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CHRISTUS - CHP TX Bronze HSA
Texas, 2019
Plan Type
HMO
Metal Tier
Bronze
Out of Pocket Maximum
$6,650
Deductible
$6,000
Emergency Room Care: 40% Coinsurance after deductible
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) | $6,000 |
|---|---|
| Deductible (Family) | $12,000 |
| Coinsurance | Not applicable |
| Out of Pocket Maximum (Individual) | $6,650 |
| Out of Pocket Maximum (Family) | $13,300 |
Doctor Visits
| Primary Care Visit | 40% Coinsurance after deductible |
|---|---|
| Specialist Visit | 40% Coinsurance after deductible |
| Inpatient Facility | 40% Coinsurance after deductible |
| Inpatient Physician | 40% Coinsurance after deductible |
| Emergency Room Services | 40% Coinsurance after deductible |
Tests and Imaging
| Imaging (CT/PET Scans, MRIs) | 40% Coinsurance after deductible |
|---|---|
| Laboratory Outpatient and Professional Services | 40% Coinsurance after deductible |
| X-Ray and Diagnostic Imaging | 40% Coinsurance after deductible |
Health Management Programs
| Asthma | Not available |
|---|---|
| Depression | Not available |
| Diabetes | Available |
| Heart Disease | Not available |
| High Blood Pressure / High Cholesterol | Not available |
| Lower Back Pain | Not available |
| Pain Management | Not available |
| Pregnancy | Not available |
| Weight Loss | Not available |
Other
| Mental / Behavioral Health Inpatient | 40% Coinsurance after deductible |
|---|---|
| Mental / Behavioral Health Outpatient | 40% Coinsurance after deductible |
| Rehabilitative Speech Therapy | 40% Coinsurance after deductible |
| Rehabilitative Occupational & Physical Therapy | 40% Coinsurance after deductible |
| Outpatient Facility | 40% Coinsurance after deductible |
| Outpatient Surgery | 40% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | 40% Coinsurance after deductible |
|---|---|
| Preferred Brand Rx | 40% Coinsurance after deductible |
| Non Preferred Brand Rx | 40% Coinsurance after deductible |
| Specialty Drugs | 40% Coinsurance after deductible |
Other Plans in Texas
| Plan | Deductible | Coinsurance | Out of Pocket |
|---|---|---|---|
| Plan CHP TX Silver LD | Deductible $3,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan CHP TX Gold | Deductible $2,400 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan CHP TX Silver HD | Deductible $5,200 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan CHP TX Silver HD | Deductible $5,200 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan CHP TX Gold | Deductible $2,400 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan CHP TX Catastrophic | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan CHP TX Bronze HSA | Deductible $6,000 | Coinsurance Not applicable | Out of Pocket $6,650 |
| Plan CHP TX Bronze | Deductible $5,500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan CHP TX Catastrophic | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan CHP TX Bronze HSA | Deductible $6,000 | Coinsurance Not applicable | Out of Pocket $6,650 |
| Plan CHP TX Bronze | Deductible $5,500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan CHP TX Bronze | Deductible $5,500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan CHP TX Bronze HSA | Deductible $6,000 | Coinsurance Not applicable | Out of Pocket $6,650 |
| Plan CHP TX Catastrophic | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan CHP TX Silver LD | Deductible $3,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan CHP TX Silver HD | Deductible $5,200 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan CHP TX Gold | Deductible $2,400 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan CHP TX Silver LD | Deductible $3,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan CHP TX Gold | Deductible $2,400 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan CHP TX Silver HD | Deductible $5,200 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan CHP TX Silver LD | Deductible $3,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan CHP TX Silver HD | Deductible $5,200 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan CHP TX Gold | Deductible $2,400 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan CHP TX Catastrophic | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan CHP TX Catastrophic | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan CHP TX Bronze | Deductible $5,500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan CHP TX Bronze HSA | Deductible $6,000 | Coinsurance Not applicable | Out of Pocket $6,650 |
| Plan CHP TX Bronze HSA | Deductible $6,000 | Coinsurance Not applicable | Out of Pocket $6,650 |
| Plan CHP TX Bronze | Deductible $5,500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan CHP TX Catastrophic | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan CHP TX Bronze | Deductible $5,500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan CHP TX Gold | Deductible $2,400 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan CHP TX Silver HD | Deductible $5,200 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan CHP TX Silver LD | Deductible $3,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan CHP TX Silver LD | Deductible $3,000 | Coinsurance Not applicable | Out of Pocket $7,900 |