Gold Plan
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Gold Plan

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.

 

  Gold
Individual medical and prescription deductible $2,000
Individual medical and prescription maximum out-of-pocket1 $6,500
 
Family medical and prescription maximum deductible $4,000
Family medical and prescription out-of-pocket maximum1 $13,000
 
Primary care office visit $30 copay
Speciality/specialist office visit $60 copay
Inpatient and outpatient services 20% after deductible
Lab outpatient and professional services 20% after deductible
Urgent care $60 copay then deductible / coinsurance
Emergency room 20% after deductible
 
Prescription Drugs2
Tier 1: Generic $10 copay
Tier 2: Preferred brand $55 copay
Tier 3: Non-preferred brand 20% after deductible
Tier 4: Specialty prescriptions3 20% after deductible
Tier 5: ACA preventive prescriptions $0
Tier 6: Select generics $0
 
Award-winning customer service
CCHP on Call Nurseline

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 2020 Prescription Medication List (available November 1st)
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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