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OUR PLANS

 

2018 Individual and Family Plans

Catastrophic5 Bronze HSA Bronze 7350/100
Deductible – In-Network
(Single/Family)
$7,350/$14,700 $6,650/$13,300 $7,350/$14,700
Out-of-Pocket Maximum – In-Network (Single/Family) $7,350/$14,700 $6,650/$13,300 $7,350/$14,700
Coinsurance In-Network
(you pay)
0% 0% 0%
PCP1 (In-Network) $0 for 3;
Coinsurance
Deductible $35 for 3; Deductible
Specialist (In-Network) Deductible Deductible Deductible
Urgent Care (In-Network) Deductible Deductible Deductible
Aurora QuickCare /Bellin FastCare $0 for 3; then Coinsurance Ded/Coins $20 Copay
Emergency Room2 (In- & Out-of-Network) Deductible Deductible Deductible
In-Network Preventive Care3 $0 $0 $0
Prescription Drugs (Tier 1) Deductible Deductible Deductible
Prescription Drugs (Tier 2) Deductible Deductible Deductible
Prescription Drugs (Tier 3) Deductible Deductible Deductible
Prescription Drugs (Specialty) Deductible Deductible Deductible
More Details More Details More Details
Silver 4000/75 Silver HSA Silver 3000/75/ Copay 40 Silver 5500/804
Deductible – In-Network (Single/Family) $4,000/$8,000 $3,200/$6,400 $3,000/$6,000 $5,500/$11,000
Out-of-Pocket Maximum In-Network (Single/Family) $7,350/$14,700 $6,550/$13,100 $7,350/$14,700 $7,350/$14,700
Coinsurance In-Network (you pay) 25% 25% 25% 20%
PCP1 (In-Network) $50 Copay Ded/Coins $40 Copay $60
Specialist (In-Network) $80 Copay Ded/Coins $80 Copay $100
Urgent Care (In-Network) $60 Copay Ded/Coins $60 Copay Ded/Coins
Aurora QuickCare /Bellin FastCare $20 Copay Ded/Coins $20 Copay $20
Emergency Room2 (In- & Out-of-Network) Deductible; then $400 Ded/Coins Deductible; then $400 Deductible; then $400
In-Network Preventive Care3 $0 $0 $0 $0
Prescription Drugs (Tier 1) $20 Copay Ded/Coins $25 Copay $10
Prescription Drugs (Tier 2) Deductible; then $75 Ded/Coins Deductible; then $75 $100
Prescription Drugs (Tier 3) Ded/Coins Ded/Coins Ded/Coins Ded/Coins
Prescription Drugs (Specialty) Ded/Coins Ded/Coins Ded/Coins Ded/Coins
More Details More Details More Details More Details
Gold 2000/80
Deductible – In-Network
(Single/Family)
$2,000/$4,000
Out-of-Pocket Maximum – In-Network
(Single/Family)
$7,350/$14,700
Coinsurance In-Network
(you pay)
20%
PCP1 (In-Network) $40 Copay
Specialist (In-Network) $60 Copay
Urgent Care (In-Network) $50 Copay
Aurora QuickCare /Bellin FastCare $15 Copay
Emergency Room2 (In- & Out-of-Network) $300 Copay
In-Network Preventive Care4 $0
Prescription Drugs (Tier 1) $10 Copay
Prescription Drugs (Tier 2) $50 Copay
Prescription Drugs (Tier 3) Deductible; then $100
Prescription Drugs (Specialty) Ded/Coins
More Details

Click the links below to access the Schedule of Benefits for these 2017 plans:

Catastrophic   |   Bronze 7150/100   |   Bronze HSA

Silver HSA  |  Silver 3800/80  |  Silver 2400/80

Silver 2000/70  |  Silver 2500/80/Copay 35 |  Silver 3500/80

Silver 5200/80   |   Gold 1000/90

All plans offer the American Indian/Alaskan Native Plan Variations (Limited Cost Sharing and No Cost Sharing) for eligible individuals.  Please click here for more information about those plan variations.

