Community Premier Silver 012 (No deductible for PCP, Urgent Care & Generics, $0 PCP 24/7 Virtual Care Options)

Community Health Choice

Silver

Ind. deductible: $2,800
Family deductible: $2,800
Ind. OOP max: $10,600
Family OOP max: $10,600

Other cost-sharing reduction variants for this plan:

73% AV Level Silver Plan 87% AV Level Silver Plan 94% AV Level Silver Plan Limited Cost Sharing Plan Variation Standard Silver Off Exchange Plan Zero Cost Sharing Plan Variation

Monthly premiums by age

Age	Individual	Individual + tobacco
21	$544	—
30	$618	—
40	$695	—
50	$972	—
60	$1,477	—

Live premium estimate

Benefits & cost sharing

Primary Care

Benefit	In-network
Preventive Care/Screening/Immunization	No charge
Primary Care Visit to Treat an Injury or Illness	$30.00

Specialist

Benefit	In-network
Specialist Visit	$50.00 Copay after deductible

Hospital

Benefit	In-network
Emergency Room Services	50.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	40.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services	50.00% Coinsurance after deductible
Urgent Care Centers or Facilities	$20.00

Pharmacy

Benefit	In-network
Generic Drugs	$10.00
Non-Preferred Brand Drugs	$40.00
Preferred Brand Drugs	$0.00
Specialty Drugs	0.00%

Mental Health

Benefit	In-network
Mental/Behavioral Health Inpatient Services	50.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services	$30.00

Other

Benefit	In-network
Abortion for Which Public Funding is Prohibited	Not covered
Accidental Dental	$60.00 Copay after deductible
Acupuncture	Not covered
Allergy Testing	$0.00
Bariatric Surgery	Not covered
Basic Dental Care - Adult	Not covered
Basic Dental Care - Child	Not covered
Chemotherapy	$60.00 Copay after deductible
Chiropractic Care	$60.00 Copay after deductible
Cosmetic Surgery	Not covered
Delivery and All Inpatient Services for Maternity Care	50.00% Coinsurance after deductible
Dental Check-Up for Children	Not covered
Diabetes Education	$30.00 Copay after deductible
Dialysis	$20.00
Durable Medical Equipment	30.00% Coinsurance after deductible
Emergency Transportation/Ambulance	$60.00 Copay after deductible
Eye Glasses for Children	$60.00 Copay after deductible
Habilitation Services	$50.00 Copay after deductible
Hearing Aids	30.00% Coinsurance after deductible
Home Health Care Services	$50.00 Copay after deductible
Hospice Services	$0.00
Imaging (CT/PET Scans, MRIs)	10.00%
Infertility Treatment	Not covered
Infusion Therapy	$0.00
Inpatient Physician and Surgical Services	No Charge after deductible
Laboratory Outpatient and Professional Services	$10.00
Long-Term/Custodial Nursing Home Care	Not covered
Major Dental Care - Adult	Not covered
Major Dental Care - Child	Not covered
Nutritional Counseling	Not covered
Orthodontia - Adult	Not covered
Orthodontia - Child	Not covered
Other Practitioner Office Visit (Nurse, Physician Assistant)	$25.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)	0.00%
Outpatient Rehabilitation Services	$60.00 Copay after deductible
Prenatal and Postnatal Care	$20.00
Private-Duty Nursing	Not covered
Prosthetic Devices	15.00% Coinsurance after deductible
Radiation	$60.00 Copay after deductible
Reconstructive Surgery	50.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy	$60.00 Copay after deductible
Rehabilitative Speech Therapy	$60.00 Copay after deductible
Routine Dental Services (Adult)	Not covered
Routine Eye Exam (Adult)	Not covered
Routine Eye Exam for Children	$50.00 Copay after deductible
Routine Foot Care	Not covered
Skilled Nursing Facility	40.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services	50.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services	$10.00
Transplant	50.00% Coinsurance after deductible
Treatment for Temporomandibular Joint Disorders	$0.00
Weight Loss Programs	Not covered
Well Baby Visits and Care	No charge
X-rays and Diagnostic Imaging	$30.00 Copay after deductible

Plan rules

Service area

This plan covers 20 geographic areas.