Health Insurance Marketplace

A plan that cares about you

Community Health Choice’s Marketplace plans pair affordability and service with one of the best networks in Southeast Texas – creating the kind of care that can only come from your local health plan.

We offer a range of plans so that our Members can customize their health coverage to their needs. What remains the same for all of our plans, however, is the unmatched level of service that you can expect to receive.

Whether you’re getting one-on-one help at our new Community Care Centers, learning how to manage a chronic condition from our care management team, or reading about how to live a healthier life on our newsletter blog, you know that you are getting the best service that any health plan can offer.

Rate Justification

Deductible Plans

Doctor and patient in agreement

Our Deductible Plans are ideal for those who prefer to pay for healthcare services as they go, in order to have low, monthly out-of-pocket expenses.

  • Bronze Deductible Plan - Lowest possible premiums.
  • Silver Deductible Plan - Balanced mix of low copays and a low deductible.
  • Gold Deductible Plan - Lowest copays and lowest deductible

Texas Department of Insurance Disclosure Form
The HMO Deductible plan include a deductible. Because you are required to pay a deductible, these plans are defined as “Consumer Choice” health benefit plan and not a state-mandated health insurance plan.

Copay Plans

Latin couple happily look over document

Our Copay Plans are ideal for those who look for predictable, up-front costs, to reduce last-minute expenses. Copay plans have 0 deductible.

  • Silver Copay Plan - Lowest premium with no deductible
  • Gold Copay Plan - Lowest copays with no deductible

Plan Overview 2018

Deductible Plans

MEMBER COST SHARE

*High Deductible Health Plan HSA Compatible

Plan ID
27248TX0010008

HMO Bronze Deductible 003

Plan ID
27248TX0010003

HMO Silver Deductible Plans 004**

Plan ID: 27248TX0010003

*Gold Deductible 005

Plan ID
27248TX0010005

*Silver Deductible 004
250% FPL and above

*Silver Deductible 004 (73)
200%-249% FPL
Silver Deductible 004 (87)
150%-199% FPL
Silver Deductible 004 (94)
100%-149% FPL
Medical Deductible
(individual / family)*
$6,000 / $12,000 $6,000 / $12,000 $2,500 / $5,000 $2,000 / $4,000 N/A N/A $500 / $1,000
Out-of-Pocket Max
(individual / family)
$6,000 / $12,000 $7,350 / $14,700 $7,350 / $14,700 $5,850 / $11,700 $2,450 / $4,900 $1,400 / $2,800 $5,000 / $10,000
MEDICAL BENEFITS MEMBER COPAYS/COINSURANCE
PCP Office Visit No charges after deductible $40 $30 $30 $15 $10 $20
Specialist Office Visit $65 $50 $50 $50 $20 $45
Outpatient Facility $400 $200 $200 $150 $30 $150
Outpaitent Surgery $400 $200 $200 $150 $30 $150
Urgent Care Services $65 $50 $50 $50 $20 $45
Ambulance Services $65 $50 $50 $50 $20 $45
Emergency Room Services 30% $500 $500 $300 $100 $400
Inpatient Hospital Care** 30% $500 copay per day $500 copay per day $300 copay per day $200 copay per day $400 copay per day
Inpatient Skilled Nursing Facility** 30% $500 copay per day $500 copay per day $300 copay per day $200 copay per day $400 copay per day
Outpatient Mental/Behavioral Substance Abuse $65 $50 $50 $50 $20 $45
Inpatient Mental/Behavioral Substance Abuse** 30% $500 copay per day $500 copay per day $300 copay per day $200 copay per day $400 copay per day
Outpatient Rehabilitation $65 $50 $50 $50 $10 $45
Medical Imaging (CT/PET Scans, MRIs) $500 $500 $500 $300 $100 $400
Routine Lab/X-Ray/Diagnostic Imaging $40 $30 $30 $15 $10 $20
PRESCRIPTION DRUGS MEMBER COPAYS/COINSURANCE
Prescription Drug Deductible
(individual / family)*
$0 $200 / $400 $0 $0 $0 $0 $0
Generic No charges after deductible $10 $10 $10 $10 $5 $10
Preferred Brand $60 $50 $40 $35 $20 $40
Non-Preferred Brand $110 $100 $90 $70 $40 $70
Specialty High Cost Drugs 40% 45% 40% 30% 20% 30%

* All coinsurance/copays apply after annual deductible has been met

** Copay applies for first 5 days of admission

♦ All coinsurance/copays apply after prescription drug deductible has been met

✤ For Bronze 003 deductible plan, 3 PCP office visits are covered at the PCP copay prior to deductible

Some products are only offered on-exchange through the Health Insurance Marketplace and require specific eligibility criteria to enroll.

