Individual/Family
Healthcare Plans

Community Health Options offers a variety of affordable health insurance options, so you can choose the benefit plan that’s right for you or your family. And with even more benefits for 2023, being healthy just got a little easier.

Choose the plan type and year from the dropdowns below:

Showing plans for
X
  • Amwell® Telehealth
  • Pediatric Vision
  • Pediatric Dental
  • Chiropractic/Osteopathic Care
  • CISP
  • National Coverage
  • Preferred Providers and Services
  • Acupuncture
  • Health Coaching
  • Wellness Benefits

Catastrophic Level

Catastrophic plans are for people under 30 or others with certain exemptions.

These plans have the lowest monthly premiums and highest deductibles. This level is an affordable way to protect from worst-case scenarios. Eligibility for catastrophic plans is limited to individuals under 30 or those with a hardship exemption from the Marketplace. These plans do not qualify for Advance Premium Tax Credits.

Health Options Clear Choice Catastrophic HMO NE
$9,100 $18,200
Deductible
$9,100 $18,200
Out-of-pocket Maximum
0% 0%
Co-insurance
  • No out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then visit 2-3 $50 co-pay, no deductible required; then, 0% co-insurance after deductible
Specialty Care Office Visit
0% co-insurance after deductible
Urgent Care Center
0% co-insurance after deductible
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then visit 2-3 $50 co-pay, no deductible required; then, 0% co-insurance after deductible
Emergency Room Visit
0% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
0% co-insurance after deductible
Tier 2 – Generics
0% co-insurance after deductible
Tier 3 – Preferred Brands
0% co-insurance after deductible
Tier 4 – Non-Preferred Brands
0% co-insurance after deductible
Tier 5 – Specialty (30 day supply only)
0% co-insurance after deductible

Bronze Level

In Bronze plans, the insurance company pays about 60%, and the Member pays 40% of the cost for health services.

Bronze plans have low premiums but require Members to pay a higher deductible and often higher out-of-pocket costs compared to other metal levels. These plans keep monthly premium costs low, while providing the same quality coverage when you receive care.

Health Options Clear Choice Bronze $9100 HMO NE
$9,100 $18,200
Deductible
$9,100 $18,200
Out-of-pocket Maximum
0% 0%
Co-insurance
  • No out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $50 co-pay; no deductible required
Specialty Care Office Visit
$80 co-pay; no deductible required
Urgent Care Center
0% co-insurance after deductible
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $50 co-pay; no deductible required
Emergency Room Visit
0% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
0% co-insurance after deductible
Tier 4 – Non-Preferred Brands
0% co-insurance after deductible
Tier 5 – Specialty (30 day supply only)
0% co-insurance after deductible

Health Options Clear Choice Bronze $9100 PPO NE
$9,100 $18,200
Deductible
$9,100 $18,200
Out-of-pocket Maximum
0% 0%
Co-insurance
  • Includes out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $50 co-pay; no deductible required
Specialty Care Office Visit
$80 co-pay; no deductible required
Urgent Care Center
0% co-insurance after deductible
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $50 co-pay; no deductible required
Emergency Room Visit
0% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
0% co-insurance after deductible
Tier 4 – Non-Preferred Brands
0% co-insurance after deductible
Tier 5 – Specialty (30 day supply only)
0% co-insurance after deductible

Health Options Clear Choice Bronze $8000 Healthy Maine HMO NE
$8,000 $16,000
Deductible
$9,100 $18,200
Out-of-pocket Maximum
50% 50%
Co-insurance
  • No out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • Acupuncture Reimbursement up to $50 per treatment session; maximum 12 visits per calendar year.
  • Health Coaching This Healthy Maine plan includes unlimited personal health coaching to help you stay motivated and engaged in your health goals, all at $0 cost-share.
  • Wellness Benefits This plan includes WellRight, our online digital wellbeing platform and mobile app. Benefits include gamified wellness challenges that enable users to choose a wellness journey that’s personalized, integration with wearable devices, and a comprehensive health assessment for all family members at no cost.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $40 co-pay; no deductible required
Specialty Care Office Visit
$80 co-pay after deductible
Urgent Care Center
$60 co-pay; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 co-pay; no deductible required
Emergency Room Visit
50% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
30% co-insurance after deductible
Tier 4 – Non-Preferred Brands
50% co-insurance after deductible
Tier 5 – Specialty (30 day supply only)
50% co-insurance after deductible

Health Options Clear Choice Bronze $8000 Healthy Maine PPO NE
$8,000 $16,000
Deductible
$9,100 $18,200
Out-of-pocket Maximum
50% 50%
Co-insurance
  • Includes out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • Acupuncture Reimbursement up to $50 per treatment session; maximum 12 visits per calendar year.
  • Health Coaching This Healthy Maine plan includes unlimited personal health coaching to help you stay motivated and engaged in your health goals, all at $0 cost-share.
  • Wellness Benefits This plan includes WellRight, our online digital wellbeing platform and mobile app. Benefits include gamified wellness challenges that enable users to choose a wellness journey that’s personalized, integration with wearable devices, and a comprehensive health assessment for all family members at no cost.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $40 co-pay; no deductible required
Specialty Care Office Visit
$80 co-pay after deductible
Urgent Care Center
$60 co-pay; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 co-pay; no deductible required
Emergency Room Visit
50% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
30% co-insurance after deductible
Tier 4 – Non-Preferred Brands
50% co-insurance after deductible
Tier 5 – Specialty (30 day supply only)
50% co-insurance after deductible

Health Options Clear Choice Bronze $7500 HMO Tiered NE

Preferred TierThe tiered plan offers a preferred cost-share, deductible and out-of-pocket maximum expense. Services received from a preferred provider have a lower cost-share than a standard provider. Expenses from these services will be applied to the preferred deductible, and both the preferred and standard out-of-pocket maximums. Preferred providers are high quality, cost-effective, in-network providers.

$7,500 $15,000
Deductible
$9,100 $18,200
Out-of-pocket Maximum
60% 60%
Co-insurance

Standard TierThe tiered plan offers a standard cost-share, deductible and out-of-pocket maximum expense. Services received from a standard provider have a higher cost-share than a preferred provider. Expenses from these services will be applied to the standard deductible and standard out-of-pocket maximum. Standard providers are high quality, in-network providers.

