductible $0 Coinsurance Not applicable Out of Pocket $5,000
Plan KelseyCare powered by Community Health Choice HMO 007 Deductible $0 Coinsurance Not applicable Out of Pocket $7,150