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Be in the know
We believe in giving our Members as much information as possible on our plans and costs so they can make the best choices for themselves and their dependents. On this page, you’ll find downloadable documents that can help you choose the plan that’s right for you.
Copay Plans
Download all of the details you need on this year’s copay plans and benefits.
Summary of Benefits:
- Evidence of Coverage
- Standard Gold Off-Exchange Plan - 27248TX0010001-00
- Standard Gold On-Exchange Plan - 27248TX0010001-01*
- Zero Cost-Sharing Plan Variation - 27248TX0010001-02*
- Limited Cost-Sharing Plan Variation - 27248TX0010001-03*
*Available on-exchange only
Cost Look Up Tool:
Summary of Benefits:
- Evidence of Coverage
- Standard Silver Off-Exchange Plan - 27248TX0010002-00
- Standard Silver On-Exchange Plan - 27248TX0010002-01*
- Zero Cost-Sharing Plan Variation - 27248TX0010002-02*
- Limited Cost-Sharing Plan Variation - 27248TX0010002-03*
- 73% AV Level Silver Plan - 27248TX0010002-04*
- 87% AV Level Silver Plan - 27248TX0010002-05*
- 94% AV Level Silver Plan - 27248TX0010002-06*
*Available on-exchange only
Cost Look Up Tool:
Summary of Benefits:
- Evidence of Coverage
- Standard Gold Off-Exchange Plan - 27248TX0010006-00
- Standard Gold On-Exchange Plan - 27248TX0010006-01
- Zero Cost-Sharing Plan Variation - 27248TX0010006-02*
- Limited Cost-Sharing Plan Variation - 27248TX0010006-03*
*Available on-exchange only
Cost Look Up Tool:
Summary of Benefits:
- Evidence of Coverage
- Standard Silver Off-Exchange Plan - 27248TX0010007-00
- Standard Silver On-Exchange Plan - 27248TX0010007-01*
- Zero Cost-Sharing Plan Variation - 27248TX0010007-02*
- Limited Cost-Sharing Plan Variation - 27248TX0010007-03*
- 73% AV Level Silver Plan - 27248TX0010007-04*
- 87% AV Level Silver Plan - 27248TX0010007-05*
- 94% AV Level Silver Plan - 27248TX0010007-06*
*Available on-exchange only
Cost Look Up Tool:
Deductible Plans
Download all of the details you need on this year’s deductible plans and benefits.
Summary of Benefits:
- Standard Bronze Off-Exchange Plan - 27248TX0010003-00
- Standard Bronze On-Exchange Plan - 27248TX0010003-01*
- Zero Cost-Sharing Plan Variation - 27248TX0010003-02*
- Limited Cost-Sharing Plan Variation - 27248TX0010003-03*
*Available on-exchange only
Cost Look Up Tool:
Summary of Benefits:
- Evidence Coverage
- Standard Silver Off-Exchange Plan - 27248TX0010004-00
- Standard Silver On-Exchange Plan - 27248TX0010004-01*
- Zero Cost-Sharing Plan Variation - 27248TX0010004-02*
- Limited Cost-Sharing Plan Variation - 27248TX0010004-03*
- 73% AV Level Silver Plan - 27248TX0010004-04*
- 87% AV Level Silver Plan - 27248TX0010004-05*
- 94% AV Level Silver Plan - 27248TX0010004-06*
*Available on-exchange only
Cost Look Up Tool:
Summary of Benefits:
- Evidence of Coverage
- Standard Gold Off-Exchange Plan - 27248TX0010005-00
- Standard Gold On-Exchange Plan - 27248TX0010005-01*
- Zero Cost-Sharing Plan Variation - 27248TX0010005-02*
- Limited Cost-Sharing Plan Variation - 27248TX0010005-03*
*Available on-exchange only
Cost Look Up Tool:
Summary of Benefits:
- Evidence of Coverage
- Standard Bronze Off-Exchange Plan - 27248TX0010008-00
- Standard Bronze On-Exchange Plan - 27248TX0010008-01*
- Zero Cost-Sharing Plan Variation - 27248TX0010008-02*
- Limited Cost-Sharing Plan Variation - 27248TX0010008-03*
*Available on-exchange only
Cost Look Up Tool:
Summary of Benefits:
- Evidence Coverage
- Standard Silver Off Exchange Plan - 27248tx0010009-00
- Standard Silver On Exchange Plan - 27248tx0010009-01*
- Zero Cost Sharing Plan Variation - 27248tx0010009-02*
- Limited Cost Sharing Plan Variation - 27248tx0010009-03*
- 73% AV Level Silver Plan - 27248tx0010009-04*
- 87% AV Level Silver Plan - 27248tx0010009-05*
- 94% AV Level Silver Plan - 27248tx0010009-06*
*Available on-exchange only
Cost Look Up Tool:
Formulary
A formulary is a list of prescription drugs available to Members. At Community Health Choice, the formulary is shared across all plans. Download the document to review your formulary benefits.
2019
Click on each document to download it and get all of the details on this year's health plans.
2018
Click on each document to download it and get all of the details on this year's health plans.