$9,000 $18,000
Deductible
$9,100 $18,200
Out-of-pocket Maximum
60% 60%
Co-insurance
  • No out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
  • Preferred Providers and Services Preferred providers and services are designated by a in the provider directory. Provider types include primary care, pediatrics, ob-gyn, specialties, P/T, O/T, S/T, urgent care facilities, imaging centers, labs, and out-patient hospital services. Preferred providers offer lower cost-sharing.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $40 co-pay Preferred/$60 co-pay Standard; no deductible required
Specialty Care Office Visit
50% co-insurance after deductible Preferred/60% co-insurance after deductible Standard
Urgent Care Center
$60 co-pay Preferred/$80 co-pay Standard; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 co-pay Preferred/$60 co-pay Standard; no deductible required
Emergency Room Visit
50% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
$50 co-pay after deductible
Tier 4 – Non-Preferred Brands
$100 co-pay after deductible
Tier 5 – Specialty (30 day supply only)
$250 co-pay after deductible

Health Options Clear Choice Bronze $7500 HMO NE
$7,500 $15,000
Deductible
$9,100 $18,200
Out-of-pocket Maximum
50% 50%
Co-insurance
  • No out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $40 co-pay; no deductible required
Specialty Care Office Visit
50% co-insurance after deductible
Urgent Care Center
$60 co-pay; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 co-pay; no deductible required
Emergency Room Visit
50% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
$50 co-pay after deductible
Tier 4 – Non-Preferred Brands
$100 co-pay after deductible
Tier 5 – Specialty (30 day supply only)
$250 co-pay after deductible

Health Options Clear Choice Bronze $7500 PPO NE
$7,500 $15,000
Deductible
$9,100 $18,200
Out-of-pocket Maximum
50% 50%
Co-insurance
  • Includes out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $40 co-pay; no deductible required
Specialty Care Office Visit
50% co-insurance after deductible
Urgent Care Center
$60 co-pay; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 co-pay; no deductible required
Emergency Room Visit
50% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
$50 co-pay after deductible
Tier 4 – Non-Preferred Brands
$100 co-pay after deductible
Tier 5 – Specialty (30 day supply only)
$250 co-pay after deductible

Health Options Clear Choice Bronze $7500 PPO NE Dental
$7,500 $15,000
Deductible
$9,100 $18,200
Out-of-pocket Maximum
50% 50%
Co-insurance
  • Includes out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Pediatric Dental Plan includes pediatric dental coverage for children aged 18 or younger, exclusive of orthodontia.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $40 co-pay; no deductible required
Specialty Care Office Visit
50% co-insurance after deductible
Urgent Care Center
$60 co-pay; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 co-pay; no deductible required
Emergency Room Visit
50% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
$50 co-pay after deductible
Tier 4 – Non-Preferred Brands
$100 co-pay after deductible
Tier 5 – Specialty (30 day supply only)
$250 co-pay after deductible

Health Options Clear Choice Bronze $7000 HSA Plus PPO NE
$7,000 $14,000
Deductible
$7,000 $14,000
Out-of-pocket Maximum
0% 0%
Co-insurance
  • Includes out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
0% co-insurance after deductible
Specialty Care Office Visit
0% co-insurance after deductible
Urgent Care Center
0% co-insurance after deductible
Amwell® Urgent Telehealth
0 co-pay after deductible
Mental Health/Substance Use Disorder (Outpatient)
0% co-insurance after deductible
Emergency Room Visit
0% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
0% co-insurance after deductible
Tier 2 – Generics
0% co-insurance after deductible
Tier 3 – Preferred Brands
0% co-insurance after deductible
Tier 4 – Non-Preferred Brands
0% co-insurance after deductible
Tier 5 – Specialty (30 day supply only)
0% co-insurance after deductible
Includes expanded, pre-deductible drug list

Health Options Clear Choice Bronze $5900 HSA PPO NE
$5,900 $11,800
Deductible
$7,500 $15,000
Out-of-pocket Maximum
50% 50%
Co-insurance
  • Includes out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
50% co-insurance after deductible
Specialty Care Office Visit
50% co-insurance after deductible
Urgent Care Center
50% co-insurance after deductible
Amwell® Urgent Telehealth
$0 co-pay after deductible
Mental Health/Substance Use Disorder (Outpatient)
50% co-insurance after deductible
Emergency Room Visit
50% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
50% co-insurance after deductible
Tier 2 – Generics
50% co-insurance after deductible
Tier 3 – Preferred Brands
50% co-insurance after deductible
Tier 4 – Non-Preferred Brands
50% co-insurance after deductible
Tier 5 – Specialty (30 day supply only)
50% co-insurance after deductible

Bronze Level – Off-Exchange Only

The following plans are offered directly through Health Options and are exempt from purchase with Advance Premium Tax Credits. You may purchase them directly through our storefront. In Bronze plans, the insurance company pays about 60%, and the Member pays 40% of the cost for health services.

Health Options Clear Choice Bronze $9100 PPO NE Dental Off MP
$9,100 $18,200
Deductible
$9,100 $18,200
Out-of-pocket Maximum
0% 0%
Co-insurance
  • Includes out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Pediatric Dental Plan includes pediatric dental coverage for children aged 18 or younger, exclusive of orthodontia.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $50 co-pay; no deductible required
Specialty Care Office Visit
$80 co-pay; no deductible required
Urgent Care Center
0% co-insurance after deductible
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $50 co-pay; no deductible required
Emergency Room Visit
0% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
0% co-insurance after deductible
Tier 4 – Non-Preferred Brands
0% co-insurance after deductible
Tier 5 – Specialty (30 day supply only)
0% co-insurance after deductible

Health Options Clear Choice Bronze $9100 PPO National Dental Off MP
$9,100 $18,200
Deductible
$9,100 $18,200
Out-of-pocket Maximum
0% 0%
Co-insurance
  • Includes out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Pediatric Dental Plan includes pediatric dental coverage for children aged 18 or younger, exclusive of orthodontia.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
  • National Coverage Plan includes in-network access to providers throughout the U.S.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $50 co-pay; no deductible required
Specialty Care Office Visit
$80 co-pay; no deductible required
Urgent Care Center
0% co-insurance after deductible
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $50 co-pay; no deductible required
Emergency Room Visit
0% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
0% co-insurance after deductible
Tier 4 – Non-Preferred Brands
0% co-insurance after deductible
Tier 5 – Specialty (30 day supply only)
0% co-insurance after deductible

Health Options Clear Choice Bronze $8000 Healthy Maine HMO NE Off MP
$8,000 $16,000
Deductible
$9,100 $18,200
Out-of-pocket Maximum
50% 50%
Co-insurance
  • No out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • Acupuncture Reimbursement up to $50 per treatment session; maximum 12 visits per calendar year.
  • Health Coaching This Healthy Maine plan includes unlimited personal health coaching to help you stay motivated and engaged in your health goals, all at $0 cost-share.
  • Wellness Benefits This plan includes WellRight, our online digital wellbeing platform and mobile app. Benefits include gamified wellness challenges that enable users to choose a wellness journey that’s personalized, integration with wearable devices, and a comprehensive health assessment for all family members at no cost.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $40 co-pay; no deductible required
Specialty Care Office Visit
$80 co-pay after deductible
Urgent Care Center
$60 co-pay; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 co-pay; no deductible required
Emergency Room Visit
50% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
30% co-insurance after deductible
Tier 4 – Non-Preferred Brands
50% co-insurance after deductible
Tier 5 – Specialty (30 day supply only)
50% co-insurance after deductible

Health Options Clear Choice Bronze $8000 Healthy Maine PPO NE Off MP
$8,000 $16,000
Deductible
$9,100 $18,200
Out-of-pocket Maximum
50% 50%
Co-insurance
  • Includes out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • Acupuncture Reimbursement up to $50 per treatment session; maximum 12 visits per calendar year.
  • Health Coaching This Healthy Maine plan includes unlimited personal health coaching to help you stay motivated and engaged in your health goals, all at $0 cost-share.
  • Wellness Benefits This plan includes WellRight, our online digital wellbeing platform and mobile app. Benefits include gamified wellness challenges that enable users to choose a wellness journey that’s personalized, integration with wearable devices, and a comprehensive health assessment for all family members at no cost.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $40 co-pay; no deductible required
Specialty Care Office Visit
$80 co-pay after deductible
Urgent Care Center
$60 co-pay; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 co-pay; no deductible required
Emergency Room Visit
50% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
30% co-insurance after deductible
Tier 4 – Non-Preferred Brands
50% co-insurance after deductible
Tier 5 – Specialty (30 day supply only)
50% co-insurance after deductible

Health Options Clear Choice Bronze $7500 HMO Tiered NE Dental Off MP

Preferred TierThe tiered plan offers a preferred cost-share, deductible and out-of-pocket maximum expense. Services received from a preferred provider have a lower cost-share than a standard provider. Expenses from these services will be applied to the preferred deductible, and both the preferred and standard out-of-pocket maximums. Preferred providers are high quality, cost-effective, in-network providers.

