Plan Brochure
CommunityCare Silver Standardized
Plan Year:
2025
Metal Level:
Silver
Silver Metal plans cover an estimated 70% of your medical and prescription drug costs. They limit your annual out-of-pocket expenses.
Medical Benefit
In Network | |
Individual Deductible | $0 |
Family Deductible | $0 |
Individual Out of Pocket Maximum | $0 |
Family Out of Pocket Maximum | $0 |
Primary Care Office Visits | No Copayment |
Specialty Care Office Visits | No Copayment |
Preventive Care | No Copayment |
Emergency Room | No Copayment |
Urgent Care | No Copayment |
Inpatient Hospital | No Copayment |
Mental Health Physician Visit | No Copayment |
Laboratory | No Copayment |
Radiology | No Copayment |
MRI, CT Scan and PET Scan | No Copayment |
Pharmacy Benefit
| |
Combined Pharmacy and Medical Individual Out-of-Pocket Maximum | $0 |
Combined Pharmacy and Medical Family Out-of-Pocket Maximum | $0 |
Retail Pharmacy - Tier1 - Preferred Generic Drugs | $0 |
Retail Pharmacy - Tier 2 - Preferred Brand Drugs | $0 |
Retail Pharmacy - Tier 3 - Non-Preferred Brand or Generic Drugs | $0 |
Retail Pharmacy - Diabetic, Ostomy, and Urologic Supplies | $0 |
Mail Order Pharmacy - Tier 1 - Preferred Generic Drugs | $0 |
Mail Order Pharmacy - Tier 2 - Preferred Brand Drugs | $0 |
Mail Order Pharmacy - Tier 3 - Non-Preferred Brand or Generic Drugs | $0 |
Mail Order Pharmacy - Diabetic, Ostomy, and Urologic Supplies | $0 |
Specialty Pharmacy - Tier 4 - Preferred Specialty Pharmacy Drugs | $0 |
Select supplies will be covered under the applicable formulary tier copay/coinsurance.
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