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Deductible & Copays

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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 to be met, before you can submit your bills to CHM.

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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) 

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Gold Plan; member pays the first $1,000 (per year). It's like an annual deductible of $1,000.

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Silver Plan; members pay the first $2,500 (per year). It's like an annual deductible of $2,500.

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Bronze Plan; members pay the first $5,000 (per year). It's like an annual deductible of $5,000.

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Qualifying Amount

The Qualifying Amount (QA), 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 single medical event.

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

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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 $1,550 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:

$1,550 Total bills

$1,000 Personal Responsibility

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$550.00 reimbursement from CHM

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In July you see your specialist, who orders a colonoscopy. The visit, colonoscopy and the follow up visit total an amount of $3,500.
 

CHM will reimburse you $3,500, which is 100% of your total bills because you have met your PR -personal responsibility- AND your QA - Qualifying Amount- is over $1,000, so you have met all the criteria.

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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 $1,100. 

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Because you have met the QA (Qualifying Amount of $1,000) and you already have met your annual deductible, your reimbursements from CHM will be $1,100, which is 100% of the total bills.

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The Qualifying Amount for the Silver plan is $2,500 and Bronze plan is  $5,000. All the examples above are with the Gold plan. Please note that the Silver and Bronze plans do not have the same benefits & coverage as the Gold plan.