$7,500 $15,000
Deductible
$9,100 $18,200
Out-of-pocket Maximum
60% 60%
Co-insurance

Standard TierThe tiered plan offers a standard cost-share, deductible and out-of-pocket maximum expense. Services received from a standard provider have a higher cost-share than a preferred provider. Expenses from these services will be applied to the standard deductible and standard out-of-pocket maximum. Standard providers are high quality, in-network providers.

$9,000 $18,000
Deductible
$9,100 $18,200
Out-of-pocket Maximum
60% 60%
Co-insurance
  • No out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Pediatric Dental Plan includes pediatric dental coverage for children aged 18 or younger, exclusive of orthodontia.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
  • Preferred Providers and Services Preferred providers and services are designated by a in the provider directory. Provider types include primary care, pediatrics, ob-gyn, specialties, P/T, O/T, S/T, urgent care facilities, imaging centers, labs, and out-patient hospital services. Preferred providers offer lower cost-sharing.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $40 co-pay Preferred/$60 co-pay Standard; no deductible required
Specialty Care Office Visit
50% co-insurance after deductible Preferred/60% co-insurance after deductible Standard
Urgent Care Center
$60 co-pay Preferred/$80 co-pay Standard; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 co-pay Preferred/$60 co-pay Standard; no deductible required
Emergency Room Visit
50% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
$50 co-pay after deductible
Tier 4 – Non-Preferred Brands
$100 co-pay after deductible
Tier 5 – Specialty (30 day supply only)
$250 co-pay after deductible

Health Options Clear Choice Bronze $7500 PPO NE Dental Off MP
$7,500 $15,000
Deductible
$9,100 $18,200
Out-of-pocket Maximum
50% 50%
Co-insurance
  • Includes out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Pediatric Dental Plan includes pediatric dental coverage for children aged 18 or younger, exclusive of orthodontia.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $40 co-pay; no deductible required
Specialty Care Office Visit
50% co-insurance after deductible
Urgent Care Center
$60 co-pay; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 co-pay; no deductible required
Emergency Room Visit
50% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
$50 co-pay after deductible
Tier 4 – Non-Preferred Brands
$100 co-pay after deductible
Tier 5 – Specialty (30 day supply only)
$250 co-pay after deductible

Health Options Clear Choice Bronze $7500 PPO National Dental Off MP
$7,500 $15,000
Deductible
$9,100 $18,200
Out-of-pocket Maximum
50% 50%
Co-insurance
  • Includes out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Pediatric Dental Plan includes pediatric dental coverage for children aged 18 or younger, exclusive of orthodontia.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
  • National Coverage Plan includes in-network access to providers throughout the U.S.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $40 co-pay; no deductible required
Specialty Care Office Visit
50% co-insurance after deductible
Urgent Care Center
$60 co-pay; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 co-pay; no deductible required
Emergency Room Visit
50% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
$50 co-pay after deductible
Tier 4 – Non-Preferred Brands
$100 co-pay after deductible
Tier 5 – Specialty (30 day supply only)
$250 co-pay after deductible

Health Options Clear Choice Bronze $7000 HSA Plus PPO National Dental Off MP
$7,000 $14,000
Deductible
$7,000 $14,000
Out-of-pocket Maximum
0% 0%
Co-insurance
  • Includes out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Pediatric Dental Plan includes pediatric dental coverage for children aged 18 or younger, exclusive of orthodontia.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • National Coverage Plan includes in-network access to providers throughout the U.S.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
0% co-insurance after deductible
Specialty Care Office Visit
0% co-insurance after deductible
Urgent Care Center
0% co-insurance after deductible
Amwell® Urgent Telehealth
$0 co-pay after deductible
Mental Health/Substance Use Disorder (Outpatient)
0% co-insurance after deductible
Emergency Room Visit
0% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
0% co-insurance after deductible
Tier 2 – Generics
0% co-insurance after deductible
Tier 3 – Preferred Brands
0% co-insurance after deductible
Tier 4 – Non-Preferred Brands
0% co-insurance after deductible
Tier 5 – Specialty (30 day supply only)
0% co-insurance after deductible
Includes expanded, pre-deductible drug list

Health Options Clear Choice Bronze $6300 HSA Plus PPO National Dental Off MP
$6,300 $12,600
Deductible
$7,500 $15,000
Out-of-pocket Maximum
50% 50%
Co-insurance
  • Includes out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Pediatric Dental Plan includes pediatric dental coverage for children aged 18 or younger, exclusive of orthodontia.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • National Coverage Plan includes in-network access to providers throughout the U.S.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
50% co-insurance after deductible
Specialty Care Office Visit
50% co-insurance after deductible
Urgent Care Center
50% co-insurance after deductible
Amwell® Urgent Telehealth
$0 co-pay after deductible
Mental Health/Substance Use Disorder (Outpatient)
50% co-insurance after deductible
Emergency Room Visit
50% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
50% co-insurance after deductible
Tier 2 – Generics
50% co-insurance after deductible
Tier 3 – Preferred Brands
50% co-insurance after deductible
Tier 4 – Non-Preferred Brands
50% co-insurance after deductible
Tier 5 – Specialty (30 day supply only)
50% co-insurance after deductible
Includes expanded, pre-deductible drug list

Silver Level

In Silver plans, the insurance company pays about 70%, and the Member pays 30% of the cost for health services.

Silver plans offer moderate monthly premiums, a moderate deductible, and often moderate out-of-pocket costs compared with other metal levels.  If your income qualifies you for cost-sharing reductions, you must choose a Silver-level plan for the associated savings. 

Health Options Clear Choice Silver $4200 HMO Tiered NE

Preferred TierThe tiered plan offers a preferred cost-share, deductible and out-of-pocket maximum expense. Services received from a preferred provider have a lower cost-share than a standard provider. Expenses from these services will be applied to the preferred deductible, and both the preferred and standard out-of-pocket maximums. Preferred providers are high quality, cost-effective, in-network providers.

$4,200 $8,400
Deductible
$9,100 $18,200
Out-of-pocket Maximum
60% 60%
Co-insurance

Standard TierThe tiered plan offers a standard cost-share, deductible and out-of-pocket maximum expense. Services received from a standard provider have a higher cost-share than a preferred provider. Expenses from these services will be applied to the standard deductible and standard out-of-pocket maximum. Standard providers are high quality, in-network providers.