1 PCP = Primary Care Provider (includes general pediatrics, internal medicine, OB/GYN, family practice, general medicine, chiropractor and geriatrics) Urgent = Urgent Care Services Emergency = Emergency Room Care Services

2 Services that meet the definition of emergency are paid at the in-network rate even when care is delivered in a non-network ER. Because we do not have a contract with out of network ER facilities, we cannot prevent these facilities from billing our members for the balance of the charge. The copay applies to the facility charge only. All other charges related to ER visit are subject to deductible/coinsurance.

3 Preventive Care received out of network is not covered

4 Silver 5500/80 plan has a separate prescription drug deductible of $4,000 associated with it.

5 Catastrophic plan applies to persons under age 30 or those with a hardship exemption from the federal Marketplace (healthcare.gov)

Our Deductibles, Explained: All plans have a January 1 to December 31 deductible. All deductibles, coinsurance, and copayments accumulate toward the out-of-pocket maximum. All plans described on this page have embedded deductibles for family coverage. This means that if you are enrolled in 2-person or family coverage, an individual family member only has to satisfy the single person deductible before the plan begins to make payment for covered services for that family member. 

 

2018 Cost Share Reduction Plans (Silver Base Plans)

73% – 2700/Copay 35 CSR 87% – $50 Ded/Copay 25 CSR 94% – $0 Ded/Copay 0 CSR
Deductible – In-Network
(Single/Family)
$2,700/$5,400 $50/$100 $0/$0
Out-of-Pocket Maximum
In-Network (Single/Family)
$5,700/$11,400 $2,450/$4,900 $1,00/$2,000
Coinsurance In-Network
(you pay)
20% 20% 20%
PCP1 (In-Network) $35 Copay $25 Copay $0 Copay
Specialist (In-Network) $70 Copay $50 Copay $20 Copay
Urgent Care (In-Network) Ded/Coins Ded/Coins Ded/Coins
Aurora QuickCare /Bellin FastCare $15 Copay $15 Copay $0 Copay
Emergency Room2(In- & Out-of-Network) Deductible; then $350 $350 $150
In-Network Preventive Care3 $0 $0 $0
Prescription Drugs (Tier 1) $10 Copay $10 Copay $0
Prescription Drugs (Tier 2) $70 Copay $55 Copay $15 Copay
Prescription Drugs (Tier 3) Ded/Coins Ded/Coins Coinsurance
Prescription Drugs (Specialty) Ded/Coins Ded/Coins Coinsurance
More Details More Details More Details

 

 

73% – 2000/80 CSR4 87% – 200/80 CSR4 94% – $50 Ded/80 CSR4
Deductible – In-Network
(Single/Family)
$2,000/$4,000 $200/$400 $50/$100
Out-of-Pocket Maximum
In-Network (Single/Family)
$5,850/$11,700 $2,450/$4,900 $1,000/$2,000
Coinsurance In-Network
(you pay)
20% 20% 20%
PCP1 (In-Network) Ded/Coins Ded/Coins Ded/Coins
Specialist (In-Network) Ded/Coins Ded/Coins Ded/Coins
Urgent Care (In-Network) Ded/Coins Ded/Coins Ded/Coins
Aurora QuickCare /Bellin FastCare Ded/Coins Ded/Coins Ded/Coins
Emergency Room2 (In- & Out-of-Network) Ded/Coins Ded/Coins Ded/Coins
In-Network Preventive Care3 $0 $0 $0
Prescription Drugs (Tier 1) Ded/Coins Ded/Coins Ded/Coins
Prescription Drugs (Tier 2) Ded/Coins Ded/Coins Ded/Coins
Prescription Drugs (Tier 3) Ded/Coins Ded/Coins Ded/Coins
Prescription Drugs (Specialty) Ded/Coins Ded/Coins Ded/Coins
More Details More Details More Details

