Member Services: 877-514-2442

OUR PLANS

Compare small business plan options below

 

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 covered as in network even when care is delivered in a non-network ER. The copay will apply only to the facility charge. 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.