Compare Healthcare

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Personal Responsibility

Members have a annual Personal Responsibility (PR) - It's like an annual insurance deductible.

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Gold Plan; member pays $1,000 per year

Silver Plan; members pay $2,500 per year

Bronze Plan; members pay $5,000 per year

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Qualifying Incident

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.

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For the Gold plan, the minimum amount to submit a medical event for reimbursement: $1,000 after discount.

 

Example:

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.

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You submit all the bills. Your reimbursement will be $150.00 from CHM, because you have a Personal Responsibility of $1,000.

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In October you see your specialist, who orders a colonoscopy. The visit, colonoscopy and the follow up visit total an amount of $3,000. 

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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.