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?

Enhanced
Gold 005
Elite
Gold 001
Elite HSA
Gold 14

PREMIER GOLD PLAN 001

MODERATE MONTHLY PREMIUMS
LOW TO MODERATE COST-SHARING

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

View 2023 Premier Gold Plan 001 Details

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

PREMIER GOLD PLAN 005

MODERATE MONTHLY PREMIUMS
LOW COST-SHARING

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

View 2023 Premier Gold 005 Plan Details

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)

PREMIER GOLD PLAN 021

MODERATE MONTHLY PREMIUMS
LOW COST-SHARING

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

View Premier Gold 021 Details

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)

Download your Evidence of Coverage:

Evidence of Coverage for Enhanced Gold OO5

Evidence of Coverage for Elite Gold OO1

Evidence of Coverage for Elite Gold O14

View Plan Documents

Enhanced Gold 005
Elite Gold 001
Elite HSA Gold 14

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

View 2022 Gold 005 Plan Details

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?

Enhanced Gold 005

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

View 2022 Gold 005 Plan Details

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%

Elite Gold 001

Community Elite Gold 001

Plan Overview

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

Elite HSA Gold 14

Community Elite HSA Gold 14

Plan Overview

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

Download your Evidence of Coverage for Gold OO5
View Plan Documents

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

2023 Gold Plans

2023 Gold Plans

Gold Plans Overview

Questions?

All Community plans come with:

Preventative Services

One of the largest Provider and facilities network in Southwest Texas

Low copay on manygeneric 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 manygeneric 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?

PREMIER GOLD PLAN 001

Plan Overview

Summary of Benefits and Coverage

Off-Exchange

PREMIER GOLD PLAN 005

Plan Overview

Summary of Benefits and Coverage

Off-Exchange

On-Exchange

Zero Cost-Sharing

Limited Cost-Sharing

PREMIER GOLD PLAN 021

Plan Overview

Summary of Benefits and Coverage

Off-Exchange

On-Exchange

Zero Cost-Sharing

Limited Cost-Sharing

Community Enhanced Gold 005

Plan Overview

Summary of Benefits & Coverage

Plan Overview

Summary of Benefits & Coverage

Community Elite Gold 001

Plan Overview

Community Elite HSA Gold 14

Plan Overview

Which Gold plan is right for you?

Community Enhanced Gold 005

Plan Overview

Summary of Benefits & Coverage

Plan Overview

Summary of Benefits & Coverage

Community Elite Gold 001

Plan Overview

Community Elite HSA Gold 14

Plan Overview

Local and Neighborly

Why Choose Community?

One of the largest Provider
and facilities network in
Southwest Texas

Low copay on many
generic drugs

No referrals needed
for specialists

One of the largest Provider and facilities network in
Southwest Texas

Low copay on many
generic drugs

No referrals needed
for specialists

Summary of Benefits
and Coverage

Summary of Benefits
and Coverage

Summary of Benefits
and Coverage