Plan Examples:
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.
Gold plan coverage:
With CHM you have a Personal Responsibility (PR) of $1,000 and you must meet a Qualifying Incident (QI) of $1,000 -in other words, you medical event needs to be $1,000 before you can submit your bill to CHM.
$9,000 bills submitted to CHM
$3,000 self pay discount obtained
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$6,000 Total bills
$1,000 Personal Responsibility
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$5,000 is what CHM will reimburse you.
CHM pays 100% of the cost with the Gold Plan
after you meet your Personal Responsibility of $1,000
Now that you have met your annual Personal Responsibility, you don't have a $1,000 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.
Silver Plan coverage:
With the Silver plan, you have a personal responsibility of $2,500 (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 - $2,500 - doctors visit cost - medication cost.
Bronze Plan coverage:
With the Bronze plan, you have a personal responsibility of $5,000 ('deductible'). Make sure that if you consider the Bronze plan, that you have $5,000 or more available because in case of a medical event, the first $5,000 would be your responsibility!
In this example CHM would pay less than $1,000 to you as there is no coverage for your doctor visit and medication bill. I highly recommend you choose the Gold plan, or the Silver plan.
Example 2
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 $1,000.
The Gold plan pays if your medical event is over $1,000. The Silver plan pays if your medical event is over $2,500 and the Bronze plan pays if your medical event is over $5,000.
Here are some great ways to pay for the $1,000 Personal Responsibility (click)
Example 3
At the end of the year you have a medical event with total bills of $2,000.
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.
Silver Plan coverage:
With the Silver plan, you have a personal responsibility of $2,500 (see it as a 'deductible') and a Qualifying Incident amount of $2,500. The PR you have already met in example 1. Because of the Qualifying Incident amount of $2,500 before you can submit your bills, you can not submit your $2,000 bill to CHM. There will be no reimbursement.
Bronze Plan coverage:
With the Bronze plan, you have a personal responsibility of $5,000 ('deductible'). Make sure if you consider the Bronze plan, that you have $5,000 or more available because in case of a medical event, the first $5,000 would be your responsibility!
In this example CHM would pay nothing, as the first $5,000 would be your responsibility before any bills get shared.
Again, I highly recommend you choose the Gold plan, or the Silver plan.