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INDIVIDUALS AND FAMILIES

Compare all plan options below



2019 Individual and Family Plans



  Catastrophic5 Bronze HSA Bronze 7900/100
Deductible – In-Network (Single/Family) $7,900/$15,800 $6,650/$13,300 $7,900/$15,800
       
Out-of-Pocket Maximum – In-Network (Single/Family) $7,900/$15,800 $6,650/$13,300 $7,900/$15,800
       
Coinsurance In-Network (you pay)  0%  0%  0%
       
PCP1 (In-Network) $0 for 3; Deductible Deductible $35 for 3; Deductible
Specialist (In-Network) Deductible Deductible Deductible
Urgent Care (In-Network) Deductible Deductible Deductible
Aurora QuickCare /Bellin FastCare $0 for 3; then Coinsurance Ded/Coins $20 Copay
Emergency Room2 (In-Network) Deductible Deductible Deductible
In-Network Preventive Care3 $0 $0 $0
Prescription Drugs (Tier 1) Deductible Deductible Deductible
Prescription Drugs (Tier 2) Deductible Deductible Deductible
Prescription Drugs (Tier 3) Deductible Deductible Deductible
Prescription Drugs (Specialty) Deductible Deductible Deductible
  More Details More Details More Details
  Silver 4000/75 Silver HSA Silver 3000/75/ Copay 40 Silver 6000/754      
Deductible – In-Network (Single/Family) $4,000/$8,000 $3,500/$7,000 $3,000/$6,000 $6,000/$12,000      
               
Out-of-Pocket Maximum In-Network (Single/Family) $7,900/$15,800 $6,650/$13,300 $7,900/$15,800 $7,900/$15,800      
               
Coinsurance In-Network (you pay) 25% 25% 25% 25%      
               
PCP1 (In-Network) $50 Copay Ded/Coins $40 Copay $60 Copay      
Specialist (In-Network) $80 Copay Ded/Coins $80 Copay $100 Copay      
Urgent Care (In-Network) $100 Copay Ded/Coins $100 Copay Ded/Coins      
Aurora QuickCare /Bellin FastCare $20 Copay Ded/Coins $20 Copay $20 Copay      
Emergency Room2 (In-Network) Deductible; then $400 Ded/Coins Deductible; then $400 Deductible; then $400      
               
In-Network Preventive Care3 $0 $0 $0 $0      
Prescription Drugs (Tier 1) $20 Copay Ded/Coins $25 Copay $10 Copay      
Prescription Drugs (Tier 2) Deductible; then $75 Ded/Coins Ded; then $75 $100 Copay      
Prescription Drugs (Tier 3) Ded/Coins Ded/Coins Ded/Coins Ded/Coins      
Prescription Drugs (Specialty) Deductible; then 30% Ded; then 30% Ded; then 30% Ded; then 40%      
  More Details More Details More Details More Details      
  Gold 2000/80
Deductible – In-Network (Single/Family) $2,000/$4,000
   
Out-of-Pocket Maximum – In-Network (Single/Family) $7,900/$15,800
   
Coinsurance In-Network (you pay) 20%
   
PCP1 (In-Network) $40 Copay
Specialist (In-Network) $60 Copay
Urgent Care (In-Network) $75 Copay
Aurora QuickCare /Bellin FastCare $15 Copay
Emergency Room2 (In-Network) $300 Copay
   
In-Network Preventive Care3 $0
Prescription Drugs (Tier 1) $10 Copay
Prescription Drugs (Tier 2) $50 Copay
Prescription Drugs (Tier 3) Deductible; then $100
Prescription Drugs (Specialty) Deductible; then 30%
  More Details

Click the links below to access the Schedule of Benefits for these 2018 plans:

Catastrophic  7350/100 |   Bronze  7350/100  |   Bronze HSA 6650/100

Silver 3000/75/Copay 40  |  Silver 5500/80 | Silver HSA 3200/75

Silver  4000/75  |   Gold 2000/80

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 6000/75 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. Deductibles and out-of-pocket maximums must be satisfied separately. 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. 

