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 2025, being healthy just got a little easier.

Choose the plan type and year from the dropdowns below:

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

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
$9,200 $18,400
Deductible
$9,200 $18,400
Out-of-pocket Maximum
0% 0%
Coinsurance
  • No out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Does not include Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions not available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
array(3) { [0]=> string(12) “adult_vision” [1]=> string(12) “chiropractic” [2]=> string(10) “telehealth” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, visits 2-3 $50 copay, no deductible required; then 0% coinsurance after deductible; copays for visits 2-3 accumulate to the deductible
Specialty Care Office Visit
0% coinsurance after deductible
Urgent Care Center
0% coinsurance after deductible
Amwell® Urgent Telehealth
$0 copay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, visits 2-3 $50 copay, no deductible required; then 0% coinsurance after deductible; copays for visits 2-3 accumulate to the deductible
Emergency Room Visit
0% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
0% coinsurance after deductible
Tier 2 – Generics
0% coinsurance after deductible
Tier 3 – Preferred Brands
0% coinsurance after deductible
Tier 4 – Non-Preferred Brands
0% coinsurance after deductible
Tier 5 – Specialty (30 day supply only)
0% coinsurance 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 lower 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 $9200 HMO NE
$9,200 $18,400
Deductible
$9,200 $18,400
Out-of-pocket Maximum
0% 0%
Coinsurance
  • No out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions not available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
array(4) { [0]=> string(12) “adult_vision” [1]=> string(12) “chiropractic” [2]=> string(4) “cisp” [3]=> string(10) “telehealth” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • CISP The Chronic Illness Support Program makes it easier for Members to manage and pay for the treatment of select chronic conditions including asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and hypertension.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $50 copay; no deductible required; copays accumulate to the deductible
Specialty Care Office Visit
$80 copay; no deductible required
Urgent Care Center
$60 copay; no deductible required
Amwell® Urgent Telehealth
$0 copay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $50 copay; no deductible required; copays accumulate to the deductible
Emergency Room Visit
0% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 copay; no deductible required
Tier 2 – Generics
$30 copay; no deductible required
Tier 3 – Preferred Brands
0% coinsurance after deductible
Tier 4 – Non-Preferred Brands
0% coinsurance after deductible
Tier 5 – Specialty (30 day supply only)
0% coinsurance after deductible

Health Options Clear Choice Bronze $9200 PPO NE
$9,200 $18,400
Deductible
$9,200 $18,400
Out-of-pocket Maximum
0% 0%
Coinsurance
  • Includes out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions not available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
array(4) { [0]=> string(12) “adult_vision” [1]=> string(12) “chiropractic” [2]=> string(4) “cisp” [3]=> string(10) “telehealth” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • CISP The Chronic Illness Support Program makes it easier for Members to manage and pay for the treatment of select chronic conditions including asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and hypertension.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $50 copay; no deductible required; copays accumulate to the deductible
Specialty Care Office Visit
$80 copay; no deductible required
Urgent Care Center
$60 copay; no deductible required
Amwell® Urgent Telehealth
$0 copay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $50 copay; no deductible required; copays accumulate to the deductible
Emergency Room Visit
0% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 copay; no deductible required
Tier 2 – Generics
$30 copay; no deductible required
Tier 3 – Preferred Brands
0% coinsurance after deductible
Tier 4 – Non-Preferred Brands
0% coinsurance after deductible
Tier 5 – Specialty (30 day supply only)
0% coinsurance after deductible

Health Options Bronze $8000 Healthy Maine HMO Tiered NE

Preferred TierThe tiered plan offers preferred cost sharing which is less expensive than standard (copays, coinsurance, deductible and out-of-pocket maximum). 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 designed by ($) in the provider directory.

$8,000 $16,000
Deductible
$9,200 $18,400
Out-of-pocket Maximum
50% 50%
Coinsurance

Standard TierThe tiered plan offers standard cost sharing which is more expensive than preferred (copays, coinsurance, deductible and out-of-pocket maximum). 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 designed by ($$) in the provider directory.

$9,200 $18,400
Deductible
$9,200 $18,400
Out-of-pocket Maximum
0% 0%
Coinsurance
  • No out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions not available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
array(8) { [0]=> string(12) “adult_vision” [1]=> string(12) “chiropractic” [2]=> string(4) “cisp” [3]=> string(11) “acupuncture” [4]=> string(8) “wellness” [5]=> string(8) “coaching” [6]=> string(10) “telehealth” [7]=> string(9) “preferred” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • CISP The Chronic Illness Support Program makes it easier for Members to manage and pay for the treatment of select chronic conditions including asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and hypertension.
  • Acupuncture Acupuncture benefit with a copay for in-network providers on select plans and up to $50 reimbursement for out-of-network providers.
  • 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.
  • Health Coaching This Healthy Maine plan includes unlimited personalized health coaching for Members 18 years and older at no cost through our wellness platform, WellRight. Trained heath coaches can meet over the telephone, through text, video chat or email.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
  • 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 copay Preferred / $85 copay Standard; no deductible required; copays accumulate to the deductible
Specialty Care Office Visit
$80 copay Preferred/$85 copay Standard; no deductible required
Urgent Care Center
$60 copay; no deductible required
Amwell® Urgent Telehealth
$0 copay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$50 copay no deductible required; copays accumulate to the deductible
Emergency Room Visit
50% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 copay; no deductible required
Tier 2 – Generics
$30 copay; no deductible required
Tier 3 – Preferred Brands
30% coinsurance after deductible
Tier 4 – Non-Preferred Brands
50% coinsurance after deductible
Tier 5 – Specialty (30 day supply only)
50% coinsurance after deductible