 

73% – 2750/Copay 35 CSR 87% – $100 Ded/Copay 25 CSR 94% – $25 Ded/Copay 5 CSR
Deductible – In-Network
(Single/Family)
$2,750/$5,500 $100/$200 $25/$50
Out-of-Pocket Maximum
In-Network (Single/Family)
$5,850/$11,700 $2,450/$4,900 $1,000/$2,000
Coinsurance In-Network
(you pay)
20% 20% 20%
PCP1 (In-Network) $35 Copay $25 Copay $0 Copay
Specialist (In-Network) $70 Copay $50 Copay $20 Copay
Urgent Care (In-Network) $50 Copay $40 Copay $10 Copay
Aurora QuickCare /Bellin FastCare $15 Copay $15 Copay $0 Copay
Emergency Room2 (In- & Out-of-Network) Deductible; then $350 $350 Copay $150 Copay
In-Network Preventive Care3 $0 $0 $0
Prescription Drugs (Tier 1) $10 Copay $10 Copay $0 Copay
Prescription Drugs (Tier 2) $70 Copay $55 Copay $15 Copay
Prescription Drugs (Tier 3) Ded/Coins Ded/Coins Ded/Coins
Prescription Drugs (Specialty) Ded/Coins Ded/Coins Ded/Coins
More Details More Details More Details

 

73% – 2850/80 CSR 87% – 150/80 CSR 94% – $50 Ded/80 CSR
Deductible – In-Network
(Single/Family)
$2,850/$5,700 $150/$300 $50/$100
Out-of-Pocket Maximum
In-Network (Single/Family)
$5,850/$11,700 $2,450/$4,900 $1,000/$2,000
Coinsurance In-Network
(you pay)
20% 20% 20%
PCP1 (In-Network) $35 $25 $0
Specialist (In-Network) $70 $50 $20
Urgent Care (In-Network) $50 $40 $10
Aurora QuickCare /Bellin FastCare $15 $15 $0
Emergency Room2 (In- & Out-of-Network) Deductible; then $350 $350 $150
In-Network Preventive Care3 $0 $0 $0
Prescription Drugs (Tier 1) $10 $10 $0
Prescription Drugs (Tier 2) $70 $55 $15
Prescription Drugs (Tier 3) Ded/Coins Ded/Coins Ded/Coins
Prescription Drugs (Specialty) Ded/Coins Ded/Coins Ded/Coins
More Details More Details More Details

Click the links below to access the Schedule of Benefits for these 2017 plans:

 Silver 5200/80

2600/Copay 30 CSR   |  $0 Ded/Copay 25 CSR  | $0 Ded/Copay 0 CSR

Silver 2500/80

2500/Copay 30 CSR   |  $0 Ded/Copay 25 CSR  |  $0 Ded/Copay 5 CSR

Silver 2400/80

1700/80 CSR   |  200/80 CSR  |  $0 Ded/80 CSR

Silver 2000/70

1200/10RX CSR   |   175/10RX CSR  |   $0 Ded/5RX CSR

Silver 3500/80

3000/80 CSR   |   700/80 CSR  |   250/80 CSR

Silver 3800/80

2550/80/Copay 35 CSR   |   0/80/Copay 30 CSR  |   0/80/Copay 5 CSR

Silver HSA

1900/80 CSR   |  250/80 CSR  |  $50 Ded/80 CSR

1 PCP = Primary Care Provider (includes general pediatrics, internal medicine, OB/GYN, family practice, general medicine, chiropractor and geriatrics) Urgent = Urgent Care Services Emergency = Emergency Room Care Services

2 Services that meet the definition of emergency are paid at the in-network rate even when care is delivered in a non-network ER. Because we do not have a contract with out of network ER facilities, we cannot prevent these facilities from billing our members for the balance of the charge. The copay applies to the facility charge only. All other charges related to ER visit are subject to deductible/coinsurance.

