2019 Plan Options
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2019 Plan Options

Together with CCHP offers plan options across four different levels to our members. Plan benefits described below are for in-network services only.

Click on the buttons below to see benefits for each plan level. After November 1, get a quote and enroll with our Online Quote Tool. You can also call our Sales Support team directly for help at 844-708-3837.

 

  Silver Silver Select Standard Silver
Individual medical and prescription deductible $4,700 $3,250 $4,000
Individual medical and prescription maximum out-of-pocket1 $7,900 $7,900 $7,900
 
Family medical and prescription maximum deductible $9,400 $6,500 $8,000
Family medical and prescription maximum out-of-pocket1 $15,800 $15,800 $15,800
 
Primary care office visit $50 copay $35 copay $30 copay
Speciality/specialist office visit $100 copay $80 copay $65 copay
Inpatient and outpatient services 40% after deductible 40% after deductible 20% after deductible
Urgent care $100 copay then deductible/coinsurance $80 copay then deductible/coinsurance $65 copay then deductible/coinsurance
Emergency room 40% after deductible 40% after deductible 20% after deductible
 
Prescription Drugs2
Tier 1: Generic $10 copay $15 copay $15 copay
Tier 2: Preferred brand 40% after deductible $55 copay $50 copay
Tier 3: Non-preferred brand 40% after deductible 40% after deductible $100
Tier 4: Specialty prescriptions3 40% after deductible 40% after deductible 20% after deductible
Tier 5: ACA preventive prescriptions $0 $0 $0
Tier 6: Select generics $0 $0 $0
 
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1 The out-of-pocket maximum is the sum of the deductible amount, prescription drug deductible amount (if applicable), copayment amount and coinsurance percentage of covered expenses, as shown in your Evidence of Coverage.
2 For a list of covered preventive prescriptions, please review our Pharmacy Benefit Guide.
3 Many specialty medications are paid according to medical plan benefits, not prescription drug benefits.

Medicaid

Children's Community Health Plan

PO Box 56099
Madison, WI 53705
1-800-482-8010

Together with CCHP

Children's Community Health Plan

PO Box 1997, MS 6280
Milwaukee, WI 53201
1-844-201-4672

 

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