$5,040 $10,080
Deductible
$9,100 $18,200
Out-of-pocket Maximum
60% 60%
Co-insurance
  • No out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
  • Preferred Providers and Services Preferred providers and services are designated by a in the provider directory. Provider types include primary care, pediatrics, ob-gyn, specialties, P/T, O/T, S/T, urgent care facilities, imaging centers, labs, and out-patient hospital services. Preferred providers offer lower cost-sharing.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $50 co-pay Preferred/$70 co-pay Standard; no deductible required
Specialty Care Office Visit
$80 co-pay Preferred/$95 co-pay Standard; no deductible required
Urgent Care Center
$50 co-pay Preferred/$70 co-pay Standard; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $50 co-pay Preferred/$70 co-pay Standard; no deductible required
Emergency Room Visit
40% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
$50 co-pay; no deductible required
Tier 4 – Non-Preferred Brands
$100 co-pay after deductible
Tier 5 – Specialty (30 day supply only)
$250 co-pay after deductible

Health Options Clear Choice Silver $4200 HMO NE
$4,200 $8,400
Deductible
$9,100 $18,200
Out-of-pocket Maximum
40% 40%
Co-insurance
  • No out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $50 co-pay; no deductible required
Specialty Care Office Visit
$80 co-pay; no deductible required
Urgent Care Center
$50 co-pay; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $50 co-pay; no deductible required
Emergency Room Visit
40% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
$50 co-pay; no deductible required
Tier 4 – Non-Preferred Brands
$100 co-pay after deductible
Tier 5 – Specialty (30 day supply only)
$250 co-pay after deductible

Health Options Clear Choice Silver $4200 PPO NE
$4,200 $8,400
Deductible
$9,100 $18,200
Out-of-pocket Maximum
40% 40%
Co-insurance
  • Includes out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $50 co-pay; no deductible required
Specialty Care Office Visit
$80 co-pay; no deductible required
Urgent Care Center
$50 co-pay; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $50 co-pay; no deductible required
Emergency Room Visit
40% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
$50 co-pay; no deductible required
Tier 4 – Non-Preferred Brands
$100 co-pay after deductible
Tier 5 – Specialty (30 day supply only)
$250 co-pay after deductible

Health Options Clear Choice Silver $3500 HMO Tiered NE

Preferred TierThe tiered plan offers a preferred cost-share, deductible and out-of-pocket maximum expense. Services received from a preferred provider have a lower cost-share than a standard provider. Expenses from these services will be applied to the preferred deductible, and both the preferred and standard out-of-pocket maximums. Preferred providers are high quality, cost-effective, in-network providers.

$3,500 $7,000
Deductible
$9,100 $18,200
Out-of-pocket Maximum
60% 60%
Co-insurance

Standard TierThe tiered plan offers a standard cost-share, deductible and out-of-pocket maximum expense. Services received from a standard provider have a higher cost-share than a preferred provider. Expenses from these services will be applied to the standard deductible and standard out-of-pocket maximum. Standard providers are high quality, in-network providers.

$4,200 $8,400
Deductible
$9,100 $18,200
Out-of-pocket Maximum
60% 60%
Co-insurance
  • No out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
  • Preferred Providers and Services Preferred providers and services are designated by a in the provider directory. Provider types include primary care, pediatrics, ob-gyn, specialties, P/T, O/T, S/T, urgent care facilities, imaging centers, labs, and out-patient hospital services. Preferred providers offer lower cost-sharing.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $40 co-pay Preferred/$60 co-pay Standard; no deductible required
Specialty Care Office Visit
$80 co-pay Preferred/$95 co-pay Standard; no deductible required
Urgent Care Center
$40 co-pay Preferred/$60 co-pay Standard; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 co-pay Preferred/$60 co-pay Standard; no deductible required
Emergency Room Visit
40% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
$50 co-pay; no deductible required
Tier 4 – Non-Preferred Brands
$100 co-pay after deductible
Tier 5 – Specialty (30 day supply only)
$250 co-pay after deductible

Health Options Clear Choice Silver $3500 HMO NE
$3,500 $7,000
Deductible
$9,100 $18,200
Out-of-pocket Maximum
40% 40%
Co-insurance
  • No out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $40 co-pay; no deductible required
Specialty Care Office Visit
$80 co-pay; no deductible required
Urgent Care Center
$40 co-pay; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 co-pay; no deductible required
Emergency Room Visit
40% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
$50 co-pay; no deductible required
Tier 4 – Non-Preferred Brands
$100 co-pay after deductible
Tier 5 – Specialty (30 day supply only)
$250 co-pay after deductible

Health Options Clear Choice Silver $3500 HMO NE Dental
$3,500 $7,000
Deductible
$9,100 $18,200
Out-of-pocket Maximum
40% 40%
Co-insurance
  • No out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Pediatric Dental Plan includes pediatric dental coverage for children aged 18 or younger, exclusive of orthodontia.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $40 co-pay; no deductible required
Specialty Care Office Visit
$80 co-pay; no deductible required
Urgent Care Center
$40 co-pay; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 co-pay; no deductible required
Emergency Room Visit
40% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
$50 co-pay; no deductible required
Tier 4 – Non-Preferred Brands
$100 co-pay after deductible
Tier 5 – Specialty (30 day supply only)
$250 co-pay after deductible

Health Options Clear Choice Silver $3500 PPO National
$3,500 $7,000
Deductible
$9,100 $18,200
Out-of-pocket Maximum
40% 40%
Co-insurance
  • Includes out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
  • National Coverage Plan includes in-network access to providers throughout the U.S.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $40 co-pay; no deductible required
Specialty Care Office Visit
$80 co-pay; no deductible required
Urgent Care Center
$40 co-pay; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 co-pay; no deductible required
Emergency Room Visit
40% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
$50 co-pay; no deductible required
Tier 4 – Non-Preferred Brands
$100 co-pay after deductible
Tier 5 – Specialty (30 day supply only)
$250 co-pay after deductible

Health Options Clear Choice Silver $3000 PPO NE
$3,000 $6,000
Deductible
$9,100 $18,200
Out-of-pocket Maximum
40% 40%
Co-insurance
  • Includes out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $40 co-pay; no deductible required
Specialty Care Office Visit
$80 co-pay; no deductible required
Urgent Care Center
$40 co-pay; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 co-pay; no deductible required
Emergency Room Visit
40% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
$50 co-pay; no deductible required
Tier 4 – Non-Preferred Brands
30% co-insurance up to max of $300/script after deductible
Tier 5 – Specialty (30 day supply only)
50% co-insurance up to max of $600/script after deductible

Health Options Clear Choice Silver $3000 PPO NE Dental
$3,000 $6,000
Deductible
$9,100 $18,200
Out-of-pocket Maximum
40% 40%
Co-insurance
  • Includes out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Pediatric Dental Plan includes pediatric dental coverage for children aged 18 or younger, exclusive of orthodontia.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $40 co-pay; no deductible required
Specialty Care Office Visit
$80 co-pay; no deductible required
Urgent Care Center
$40 co-pay; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 co-pay; no deductible required
Emergency Room Visit
40% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
$50 co-pay; no deductible required
Tier 4 – Non-Preferred Brands
30% co-insurance up to max of $300/script after deductible
Tier 5 – Specialty (30 day supply only)
50% co-insurance up to max of $600/script after deductible

Silver Level – Off Exchange Only

In Silver plans, the insurance company pays about 70%, and the Member pays 30% of the cost for health services.