3 Preventive Care received out of network is not covered

4 HSA Plan CSRs – None of the CSR variations for the Envision Silver HSA 3200/75 are HSA compatible.

Our Deductibles, Explained: All plans have a January 1 to December 31 deductible. All deductibles, coinsurance, and copayments accumulate toward the out-of-pocket maximum. All plans described on this page have embedded deductibles for family coverage. This means that if you are enrolled in 2-person or family coverage, an individual family member only has to satisfy the single person deductible before the plan begins to make payment for covered services for that family member. 

 

2018 Small Businesses Plans

 

Bronze 7000/100 Bronze HSA 5800/90 Bronze HSA 6400/100
Deductible – In-Network
(Single/Family)
$7,000/$14,000 $5,800/$11,600 $6,400/$12,800
Your deductible increases when you go out of network.
(Single/Family)
$14,000/$28,000 $11,600/$23,200 $12,800/$25,600
Out-of-Pocket Maximum
In-Network (Single/Family)
$7,000/$14,000 $6,500/$13,000 $6,400/$12,800
Out-of-Pocket Maximum
Out-of-Network (Single/Family)
$28,000/$56,000 $13,000/$26,000 $25,600/$51,200
Coinsurance In-Network
(you pay)
0% 10% 0%
Coinsurance Out-of-Network (you pay) 30% 40% 30%
PCP1 (In-Network) $35 for 3; Deductible Ded/Coins Deductible
Specialist (In-Network) Deductible Ded/Coins Deductible
Urgent Care (In-Network) Deductible Ded/Coins Deductible
Aurora QuickCare /Bellin FastCare Counts as PCP visit Ded/Coins Deductible
Emergency Room2 (In- & Out-of-Network) In-Network Deductible In-Network Ded/Coins In-Network Deductible
In-Network Preventive Care3 $0 $0 $0
Prescription Drugs (Tier 1) Deductible Ded/Coins Deductible
Prescription Drugs (Tier 2) Deductible Ded/Coins Deductible
Prescription Drugs (Tier 3) Deductible Ded/Coins Deductible
Prescription Drugs (Specialty) Deductible Ded/Coins Deductible
More Details More Details More Details

 

 

Silver 3600/80 Silver HSA 3600/100 Silver 3000/80/
Copay 35
Silver 2600/80 Silver 2000/80 Silver HSA 3000/80
Deductible – In-Network
(Single/Family)
$3,600/$7,200 $3,600/$7,200 $3,000/$6,000 $2,600/$5,200 $2,000/$4,000 $3,000/$6,000
Your deductible increases when you go out of network.
(Single/Family)
$7,200/$14,400 $7,200/$14,400 $6,000/$12,000 $5,200/$10,400 $4,000/$8,000 $6,000/$12,000
Out-of-Pocket Maximum – In-Network
(Single/Family)
$6,850/$13,700 $3,600/$7,200 $7,350/$14,700 $6,850/$13,700 $6,400/$12,800 $4,500/$9,000
Out-of-Pocket Maximum – Out-of-Network
(Single/Family)
$13,700/$27,400 $14,400/$28,800 $14,700/$29,400 $13,700/$27,400 $12,800/$25,600 $9,000/$18,000
Coinsurance In-Network
(you pay)
20% 0% 20% 20% 20% 20%
Coinsurance Out-of-Network (you pay) 50% 30% 50% 50% 50% 50%
PCP1 (In-Network) $40 Copay Deductible $35 Copay Ded/Coins Ded/Coins Ded/Coins
Specialist (In-Network) $80 Copay Deductible $75 Copay Ded/Coins Ded/Coins Ded/Coins
Urgent Care (In-Network) $50 Copay Deductible $50 Copay Ded/Coins Ded/Coins Ded/Coins
Aurora QuickCare /Bellin FastCare $15 Copay Ded/Coins $15 Copay Ded/Coins Ded/Coins Ded/Coins
Emergency Room2 (In- & Out-of-Network) $300 Copay In-Network
Deductible
$300 Copay In-Network
Ded/Coins
In-Network
Ded/Coins
In-Network
Ded/Coins
In-Network Preventive Care3 $0 $0 $0 $0 $0 $0
Prescription Drugs
(Tier 1)
$25 Copay Deductible $25 Copay $10 Copay Ded/Coins Ded/Coins
Prescription Drugs
(Tier 2)
$50 Copay Deductible $65 Copay Ded/Coins Ded/Coins Ded/Coins
Prescription Drugs
(Tier 3)
$75 Copay Deductible Ded/Coins Ded/Coins Ded/Coins Ded/Coins
Prescription Drugs (Specialty) Ded/Coins Deductible Ded/Coins Ded/Coins Ded/Coins Ded/Coins
More Details More Details More Details More Details More Details More Details

