Know the details of your 2021 plan
Understanding the details of your health plan is important. Get better acquainted with your benefits here. If you still have any questions, we are just a phone call away.
Definition of Terms
- Evidence of Coverage (EOC): The EOC documents in detail the health care benefits covered by a plan. It also provides information on plan requirements and cost-sharing for certain benefits.
- Summary of Benefit and Coverage (SBC): The SBC is an easy-to-read summary document that allows comparison between health plans. This document lists important information about the plan such as cost-sharing, coverage limitations, exceptions and benefits scenarios. .
- Formulary: A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Also called a drug list
All Community plans come with:
- Free preventative care
- 24/7/365 Nurse Advice Line
- Huge doctor / hospital network
- No referrals for specialists
Important Member Handbook Update
Dear Member:
On September 1, 2021, Community Health Choice will implement the Copay Max program for certain specialty medications. Here is the information that we will add to our Member Handbooks when we print them again:
- We may offer a Copay Assistance program for certain specialty drugs dispensed through the Specialty Drug program. Your out-of-pocket cost will be $0 for specialty drugs in the Copay Assistance program. Only the amount you pay and not the copay assistance portion will apply to your annual deductible and/or out-of-pocket maximum. If a drug does not qualify for the Copay Assistance program, your copay will default to the formulary’s current tiered cost share.
- You will be automatically enrolled into the Copay Assistance program. If you would like to opt-out of the Copay Assistance program, please call 855-847-3553, Monday – Thursday 8 a.m. – 7 p.m. CST and Friday 8 a.m. – 6 p.m. CST. If you opt-out, your copay will default to the formulary’s current tiered cost share.
Questions?
Our hours of operation are
8 a.m. – 5 p.m.
Call Us:
Local: 713.295.6704
Toll-Free 1.855.315.5386
