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.


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
Outpatient lab services 20% after deductible
Urgent care 20% after deductible
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
Health management programs
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 2021 Prescription Medication List.
3 Many specialty medications are paid according to medical plan benefits, not prescription drug benefits.



Children's Community Health Plan

PO Box 56099
Madison, WI 53705

Together with CCHP

Children's Community Health Plan

PO Box 1997, MS 6280
Milwaukee, WI 53201


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