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 to be met, before you can submit your bills to CHM.
All members have a annual Personal Responsibility (PR)
(It's like an annual insurance deductible)
Gold Plan; member pays the first $1,000 (per year). It's like an annual deductible of $1,000.
Silver Plan; members pay the first $2,500 (per year). It's like an annual deductible of $2,500.
Bronze Plan; members pay the first $5,000 (per year). It's like an annual deductible of $5,000.
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.
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 $1,550 after self pay discounts for the CT Scan, Ultrasound, Labs and doctor visits.
You submit all the bills. Your reimbursement will be:
$1,550 Total bills
$1,000 Personal Responsibility
$550.00 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 $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.
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.
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.
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.