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.
Community is increasing rates effective January 1, 2017 for its Health Insurance Marketplace (HIM) product 27248TX001. The increase is primarily the result of higher than expected utilization for 2016 which is reflected in the utilization trend assumption. Other factors include a change to actuarial value assumptions, cost trend, lower tobacco surcharge revenue, provider reimbursement changes, and the elimination of the federal transitional reinsurance program for 2017.
Community is also revising actuarial rating methods and assumptions that results in a reallocation of costs among plans. Specifically, it is changing the method by which general administrative expenses are allocated to a per member basis. This is a common and generally accepted approach since costs are spread evenly across all members. It is also updating actuarial value assumptions for its plans. Actuarial value is the percentage of claim costs paid by the plan on behalf of members. It can change due to several factors including cost inflation and benefit changes.
As a result of these method and assumption changes, premium rates for individual plans are increasing from 17.4 percentage to 27.7 percentage. The composite average increase for the product is 20.9 percentage. The increase is highest for the HMO Bronze 003 plan, since the administrative expense is a higher percentage of premium and the actuarial value of the plan increased by more than the actuarial value of other plans. The increases impact approximately 95,000 members enrolled in the product.
Community first offered its HIM product January 1, 2014. Membership has increased from less than 250 members in 2014 to approximately 94,000 currently. Financial experience for the product is still incomplete since 2014 results are not credible and the risk adjustment transfer for 2015 has not been finalized.
Premium rates for 2017 reflect claim costs that were increased relative to the prior year for anticipated changes due to medical and prescription drug inflation and increased utilization. This includes changes to provider reimbursement agreements.
Effective January 1, 2017 benefits have changed for all plans except the HMO Gold 001 and HMO Silver 002 and 004 CSR 94 plans based on new Actuarial Value Calculator testing. Changes were necessary to maintain plans that complied with requirements to be classified as Gold, Silver, and Bronze.
Average administrative costs per member are lower for 2017 relative to 2016 due to membership growth. The lower average cost offsets the increase which would be necessary due to the elimination of the federal transitional reinsurance program.
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.
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 2017
|Deductible Plans**||Copay Plans|
|MEMBER COST SHARE||COMMUNITY HEALTH CHOICE HMO BRONZE 003♦||COMMUNITY HEALTH CHOICE HMO SILVER 004✓||COMMUNITY HEALTH CHOICE HMO GOLD 005||COMMUNITY HEALTH CHOICE HMO SILVER 002✓
PLAN ID 27248TX0010002
KELSEYCARE POWERED BY COMMUNITY HEALTH CHOICE HMO SILVER 007✓
|COMMUNITY HEALTH CHOICE HMO GOLD 001
PLAN ID 27248TX0010001
KELSEYCARE POWERED BY COMMUNITY HEALTH CHOICE HMO GOLD 006
|Medical Deductible (Individual/family)||$5,000/$10,000||$1,500/$3,000||$500/$1,000||$0||$0|
|Out-Of-Pocket Max (Individual/family)||$7,150/$14,300||$7,150/$14,300||$5,000/$10,000||$7,150/$14,300||$5,000/$10,000|
|Annual Max Benefit per person||Unlimited||Unlimited||Unlimited||Unlimited||Unlimited|
|PCP Office Visit||$40||$30||$20||$40||$30|
|Specialist Office Visit||$65||$50||$45||$75||$65|
|Urgent Care Services||$65||$50||$45||$75||$65|
|Emergency Room Services||$500||$500||$400||$600||$400|
|Inpatient Hospital Care||$500 copay/day*||$500 copay/day*||$400 copay/day*||$600 copay/day*||$400 copay/day*|
|Inpatient Physician and Surgical||$65 copay/day*||$50 copay/day*||$45 copay/day*||$75 copay/day*||$65 copay/day*|
|Skilled Nursing Facility||$500 copay/day*||$500 copay/day*||$400 copay/day*||$600 copay/day*||$500 copay/day*|
|Mental/Behavioral Health Outpatient||$65||$50||$45||$75||$65|
|Mental/Behavioral Health Inpatient||$500 copay/day*||$500 copay/day*||$400 copay/day*||$600 copay/day*||$400 copay/day*|
|Medical Imaging (CT/PET Scans/MRIs)||$500||$500||$400||$600||$300|
|Generic||$10 (after $200 deductible)||$10||$10||$35||$15|
|Preferred Brand||$85 (after $200 deductible)||$50||$40||$100||$40|
|Non-Preferred Brand||$110 (after $200 deductible)||$100||$70||$110||$80|
|Specialty High Cost Drugs||40% (after $200 deductible)||45%||
|✓Your costs may be even less if you qualify for financial help.
*Copay applies per day for the first 5 days.
**For Deductible Plans, copays apply only after deductible has been met.
♦For Bronze Deductible Plans, 3 PCP office visits are covered at the PCP copay prior to deductible.
Download printable version.
|2017 Rates Grid||Download printable version.|
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
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.
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.