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Community Health Choice, Inc.
  1. Home
  2. Plans & Benefits
  3. Marketplace
  4. Know the details 2019
Content
Male Community Health Choice member comparing Healthcare Insurance Marketplace plan documents

Questions? Our hours of operation are 8 a.m. – 8 p.m.

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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.

Man and woman holding a coffee cup while looking at their laptop.

Copay Plans

Download all of the details you need on this year’s copay plans and benefits.

HMO Gold Copay 001

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:
  • HMO 001 On-Exchange
  • HMO 001 Zero-Cost
  • HMO 001 Limited-Cost

HMO Silver Copay 002

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:
  • HMO 002 On-Exchange
  • HMO 002 Zero Cost Sharing Plan Variation
  • HMO 002 Limited Cost Sharing Plan Variation
  • HMO 002 73 
  • HMO 002 87
  • HMO 002 94

Limited Network Plan 006

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:
  • HMO 006 On-Exchange
  • HMO 006 Zero Cost-Sharing Plan Variation
  • HMO 006 Limited Cost-Sharing Plan Variation

Limited Network Plan 007

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:
  • HMO 007 On-Exchange
  • HMO 007 Zero Cost-Sharing Plan Variation
  • HMO 007 Limited Cost-Sharing Plan Variation
  • HMO 007 73
  • HMO 007 87
  • HMO 007 94

Deductible Plans

Download all of the details you need on this year’s deductible plans and benefits.

HMO Bronze Deductible 003

Summary of Benefits:
  • Evidence of Coverage
  • 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:
  • HMO 003 On-Exchange
  • HMO 003 Off-Exchange
  • HMO 003 Zero Cost-Sharing Plan Variation
  • HMO 003 Limited Cost-Sharing Plan Variation

HMO Silver Deductible 004

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:
  • HMO 004 On-Exchange
  • HMO 004 Off-Exchange
  • HMO 004 Zero Cost-Sharing Plan Variation
  • HMO-004 Limited Cost-Sharing Plan Variation
  • HMO 004 73
  • HMO 004 87
  • HMO 004 94

HMO Gold Deductible 005

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:
  • HMO Gold 005 On-Exchange
  • HMO Gold 005 Off-Exchange
  • HMO Gold 005 Zero Cost-Sharing Plan Variation
  • HMO Gold 005 Limited Cost-Sharing Plan Variation

HMO Bronze HSA Deductible 008

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:
  • HMO 008 On-Exchange
  • HMO 008 Off-Exchange
  • HMO 008 Zero Cost-Sharing Plan Variation
  • HMO 008 Limited Cost-Sharing Plan Variation

HMO Silver 009

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:
  • HMO 009 On-Exchange
  • HMO 009 Off-Exchange
  • HMO 009 Zero Cost Sharing Plan Variation
  • HMO-009-Limited-Cost-Sharing-Plan-Variation
  • HMO 009 73
  • HMO 009 87
  • HMO 009 94

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.

Formulary and Summary of Formulary Benefits

Pharmacy Benefit Schedule

2019

Click on each document to download it and get all of the details on this year's health plans.

  • Behavioral Health Provider Update effective September 1, 2019
  • Member Handbook
  • Pharmacy Member Handbook
  • Marketplace Member Guide
  • Limited Network Marketplace Member Guide
  • Sales Guide
  • Rates Grid
  • Comparison Chart
  • Transparency in Coverage Reporting
  • Marketplace Application

2018

Click on each document to download it and get all of the details on this year's health plans.

  • Member Handbook
  • Pharmacy Member Handbook
  • Marketplace Member Guide
  • Limited Network Marketplace Member Guide
  • Sales Guide
  • Rates Grid
  • Comparison Chart
  • Rate Justification
  • Marketplace Application
  • Transparency in Coverage Reporting

About Community

Community Health Choice, Inc.

2636 South Loop West, Suite 125
Houston, TX 77054

STAR/CHIP
Local: 713-295-2294 | Toll-Free: 1-888-760-2600
Health Insurance Marketplace
Local: 713-295-6704 | Toll-Free 1-855-315-5386

News

December Scheduled Softheon Maintenance

02 Dec 2019

November Scheduled Softheon Maintenance

01 Nov 2019

October Scheduled Softheon Maintenance

03 Oct 2019

September Payment Deadline Extension

01 Oct 2019

Community offices to close early due to weather

20 Sep 2019

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