While all our 2023 Individual and Family plans are available for purchase, the following plans are offered directly through Health Options and are exempt from purchase with Advance Premium Tax Credits.  You may purchase them directly through our storefront.

Health Options Clear Choice Silver $5500 HMO Tiered NE Dental Off MP

Preferred TierThe tiered plan offers a preferred cost-share, deductible and out-of-pocket maximum expense. Services received from a preferred provider have a lower cost-share than a standard provider. Expenses from these services will be applied to the preferred deductible, and both the preferred and standard out-of-pocket maximums. Preferred providers are high quality, cost-effective, in-network providers.

$5,500 $11,000
Deductible
$8,500 $17,000
Out-of-pocket Maximum
50% 50%
Co-insurance

Standard TierThe tiered plan offers a standard cost-share, deductible and out-of-pocket maximum expense. Services received from a standard provider have a higher cost-share than a preferred provider. Expenses from these services will be applied to the standard deductible and standard out-of-pocket maximum. Standard providers are high quality, in-network providers.

$6,600 $13,200
Deductible
$9,100 $18,200
Out-of-pocket Maximum
50% 50%
Co-insurance
  • No out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Pediatric Dental Plan includes pediatric dental coverage for children aged 18 or younger, exclusive of orthodontia.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
  • Preferred Providers and Services Preferred providers and services are designated by a in the provider directory. Provider types include primary care, pediatrics, ob-gyn, specialties, P/T, O/T, S/T, urgent care facilities, imaging centers, labs, and out-patient hospital services. Preferred providers offer lower cost-sharing.
  • Wellness Benefits This plan includes WellRight, our online digital wellbeing platform and mobile app. Benefits include gamified wellness challenges that enable users to choose a wellness journey that’s personalized, integration with wearable devices, and a comprehensive health assessment for all family members at no cost.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $40 co-pay Preferred/$60 co-pay Standard; no deductible required
Specialty Care Office Visit
$70 co-pay Preferred/$85 co-pay Standard; no deductible required
Urgent Care Center
$40 co-pay Preferred/$60 co-pay Standard; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 co-pay Preferred/$60 co-pay Standard; no deductible required
Emergency Room Visit
30% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
$50 co-pay; no deductible required
Tier 4 – Non-Preferred Brands
30% co-insurance after deductible
Tier 5 – Specialty (30 day supply only)
50% co-insurance after deductible

Health Options Clear Choice Silver $5500 HMO NE Dental Off MP
$5,500 $11,000
Deductible
$8,500 $17,000
Out-of-pocket Maximum
30% 30%
Co-insurance
  • No out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Pediatric Dental Plan includes pediatric dental coverage for children aged 18 or younger, exclusive of orthodontia.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
  • Wellness Benefits This plan includes WellRight, our online digital wellbeing platform and mobile app. Benefits include gamified wellness challenges that enable users to choose a wellness journey that’s personalized, integration with wearable devices, and a comprehensive health assessment for all family members at no cost.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $40 co-pay; no deductible required
Specialty Care Office Visit
$70 co-pay; no deductible required
Urgent Care Center
$40 co-pay; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 co-pay; no deductible required
Emergency Room Visit
30% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
$50 co-pay; no deductible required
Tier 4 – Non-Preferred Brands
30% co-insurance after deductible
Tier 5 – Specialty (30 day supply only)
50% co-insurance after deductible

Health Options Clear Choice Silver $5500 PPO National Dental Off MP
$5,500 $11,000
Deductible
$8,500 $17,000
Out-of-pocket Maximum
30% 30%
Co-insurance
  • Includes out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Pediatric Dental Plan includes pediatric dental coverage for children aged 18 or younger, exclusive of orthodontia.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
  • National Coverage Plan includes in-network access to providers throughout the U.S.
  • Wellness Benefits This plan includes WellRight, our online digital wellbeing platform and mobile app. Benefits include gamified wellness challenges that enable users to choose a wellness journey that’s personalized, integration with wearable devices, and a comprehensive health assessment for all family members at no cost.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $40 co-pay; no deductible required
Specialty Care Office Visit
$70 co-pay; no deductible required
Urgent Care Center
$40 co-pay; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 co-pay; no deductible required
Emergency Room Visit
30% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
$50 co-pay; no deductible required
Tier 4 – Non-Preferred Brands
30% co-insurance after deductible
Tier 5 – Specialty (30 day supply only)
50% co-insurance after deductible

Health Options Clear Choice Silver $4500 HSA HMO Tiered NE Dental Off MP

Preferred TierThe tiered plan offers a preferred cost-share, deductible and out-of-pocket maximum expense. Services received from a preferred provider have a lower cost-share than a standard provider. Expenses from these services will be applied to the preferred deductible, and both the preferred and standard out-of-pocket maximums. Preferred providers are high quality, cost-effective, in-network providers.

$4,500 $9,000
Deductible
$7,000 $14,000
Out-of-pocket Maximum
40% 40%
Co-insurance

Standard TierThe tiered plan offers a standard cost-share, deductible and out-of-pocket maximum expense. Services received from a standard provider have a higher cost-share than a preferred provider. Expenses from these services will be applied to the standard deductible and standard out-of-pocket maximum. Standard providers are high quality, in-network providers.

$5,400 $10,800
Deductible
$7,500 $15,000
Out-of-pocket Maximum
40% 40%
Co-insurance
  • No out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Pediatric Dental Plan includes pediatric dental coverage for children aged 18 or younger, exclusive of orthodontia.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
  • Preferred Providers and Services Preferred providers and services are designated by a in the provider directory. Provider types include primary care, pediatrics, ob-gyn, specialties, P/T, O/T, S/T, urgent care facilities, imaging centers, labs, and out-patient hospital services. Preferred providers offer lower cost-sharing.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
20% co-insurance after deductible Preferred/40% co-insurance after deductible Standard
Specialty Care Office Visit
20% co-insurance after deductible Preferred/40% co-insurance after deductible Standard
Urgent Care Center
20% co-insurance after deductible Preferred/40% co-insurance after deductible Standard
Amwell® Urgent Telehealth
$0 co-pay after deductible
Mental Health/Substance Use Disorder (Outpatient)
20% co-insurance after deductible Preferred/40% co-insurance after deductible Standard
Emergency Room Visit
20% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
20% co-insurance after deductible
Tier 2 – Generics
20% co-insurance after deductible
Tier 3 – Preferred Brands
20% co-insurance after deductible
Tier 4 – Non-Preferred Brands
20% co-insurance after deductible
Tier 5 – Specialty (30 day supply only)
20% co-insurance after deductible

Health Options Clear Choice Silver $4500 HSA HMO NE Dental Off MP
$4,500 $9,000
Deductible
$7,000 $14,000
Out-of-pocket Maximum
20% 20%
Co-insurance
  • No out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Pediatric Dental Plan includes pediatric dental coverage for children aged 18 or younger, exclusive of orthodontia.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
20% co-insurance after deductible
Specialty Care Office Visit
20% co-insurance after deductible
Urgent Care Center
20% co-insurance after deductible
Amwell® Urgent Telehealth
$0 co-pay after deductible
Mental Health/Substance Use Disorder (Outpatient)
20% co-insurance after deductible
Emergency Room Visit
20% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
20% co-insurance after deductible
Tier 2 – Generics
20% co-insurance after deductible
Tier 3 – Preferred Brands
20% co-insurance after deductible
Tier 4 – Non-Preferred Brands
20% co-insurance after deductible
Tier 5 – Specialty (30 day supply only)
20% co-insurance after deductible

Health Options Clear Choice Silver $4200 HMO Tiered NE Dental Off MP

Preferred TierThe tiered plan offers a preferred cost-share, deductible and out-of-pocket maximum expense. Services received from a preferred provider have a lower cost-share than a standard provider. Expenses from these services will be applied to the preferred deductible, and both the preferred and standard out-of-pocket maximums. Preferred providers are high quality, cost-effective, in-network providers.

