Members have a annual Personal Responsibility (PR) - It's like an annual insurance deductible.
Gold Plan; member pays $1,000 per year
Silver Plan; members pay $2,500 per year
Bronze Plan; members pay $5,000 per year
The Qualifying Incident (QI), is an amount what needs to be met, before you can submit bills to CHM and become eligible for reimbursement. This is not for a single bill, this is for your total bills of a medical event.
For the Gold plan, the minimum amount to submit a medical event for reimbursement: $1,000 after discount.
In January you go to the doctor. He orders a CT scan, Ultra Sound, Lab work and a follow up visit. The total bills for this medical event add up to be $1,150.00 after self pay discounts for the CT Scan, Ultrasound, Labs and doctor visits.
You submit all the bills. Your reimbursement will be $150.00 from CHM, because you have a Personal Responsibility of $1,000.
In October you see your specialist, who orders a colonoscopy. The visit, colonoscopy and the follow up visit total an amount of $3,000.
CHM will reimburse you $$3,000 because you have met your PR -personal responsibility- AND your QI - Qualifying Incident- is over $1,000, so you have met all the criteria.
The Qualifying Incident amount for the Silver plan is $2,500 and Bronze $5,000.