SILVER $0 DED/COPAY 5 MAX 1,000 CSR PLAN
3600/80 – 94%
for Individuals and Families
MAJOR PLAN BENEFIT
Our Cost Share Reduction (CSR) plans lower the amount you pay for deductibles, coinsurance and co-payments. You also have a lower out-of-pocket maximum. You can get these savings in plans in the Silver plan category if your income is below a certain level. To see if you qualify for a CSR plan, visit www.healthcare.gov/lower-costs.
Even if you haven’t met your yearly deductible, you can still get the free, in-network preventive care recommended under the Affordable Care Act. Preventive care includes certain screenings, vaccines, and annual physicals when performed by an in-network provider.
CGHC DOCTOR LINE
The CGHC Doctor Line, powered by Teladoc, Inc is a service that allows you to receive treatment from a Board Certified, licensed physician via phone, video, or mobile app. The first three consultations are free for most CGHC members except for those in a Health Savings Account (HSA) compatible plan, due to federal HSA rules. If you have satisfied your three visits, or you are in an HSA plan, you will pay $40 or your PCP co-pay, whichever is less. Learn more about the CGHC Doctor Line!
COVERAGE WHERE YOU NEED IT
YOUR NETWORK OF PROVIDERS
We are proud to partner with Aurora Healthcare System and Bellin Health, both recognized for quality, to serve our members in 19 counties. Learn more about the Envision Aurora/Bellin network!
URGENT CARE COPAY EQUAL TO A PCP VISIT
We understand the importance of enabling you to see a doctor when you need to, which may not always be during typical office hours.
COVERAGE FROM ANY PHARMACY
This plan does not limit you to certain in-network pharmacy providers.
EMERGENCY CARE, ANYWHERE, IS IN-NETWORK
Services that meet the definition of emergency are covered as in network even when care is delivered in a non-network ER.
GET THE MOST FROM YOUR PLAN
During the plan year, CGHC will pay 80% of all your in-network, covered health bills until you reach your Out-of-Pocket Maximum of $1,000. At that point, we’ll cover 100% of your in-network covered medical bills for the rest of the year.
YOU WILL PAY
$5 – Primary Care Provider
$5 – Urgent Care
$10 – Specialist
$100 – Emergency Room
Single – $0
Family – $0
Single – $1,000
Family – $2,000
20% of charges for in-network care
50% of charges for out-of-network care
$10 – Tier 1
$15 – Tier 2
$40 – Tier 3
Specialty – You will pay 20% of the discounted price of covered specialty medications until you reach your out-of-pocket maximum, then they will be covered at 100%
VIEW OTHER PLANS
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.