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SMALL BUSINESSES

Compare all plan options below

Small Business Plans

Bronze 6850/100 Bronze HSA 5650/90 Silver HSA 3000/80 Silver 2400/80 Silver 1800/80 Silver 3600/80 Silver 2400/80/
Copay 35
Gold HSA 2300/100 Gold 1000/90 Gold 600/80
Deductible – In-Network
(Single/Family)
$6,850/
$13,700
$5,650/
$11,300
$3,000/
$6,000
$2,400/
$4,800
$1,800/
$3,600
$3,600/
$7,200
$2,400/
$4,800
$2,300/
$4,600
$1,000/
$2,000
$600/
$1,200
Your deductible increases when you go out of network.
(Single/Family)
$13,700/
$27,400
$11,300/
$22,600
$6,000/
$12,000
$4,800/
$9,600
$3,600/
$7,200
$7,200/
$14,400
$4,800/
$9,600
$4,600/
$9,200
$2,000/
$4,000
$1,200/
$2,400
Out-of-Pocket Maximum
In-Network (Single/Family)
$6,850/
$13,700
$6,500/
$13,000
$4,500/
$9,000
5$6,850/
$13,700
$6,850/
$13,700
$6,850/
$13,700
5$6,850/
$13,700
$2,300/
$4,600
$6,850/
$13,700
$6,850/
$13,700
Out-of-Pocket Maximum
Out-of-Network (Single/Family)
$27,400/
$54,800
$13,000/
$26,000
$9,000/
$18,000
$13,700/
$27,400
$13,700/
$27,400
$13,700/
$27,400
$13,700/
$27,400
$9,200/
$18,400
$13,700/
$27,400
$13,700/
$27,400
Coinsurance In-Network
(you pay)
0% 10% 20% 20% 20% 20% 20% 0% 10% 20%
Coinsurance Out-of-Network (you pay) 30% 40% 50% 50% 50% 50% 50% 30% 40% 50%
PCP1 (In-Network) $35 for 3;
Deductible
Ded/Coins Ded/Coins Ded/Coins Ded/Coins $35 Copay $35 Copay Deductible $35
Copay
$35
Copay
Specialist (In-Network) Ded/Coins Ded/Coins Ded/Coins Ded/Coins Ded/Coins $60
Copay
$60
Copay
Deductible $60
Copay
$60
Copay
Urgent Care (In-Network) Ded/Coins Ded/Coins Ded/Coins Ded/Coins Ded/Coins $35
Copay
$35
Copay
Deductible $35
Copay
$35
Copay
CGHC Doctor Line2 $0 for 3 $0 for 3 $0 for 3 $0 for 3 $0 for 3 $0 for 3 $0 for 3
In-Network Preventive Care3 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0
Emergency Room4 (In- & Out-of-Network) In-Network Ded/Coins In-Network Ded/Coins In-Network Ded/Coins In-Network Ded/Coins In-Network Ded/Coins $250
Copay
$250
Copay
In-Network Deductible $250
Copay
$250
Copay
Prescription Drugs (Tier 1) Deductible Ded/Coins Ded/Coins Ded/Coins Ded/Coins $25 $25 Deductible $10 $10
Prescription Drugs (Tier 2) Deductible Ded/Coins Ded/Coins Ded/Coins Ded/Coins $50 $50 Deductible $45 $45
Prescription Drugs (Tier 3) Deductible Ded/Coins Ded/Coins Ded/Coins Ded/Coins $75 $75 Deductible $75 $75
Prescription Drugs (Specialty) Deductible Ded/Coins Ded/Coins Ded/Coins Ded/Coins Ded/
Coins
Ded/
Coins
Deductible Ded/
Coins
Ded/
Coins
More Details More
Details
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Bronze 6850/100 Bronze HSA 5650/90
Deductible – In-Network
(Single/Family)
$6,850/$13,700 $5,650/$11,300
Your deductible increases when you go out of network. (Single/Family) $13,700/$27,400 $11,300/$22,600
Out-of-Pocket Maximum
In-Network (Single/Family)
$6,850/$13,700 $6,500/$13,000
Out-of-Pocket Maximum
Out-of-Network (Single/Family)
$27,400/$54,800 $13,000/$26,000
Coinsurance In-Network
(you pay)
0% 10%
Coinsurance Out-of-Network (you pay) 30% 40%
PCP1 (In-Network) $35 for 3; Deductible Ded/Coins
Specialist (In-Network) Deductible Ded/Coins
Urgent Care (In-Network) Deductible 5Ded/Coins
CGHC Doctor Line2 $0 for 3
In-Network Preventive Care3 $0 $0
Emergency Room4 (In- & Out-of-Network) In-Network Deductible In-Network Ded/Coins
Prescription Drugs (Tier 1) Deductible Ded/Coins
Prescription Drugs (Tier 2) Deductible Ded/Coins
