Common Ground Healthcare Cooperative

CGHC Value Plus Bronze $8700 Deductible ($35 PCP Copay)

Prescription Drug Information

Inpatient Coverage

Emergency and Urgent Care

Major Dental Care

Links

Plan Overview

Combined Medical and Drug Deductible	Individual: $8,700 Family: $17,400 Per Person: $8,700
Medical Out-of-Pocket Maximum	Individual: Not Applicable Family: not applicable Per Person: not applicable
Drug Out-of-Pocket Maximum	Individual: Not Applicable Family: not applicable Per Person: not applicable
Combined Medical and Drug Out of Pocket Maximum	Individual: $8,700 Family: $17,400 Per Person: $8,700

Office Visit

Primary Doctor	CoPay: $35.00 CoInsurance: Not Applicable Covered: Covered
Specialist	CoPay: Not Applicable CoInsurance: 0.00% Coinsurance after deductible Covered: Covered

Prescription Drug Information

Preferred Brand Drugs	CoPay: Not Applicable CoInsurance: 0.00% Coinsurance after deductible Covered: Covered Benefit Explanation: Not Covered if the drug is not on the formulary or is not approved via the non-formulary drug coverage exception process
Non Preferred Brand Drugs	CoPay: Not Applicable CoInsurance: 0.00% Coinsurance after deductible Covered: Covered Benefit Explanation: Not Covered if the drug is not on the formulary or is not approved via the non-formulary drug coverage exception process
Generic Drugs	CoPay: Not Applicable CoInsurance: 0.00% Coinsurance after deductible Covered: Covered Benefit Explanation: Not Covered if the drug is not on the formulary or is not approved via the non-formulary drug coverage exception process
Specialty Drugs	CoPay: Not Applicable CoInsurance: 0.00% Coinsurance after deductible Covered: Covered Benefit Explanation: Not Covered if the drug is not on the formulary or is not approved via the non-formulary drug coverage exception process

Inpatient Coverage

Hospital Services	CoPay: Not Applicable CoInsurance: 0.00% Coinsurance after deductible Covered: Covered
Inpatient Services	CoPay: Not Applicable CoInsurance: 0.00% Coinsurance after deductible Covered: Covered

Emergency and Urgent Care

Emergency Room	CoPay: Not Applicable CoInsurance: 0.00% Coinsurance after deductible Covered: Covered
Urgent Care Facility	CoPay: Not Applicable CoInsurance: 0.00% Coinsurance after deductible Covered: Covered

Maternity

Labor and Delivery Hospital Stay	CoPay: Not Applicable CoInsurance: 0.00% Coinsurance after deductible Covered: Covered
Pre and Postnatal Office Visit	CoPay: Not Applicable CoInsurance: 0.00% Coinsurance after deductible Covered: Covered

Vision

Routine Eye Exams For Children

CoPay: $0.00
CoInsurance: Not Applicable
Covered: Covered
Limit Quantity: 1
Limit Unit : Exam(s) per Year

Major Dental Care

Routine Dental Checkups for Children	CoPay: Not Applicable CoInsurance: Not Applicable Covered: Not Covered
Basic Dental Care - Child	Covered: Not Covered
Major Dental Care - Child	Covered: Not Covered

Related Articles

You may be interested in these relevant articles from across the HealthMarkets.com network.

Do These 10 Hand Exercises for Arthritis Daily to Ease The Pain

Are there hand exercises for arthritis that can ease the pain? Yes! In this…Read More

Read More

What Does Basic Health Insurance Cost?

Shopping for healthcare can be time-consuming and feel overwhelming. And one frustrating part can…Read More

Read More

Exercises for Limited Mobility: 7 Easy Ways to Stay Active

Staying active can be difficult if you experience limited mobility. In this article, we’ll…Read More

Read More