$4,200 $8,400
Deductible
$9,100 $18,200
Out-of-pocket Maximum
60% 60%
Co-insurance

Standard TierThe tiered plan offers a standard cost-share, deductible and out-of-pocket maximum expense. Services received from a standard provider have a higher cost-share than a preferred provider. Expenses from these services will be applied to the standard deductible and standard out-of-pocket maximum. Standard providers are high quality, in-network providers.

$5,040 $10,080
Deductible
$9,100 $18,200
Out-of-pocket Maximum
60% 60%
Co-insurance
  • No out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Pediatric Dental Plan includes pediatric dental coverage for children aged 18 or younger, exclusive of orthodontia.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
  • Preferred Providers and Services Preferred providers and services are designated by a in the provider directory. Provider types include primary care, pediatrics, ob-gyn, specialties, P/T, O/T, S/T, urgent care facilities, imaging centers, labs, and out-patient hospital services. Preferred providers offer lower cost-sharing.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $50 co-pay Preferred/$70 co-pay Standard; no deductible required
Specialty Care Office Visit
$80 co-pay Preferred/$95 co-pay Standard; no deductible required
Urgent Care Center
$50 co-pay Preferred/$70 co-pay Standard; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $50 co-pay Preferred/$70 co-pay Standard; no deductible required
Emergency Room Visit
40% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
$50 co-pay; no deductible required
Tier 4 – Non-Preferred Brands
$100 co-pay after deductible
Tier 5 – Specialty (30 day supply only)
$250 co-pay after deductible

Health Options Clear Choice Silver $4200 PPO National Dental Off MP
$4,200 $8,400
Deductible
$9,100 $18,200
Out-of-pocket Maximum
40% 40%
Co-insurance
  • Includes out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Pediatric Dental Plan includes pediatric dental coverage for children aged 18 or younger, exclusive of orthodontia.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
  • National Coverage Plan includes in-network access to providers throughout the U.S.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $50 co-pay; no deductible required
Specialty Care Office Visit
$80 co-pay; no deductible required
Urgent Care Center
$50 co-pay; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $50 co-pay; no deductible required
Emergency Room Visit
40% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
$50 co-pay; no deductible required
Tier 4 – Non-Preferred Brands
$100 co-pay after deductible
Tier 5 – Specialty (30 day supply only)
$250 co-pay after deductible

Health Options Clear Choice Silver $4000 HSA PPO NE Dental Off MP
$4,000 $8,000
Deductible
$7,000 $14,000
Out-of-pocket Maximum
20% 20%
Co-insurance
  • Includes out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Pediatric Dental Plan includes pediatric dental coverage for children aged 18 or younger, exclusive of orthodontia.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • Acupuncture Reimbursement up to $50 per treatment session; maximum 12 visits per calendar year.
  • Wellness Benefits This plan includes WellRight, our online digital wellbeing platform and mobile app. Benefits include gamified wellness challenges that enable users to choose a wellness journey that’s personalized, integration with wearable devices, and a comprehensive health assessment for all family members at no cost.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
20% co-insurance after deductible
Specialty Care Office Visit
20% co-insurance after deductible
Urgent Care Center
20% co-insurance after deductible
Amwell® Urgent Telehealth
$0 co-pay after deductible
Mental Health/Substance Use Disorder (Outpatient)
20% co-insurance after deductible
Emergency Room Visit
20% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
20% co-insurance after deductible
Tier 2 – Generics
20% co-insurance after deductible
Tier 3 – Preferred Brands
20% co-insurance after deductible
Tier 4 – Non-Preferred Brands
20% co-insurance after deductible
Tier 5 – Specialty (30 day supply only)
20% co-insurance after deductible

Health Options $4000 HMO National Off MP
$4,000 $8,000
Deductible
$9,100 $18,200
Out-of-pocket Maximum
40% 40%
Co-insurance
  • No out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
  • National Coverage Plan includes in-network access to providers throughout the U.S.
  • Wellness Benefits This plan includes WellRight, our online digital wellbeing platform and mobile app. Benefits include gamified wellness challenges that enable users to choose a wellness journey that’s personalized, integration with wearable devices, and a comprehensive health assessment for all family members at no cost.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $50 co-pay; no deductible required
Specialty Care Office Visit
$85 co-pay; no deductible required
Urgent Care Center
$50 co-pay; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $50 co-pay; no deductible required
Emergency Room Visit
40% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$35 co-pay; no deductible required
Tier 3 – Preferred Brands
$70 co-pay; no deductible required
Tier 4 – Non-Preferred Brands
30% co-insurance up to max of $400/script after deductible
Tier 5 – Specialty (30 day supply only)
30% co-insurance up to max of $500/script after deductible

Health Options Clear Choice Silver $3500 HSA HMO NE Dental Off MP
$3,500 $7,000
Deductible
$7,000 $14,000
Out-of-pocket Maximum
10% 10%
Co-insurance
  • No out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Pediatric Dental Plan includes pediatric dental coverage for children aged 18 or younger, exclusive of orthodontia.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
10% co-insurance after deductible
Specialty Care Office Visit
10% co-insurance after deductible
Urgent Care Center
10% co-insurance after deductible
Amwell® Urgent Telehealth
$0 co-pay after deductible
Mental Health/Substance Use Disorder (Outpatient)
10% co-insurance after deductible
Emergency Room Visit
10% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay after deductible
Tier 2 – Generics
$25 co-pay after deductible
Tier 3 – Preferred Brands
$50 co-pay after deductible
Tier 4 – Non-Preferred Brands
$100 co-pay after deductible
Tier 5 – Specialty (30 day supply only)
$250 co-pay after deductible

Health Options Clear Choice Silver $3500 HMO Tiered NE Dental Off MP

Preferred TierThe tiered plan offers a preferred cost-share, deductible and out-of-pocket maximum expense. Services received from a preferred provider have a lower cost-share than a standard provider. Expenses from these services will be applied to the preferred deductible, and both the preferred and standard out-of-pocket maximums. Preferred providers are high quality, cost-effective, in-network providers.

$3,500 $7,000
Deductible
$9,100 $18,200
Out-of-pocket Maximum
60% 60%
Co-insurance

Standard TierThe tiered plan offers a standard cost-share, deductible and out-of-pocket maximum expense. Services received from a standard provider have a higher cost-share than a preferred provider. Expenses from these services will be applied to the standard deductible and standard out-of-pocket maximum. Standard providers are high quality, in-network providers.

