CHM Gold plan coverage examples

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Example 1

You receive treatment early in the year for a gallbladder problem. Your bills for a doctors visit, sonogram, surgery, lab work, medications and follow up with the doctor totals to be $9,000 (this is one medical event). Because you are self pay the medical providers have given you a total of $3,000 self-pay discounts. You submit all bills to CHM through the easy online portal.

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Gold plan coverage:

With CHM you have a Personal Responsibility (PR) of $1,250 and you must meet a Qualifying Amount (QA) of $1,250.

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$9,000 bills submitted to CHM

$3,000 self pay discount obtained

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$6,000 Total bills

$1,250 Personal Responsibility

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$4,750 is what CHM will reimburse you.

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CHM's Gold Plan pays 100% of the cost with after you meet your Personal Responsibility of $1,250. 

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Now that you have met your annual Personal Responsibility, you don't have a $1,250 deductible for the rest of the year. In other words, if you have a medical event later in this year of $1,500, you will get fully reimbursed $1,500 by CHM.

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Silver Plan coverage:

With the Silver plan, you have a personal responsibility of $3,000 (see it as a 'deductible').

Also the Silver plan does not cover doctor visits and medication. 

The total reimbursement with the Silver plan will be

$6,000 - $3,000 - doctors visit cost - medication cost.

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Bronze Plan coverage:

With the Bronze plan, you have a personal responsibility of $6,000 ('deductible'). Make sure that if you consider the Bronze plan, that you have $6,000 or more available because in case of a medical event, the first $6,000 would be your responsibility!

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In this example CHM would pay nothing to you as there is no coverage for your doctor visit and medication bill. I highly recommend you choose the Gold plan.

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Example 2

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In the middle of the same year you have some blood tests done for an unrelated illness. The total cost for the test and the doctors visits: $650. CHM does not share any of these bills because the total cost of the incident is less than $1,250 (QA). If you didn't meet your deductible yet, you still could submit these charges to CHM so it will reduce your deductible. 

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The Gold plan pays if your medical event is over $1,250. The Silver plan pays if your medical event is over $3,000 and the Bronze plan pays if your medical event is over $6,000.

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Here are some great ways to pay for the $1,250 Personal Responsibility (click)

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Example 3

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At the end of the year you have a medical event with total bills of $2,000.

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Gold plan coverage:

CHM pays $2,000 which is 100 percent of the cost after discounts. The Gold plan covers doctor visits (including follow up), surgery, x-rays, lab work and medication during a covered medical incident.

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Silver Plan coverage:

With the Silver plan, you have a personal responsibility of $3,000 (see it as a 'deductible') and a Qualifying Incident amount of $3,000. The PR you have already met in example 1. Because of the Qualifying Incident amount of $3,000 before you can submit your bills, you can not submit your $2,000 bill to CHM. There will be no reimbursement.

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Bronze Plan coverage:

With the Bronze plan, you have a personal responsibility of $6,000 ('deductible'). Make sure if you consider the Bronze plan, that you have $6,000 or more available because in case of a medical event, the first $6,000 would be your responsibility!

 

In this example CHM would pay nothing, as the first $6,000 would be your responsibility before any bills get shared.

 

Again, I highly recommend you choose the Gold plan.

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