Health Options Bronze $8000 Healthy Maine HMO NE
$8,000 $16,000
Deductible
$9,200 $18,400
Out-of-pocket Maximum
50% 50%
Coinsurance
  • No out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions not available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
array(7) { [0]=> string(12) “adult_vision” [1]=> string(12) “chiropractic” [2]=> string(4) “cisp” [3]=> string(11) “acupuncture” [4]=> string(8) “wellness” [5]=> string(8) “coaching” [6]=> string(10) “telehealth” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • CISP The Chronic Illness Support Program makes it easier for Members to manage and pay for the treatment of select chronic conditions including asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and hypertension.
  • Acupuncture Acupuncture benefit with a copay for in-network providers on select plans and up to $50 reimbursement for out-of-network providers.
  • 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.
  • Health Coaching This Healthy Maine plan includes unlimited personalized health coaching for Members 18 years and older at no cost through our wellness platform, WellRight. Trained heath coaches can meet over the telephone, through text, video chat or email.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $50 copay; no deductible required; copays accumulate to the deductible
Specialty Care Office Visit
$80 copay after deductible
Urgent Care Center
$60 copay; no deductible required
Amwell® Urgent Telehealth
$0 copay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $50 copay; no deductible required; copays accumulate to the deductible
Emergency Room Visit
50% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 copay; no deductible required
Tier 2 – Generics
$30 copay; no deductible required
Tier 3 – Preferred Brands
30% coinsurance after deductible
Tier 4 – Non-Preferred Brands
50% coinsurance after deductible
Tier 5 – Specialty (30 day supply only)
50% coinsurance after deductible

Health Options Bronze $8000 Healthy Maine PPO NE
$8,000 $16,000
Deductible
$9,200 $18,400
Out-of-pocket Maximum
50% 50%
Coinsurance
  • Includes out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions not available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
array(7) { [0]=> string(12) “adult_vision” [1]=> string(12) “chiropractic” [2]=> string(4) “cisp” [3]=> string(11) “acupuncture” [4]=> string(8) “wellness” [5]=> string(8) “coaching” [6]=> string(10) “telehealth” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • CISP The Chronic Illness Support Program makes it easier for Members to manage and pay for the treatment of select chronic conditions including asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and hypertension.
  • Acupuncture Acupuncture benefit with a copay for in-network providers on select plans and up to $50 reimbursement for out-of-network providers.
  • 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.
  • Health Coaching This Healthy Maine plan includes unlimited personalized health coaching for Members 18 years and older at no cost through our wellness platform, WellRight. Trained heath coaches can meet over the telephone, through text, video chat or email.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $50 copay; no deductible required; copays accumulate to the deductible
Specialty Care Office Visit
$80 copay after deductible
Urgent Care Center
$60 copay; no deductible required
Amwell® Urgent Telehealth
$0 copay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $50 copay; no deductible required; copays accumulate to the deductible
Emergency Room Visit
50% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 copay; no deductible required
Tier 2 – Generics
$30 copay; no deductible required
Tier 3 – Preferred Brands
30% coinsurance after deductible
Tier 4 – Non-Preferred Brands
50% coinsurance after deductible
Tier 5 – Specialty (30 day supply only)
50% coinsurance after deductible

Health Options Clear Choice Bronze $7500 HMO Tiered NE
$9,000 $18,000
Deductible
$9,200 $18,400
Out-of-pocket Maximum
60% 60%
Coinsurance
  • No out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions not available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
array(6) { [0]=> string(12) “adult_vision” [1]=> string(12) “chiropractic” [2]=> string(4) “cisp” [3]=> string(7) “firefly” [4]=> string(10) “telehealth” [5]=> string(9) “preferred” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • CISP The Chronic Illness Support Program makes it easier for Members to manage and pay for the treatment of select chronic conditions including asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and hypertension.
  • Reduced Copays Plan includes lower copays at Firefly Health primary care and at specified urgent care locations.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
  • 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 $45 copay Preferred / $80 copay Standard; no deductible required; copays accumulate to the deductible
Specialty Care Office Visit
$80 copay Preferred; no deductible required / $80 copay after deductible Standard
Urgent Care Center
$95 copay; no deductible required
Amwell® Urgent Telehealth
$0 copay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $45 copay; no deductible required; copays accumulate to the deductible
Emergency Room Visit
50% Coinsurance after Deductible
Prescriptions
Tier 1 – Preferred Generics
$5 copay
Tier 2 – Generics
$30 copay
Tier 3 – Preferred Brands
$50 copay after deductible
Tier 4 – Non-Preferred Brands
$100 copay after deductible
Tier 5 – Specialty (30 day supply only)
$250 copay after deductible

Health Options Clear Choice Bronze $7500 HMO NE
$7,500 $15,000
Deductible
$9,200 $18,400
Out-of-pocket Maximum
50% 50%
Coinsurance
  • No out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions not available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
array(4) { [0]=> string(12) “adult_vision” [1]=> string(12) “chiropractic” [2]=> string(4) “cisp” [3]=> string(10) “telehealth” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • CISP The Chronic Illness Support Program makes it easier for Members to manage and pay for the treatment of select chronic conditions including asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and hypertension.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $45 copay; no deductible required; copays accumulate to the deductible
Specialty Care Office Visit
$80 copay; no deductible required
Urgent Care Center
$60 copay; no deductible required
Amwell® Urgent Telehealth
$0 copay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $45 copay; no deductible required; copays accumulate to the deductible
Emergency Room Visit
50% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 copay; no deductible required
Tier 2 – Generics
$30 copay; no deductible required
Tier 3 – Preferred Brands
$50 copay after deductible
Tier 4 – Non-Preferred Brands
$100 copay after deductible
Tier 5 – Specialty (30 day supply only)
$250 copay after deductible