$4,200 $8,400
Deductible
$9,100 $18,200
Out-of-pocket Maximum
60% 60%
Co-insurance
  • No out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Pediatric Dental Plan includes pediatric dental coverage for children aged 18 or younger, exclusive of orthodontia.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
  • Preferred Providers and Services Preferred providers and services are designated by a in the provider directory. Provider types include primary care, pediatrics, ob-gyn, specialties, P/T, O/T, S/T, urgent care facilities, imaging centers, labs, and out-patient hospital services. Preferred providers offer lower cost-sharing.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $40 co-pay Preferred/$60 co-pay Standard; no deductible required
Specialty Care Office Visit
$80 co-pay Preferred/$95 co-pay Standard; no deductible required
Urgent Care Center
$40 co-pay Preferred/$60 co-pay Standard; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 co-pay Preferred/$60 co-pay Standard; no deductible required
Emergency Room Visit
40% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
$50 co-pay; no deductible required
Tier 4 – Non-Preferred Brands
$100 co-pay after deductible
Tier 5 – Specialty (30 day supply only)
$250 co-pay after deductible

Health Options Clear Choice Silver $3500 PPO NE Dental Off MP
$3,500 $7,000
Deductible
$9,100 $18,200
Out-of-pocket Maximum
40% 40%
Co-insurance
  • Includes out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Pediatric Dental Plan includes pediatric dental coverage for children aged 18 or younger, exclusive of orthodontia.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $40 co-pay; no deductible required
Specialty Care Office Visit
$80 co-pay; no deductible required
Urgent Care Center
$40 co-pay; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 co-pay; no deductible required
Emergency Room Visit
40% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
$50 co-pay; no deductible required
Tier 4 – Non-Preferred Brands
$100 co-pay after deductible
Tier 5 – Specialty (30 day supply only)
$250 co-pay after deductible

Health Options Clear Choice Silver $3500 PPO National Dental Off MP
$3,500 $7,000
Deductible
$9,100 $18,200
Out-of-pocket Maximum
40% 40%
Co-insurance
  • Includes out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Pediatric Dental Plan includes pediatric dental coverage for children aged 18 or younger, exclusive of orthodontia.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
  • National Coverage Plan includes in-network access to providers throughout the U.S.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $40 co-pay; no deductible required
Specialty Care Office Visit
$80 co-pay; no deductible required
Urgent Care Center
$40 co-pay; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 co-pay; no deductible required
Emergency Room Visit
40% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
$50 co-pay; no deductible required
Tier 4 – Non-Preferred Brands
$100 co-pay after deductible
Tier 5 – Specialty (30 day supply only)
$250 co-pay after deductible

Health Options Clear Choice Silver $3000 HSA Plus PPO National Dental Off MP
$3,000 $6,000
Deductible
$7,000 $14,000
Out-of-pocket Maximum
15% 15%
Co-insurance
  • Includes out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Pediatric Dental Plan includes pediatric dental coverage for children aged 18 or younger, exclusive of orthodontia.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • National Coverage Plan includes in-network access to providers throughout the U.S.
  • Wellness Benefits This plan includes WellRight, our online digital wellbeing platform and mobile app. Benefits include gamified wellness challenges that enable users to choose a wellness journey that’s personalized, integration with wearable devices, and a comprehensive health assessment for all family members at no cost.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
15% co-insurance after deductible
Specialty Care Office Visit
15% co-insurance after deductible
Urgent Care Center
15% co-insurance after deductible
Amwell® Urgent Telehealth
$0 co-pay after deductible
Mental Health/Substance Use Disorder (Outpatient)
15% co-insurance after deductible
Emergency Room Visit
15% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay after deductible
Tier 2 – Generics
$25 co-pay after deductible
Tier 3 – Preferred Brands
$50 co-pay after deductible
Tier 4 – Non-Preferred Brands
$100 co-pay after deductible
Tier 5 – Specialty (30 day supply only)
$250 co-pay after deductible
Includes expanded, pre-deductible drug list

Health Options Clear Choice Silver $3000 PPO NE Dental Off MP
$3,000 $6,000
Deductible
$9,100 $18,200
Out-of-pocket Maximum
40% 40%
Co-insurance
  • Includes out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Pediatric Dental Plan includes pediatric dental coverage for children aged 18 or younger, exclusive of orthodontia.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $40 co-pay; no deductible required
Specialty Care Office Visit
$80 co-pay; no deductible required
Urgent Care Center
$40 co-pay; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 co-pay; no deductible required
Emergency Room Visit
40% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
$50 co-pay; no deductible required
Tier 4 – Non-Preferred Brands
30% co-insurance up to $300/script max after deductible
Tier 5 – Specialty (30 day supply only)
50% co-insurance up to $600/script max after deductible

Gold Level

In Gold plans, the insurance company pays about 80% and the Member pays 20% of the cost for health services.

Gold plans have higher monthly premiums, but lower deductibles and out-of-pocket costs compared to other metal levels. These plans are a good option if you prefer lower deductibles and out-of-pocket expenses, anticipate the need for frequent or high-cost medical treatment, and are comfortable with a larger monthly premium expense. 

Health Options Clear Choice Gold $2500 PPO NE
$2,500 $5,000
Deductible
$5,000 $10,000
Out-of-pocket Maximum
30% 30%
Co-insurance
  • Includes out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $20 co-pay; no deductible required
Specialty Care Office Visit
$50 co-pay; no deductible required
Urgent Care Center
$40 co-pay; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $20 co-pay; no deductible required
Emergency Room Visit
30% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
$50 co-pay; no deductible required
Tier 4 – Non-Preferred Brands
30% co-insurance, up to max of $300/script; no deductible required
Tier 5 – Specialty (30 day supply only)
50% co-insurance. up to max of $600/script; no deductible required

Health Options Clear Choice Gold $2500 PPO NE Dental
$2,500 $5,000
Deductible
$5,000 $10,000
Out-of-pocket Maximum
30% 30%
Co-insurance
  • Includes out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Pediatric Dental Plan includes pediatric dental coverage for children aged 18 or younger, exclusive of orthodontia.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $20 co-pay; no deductible required
Specialty Care Office Visit
$50 co-pay; no deductible required
Urgent Care Center
$40 co-pay; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $20 co-pay; no deductible required
Emergency Room Visit
30% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
$50 co-pay; no deductible required
Tier 4 – Non-Preferred Brands
30% co-insurance, up to max of $300/script; no deductible required
Tier 5 – Specialty (30 day supply only)
50% co-insurance. up to max of $600/script; no deductible required

Health Options Clear Choice Gold $2500 PPO National Dental
$2,500 $5,000
Deductible
$5,000 $10,000
Out-of-pocket Maximum
30% 30%
Co-insurance
  • Includes out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Pediatric Dental Plan includes pediatric dental coverage for children aged 18 or younger, exclusive of orthodontia.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $20 co-pay; no deductible required
Specialty Care Office Visit
$50 co-pay; no deductible required
Urgent Care Center
$40 co-pay; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $20 co-pay; no deductible required
Emergency Room Visit
30% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
$50 co-pay; no deductible required
Tier 4 – Non-Preferred Brands
30% co-insurance, up to max of $300/script; no deductible required
Tier 5 – Specialty (30 day supply only)
50% co-insurance. up to max of $600/script; no deductible required

