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Deductible & Copays

With CHM there are 3 different plans and each plan has it's own deductible, called PR - Personal Responsibility... There are no copays for any of the 3 plans, however there is a Qualifying Amount (QA), a minimum amount that has to be met, before you can submit your bills to CHM for reimbursement.

 

 

Personal Responsibility

All members have a annual Personal Responsibility (PR) which is an amount what will be deducted out of your reimbursement if you have a medical event (PR is like an annual deductible). 

Gold Plan; Deductible or PR -Personal Responsibility: $1,250 

Silver Plan; Deductible or PR -Personal Responsibility: $2,500​

Bronze Plan; Deductible or PR -Personal Responsibility: $5,00 

SeniorShare Plan; Deductible or PR -Personal Responsibility: $500

Qualifying Amount

The Qualifying Amount (QA), is an amount what has 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 single medical event.

For the Gold plan, the minimum amount to submit a medical event for reimbursement: $1,250 after discount.

Example (read until the end for a full understanding):

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 $2,500 after self pay discounts.

You submit all the bills through the easy online portal of CHM because you  have met the minimum Qualifying Amount to submit to CHM.

Your reimbursement will be:

$2,500 Total bills

$1,250 Personal Responsibility

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$1,250.00 reimbursement from CHM

In July you see your specialist, who orders a colonoscopy. The visit, colonoscopy and the follow up visit total an amount of $6,500.
 

CHM will reimburse you $6,500, which is 100% of your total bills because you have met your PR -personal responsibility- AND your QA - Qualifying Amount- is over $1,250, so you have met all the criteria.

In November you go for your annual exam. The doctor orders lab work and some other medical testing. Your total bills add up to be $1,250. 

Because you have met the QA (Qualifying Amount of $1,250) and you already have met your annual deductible, your reimbursements from CHM will be $1,250, which is 100% of the total bills.

Please note that the Silver and Bronze plans do not have the same benefits & coverage as the Gold plan. 

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