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 VisitsNo Copayment
Specialty Care Office VisitsNo Copayment
Preventive CareNo Copayment
Emergency RoomNo Copayment
Urgent CareNo Copayment
Inpatient HospitalNo Copayment
Mental Health Physician VisitNo Copayment
LaboratoryNo Copayment
RadiologyNo 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