Health Options Clear Choice Gold $1500 PPO NE
$1,500 $3,000
Deductible
$5,000 $10,000
Out-of-pocket Maximum
30% 30%
Co-insurance
  • Includes out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
  • Acupuncture Reimbursement up to $50 per treatment session; maximum 12 visits per calendar year.
  • Wellness Benefits This plan includes WellRight, our online digital wellbeing platform and mobile app. Benefits include gamified wellness challenges that enable users to choose a wellness journey that’s personalized, integration with wearable devices, and a comprehensive health assessment for all family members at no cost.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $25 co-pay; no deductible required
Specialty Care Office Visit
$50 co-pay; no deductible required
Urgent Care Center
$40 co-pay; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $25 co-pay; no deductible required
Emergency Room Visit
30% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
$50 co-pay; no deductible required
Tier 4 – Non-Preferred Brands
$100 co-pay after deductible
Tier 5 – Specialty (30 day supply only)
$250 co-pay after deductible

Health Options Clear Choice Gold $1500 PPO National
$1,500 $3,000
Deductible
$5,000 $10,000
Out-of-pocket Maximum
30% 30%
Co-insurance
  • Includes out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
  • National Coverage Plan includes in-network access to providers throughout the U.S.
  • Acupuncture Reimbursement up to $50 per treatment session; maximum 12 visits per calendar year.
  • Wellness Benefits This plan includes WellRight, our online digital wellbeing platform and mobile app. Benefits include gamified wellness challenges that enable users to choose a wellness journey that’s personalized, integration with wearable devices, and a comprehensive health assessment for all family members at no cost.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $25 co-pay; no deductible required
Specialty Care Office Visit
$50 co-pay; no deductible required
Urgent Care Center
$40 co-pay; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $25 co-pay; no deductible required
Emergency Room Visit
30% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
$50 co-pay; no deductible required
Tier 4 – Non-Preferred Brands
$100 co-pay after deductible
Tier 5 – Specialty (30 day supply only)
$250 co-pay after deductible

Gold Level – Off Exchange Only

In Gold plans, the insurance company pays about 80% and the Member pays 20% of the cost for health services.

While all our 2023 Individual and Family plans are available for purchase, the following plans are offered directly through Health Options and are exempt from purchase with Advance Premium Tax Credits.  You may purchase them directly through our storefront.

Health Options Clear Choice Gold $2500 PPO NE Dental Off MP
$2,500 $5,000
Deductible
$5,000 $10,000
Out-of-pocket Maximum
30% 30%
Co-insurance
  • Includes out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Pediatric Dental Plan includes pediatric dental coverage for children aged 18 or younger, exclusive of orthodontia.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $20 co-pay; no deductible required
Specialty Care Office Visit
$50 co-pay; no deductible required
Urgent Care Center
$40 co-pay; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $20 co-pay; no deductible required
Emergency Room Visit
30% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
$50 co-pay; no deductible required
Tier 4 – Non-Preferred Brands
30% co-insurance, up to max of $300/Rx; no deductible required
Tier 5 – Specialty (30 day supply only)
50% co-insurance. up to max of $600/Rx; no deductible required

Health Options Clear Choice Gold $2500 PPO National Dental Off MP
$2,500 $5,000
Deductible
$5,000 $10,000
Out-of-pocket Maximum
30% 30%
Co-insurance
  • Includes out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Pediatric Dental Plan includes pediatric dental coverage for children aged 18 or younger, exclusive of orthodontia.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
  • National Coverage Plan includes in-network access to providers throughout the U.S.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $20 co-pay; no deductible required
Specialty Care Office Visit
$50 co-pay; no deductible required
Urgent Care Center
$40 co-pay; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $20 co-pay; no deductible required
Emergency Room Visit
30% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
$50 co-pay; no deductible required
Tier 4 – Non-Preferred Brands
30% co-insurance, up to max of $300/Rx; no deductible required
Tier 5 – Specialty (30 day supply only)
50% co-insurance. up to max of $600/Rx; no deductible required

Health Options Clear Choice Gold $1500 PPO National Dental Off MP
$1,500 $3,000
Deductible
$5,000 $10,000
Out-of-pocket Maximum
30% 30%
Co-insurance
  • Includes out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Pediatric Dental Plan includes pediatric dental coverage for children aged 18 or younger, exclusive of orthodontia.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
  • National Coverage Plan includes in-network access to providers throughout the U.S.
  • Acupuncture Reimbursement up to $50 per treatment session; maximum 12 visits per calendar year.
  • Wellness Benefits This plan includes WellRight, our online digital wellbeing platform and mobile app. Benefits include gamified wellness challenges that enable users to choose a wellness journey that’s personalized, integration with wearable devices, and a comprehensive health assessment for all family members at no cost.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $25 co-pay; no deductible required
Specialty Care Office Visit
$50 co-pay; no deductible required
Urgent Care Center
$40 co-pay; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $25 co-pay; no deductible required
Emergency Room Visit
30% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 co-pay; no deductible required
Tier 2 – Generics
$25 co-pay; no deductible required
Tier 3 – Preferred Brands
$50 co-pay; no deductible required
Tier 4 – Non-Preferred Brands
$100 co-pay after deductible
Tier 5 – Specialty (30 day supply only)
$250 co-pay after deductible

Platinum Level

In Platinum plans, the insurance company pays about 90%, and the Member pays 10% of the cost for health services.

Our Platinum plan has the highest monthly premium but offers the most financial coverage when you need care. This plan is a good option for Members who are comfortable with the monthly premiums, prefer low out-of-pocket expenses, and expect to make frequent use of their health benefits.

Health Options Clear Choice Platinum PPO NE
$500 $1,000
Deductible
$3,000 $6,000
Out-of-pocket Maximum
20% 20%
Co-insurance
  • Includes out-of-network benefits Out-of-network benefits have separate and higher deductibles and cost-sharing and Member responsibility for claims and pre-approval processes.
  • Cost-share reductions not available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
  • Amwell® Telehealth Plan includes $0 access to telehealth for urgent care via Amwell®.
  • Pediatric Vision Plan includes pediatric vision coverage, including exam and glasses or contacts for children aged 18 or younger.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy.
  • CISP Plan includes our Chronic Illness Support Program, which reduces cost sharing for Members with asthma, diabetes, coronary artery disease, chronic pulmonary disease, and hypertension.
  • Wellness Benefits This plan includes WellRight, our online digital wellbeing platform and mobile app. Benefits include gamified wellness challenges that enable users to choose a wellness journey that’s personalized, integration with wearable devices, and a comprehensive health assessment for all family members at no cost.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $20 co-pay; no deductible required
Specialty Care Office Visit
$40 co-pay; no deductible required
Urgent Care Center
$25 co-pay; no deductible required
Amwell® Urgent Telehealth
$0 co-pay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $20 co-pay; no deductible required
Emergency Room Visit
20% co-insurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$0 co-pay; no deductible required
Tier 2 – Generics
$0 co-pay; no deductible required
Tier 3 – Preferred Brands
$15 co-pay; no deductible required
Tier 4 – Non-Preferred Brands
$100 co-pay after deductible
Tier 5 – Specialty (30 day supply only)
$250 co-pay after deductible
Includes expanded, pre-deductible drug list