Frequently Asked Questions
Agent Section
Once a month, 4th Friday of the month
Statements are sent out via secure email every 3rd Friday of the month. If you do not receive this statement, contact Agent.Commissions@CommunityHealthChoice.org
First, make sure you are entering your username, NPN, and password given in your confirmation email when you were granted access or when you were appointed.
If you are still unable to login, you can request this information from Agent.Credentialing@CommunityHealthChoice.org
Member Section
Community Health Choice only offers HMO plans that require you to see an in-network (contracted) provider for covered services. Covered Services provided by a non-participating provider would only be covered in the case of an emergency or with prior authorization.
No. If your children are currently enrolled in CHIP or Medicaid or become eligible for CHIP or Medicaid during the year, they are not required to be enrolled on your Marketplace plan. You will however, have to enroll them in these programs when they become eligible and remove them from your Marketplace plan, or if they lose CHIP or Medicaid you can enroll them on your Marketplace plan at that time.
Yes. Your out of pocket maximum includes copayments, coinsurance(s), and deductible for all covered services. It does not include your monthly premium (you are always responsible for paying your monthly premium). If you reach your MOOP during the calendar year (01/01 - 12/31) you are covered at 100% for the remainder of that calendar year.
Yes, you will be required to select a PCP. If you do not select a PCP we will select one for you. You can change your PCP at anytime by calling Member Services. The change will take effect on the first day of the following month.
No, Community does not require you to have a referral to see a specialist however, there are some specialists that will require you to have seen a PCP and have a PCP referral before they will agree to schedule an appointment. If you are a Member of a Community Limited Network Plan using the Kelsey-Seybold Clinic network, Kelsey will require referrals but manages all their specialist referrals themselves.
Yes, after you have made your 2019 January premium payment (due by December 31, 2018), you will receive a welcome packet and a new Member ID card. A temporary card will also be available in your Member Portal after December 31st if you should ever lose it and need to print one before you receive a new one in the mail.
Payments can be made online through the one-time payment option, online through your Member Portal, through mail by check or money order, and by phone through our automated payment line or a member of our team. You may also pay onsite at our Community Cares Center Monday through Friday 8:00 a.m. to 5:00 p.m.
Payments can be made by check, money order, credit card, or checking/savings accounts.
Yes, you can set up automatic payments for 2019. However, you must first make your January 2019 premium payment and allow that payment to post to your account before setting up recurring payments.
If the Member is enrolled On-Exchange through the Health Insurance Marketplace, they need to call HC.gov @ 1.800.318.2596 to cancel their coverage. If the Member is enrolled Off-Exchange (direct with Community) then the Member can complete and return a Policy Termination Form for processing.
Newborns delivered by a person covered under a Community Policy are covered for the first 31 days of life for services related to the delivery. If you want full continuous coverage for the child, you will need to add them to your policy once the child is born
Routine eye exams, and eyeglasses or contact lens and covered for children 18 and under
During the annual open enrollment period you can change plans. Outside of annual open enrollment you can only make a plan change if you have a qualifying event (e.g. birth of child, loss of other coverage, etc.)
In order to access Kelsey-Seybold you must be enrolled in one of our Community Health Choice Limited Network plans. The plans are the Silver Limited Network 007 or the Gold Limited Network 006.
Community only offers HMO policies in Harris, Brazoria, Chambers, Fort Bend, Galveston, Jefferson, Liberty, Montgomery, Orange, and Waller Counties.
You can determine tax credit qualification by completing an account through Healthcare.gov or by calling Healthcare.gov at 1.800.318.2596.
If you have no income or your income is below 100% FPL as reported on your income tax return; you do not qualify for advanced premium tax credits through the Health Insurance Marketplace and you are not required to have health insurance or pay a penalty. You do however, need to file for a hardship exemption with HC.gov (this may also apply to someone earning up to 138%FPL)
Telehealth services gives you access to a board-certified doctor within minutes by phone - at no cost to you. The doctor can treat routine medical concerns 24/7 from anywhere by phone, web or mobile app. You can even get a new prescription or a refill. Telehealth services are available on most Community Health Choice Marketplace plans. Please contact Member Services at 713.295.6704 to confirm if your plan offers telehealth services.
Examples of when you may utilize telehealth services are when your primary care doctor is not available, you are traveling, or if you are thinking of visiting the ER or Urgent Care for routine medical concerns.
Please note that telehealth services are available on most Community Health Choice Marketplace plans. Please contact Member Services at 713.295.6704 to confirm if your plan offers telehealth services.
Telehealth services helps treat:
- Sinus problems
- Bronchitis
- Cold and flu symptoms
- Allergies
- Respiratory infections
- Ear infections
- And more
Please note that telehealth services are available service on most Community Health Choice Marketplace plans. Please contact Member Services at 713.295.6704 to confirm if your plan offers telehealth services.