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​​💡 CHM Gold Plan Coverage Examples

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✅ Example 1: Gallbladder Surgery Early in the Year

You receive treatment for a gallbladder issue, including a doctor’s visit, sonogram, surgery, lab work, medications, and follow-up care.

• Total billed amount: $9,000

• Self-pay discount received: $3,000

• Final bill submitted to CHM: $6,000

 

Gold Plan Coverage:

• Your Personal Responsibility (PR) is $1,250

• Your Qualifying Amount (QA) is also $1,250

  • This is the minimum amount required before you can submit bills to CHM

• CHM reimburses: $6,000 – $1,250 = $4,750

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✅ Once your PR is met for the year, any future qualifying medical events are reimbursed at 100%. For example, if you have a $1,500 medical event later in the year, CHM will reimburse the full amount.

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⚖️ Silver Plan Comparison

• PR: $3,000

• Does not cover doctor visits or medications

• Reimbursement: $6,000 – $3,000 – doctor visit cost – medication cost

 

⚠️ Bronze Plan Comparison

• PR: $6,000

• No coverage for doctor visits or medications

• In this example, CHM would reimburse $0

 

If you choose the Bronze plan, be prepared to cover the first $6,000 out-of-pocket.

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💬 Our Recommendation: Choose the Gold Plan for the most complete coverage and peace of mind.

 

 

✅ Example 2: Blood Tests for an Unrelated Illness

Mid-year, you have blood tests and doctor visits totaling $650.

• Because the total is below the $1,250 QA, CHM does not reimburse this event.

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Plan Thresholds for Reimbursement:

Qualifying Amounts per plan:

Gold-----$1,250

Silver----$3,000

Bronze--$6,000

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✅ Example 3: $2,000 Medical Event at Year-End

You have a medical event with total bills of $2,000 after discounts.

 

Gold Plan Coverage:

• PR already met earlier in the year

• CHM reimburses the full $2,000

• Covers doctor visits, surgery, x-rays, lab work, and medications

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Silver Plan Coverage:

• PR met, but QA of $3,000 not met

• No reimbursement

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Bronze Plan Coverage:

• QA and PR both set at $6,000

• No reimbursement

 

⚠️ Bronze and Silver plans are best for major hospitalization only. For full-spectrum coverage, the Gold Plan is your best choice.

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