Prescription Drugs (Tier 3) Deductible Ded/Coins
Prescription Drugs (Specialty) Deductible Ded/Coins
More Details More Details
Silver HSA 3000/80 Silver 2400/80 Silver 1800/80 Silver 3600/80 Silver 2400/80/
Copay 35
Deductible – In-Network
(Single/Family)
$3,000/$6,000 $2,400/$4,800 $1,800/$3,600 $3,600/$7,200 $2,400/$4,800
Your deductible increases when you go out of network.
(Single/Family)
$6,000/$12,000 $4,800/$9,600 $3,600/$7,200 $7,200/$14,400 $4,800/$9,600
Out-of-Pocket Maximum – In-Network
(Single/Family)
$4,500/$9,000 6,850/$13,700 6,850/$13,700 $6,850/$13,700 $6,850/$13,700
Out-of-Pocket Maximum – Out-of-Network
(Single/Family)
$9,000/$18,000 $13,700/$27,400 $13,700/$27,400 $13,700/$27,400 $13,700/$27,400
Coinsurance In-Network
(you pay)
20% 20% 20% 20% 20%
Coinsurance Out-of-Network (you pay) 50% 50% 50% 50% 50%
PCP1 (In-Network) Ded/Coins Ded/Coins Ded/Coins $35 Copay $35 Copay
Specialist (In-Network) Ded/Coins Ded/Coins Ded/Coins $60 Copay $60 Copay
Urgent Care (In-Network) Ded/Coins Ded/Coins Ded/Coins $35 Copay $35 Copay
CGHC Doctor Line2 $0 for 3 $0 for 3 $0 for 3 $0 for 3
In-Network Preventive Care3 $0 $0 $0 $0 $0
Emergency Room4 (In- & Out-of-Network) In-Network
Ded/Coins
In-Network
Ded/Coins
In-Network
Ded/Coins
In-Network
Ded/Coins
In-Network
Ded/Coins
Prescription Drugs (Tier 1) Ded/Coins Ded/Coins Ded/Coins $25 Copay $25 Copay
Prescription Drugs (Tier 2) Ded/Coins Ded/Coins Ded/Coins $50 Copay $50 Copay
Prescription Drugs (Tier 3) Ded/Coins Ded/Coins Ded/Coins $75 Copay $75 Copay
Prescription Drugs (Specialty) Ded/Coins Ded/Coins Ded/Coins Ded/Coins Ded/Coins
More Details More Details More Details More Details More Details
Gold HSA 2300/100 Gold 1000/90 Gold 600/80
Deductible – In-Network
(Single/Family)
$2,300/$4,600 $1,000/$2,000 $600/$1,200
Your deductible increases when you go out of network.
(Single/Family)
$4,600/$9,200 $2,000/$4,000 $1,200/$2,400
Out-of-Pocket Maximum
In-Network (Single/Family)
$2,300/$4,600 $6,850/$13,700 $6,850/$13,700
Out-of-Pocket Maximum
Out-of-Network (Single/Family)
$9,200/$18,400 $13,700/$27,400 $13,700/$27,400
Coinsurance In-Network
(you pay)
0% 10% 20%
Coinsurance Out-of-Network (you pay) 30% 40% 50%
PCP1 (In-Network) Deductible $35 Copay $35 Copay
Specialist (In-Network) Deductible $60 Copay $60 Copay
Urgent Care (In-Network) Deductible $35 Copay $35 Copay
CGHC Doctor Line2 $0 for 3 $0 for 3
In-Network Preventive Care3 $0 $0 $0
Emergency Room4 (In- & Out-of-Network) In-Network Deductible $250 Copay $250 Copay
Prescription Drugs (Tier 1) Deductible $10 Copay $10 Copay
Prescription Drugs (Tier 2) Deductible $45 Copay $45 Copay
Prescription Drugs (Tier 3) Deductible $75 Copay $75 Copay
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 2015 plans:

Bronze 5800/100   |   Bronze HSA

Silver 1500/80   |   Silver 2000/80   |   Silver HSA 2500/80

Silver 2000/80/Copay 30   |   Silver 3000/80/Copay 30

Gold HSA 2000/100   |   Gold 500/90   |   Gold 500/80

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 CGHC Doctor Line – This service makes available to our members phone calls with a licensed physician. 3 no-cost doctor line calls are provided per non-HSA policy holder. Total visits are capped at 3 within 3 months or 8 within 12 months.

3 Preventive care received out of network is not covered.

4 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.

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.