Member Services: 877-514-2442

SILVER 5200/80 CSR PLAN
2600/Copay 30 – 73%

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.

HEALTH PERKS

PREVENTIVE CARE
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 new service that allows you to receive treatment from a Board Certified, licensed physician via video, mobile application, or telephone. 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.

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. Click here to find a provider in the Envision network.

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.
(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.)

CONVENIENT ACCESS TO CARE
Get the care you need, when you need it. Stop by one of the Aurora QuickCare or Bellin FastCare locations for convenient access to diagnose or treat common conditions such as strep throat, ear infection or sinus infection. CGHC members can take advantage of a special co-pay rate for visits.

GET THE MOST FROM YOUR PLAN

Most of your healthcare costs are paid after you hit your deductible and your out-of-pocket maximum. Once you’ve met your
deductible during the plan year, CGHC will pay 80% of all your in-network health bills until you reach your Out-of-Pocket Maximum
of $5,700 (more for families and out-of-network providers). At that point, we’ll cover 100% of your in-network covered medical bills for
the rest of the year.

PLAN FACTS

YOU WILL PAY
(per visit)

$30 – Primary Care Provider
$15 – Express Care
Deductible/Coinsurance
– Urgent Care
$50
– Specialist
Deductible, then $300
 – Emergency Room

IN-NETWORK DEDUCTIBLE

Single – $2,600
Family – $5,200

OUT-OF-POCKET MAX.

Single – $5,700
Family – $11,400
(In-Network)

CO-INSURANCE

20% of charges for in-network care
50% of charges for out-of-network care

PRESCRIPTION DRUGS

$10 – Tier 1
$50 – Tier 2
$75 – Tier 3
Specialty – You will pay the discounted price of covered specialty medications until your deductible is met, then you will pay 20% of the discounted rate until you reach your out-of-pocket maximum.

Download a copy of your plan’s Summary of Benefits and Coverage

Common Ground Healthcare Cooperative complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

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.