Health Options Clear Choice Bronze $7500 PPO NE
$7,500 $15,000
Deductible
$9,200 $18,400
Out-of-pocket Maximum
50% 50%
Coinsurance
  • Includes out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions not available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
array(4) { [0]=> string(12) “adult_vision” [1]=> string(12) “chiropractic” [2]=> string(4) “cisp” [3]=> string(10) “telehealth” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • CISP The Chronic Illness Support Program makes it easier for Members to manage and pay for the treatment of select chronic conditions including asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and hypertension.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $45 copay; no deductible required; copays accumulate to the deductible
Specialty Care Office Visit
$80 copay; no deductible required
Urgent Care Center
$60 copay; no deductible required
Amwell® Urgent Telehealth
$0 copay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $45 copay; no deductible required; copays accumulate to the deductible
Emergency Room Visit
50% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 copay; no deductible required
Tier 2 – Generics
$30 copay; no deductible required
Tier 3 – Preferred Brands
$50 copay after deductible
Tier 4 – Non-Preferred Brands
$100 copay after deductible
Tier 5 – Specialty (30 day supply only)
$250 copay after deductible

Health Options Clear Choice Bronze $7500 PPO NE Dental
$7,500 $15,000
Deductible
$9,200 $18,400
Out-of-pocket Maximum
50% 50%
Coinsurance
  • Includes out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions not available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
array(5) { [0]=> string(12) “adult_vision” [1]=> string(6) “dental” [2]=> string(12) “chiropractic” [3]=> string(4) “cisp” [4]=> string(10) “telehealth” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Pediatric Dental Plan includes pediatric dental coverage through Northeast Delta Dental® with a separate, low deductible.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • CISP The Chronic Illness Support Program makes it easier for Members to manage and pay for the treatment of select chronic conditions including asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and hypertension.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $45 copay; no deductible required; copays accumulate to the deductible
Specialty Care Office Visit
$80 copay; no deductible required
Urgent Care Center
$60 copay; no deductible required
Amwell® Urgent Telehealth
$0 copay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $45 copay; no deductible required; copays accumulate to the deductible
Emergency Room Visit
50% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 copay; no deductible required
Tier 2 – Generics
$30 copay; no deductible required
Tier 3 – Preferred Brands
$50 copay after deductible
Tier 4 – Non-Preferred Brands
$100 copay after deductible
Tier 5 – Specialty (30 day supply only)
$250 copay after deductible

Health Options Clear Choice Bronze $7200 HSA Plus PPO NE
$7,200 $14,400
Deductible
$7,200 $14,400
Out-of-pocket Maximum
0% 0%
Coinsurance
  • Includes out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Does not include Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions not available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
array(3) { [0]=> string(12) “adult_vision” [1]=> string(12) “chiropractic” [2]=> string(10) “telehealth” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
0% coinsurance after deductible
Specialty Care Office Visit
0% coinsurance after deductible
Urgent Care Center
0% coinsurance after deductible
Amwell® Urgent Telehealth
0 copay after deductible
Mental Health/Substance Use Disorder (Outpatient)
0% coinsurance after deductible
Emergency Room Visit
0% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
0% coinsurance after deductible
Tier 2 – Generics
0% coinsurance after deductible
Tier 3 – Preferred Brands
0% coinsurance after deductible
Tier 4 – Non-Preferred Brands
0% coinsurance after deductible
Tier 5 – Specialty (30 day supply only)
0% coinsurance after deductible
Includes expanded, pre-deductible drug list

Health Options Clear Choice Bronze $6300 HSA PPO NE
$6,300 $12,600
Deductible
$7,500 $15,000
Out-of-pocket Maximum
50% 50%
Coinsurance
  • Includes out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions not available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
array(3) { [0]=> string(12) “adult_vision” [1]=> string(12) “chiropractic” [2]=> string(10) “telehealth” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
50% coinsurance after deductible
Specialty Care Office Visit
50% coinsurance after deductible
Urgent Care Center
50% coinsurance after deductible
Amwell® Urgent Telehealth
$0 copay after deductible
Mental Health/Substance Use Disorder (Outpatient)
50% coinsurance after deductible
Emergency Room Visit
50% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
50% coinsurance after deductible
Tier 2 – Generics
50% coinsurance after deductible
Tier 3 – Preferred Brands
50% coinsurance after deductible
Tier 4 – Non-Preferred Brands
50% coinsurance after deductible
Tier 5 – Specialty (30 day supply only)
50% coinsurance 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. In Bronze plans, the insurance company pays about 60%, and the Member pays 40% of the cost for health services.

You may purchase them directly through our storefront.

Health Options Clear Choice Bronze $9200 PPO National Dental Off MP
$9,200 $18,400
Deductible
$9,200 $18,400
Out-of-pocket Maximum
0% 0%
Coinsurance
  • Includes out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
array(6) { [0]=> string(12) “adult_vision” [1]=> string(6) “dental” [2]=> string(12) “chiropractic” [3]=> string(4) “cisp” [4]=> string(10) “telehealth” [5]=> string(8) “national” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Pediatric Dental Plan includes pediatric dental coverage through Northeast Delta Dental® with a separate, low deductible.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • CISP The Chronic Illness Support Program makes it easier for Members to manage and pay for the treatment of select chronic conditions including asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and hypertension.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
  • National Coverage Plan includes in-network access to providers throughout the U.S. via the First Health Network.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $50 copay; no deductible required; copays accumulate to the deductible
Specialty Care Office Visit
$80 copay; no deductible required
Urgent Care Center
$60 copay; no deductible required
Amwell® Urgent Telehealth
$0 copay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $50 copay; no deductible required; copays accumulate to the deductible
Emergency Room Visit
0% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 copay; no deductible required
Tier 2 – Generics
$30 copay; no deductible required
Tier 3 – Preferred Brands
0% coinsurance after deductible
Tier 4 – Non-Preferred Brands
0% coinsurance after deductible
Tier 5 – Specialty (30 day supply only)
0% coinsurance after deductible

