2023 Gold Plans – OLD

2023 Gold Plans

2023 Gold Plans

Gold Plans Overview

Once you understand the differences, it’s easier to find the best plan that fits you and your family. We want you to get all the coverage you need without paying for benefits you don’t.

Gold cheat sheet:

  • Gold plans have the highest premiums.
  • Gold plans have lower out-of-pocket costs.
  • On average, the insurance company pays 80%. You pay 20%.
  • “Get this plan if your doctor knows you better than your spouse.”

Questions?

Our hours of operation
are 8 a.m. – 5 p.m.

Call Us:
Local: 713.295.6704
Toll-Free: 1.855.315.5386

All Community plans come with:

Preventative Services

One of the largest Provider
and facilities network in
Southwest Texas

Low copay on many
generic drugs

Most primary care visits, specialist visits, urgent care, and generic drugs are not subject to deductible

Free 24/7 telehealth

No referrals needed
for specialists

Preventative Services

Free 24/7 telehealth

One of the largest Provider and facilities network in
Southwest Texas

Low copay on many
generic drugs

No referrals needed
for specialists

Most primary care visits, specialist visits, urgent care, and generic drugs are not subject to deductible

Which Gold plan is right for you?

Plan Overview

Important Features of 2023 Premier Gold 001 Plan:
Things to Keep in Mind:

The Advanced Premium Tax Credit can lower your monthly payment. If you’re eligible, you can apply it to any Bronze plan.

View Quick Reference Guide

Summary of Benefits
and Coverage

Off-Exchange

Download PDF

LOWEST PREMIUMS
HIGHER OUT-OF-POCKET COST FOR SERVICES

  • Medical Deductible (Individual)
    N/A
  • Maximum Out-of-Pocket (Individual)
    $9,100
  • Primary Care Physician Office Visit
    $30
  • Specialist Office Visit
    $65
  • Urgent Care Visit
    $65
  • Emergency Room Visit
    $800
  • Inpatient Hospital Stay
    $800**
  • Prescription Drug Deductible
    N/A
  • Generic
    $20
  • Preferred Brand
    $40
  • Non-Preferred Brand
    $80
  • Specialty High-Cost Drugs
    30%

**Copay applies for first 5 days of admission for all inpatient services

Plan Overview

Important Features of 2023 Premier Gold 005 Plan:
Things to Keep in Mind:

The Advanced Premium Tax Credit can lower your monthly payment. If you’re eligible, you can apply it to the Gold 005 Plan.

View Quick Reference Guide

Summary of Benefits
and Coverage

Off-Exchange

Download PDF

On-Exchange

Download PDF

Zero Cost-Sharing

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Limited Cost-Sharing

Download PDF

  • Medical Deductible (Individual)
     $1,600
  • Maximum Out-of-Pocket (Individual)
    $9,100
  • Primary Care Physician Office Visit
    $20*
  • Specialist Office Visit
    $40*
  • Urgent Care Visit
    $40*
  • Emergency Room Visit
    25%
  • Inpatient Hospital Stay
    25%
  • Prescription Drug Deductible
    Combined with Medical Deductible
  • Generic
    $10*
  • Preferred Brand
    $50
  • Non-Preferred Brand
    $75
  • Specialty High-Cost Drugs
    35%

*Services are exempt from deductible where indicated (PCP/Specialist/Urgent Care/Generic RX)

Plan Overview

Important Features of 2023 Premier Gold 021 Plan:
Things to Keep in Mind:

The Advanced Premium Tax Credit can lower your monthly payment.

View Quick Reference Guide

Summary of Benefits
and Coverage

Off-Exchange

Download PDF

On-Exchange

Download PDF

Zero Cost-Sharing

Download PDF

Limited Cost-Sharing

Download PDF

  • Medical Deductible (Individual)
    $2,000
  • Maximum Out-of-Pocket (Individual)
    $8,700
  • Primary Care Physician Office Visit
    $30*
  • Specialist Office Visit
    $60*
  • Urgent Care Visit
    $45*
  • Emergency Room Visit
    25%
  • Inpatient Hospital Stay
    25%
  • Prescription Drug Deductible
    Combined with Medical Deductible
  • Generic
    $15*
  • Preferred Brand
    $30*
  • Non-Preferred Brand
    $60*
  • Specialty High-Cost Drugs
    $250*

*Services are exempt from deductible where indicated (PCP/Specialist/Urgent Care/Generic RX)