 

Gold 600/80 Gold 1000/80
Deductible – In-Network
(Single/Family)
$600/$1,200 $1,000/$2,000
Your deductible increases when you go out of network.
(Single/Family)
$1,200/$2,400 $2,000/$4,000
Out-of-Pocket Maximum
In-Network (Single/Family)
$6,850/$13,700 $7,300/$14,700
Out-of-Pocket Maximum
Out-of-Network (Single/Family)
$13,700/$27,400 $14,700/$29,400
Coinsurance In-Network
(you pay)
20% 20%
Coinsurance Out-of-Network (you pay) 50% 50%
PCP1 (In-Network) $35 Copay $35 Copay
Specialist (In-Network) $60 Copay $60 Copay
Urgent Care (In-Network) $50 Copay $50 Copay
Aurora QuickCare /Bellin FastCare $15 Copay $15 Copay
Emergency Room2 (In- & Out-of-Network) $300 Copay $300 Copay
In-Network Preventive Care3 $0 $0
Prescription Drugs (Tier 1) $10 Copay $10 Copay
Prescription Drugs (Tier 2) $45 Copay $45 Copay
Prescription Drugs (Tier 3) $75 Copay $75 Copay
Prescription Drugs (Specialty) Ded/Coins Ded/Coins
More Details More Details

Click the links below to access the Schedule of Benefits for these 2017 plans:

Bronze 7000/100   |   Bronze HSA

Silver HSA 3600/100  |  Silver HSA 3000/80 Silver 2400/80 Copay 35

Silver 3600/80   |  Silver 2000/80

Gold HSA   |   Gold 2700/100   |   Gold 600/80  |  Gold 1000/80

1 PCP = Primary Care Provider (includes general pediatrics, internal medicine, OB/GYN, family practice, general medicine, chiropractor and geriatrics) Urgent = Urgent Care Services Emergency = Emergency Room Care Services

2 Services that meet the definition of emergency are paid at the in-network rate even when care is delivered in a non-network ER. Because we do not have a contract with out of network ER facilities, we cannot prevent these facilities from billing our members for the balance of the charge. The copay applies to the facility charge only. All other charges related to ER visit are subject to deductible/coinsurance.

3 Preventive Care received out of network is not covered

Our Deductibles, Explained: All plans have a January 1 to December 31 deductible. All deductibles, coinsurance, and copayments accumulate toward the out-of-pocket maximum. In-network and out-of-network deductibles and out-of-pocket maximums must be satisfied separately. All plans described on this page with the exception of the Gold HSA plan have embedded deductibles for family coverage. This means that if you are enrolled in 2-person or family coverage, an individual family member only has to satisfy the single person deductible before the plan begins to make payment for covered services for that family member. With the Gold HSA, we are required to “aggregate” the deductibles to meet the minimum requirements for HSAs. Aggregate deductibles require a single person in family coverage to meet the family deductible before non-preventive health services are covered.

Common Ground Healthcare Cooperative does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations.

This page provides summary information.  Please refer to the certificate of coverage and schedule of benefits for a complete listing of benefits and terms of coverage.  A list of exclusions and limitations can be found here.