Health Options Bronze $8000 Healthy Maine HMO National Off MP
$8,000 $16,000
Deductible
$9,200 $18,350
Out-of-pocket Maximum
50% 50%
Coinsurance
  • No out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
array(9) { [0]=> string(12) “adult_vision” [1]=> string(6) “dental” [2]=> string(12) “chiropractic” [3]=> string(4) “cisp” [4]=> string(11) “acupuncture” [5]=> string(8) “wellness” [6]=> string(8) “coaching” [7]=> string(10) “telehealth” [8]=> string(8) “national” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Pediatric Dental Plan includes pediatric dental coverage through Northeast Delta Dental® with a separate, low deductible.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • CISP The Chronic Illness Support Program makes it easier for Members to manage and pay for the treatment of select chronic conditions including asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and hypertension.
  • Acupuncture Acupuncture benefit with a copay for in-network providers on select plans and up to $50 reimbursement for out-of-network providers.
  • 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.
  • Health Coaching This Healthy Maine plan includes unlimited personalized health coaching for Members 18 years and older at no cost through our wellness platform, WellRight. Trained heath coaches can meet over the telephone, through text, video chat or email.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
  • National Coverage Plan includes in-network access to providers throughout the U.S. via the First Health Network.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $50 copay; no deductible required; copays accumulate to the deductible
Specialty Care Office Visit
$80 copay after deductible
Urgent Care Center
$60 copay; no deductible required
Amwell® Urgent Telehealth
$0 copay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $50 copay; no deductible required; copays accumulate to the deductible
Emergency Room Visit
50% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 copay; no deductible required
Tier 2 – Generics
$30 copay; no deductible required
Tier 3 – Preferred Brands
30% coinsurance after deductible
Tier 4 – Non-Preferred Brands
50% coinsurance after deductible
Tier 5 – Specialty (30 day supply only)
50% coinsurance after deductible

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

Preferred TierThe tiered plan offers preferred cost sharing which is less expensive than standard (copays, coinsurance, deductible and out-of-pocket maximum). 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 designed by ($) in the provider directory.

$7,500 $15,000
Deductible
$9,200 $18,400
Out-of-pocket Maximum
50% 50%
Coinsurance

Standard TierThe tiered plan offers standard cost sharing which is more expensive than preferred (copays, coinsurance, deductible and out-of-pocket maximum). 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 designed by ($$) in the provider directory.

$9,000 $18,000
Deductible
$9,200 $18,400
Out-of-pocket Maximum
60% 60%
Coinsurance
  • No out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
array(6) { [0]=> string(12) “adult_vision” [1]=> string(6) “dental” [2]=> string(12) “chiropractic” [3]=> string(4) “cisp” [4]=> string(10) “telehealth” [5]=> string(9) “preferred” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Pediatric Dental Plan includes pediatric dental coverage through Northeast Delta Dental® with a separate, low deductible.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • CISP The Chronic Illness Support Program makes it easier for Members to manage and pay for the treatment of select chronic conditions including asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and hypertension.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
  • 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 $45 copay Preferred / $80 copay Standard; no deductible required; copays accumulate to the deductible
Specialty Care Office Visit
$80 copay Preferred; no deductible required / $80 copay after deductible Standard
Urgent Care Center
$60 copay Preferred; no deductible required
Amwell® Urgent Telehealth
$0 copay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $45 copay; no deductible required; copays accumulate to the deductible
Emergency Room Visit
50% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 copay; no deductible required
Tier 2 – Generics
$30 copay; no deductible required
Tier 3 – Preferred Brands
$50 copay after deductible
Tier 4 – Non-Preferred Brands
$100 copay after deductible
Tier 5 – Specialty (30 day supply only)
$250 copay after deductible

Health Options Clear Choice Bronze $7500 PPO National Dental Off MP
$7,500 $15,000
Deductible
$9,200 $18,400
Out-of-pocket Maximum
50% 50%
Coinsurance
  • Includes out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
array(6) { [0]=> string(12) “adult_vision” [1]=> string(6) “dental” [2]=> string(12) “chiropractic” [3]=> string(4) “cisp” [4]=> string(10) “telehealth” [5]=> string(8) “national” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Pediatric Dental Plan includes pediatric dental coverage through Northeast Delta Dental® with a separate, low deductible.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • CISP The Chronic Illness Support Program makes it easier for Members to manage and pay for the treatment of select chronic conditions including asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and hypertension.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
  • National Coverage Plan includes in-network access to providers throughout the U.S. via the First Health Network.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $45 copay; no deductible required; copays accumulate to the deductible
Specialty Care Office Visit
$80 copay; no deductible required
Urgent Care Center
$60 copay; no deductible required
Amwell® Urgent Telehealth
$0 copay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $45 copay; no deductible required; copays accumulate to the deductible
Emergency Room Visit
50% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 copay; no deductible required
Tier 2 – Generics
$30 copay; no deductible required
Tier 3 – Preferred Brands
$50 copay after deductible
Tier 4 – Non-Preferred Brands
$100 copay after deductible
Tier 5 – Specialty (30 day supply only)
$250 copay after deductible

