EOBs for plan members are temporarily unavailable to view online. If you have questions about plan benefits, please contact the CommunityCare customer service team for assistance.

Plan Brochure

CommunityCare Gold L21 Select Plus

Plan Year:
2021
Metal Level:
Gold

Gold Metal plans cover an estimated 80% of your medical and prescription drug costs. They also limit your annual out-of-pocket expenses.

Individual Deductible:$4,000
Individual Out of Pocket Maximum:$8,100
Office Visit Copay:$30
Preferred Generics:$15
Preferred Brand Name:$45
Non-Preferred Brand Name:$95*
Individual Rx Deductible:Integrated
Preferred Specialty:$300*
Non-Preferred Specialty:$350*
*Subject to the deductible.

Essential Benefits

All health plans in the exchanges are required to provide a minimum set of benefits which are termed essential benefits. These benefits include:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health services
  • Substance use disorder services
  • Prescription drug coverage
  • Rehabilitative and habilitative services and devices
  • Preventative and wellness services
  • Pediatric Services