Cost Share Reduction Plans (Silver Base Plans)

  73% – 2700/Copay 35 CSR 87% – 300/Copay 15 CSR 94% – $50 Ded/Copay 5 CSR
Deductible – In-Network (Single/Family) $2,700/$5,400 $300/$600 $50/$100
       
Out-of-Pocket Maximum In-Network (Single/Family) $6,300/$12,600 $2,600/$5,200 $1,200/$2,400
       
Coinsurance In-Network (you pay) 25% 20% 20%
       
PCP1 (In-Network) $40 Copay $15 Copay $5 Copay
Specialist (In-Network) $80 Copay $30 Copay $20 Copay
Urgent Care (In-Network) Ded/Coins Ded/Coins Ded/Coins
Aurora QuickCare /Bellin FastCare $15 Copay $15 Copay $5 Copay
Emergency Room2(In- & Out-of-Network) Deductible; then $400 $350 $150
       
In-Network Preventive Care3 $0 $0 $0
Prescription Drugs (Tier 1) $10 Copay $10 Copay $0
Prescription Drugs (Tier 2) $75 Copay $55 Copay $15 Copay
Prescription Drugs (Tier 3) Ded/Coins Ded/Coins Ded/Coins
Prescription Drugs (Specialty) Deductible; then 30% Ded; then 30% Ded; then 30%
  More Details More Details More Details
  73% – 2000/80 CSR4 87% – 450/80 CSR4 94% – 100/85 CSR4
Deductible – In-Network (Single/Family) $2,000/$4,000 $450/$900 $100/$200
       
Out-of-Pocket Maximum In-Network (Single/Family) $6,300/$12,600 $2,600/$5,200 $1,200/$2,400
       
Coinsurance In-Network (you pay) 20% 20% 15%
       
PCP1 (In-Network) Ded/Coins Ded/Coins Ded/Coins
Specialist (In-Network) Ded/Coins Ded/Coins Ded/Coins
Urgent Care (In-Network) Ded/Coins Ded/Coins Ded/Coins
Aurora QuickCare /Bellin FastCare Ded/Coins Ded/Coins Ded/Coins
Emergency Room2 (In-Network) Ded/Coins Ded/Coins Ded/Coins
       
In-Network Preventive Care3 $0 $0 $0
Prescription Drugs (Tier 1) Ded/Coins Ded/Coins Ded/Coins
Prescription Drugs (Tier 2) Ded/Coins Ded/Coins Ded/Coins
Prescription Drugs (Tier 3) Ded/Coins Ded/Coins Ded/Coins
Prescription Drugs (Specialty) Ded; then 30% Ded; then 30% Ded; then 30%
  More Details More Details More Details
  73% – 2750/75 CSR 87% – 350/80 CSR 94% – 150/80 CSR
Deductible – In-Network (Single/Family) $2,750/$5,500 $350/$700 $150/$300
       
Out-of-Pocket Maximum In-Network (Single/Family) $6,300/$12,600 $2,600/$5,200 $1,200/$2,400
       
Coinsurance In-Network (you pay) 25% 20% 20%
       
PCP1 (In-Network) $40 Copay $15 Copay $5 Copay
Specialist (In-Network) $80 Copay $30 Copay $20 Copay
Urgent Care (In-Network) $75 Copay $60 Copay $30 Copay
Aurora QuickCare /Bellin FastCare $15 Copay $15 Copay $5 Copay
Emergency Room2 (In-Network) Deductible; then $400 $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) $75 Copay $55 Copay $15 Copay
Prescription Drugs (Tier 3) Ded/Coins Ded/Coins Ded/Coins
Prescription Drugs (Specialty) Ded; then 30% Ded; then 30% Ded; then 30%
  More Details More Details More Details
  73% – 2850 Ded/75 CSR 87% – 400 Ded/80 CSR 94% – 200 Ded/80 CSR
Deductible – In-Network (Single/Family) $2,850/$5,700 $400/$800 $200/$400
       
Out-of-Pocket Maximum In-Network (Single/Family) $6,300/$12,600 $2,600/$5,200 $1,200/$2,400
       
Coinsurance In-Network (you pay) 25% 20% 20%
       
PCP1 (In-Network) $40 $15 $5
Specialist (In-Network) $80 $30 $20
Urgent Care (In-Network) $75 $60 $30
Aurora QuickCare /Bellin FastCare $15 $15 $5
Emergency Room2 (In-Network) Deductible; then $400 $350 $150
       
In-Network Preventive Care3 $0 $0 $0
Prescription Drugs (Tier 1) $10 $10 $0
Prescription Drugs (Tier 2) $75 $55 $15
Prescription Drugs (Tier 3) Ded/Coins Ded/Coins Ded/Coins
Prescription Drugs (Specialty) Ded; then 30% Ded; then 30% Ded; then 30%
  More Details More Details More Details

Click the links below to access the Schedule of Benefits for these 2018 plans:

 Silver 4000/75

2850 CSR   |  150 CSR  | 50 CSR

Silver HSA 3200/75

2000 CSR   |  200 CSR  |  50 CSR

Silver 3000/75/Copay 40

2750 CSR   |  100 CSR  |  25 CSR

Silver 5500/80

2700 CSR   |   50 CSR  |   0 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. 

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.