Health Options Clear Choice Bronze $7200 HSA Plus PPO National Dental Off MP
$7,200 $14,400
Deductible
$7,200 $14,400
Out-of-pocket Maximum
0% 0%
Coinsurance
  • Includes out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Does not include Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
array(5) { [0]=> string(12) “adult_vision” [1]=> string(6) “dental” [2]=> string(12) “chiropractic” [3]=> string(10) “telehealth” [4]=> string(8) “national” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Pediatric Dental Plan includes pediatric dental coverage through Northeast Delta Dental® with a separate, low deductible.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
  • National Coverage Plan includes in-network access to providers throughout the U.S. via the First Health Network.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
0% coinsurance after deductible
Specialty Care Office Visit
0% coinsurance after deductible
Urgent Care Center
0% coinsurance after deductible
Amwell® Urgent Telehealth
$0 copay after deductible
Mental Health/Substance Use Disorder (Outpatient)
0% coinsurance after deductible
Emergency Room Visit
0% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
0% coinsurance after deductible
Tier 2 – Generics
0% coinsurance after deductible
Tier 3 – Preferred Brands
0% coinsurance after deductible
Tier 4 – Non-Preferred Brands
0% coinsurance after deductible
Tier 5 – Specialty (30 day supply only)
0% coinsurance 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%
Coinsurance
  • Includes out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Does not include Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
array(5) { [0]=> string(12) “adult_vision” [1]=> string(6) “dental” [2]=> string(12) “chiropractic” [3]=> string(10) “telehealth” [4]=> string(8) “national” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Pediatric Dental Plan includes pediatric dental coverage through Northeast Delta Dental® with a separate, low deductible.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
  • National Coverage Plan includes in-network access to providers throughout the U.S. via the First Health Network.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
50% coinsurance after deductible
Specialty Care Office Visit
50% coinsurance after deductible
Urgent Care Center
50% coinsurance after deductible
Amwell® Urgent Telehealth
$0 copay after deductible
Mental Health/Substance Use Disorder (Outpatient)
50% coinsurance after deductible
Emergency Room Visit
50% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
50% coinsurance after deductible
Tier 2 – Generics
50% coinsurance after deductible
Tier 3 – Preferred Brands
50% coinsurance after deductible
Tier 4 – Non-Preferred Brands
50% coinsurance after deductible
Tier 5 – Specialty (30 day supply only)
50% coinsurance 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 preferred cost sharing which is less expensive than standard (copays, coinsurance, deductible and out-of-pocket maximum). 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 designed by ($) in the provider directory.

$4,200 $8,400
Deductible
$8,000 $16,000
Out-of-pocket Maximum
30% 30%
Coinsurance

Standard TierThe tiered plan offers standard cost sharing which is more expensive than preferred (copays, coinsurance, deductible and out-of-pocket maximum). 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 designed by ($$) in the provider directory.

$5,040 $10,080
Deductible
$8,000 $16,000
Out-of-pocket Maximum
50% 50%
Coinsurance
  • No out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
array(6) { [0]=> string(12) “adult_vision” [1]=> string(12) “chiropractic” [2]=> string(4) “cisp” [3]=> string(7) “firefly” [4]=> string(10) “telehealth” [5]=> string(9) “preferred” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • CISP The Chronic Illness Support Program makes it easier for Members to manage and pay for the treatment of select chronic conditions including asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and hypertension.
  • Reduced Copays Plan includes lower copays at Firefly Health primary care and at specified urgent care locations.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
  • 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 copay Preferred / $70 copay Standard; no deductible required; copays accumulate to the deductible
Specialty Care Office Visit
$60 copay Preferred; no deductible required / $60 copay after deductible Standard
Urgent Care Center
$75 copay Standard; no deductible required
Amwell® Urgent Telehealth
$0 copay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 copay Preferred / $70 copay Standard; no deductible required; copays accumulate to the deductible
Emergency Room Visit
30% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 copay; no deductible required
Tier 2 – Generics
$25 copay; no deductible required
Tier 3 – Preferred Brands
$50 copay; no deductible required
Tier 4 – Non-Preferred Brands
30% coinsurance after deductible
Tier 5 – Specialty (30 day supply only)
50% coinsurance after deductible

Health Options Clear Choice Silver $4200 HMO NE
$4,200 $8,400
Deductible
$8,000 $16,000
Out-of-pocket Maximum
30% 30%
Coinsurance
  • No out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
array(4) { [0]=> string(12) “adult_vision” [1]=> string(12) “chiropractic” [2]=> string(4) “cisp” [3]=> string(10) “telehealth” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • CISP The Chronic Illness Support Program makes it easier for Members to manage and pay for the treatment of select chronic conditions including asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and hypertension.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $40 copay; no deductible required; copays accumulate to the deductible
Specialty Care Office Visit
$60 copay; no deductible required
Urgent Care Center
$40 copay; no deductible required
Amwell® Urgent Telehealth
$0 copay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 copay; no deductible required; copays accumulate to the deductible
Emergency Room Visit
30% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 copay; no deductible required
Tier 2 – Generics
$25 copay; no deductible required
Tier 3 – Preferred Brands
$50 copay; no deductible required
Tier 4 – Non-Preferred Brands
30% coinsurance after deductible
Tier 5 – Specialty (30 day supply only)
50% coinsurance after deductible

Health Options Clear Choice Silver $4200 PPO NE
$4,200 $8,400
Deductible
$8,000 $16,000
Out-of-pocket Maximum
30% 30%
Coinsurance
  • Includes out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
array(4) { [0]=> string(12) “adult_vision” [1]=> string(12) “chiropractic” [2]=> string(4) “cisp” [3]=> string(10) “telehealth” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • CISP The Chronic Illness Support Program makes it easier for Members to manage and pay for the treatment of select chronic conditions including asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and hypertension.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $40 copay; no deductible required; copays accumulate to the deductible
Specialty Care Office Visit
$60 copay; no deductible required
Urgent Care Center
$40 copay; no deductible required
Amwell® Urgent Telehealth
$0 copay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 copay; no deductible required; copays accumulate to the deductible
Emergency Room Visit
30% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 copay; no deductible required
Tier 2 – Generics
$25 copay; no deductible required
Tier 3 – Preferred Brands
$50 copay; no deductible required
Tier 4 – Non-Preferred Brands
30% coinsurance after deductible
Tier 5 – Specialty (30 day supply only)
50% coinsurance after deductible

Health Options Clear Choice Silver $3500 HMO Tiered NE

Preferred TierThe tiered plan offers preferred cost sharing which is less expensive than standard (copays, coinsurance, deductible and out-of-pocket maximum). 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 designed by ($) in the provider directory.

$3,500 $7,000
Deductible
$8,500 $17,000
Out-of-pocket Maximum
30% 30%
Coinsurance

Standard TierThe tiered plan offers standard cost sharing which is more expensive than preferred (copays, coinsurance, deductible and out-of-pocket maximum). 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 designed by ($$) in the provider directory.