Community Enhanced Gold 005

Plan Overview

  • No deductible for visits to PCP, Specialists, Urgent Care, or for Generic Medications
  • Free 24/7 Telehealth
  • This plan is best suited for individuals/families who may be managing multiple chronic health conditions and are okay paying higher premiums to keep out-of-pocket costs low.
  • HIOS ID: 27248TX0010005

Summary of Benefits & Coverage

Plan Overview

  • No deductible for visits to PCP, Specialists, Urgent Care, or for Generic Medications
  • Free 24/7 Telehealth
  • This plan is best suited for individuals/families who may be managing multiple chronic health conditions and are okay paying higher premiums to keep out-of-pocket costs low.
  • HIOS ID: 27248TX0010005

Summary of Benefits & Coverage

  • Annual Deductible
    $2,000
  • Maximum out-of-pocket
    $8,700
  • Emergency Room Visits
    25%
  • Inpatient Hospital Stay
    25%
  • PCP
    $20
  • Specialist
    $40
  • Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services
    $20
  • Imaging (CT/MRI/PET)
    25%
  • Speech Therapy
    $40
  • Occupational and Physical Therapy
    $40
  • Laboratory Outpatient and Professional Services
    $20
  • X-rays and Diagnostic Imaging
    $20
  • Skilled Nursing Facility
    25%
  • Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)
    25%
  • Outpatient Surgery Physician/Surgical Services
    25%
  • Prescription Drugs: Generics
    $10
  • Preferred Brand
    $50
  • Non-Preferred Brand
    $75
  • Specialty Drugs
    35%

Community Elite Gold 001

Plan Overview

  • The Community Elite Gold 001 plan is only offered Off-Exchange.

Community Elite HSA Gold 14

Plan Overview

  • The Community Elite HSA Gold 14 plan is only offered Off-Exchange.

Which Gold plan is right for you?

Community Enhanced Gold 005

Plan Overview

  • No deductible for visits to PCP, Specialists, Urgent Care, or for Generic Medications
  • Free 24/7 Telehealth
  • This plan is best suited for individuals/families who may be managing multiple chronic health conditions and are okay paying higher premiums to keep out-of-pocket costs low.
  • HIOS ID: 27248TX0010005

Summary of Benefits & Coverage

Plan Overview

  • No deductible for visits to PCP, Specialists, Urgent Care, or for Generic Medications
  • Free 24/7 Telehealth
  • This plan is best suited for individuals/families who may be managing multiple chronic health conditions and are okay paying higher premiums to keep out-of-pocket costs low.
  • HIOS ID: 27248TX0010005

Summary of Benefits & Coverage

  • Annual Deductible
    $2,000
  • Maximum out-of-pocket
    $8,700
  • Emergency Room Visits
    25%
  • Inpatient Hospital Stay
    25%
  • PCP
    $20
  • Specialist
    $40
  • Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services
    $20
  • Imaging (CT/MRI/PET)
    25%
  • Speech Therapy
    $40
  • Occupational and Physical Therapy
    $40
  • Laboratory Outpatient and Professional Services
    $20
  • X-rays and Diagnostic Imaging
    $20
  • Skilled Nursing Facility
    25%
  • Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)
    25%
  • Outpatient Surgery Physician/Surgical Services
    25%
  • Prescription Drugs: Generics
    $10
  • Preferred Brand
    $50
  • Non-Preferred Brand
    $75
  • Specialty Drugs
    35%

Community Elite Gold 001

Plan Overview

  • The Community Elite Gold 001 plan is only offered Off-Exchange.

Community Elite HSA Gold 14

Plan Overview

  • The Community Elite HSA Gold 14 plan is only offered Off-Exchange.

Local and Neighborly

What does it mean when we say we are local? It means that our service area is 20 counties in the Greater Houston and Beaumont areas. It means that our Providers and facilities are near to you. That’s why we partner with about 7,500 Providers across 20 counties in Southeast Texas, including doctors and clinics at integrated-care organizations. The doctors and facilities and specialists that you see in your times of need are nearby and neighborly.

Why Choose Community?

As a local nonprofit health plan, Community Health Choice gives you plenty of reasons to join our Community. From the benefits and special programs we offer to the way our Member Services team helps you make the most of them, Community is always working life forward for you and your family.

“I always tell people to choose Community Health Choice. I tell them it’s the best health insurance they will ever be with.”
– Chandolyn
Member of Community Health Choice