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OUR PLANS

 

2018 Individual and Family Plans

Catastrophic5Bronze HSABronze 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)DeductibleDeductibleDeductible
Urgent Care (In-Network)DeductibleDeductibleDeductible
Aurora QuickCare /Bellin FastCare$0 for 3; then CoinsuranceDed/Coins$20 Copay
Emergency Room2 (In- & Out-of-Network)DeductibleDeductibleDeductible
In-Network Preventive Care3$0$0$0
Prescription Drugs (Tier 1)DeductibleDeductibleDeductible
Prescription Drugs (Tier 2)DeductibleDeductibleDeductible
Prescription Drugs (Tier 3)DeductibleDeductibleDeductible
Prescription Drugs (Specialty)DeductibleDeductibleDeductible
More DetailsMore DetailsMore Details
Silver 4000/75Silver HSASilver 3000/75/ Copay 40Silver 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 CopayDed/Coins$40 Copay$60
Specialist (In-Network)$80 CopayDed/Coins$80 Copay$100
Urgent Care (In-Network)$60 CopayDed/Coins$60 CopayDed/Coins
Aurora QuickCare /Bellin FastCare$20 CopayDed/Coins$20 Copay$20
Emergency Room2 (In- & Out-of-Network)Deductible; then $400Ded/CoinsDeductible; then $400Deductible; then $400
In-Network Preventive Care3$0$0$0$0
Prescription Drugs (Tier 1)$20 CopayDed/Coins$25 Copay$10
Prescription Drugs (Tier 2)Deductible; then $75Ded/CoinsDeductible; then $75$100
Prescription Drugs (Tier 3)Ded/CoinsDed/CoinsDed/CoinsDed/Coins
Prescription Drugs (Specialty)Ded/CoinsDed/CoinsDed/CoinsDed/Coins
More DetailsMore DetailsMore DetailsMore 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 CSR87% – $50 Ded/Copay 25 CSR94% – $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/CoinsDed/CoinsDed/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/CoinsDed/CoinsCoinsurance
Prescription Drugs (Specialty)Ded/CoinsDed/CoinsCoinsurance
More DetailsMore DetailsMore Details

 

 

73% – 2000/80 CSR487% – 200/80 CSR494% – $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/CoinsDed/CoinsDed/Coins
Specialist (In-Network)Ded/CoinsDed/CoinsDed/Coins
Urgent Care (In-Network)Ded/CoinsDed/CoinsDed/Coins
Aurora QuickCare /Bellin FastCareDed/CoinsDed/CoinsDed/Coins
Emergency Room2 (In- & Out-of-Network)Ded/CoinsDed/CoinsDed/Coins
In-Network Preventive Care3$0$0$0
Prescription Drugs (Tier 1)Ded/CoinsDed/CoinsDed/Coins
Prescription Drugs (Tier 2)Ded/CoinsDed/CoinsDed/Coins
Prescription Drugs (Tier 3)Ded/CoinsDed/CoinsDed/Coins
Prescription Drugs (Specialty)Ded/CoinsDed/CoinsDed/Coins
More DetailsMore DetailsMore Details

 

73% – 2750/Copay 35 CSR87% – $100 Ded/Copay 25 CSR94% – $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/CoinsDed/CoinsDed/Coins
Prescription Drugs (Specialty)Ded/CoinsDed/CoinsDed/Coins
More DetailsMore DetailsMore Details

 

73% – 2850/80 CSR87% – 150/80 CSR94% – $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/CoinsDed/CoinsDed/Coins
Prescription Drugs (Specialty)Ded/CoinsDed/CoinsDed/Coins
More DetailsMore DetailsMore 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 7000/100Bronze HSA 5800/90Bronze 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; DeductibleDed/CoinsDeductible
Specialist (In-Network)DeductibleDed/CoinsDeductible
Urgent Care (In-Network)DeductibleDed/CoinsDeductible
Aurora QuickCare /Bellin FastCareCounts as PCP visitDed/CoinsDeductible
Emergency Room2 (In- & Out-of-Network)In-Network DeductibleIn-Network Ded/CoinsIn-Network Deductible
In-Network Preventive Care3$0$0$0
Prescription Drugs (Tier 1)DeductibleDed/CoinsDeductible
Prescription Drugs (Tier 2)DeductibleDed/CoinsDeductible
Prescription Drugs (Tier 3)DeductibleDed/CoinsDeductible
Prescription Drugs (Specialty)DeductibleDed/CoinsDeductible
More DetailsMore DetailsMore Details

 

 

Silver 3600/80Silver HSA 3600/100Silver 3000/80/
Copay 35
Silver 2600/80Silver 2000/80Silver 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 CopayDeductible$35 CopayDed/CoinsDed/CoinsDed/Coins
Specialist (In-Network)$80 CopayDeductible$75 CopayDed/CoinsDed/CoinsDed/Coins
Urgent Care (In-Network)$50 CopayDeductible$50 CopayDed/CoinsDed/CoinsDed/Coins
Aurora QuickCare /Bellin FastCare$15 CopayDed/Coins$15 CopayDed/CoinsDed/CoinsDed/Coins
Emergency Room2 (In- & Out-of-Network)$300 CopayIn-Network
Deductible
$300 CopayIn-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 CopayDeductible$25 Copay$10 CopayDed/CoinsDed/Coins
Prescription Drugs
(Tier 2)
$50 CopayDeductible$65 CopayDed/CoinsDed/CoinsDed/Coins
Prescription Drugs
(Tier 3)
$75 CopayDeductibleDed/CoinsDed/CoinsDed/CoinsDed/Coins
Prescription Drugs (Specialty)Ded/CoinsDeductibleDed/CoinsDed/CoinsDed/CoinsDed/Coins
More DetailsMore DetailsMore DetailsMore DetailsMore DetailsMore Details

 

Gold 600/80Gold 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/CoinsDed/Coins
More DetailsMore 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.