$4,200 $8,400
Deductible
$8,500 $17,000
Out-of-pocket Maximum
50% 50%
Coinsurance
  • No out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
array(5) { [0]=> string(12) “adult_vision” [1]=> string(12) “chiropractic” [2]=> string(4) “cisp” [3]=> string(10) “telehealth” [4]=> string(9) “preferred” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • CISP The Chronic Illness Support Program makes it easier for Members to manage and pay for the treatment of select chronic conditions including asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and hypertension.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
  • 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 copay Preferred / $70 copay Standard; no deductible required; copays accumulate to the deductible
Specialty Care Office Visit
$60 copay Preferred; no deductible required / $60 copay after deductible Standard
Urgent Care Center
$40 copay; no deductible required
Amwell® Urgent Telehealth
$0 copay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 copay; no deductible required; copays accumulate to the deductible
Emergency Room Visit
30% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 copay; no deductible required
Tier 2 – Generics
$25 copay; no deductible required
Tier 3 – Preferred Brands
$50 copay; no deductible required
Tier 4 – Non-Preferred Brands
$100 copay after deductible
Tier 5 – Specialty (30 day supply only)
$250 copay after deductible

Health Options Clear Choice Silver $3500 HMO NE
$3,500 $7,000
Deductible
$8,500 $17,000
Out-of-pocket Maximum
30% 30%
Coinsurance
  • No out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
array(4) { [0]=> string(12) “adult_vision” [1]=> string(12) “chiropractic” [2]=> string(4) “cisp” [3]=> string(10) “telehealth” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • CISP The Chronic Illness Support Program makes it easier for Members to manage and pay for the treatment of select chronic conditions including asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and hypertension.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $40 copay; no deductible required; copays accumulate to the deductible
Specialty Care Office Visit
$60 copay; no deductible required
Urgent Care Center
$40 copay; no deductible required
Amwell® Urgent Telehealth
$0 copay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 copay; no deductible required; copays accumulate to the deductible
Emergency Room Visit
30% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 copay; no deductible required
Tier 2 – Generics
$25 copay; no deductible required
Tier 3 – Preferred Brands
$50 copay; no deductible required
Tier 4 – Non-Preferred Brands
$100 copay after deductible
Tier 5 – Specialty (30 day supply only)
$250 copay after deductible

Health Options Clear Choice Silver $3500 HMO NE Dental
$3,500 $7,000
Deductible
$8,500 $17,000
Out-of-pocket Maximum
30% 30%
Coinsurance
  • No out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
array(5) { [0]=> string(12) “adult_vision” [1]=> string(6) “dental” [2]=> string(12) “chiropractic” [3]=> string(4) “cisp” [4]=> string(10) “telehealth” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Pediatric Dental Plan includes pediatric dental coverage through Northeast Delta Dental® with a separate, low deductible.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • CISP The Chronic Illness Support Program makes it easier for Members to manage and pay for the treatment of select chronic conditions including asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and hypertension.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $40 copay; no deductible required; copays accumulate to the deductible
Specialty Care Office Visit
$60 copay; no deductible required
Urgent Care Center
$40 copay; no deductible required
Amwell® Urgent Telehealth
$0 copay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 copay; no deductible required; copays accumulate to the deductible
Emergency Room Visit
30% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 copay; no deductible required
Tier 2 – Generics
$25 copay; no deductible required
Tier 3 – Preferred Brands
$50 copay; no deductible required
Tier 4 – Non-Preferred Brands
$100 copay after deductible
Tier 5 – Specialty (30 day supply only)
$250 copay after deductible

Health Options Clear Choice Silver $3500 PPO NE
$3,500 $7,000
Deductible
$8,500 $17,000
Out-of-pocket Maximum
30% 30%
Coinsurance
  • Includes out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
array(4) { [0]=> string(12) “adult_vision” [1]=> string(12) “chiropractic” [2]=> string(4) “cisp” [3]=> string(10) “telehealth” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • CISP The Chronic Illness Support Program makes it easier for Members to manage and pay for the treatment of select chronic conditions including asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and hypertension.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $40 copay; no deductible required; copays accumulate to the deductible
Specialty Care Office Visit
$60 copay; no deductible required
Urgent Care Center
$40 copay; no deductible required
Amwell® Urgent Telehealth
$0 copay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 copay; no deductible required; copays accumulate to the deductible
Emergency Room Visit
30% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 copay; no deductible required
Tier 2 – Generics
$25 copay; no deductible required
Tier 3 – Preferred Brands
$50 copay; no deductible required
Tier 4 – Non-Preferred Brands
$100 copay after deductible
Tier 5 – Specialty (30 day supply only)
$250 copay after deductible

Health Options Clear Choice Silver $3500 PPO NE Dental
$3,500 $7,000
Deductible
$8,500 $17,000
Out-of-pocket Maximum
30% 30%
Coinsurance
  • Includes out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
array(6) { [0]=> string(12) “adult_vision” [1]=> string(6) “dental” [2]=> string(12) “chiropractic” [3]=> string(4) “cisp” [4]=> string(10) “telehealth” [5]=> string(9) “preferred” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Pediatric Dental Plan includes pediatric dental coverage through Northeast Delta Dental® with a separate, low deductible.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • CISP The Chronic Illness Support Program makes it easier for Members to manage and pay for the treatment of select chronic conditions including asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and hypertension.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
  • 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 copay; no deductible required; copays accumulate to the deductible
Specialty Care Office Visit
$60 copay; no deductible required
Urgent Care Center
$40 copay; no deductible required
Amwell® Urgent Telehealth
$0 copay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 copay; no deductible required; copays accumulate to the deductible
Emergency Room Visit
30% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 copay; no deductible required
Tier 2 – Generics
$25 copay; no deductible required
Tier 3 – Preferred Brands
$50 copay; no deductible required
Tier 4 – Non-Preferred Brands
$100 copay after deductible
Tier 5 – Specialty (30 day supply only)
$250 copay after deductible