Copay Plans

MEMBER COST SHARE

HMO Silver Copay 002 & 007

Plan ID’s 27248TX0010002 & 27248TX0010007

Gold Copay 001 & 006

Plan ID’s 27248TX0010001
and 27248TX0010006

Silver Copay 002 & 007
250% FPL and above

Silver Copay 002 & 007 (73)
200%-249% FPL
Silver Copay 002 & 007 (87)
150%-199% FPL
Silver Copay 002 & 007 (94)
100%-149% FPL
Medical Deductible
(individual / family)*
$0 $0 $0 $0 $0
Out-of-Pocket Max
(individual / family)
$7,350 / $14,700 $5,850 / $11,700 $2,450 / $4,900 $1,400 / $2,800 $7,350 / $14,700
MEDICAL BENEFITS MEMBER COPAYS/COINSURANCE
PCP Office Visit $40 $40 $15 $10 $30
Specialist Office Visit $75 $75 $50 $20 $65
Outpatient Facility $300 $300 $150 $30 $150
Outpaitent Surgery $300 $300 $150 $30 $150
Urgent Care Services $75 $75 $50 $20 $65
Ambulance Services $75 $75 $50 $20 $65
Emergency Room Services $600 $600 $300 $100 $400
Inpatient Hospital Care** $600 $600 $300 $200 $400
Inpatient Skilled Nursing Facility** $600 $600 $300 $200 $400
Outpatient Mental/Behavioral Substance Abuse $75 $75 $50 $20 $65
Inpatient Mental/Behavioral Substance Abuse** $600 $600 $300 $200 $400
Outpatient Rehabilitation $75 75 $50 $10 $65
Medical Imaging (CT/PET Scans, MRIs) $350 $350 $300 $100 $300
Routine Lab/X-Ray/Diagnostic Imaging $40 $40 $15 $10 $30
PRESCRIPTION DRUGS MEMBER COPAYS/COINSURANCE
Prescription Drug Deductible
(individual / family)*
$350/$750 $350/$750 $0 $0 $0
Generic $35 $10 $10 $5 $15
Preferred Brand $110 $110 $35 $20 $40
Non-Preferred Brand $120 $120 $70 $40 $80
Specialty High Cost Drugs 50% 50% 30% 20% 30%

 

* All coinsurance/copays apply after annual deductible has been met

** Copay applies for first 5 days of admission

All coinsurance/copays apply after prescription drug deductible has been met

For Bronze 003 deductible plan, 3 PCP office visits are covered at the PCP copay prior to deductible

Some products are only offered on-exchange through the Health Insurance Marketplace and require specific eligibility criteria to enroll.

Customer service that cares

Enrolling in a Community Health Choice plan means choosing service. We strive to create the best possible experience for every one of our Members. Part of our mission is to make healthcare hassle-free, and we do that by always working our hardest to make our plans simple and easy to use. Some of these efforts include:

  • Care Center locations in Houston and Beaumont
  • Application assistance
  • Dedicated Marketplace Member Services Team
  • Customer service available via phone, email, social media, or in person
  • The Sun, a newsletter blog with valuable information on your health and your plan
  • Convenient payment options
  • A care management team for chronic conditions like diabetes and asthma

You don’t want healthcare to be harder than it has to be, and neither do we. That’s why we treat our Members the right way, making sure that they know that Community is always there to help them live their happiest, healthiest lives.

THE NETWORK SOUTHEAST TEXAS NEEDS

We’ve created a network of over 6,500 Providers across 10 counties in Southeast Texas, including:

  • Baptist Hospitals of Southeast Texas - Orange
  • Baptist Hospitals of Southeast Texas - Port Arthur
  • Baylor College of Medicine
  • Brazosport Health Alliance
  • Brazosport Regional Hospital
  • CHI St. Luke’s Health System
  • Harris Health System
  • Huntsville Memorial Hospital
  • Liberty Dayton Regional Medical Center
  • Memorial Hermann Hospital System
  • MHMD Physician Group
  • OakBend Medical Center
  • St. Joseph Medical Center
  • The Medical Center of Southeast Texas
  • UTMB Health
  • UTMB Health Angleton Danbury
  • UTMB Faculty Group
  • UT Physicians
  • Winnie Community Hospital

 

Coverage Area Map

Coverage Area map

The care you need, where you need it

Community Health Choice refuses to offer anything less than a great health plan. And a great health plan comes with a great network. That’s why we partner with over 7,000 Providers across ten counties in Southeast Texas, including doctors and clinics at integrated care organizations such as Kelsey-Seybold and Memorial-Hermann.

The strength of our network does not just come from its size. The Providers we partner with meet our very high standards of quality. When you see one of the Providers in our network, you can know that we’ve made sure that they will treat you fairly, professionally, and honestly.

Affordable health plans are not worth much if they don’t have the support of a strong network like Community’s. The doctors and facilities and specialists that you see in your times of need are the backbone of any health plan. Even if you don’t expect to need it, it’s already there – ready to make sure you get the care you need.

You don't have to pay more for a great health plan

Community Health Choice exists to make sure people have health insurance coverage so they can get the care they need. We believe too many people in our community are not getting the regular, comprehensive care they need to live the long, healthy lives they deserve. But we’re changing that.

We don’t charge more for our services just because we could. Our plans cost what they do because it’s as low as we can go. We take what profits we earn and invest that money back into our community.

All of this means one thing: We consistently have some of the lowest prices on health coverage in Houston. Our plans start as low as $6 a day, and we take pride in that.

The affordability of our plans means that even more people can fit health coverage into their budgets. And that means we’re doing exactly what we’re supposed to.

Local and neighborly

What does it mean when we say we are local?

It means that we live and work here, with our main office in the shadow of NRG stadium.

It also means that the people who we serve live here. Our service area is 10 counties in the greater Houston and Beaumont areas. Our entire focus is on them.

We make sure these people have access to healthcare. We partner with other local organizations that are trying to make where we live better for all of us by offering job training opportunities and focusing on educating the youngest members of our community. We take real action to make this a better place to live.

Above all, it means we are neighborly. We want to treat you not just as a Member of Community, but as a member of the community we all live in.

That means a level of service and caring that you’ll only get from your neighborhood health plan.

Ready to Shop?

Signing up is easy, just visit our Health Insurance Marketplace direct enrollment portal to compare coverage options., find out if you’re eligible for tax credits to help you pay your premium, and enroll in a plan.

Frequently Asked Questions

Answers to common questions and a glossary of terms.  More »

Apply for Coverage

You can now enroll in a Community Marketplace plan from our Web site!

 If you would like to enroll in a health plan offered by Community Health Choice, please fill out the application provided below and fax or mail it to the information provided on the application.