Member Services: 877-514-2442

SMALL BUSINESSES

Compare all plan options below

Small Business Plans

Bronze 6850/100Bronze HSA 5650/90Silver HSA 3000/80Silver 2400/80Silver 1800/80Silver 3600/80Silver 2400/80/
Copay 35
Gold HSA 2300/100Gold 1000/90Gold 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/CoinsDed/CoinsDed/CoinsDed/Coins$35 Copay$35 CopayDeductible$35
Copay
$35
Copay
Specialist (In-Network)Ded/CoinsDed/CoinsDed/CoinsDed/CoinsDed/Coins$60
Copay
$60
Copay
Deductible$60
Copay
$60
Copay
Urgent Care (In-Network)Ded/CoinsDed/CoinsDed/CoinsDed/CoinsDed/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/CoinsIn-Network Ded/CoinsIn-Network Ded/CoinsIn-Network Ded/CoinsIn-Network Ded/Coins$250
Copay
$250
Copay
In-Network Deductible$250
Copay
$250
Copay
Prescription Drugs (Tier 1)DeductibleDed/CoinsDed/CoinsDed/CoinsDed/Coins$25$25Deductible$10$10
Prescription Drugs (Tier 2)DeductibleDed/CoinsDed/CoinsDed/CoinsDed/Coins$50$50Deductible$45$45
Prescription Drugs (Tier 3)DeductibleDed/CoinsDed/CoinsDed/CoinsDed/Coins$75$75Deductible$75$75
Prescription Drugs (Specialty)DeductibleDed/CoinsDed/CoinsDed/CoinsDed/CoinsDed/
Coins
Ded/
Coins
DeductibleDed/
Coins
Ded/
Coins
More DetailsMore
Details
More DetailsMore DetailsMore DetailsMore DetailsMore DetailsMore DetailsMore DetailsMore Details
Bronze 6850/100Bronze 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; DeductibleDed/Coins
Specialist (In-Network)DeductibleDed/Coins
Urgent Care (In-Network)Deductible5Ded/Coins
CGHC Doctor Line2$0 for 3
In-Network Preventive Care3$0$0
Emergency Room4 (In- & Out-of-Network)In-Network DeductibleIn-Network Ded/Coins
Prescription Drugs (Tier 1)DeductibleDed/Coins
Prescription Drugs (Tier 2)DeductibleDed/Coins
Prescription Drugs (Tier 3)DeductibleDed/Coins
Prescription Drugs (Specialty)DeductibleDed/Coins
More DetailsMore Details
Silver HSA 3000/80Silver 2400/80Silver 1800/80Silver 3600/80Silver 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/$9,0006,850/$13,7006,850/$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/CoinsDed/CoinsDed/Coins$35 Copay$35 Copay
Specialist (In-Network)Ded/CoinsDed/CoinsDed/Coins$60 Copay$60 Copay
Urgent Care (In-Network)Ded/CoinsDed/CoinsDed/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/CoinsDed/CoinsDed/Coins$25 Copay$25 Copay
Prescription Drugs (Tier 2)Ded/CoinsDed/CoinsDed/Coins$50 Copay$50 Copay
Prescription Drugs (Tier 3)Ded/CoinsDed/CoinsDed/Coins$75 Copay$75 Copay
Prescription Drugs (Specialty)Ded/CoinsDed/CoinsDed/CoinsDed/CoinsDed/Coins
More DetailsMore DetailsMore DetailsMore DetailsMore Details
Gold HSA 2300/100Gold 1000/90Gold 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/CoinsDed/CoinsDed/Coins
More DetailsMore DetailsMore 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.