Health Options Clear Choice Silver $3500 PPO National
$3,500 $7,000
Deductible
$8,500 $17,000
Out-of-pocket Maximum
30% 30%
Coinsurance
  • Includes out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
array(6) { [0]=> string(12) “adult_vision” [1]=> string(12) “chiropractic” [2]=> string(4) “cisp” [3]=> string(10) “telehealth” [4]=> string(8) “national” [5]=> string(12) “outofcountry” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • CISP The Chronic Illness Support Program makes it easier for Members to manage and pay for the treatment of select chronic conditions including asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and hypertension.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
  • National Coverage Plan includes in-network access to providers throughout the U.S. via the First Health Network.
  • Out-of-Country Plan includes access to care for emergent conditions outside the U.S.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $40 copay; no deductible required; copays accumulate to the deductible
Specialty Care Office Visit
$60 copay; no deductible required
Urgent Care Center
$40 copay; no deductible required
Amwell® Urgent Telehealth
$0 copay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 copay; no deductible required; copays accumulate to the deductible
Emergency Room Visit
30% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 copay; no deductible required
Tier 2 – Generics
$25 copay; no deductible required
Tier 3 – Preferred Brands
$50 copay; no deductible required
Tier 4 – Non-Preferred Brands
$100 copay after deductible
Tier 5 – Specialty (30 day supply only)
$250 copay 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 2025 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 $4500 HSA HMO Tiered NE Dental Off MP

Preferred TierThe tiered plan offers preferred cost sharing which is less expensive than standard (copays, coinsurance, deductible and out-of-pocket maximum). 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 designed by ($) in the provider directory.

$4,500 $9,000
Deductible
$7,000 $13,950
Out-of-pocket Maximum
20% 20%
Coinsurance

Standard TierThe tiered plan offers standard cost sharing which is more expensive than preferred (copays, coinsurance, deductible and out-of-pocket maximum). 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 designed by ($$) in the provider directory.

$5,400 $10,750
Deductible
$7,500 $15,000
Out-of-pocket Maximum
40% 40%
Coinsurance
  • No out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
array(5) { [0]=> string(12) “adult_vision” [1]=> string(6) “dental” [2]=> string(12) “chiropractic” [3]=> string(10) “telehealth” [4]=> string(9) “preferred” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Pediatric Dental Plan includes pediatric dental coverage through Northeast Delta Dental® with a separate, low deductible.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
  • 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% coinsurance after deductible Preferred; 40% coinsurance after deductible Standard
Specialty Care Office Visit
20% coinsurance after deductible Preferred; 40% coinsurance after deductible Standard
Urgent Care Center
20% coinsurance after deductible
Amwell® Urgent Telehealth
$0 copay after deductible
Mental Health/Substance Use Disorder (Outpatient)
20% coinsurance after deductible
Emergency Room Visit
20% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
20% coinsurance after deductible
Tier 2 – Generics
20% coinsurance after deductible
Tier 3 – Preferred Brands
20% coinsurance after deductible
Tier 4 – Non-Preferred Brands
20% coinsurance after deductible
Tier 5 – Specialty (30 day supply only)
20% coinsurance after deductible

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

Preferred TierThe tiered plan offers preferred cost sharing which is less expensive than standard (copays, coinsurance, deductible and out-of-pocket maximum). 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 designed by ($) in the provider directory.

$4,200 $8,400
Deductible
$8,000 $16,000
Out-of-pocket Maximum
30% 30%
Coinsurance

Standard TierThe tiered plan offers standard cost sharing which is more expensive than preferred (copays, coinsurance, deductible and out-of-pocket maximum). 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 designed by ($$) in the provider directory.

$5,040 $10,080
Deductible
$8,000 $16,000
Out-of-pocket Maximum
30% 30%
Coinsurance
  • No out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
array(6) { [0]=> string(12) “adult_vision” [1]=> string(6) “dental” [2]=> string(12) “chiropractic” [3]=> string(4) “cisp” [4]=> string(10) “telehealth” [5]=> string(9) “preferred” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Pediatric Dental Plan includes pediatric dental coverage through Northeast Delta Dental® with a separate, low deductible.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • CISP The Chronic Illness Support Program makes it easier for Members to manage and pay for the treatment of select chronic conditions including asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and hypertension.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
  • 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 copay Preferred / $70 copay Standard; no deductible required; copays accumulate to the deductible
Specialty Care Office Visit
$60 copay Preferred; no deductible required / $60 copay after deductible Standard
Urgent Care Center
$40 copay; no deductible required
Amwell® Urgent Telehealth
$0 copay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 copay; no deductible required; copays accumulate to the deductible
Emergency Room Visit
30% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 copay; no deductible required
Tier 2 – Generics
$25 copay; no deductible required
Tier 3 – Preferred Brands
$50 copay; no deductible required
Tier 4 – Non-Preferred Brands
30% coinsurance after deductible
Tier 5 – Specialty (30 day supply only)
50% coinsurance after deductible

Health Options Clear Choice Silver $4200 PPO National Dental Off MP
$4,200 $8,400
Deductible
$8,000 $16,000
Out-of-pocket Maximum
30% 30%
Coinsurance
  • Includes out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
array(7) { [0]=> string(12) “adult_vision” [1]=> string(6) “dental” [2]=> string(12) “chiropractic” [3]=> string(4) “cisp” [4]=> string(10) “telehealth” [5]=> string(8) “national” [6]=> string(12) “outofcountry” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Pediatric Dental Plan includes pediatric dental coverage through Northeast Delta Dental® with a separate, low deductible.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • CISP The Chronic Illness Support Program makes it easier for Members to manage and pay for the treatment of select chronic conditions including asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and hypertension.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
  • National Coverage Plan includes in-network access to providers throughout the U.S. via the First Health Network.
  • Out-of-Country Plan includes access to care for emergent conditions outside the U.S.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $40 copay; no deductible required; copays accumulate to the deductible
Specialty Care Office Visit
$60 copay; no deductible required
Urgent Care Center
$40 copay; no deductible required
Amwell® Urgent Telehealth
$0 copay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 copay; no deductible required; copays accumulate to the deductible
Emergency Room Visit
30% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 copay; no deductible required
Tier 2 – Generics
$25 copay; no deductible required
Tier 3 – Preferred Brands
$50 copay; no deductible required
Tier 4 – Non-Preferred Brands
30% coinsurance after deductible
Tier 5 – Specialty (30 day supply only)
50% coinsurance after deductible

Health Options Silver $4000 HMO National Off MP
$4,000 $8,000
Deductible
$9,100 $18,200
Out-of-pocket Maximum
40% 40%
Coinsurance
  • No out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
array(7) { [0]=> string(12) “adult_vision” [1]=> string(12) “chiropractic” [2]=> string(4) “cisp” [3]=> string(8) “wellness” [4]=> string(10) “telehealth” [5]=> string(8) “national” [6]=> string(12) “outofcountry” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • CISP The Chronic Illness Support Program makes it easier for Members to manage and pay for the treatment of select chronic conditions including asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes 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.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
  • National Coverage Plan includes in-network access to providers throughout the U.S. via the First Health Network.
  • Out-of-Country Plan includes access to care for emergent conditions outside the U.S.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $45 copay; no deductible required; copays accumulate to the deductible
Specialty Care Office Visit
$80 copay; no deductible required
Urgent Care Center
$50 copay; no deductible required
Amwell® Urgent Telehealth
$0 copay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $45 copay; no deductible required; copays accumulate to the deductible
Emergency Room Visit
40% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 copay; no deductible required
Tier 2 – Generics
$35 copay; no deductible required
Tier 3 – Preferred Brands
$70 copay; no deductible required
Tier 4 – Non-Preferred Brands
30% coinsurance after deductible up to a max of $400/script
Tier 5 – Specialty (30 day supply only)
30% coinsurance after deductible up to a max of $500/script

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

Preferred TierThe tiered plan offers preferred cost sharing which is less expensive than standard (copays, coinsurance, deductible and out-of-pocket maximum). 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 designed by ($) in the provider directory.

$3,500 $7,000
Deductible
$8,500 $17,000
Out-of-pocket Maximum
30% 30%
Coinsurance

Standard TierThe tiered plan offers standard cost sharing which is more expensive than preferred (copays, coinsurance, deductible and out-of-pocket maximum). 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 designed by ($$) in the provider directory.

$4,200 $8,400
Deductible
$8,500 $17,000
Out-of-pocket Maximum
50% 50%
Coinsurance
  • No out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
array(6) { [0]=> string(12) “adult_vision” [1]=> string(6) “dental” [2]=> string(12) “chiropractic” [3]=> string(4) “cisp” [4]=> string(10) “telehealth” [5]=> string(9) “preferred” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Pediatric Dental Plan includes pediatric dental coverage through Northeast Delta Dental® with a separate, low deductible.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • CISP The Chronic Illness Support Program makes it easier for Members to manage and pay for the treatment of select chronic conditions including asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and hypertension.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
  • 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 copay Preferred / $70 copay Standard; no deductible required; copays accumulate to the deductible
Specialty Care Office Visit
$60 copay Preferred; no deductible required / $60 copay after deductible Standard
Urgent Care Center
$40 copay; no deductible required
Amwell® Urgent Telehealth
$0 copay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 copay; no deductible required; copays accumulate to the deductible
Emergency Room Visit
30% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 copay
Tier 2 – Generics
$25 copay
Tier 3 – Preferred Brands
$50 copay
Tier 4 – Non-Preferred Brands
$100 copay after deductible
Tier 5 – Specialty (30 day supply only)
$250 copay after deductible

Health Options Clear Choice Silver $3500 PPO NE Dental Off MP
$3,500 $7,000
Deductible
$8,500 $17,000
Out-of-pocket Maximum
30% 30%
Coinsurance
  • Includes out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
array(5) { [0]=> string(12) “adult_vision” [1]=> string(6) “dental” [2]=> string(12) “chiropractic” [3]=> string(4) “cisp” [4]=> string(10) “telehealth” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Pediatric Dental Plan includes pediatric dental coverage through Northeast Delta Dental® with a separate, low deductible.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • CISP The Chronic Illness Support Program makes it easier for Members to manage and pay for the treatment of select chronic conditions including asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and hypertension.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $40 copay; no deductible required; copays accumulate to the deductible
Specialty Care Office Visit
$60 copay; no deductible required
Urgent Care Center
$40 copay; no deductible required
Amwell® Urgent Telehealth
$0 copay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 copay; no deductible required; copays accumulate to the deductible
Emergency Room Visit
30% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 copay; no deductible required
Tier 2 – Generics
$25 copay; no deductible required
Tier 3 – Preferred Brands
$50 copay; no deductible required
Tier 4 – Non-Preferred Brands
$100 copay after deductible
Tier 5 – Specialty (30 day supply only)
$100 copay after deductible

Health Options Clear Choice Silver $3500 PPO National Dental Off MP
$3,500 $7,000
Deductible
$8,500 $17,000
Out-of-pocket Maximum
-10% -10%
Coinsurance
  • Includes out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
array(7) { [0]=> string(12) “adult_vision” [1]=> string(6) “dental” [2]=> string(12) “chiropractic” [3]=> string(4) “cisp” [4]=> string(10) “telehealth” [5]=> string(8) “national” [6]=> string(12) “outofcountry” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Pediatric Dental Plan includes pediatric dental coverage through Northeast Delta Dental® with a separate, low deductible.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • CISP The Chronic Illness Support Program makes it easier for Members to manage and pay for the treatment of select chronic conditions including asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and hypertension.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
  • National Coverage Plan includes in-network access to providers throughout the U.S. via the First Health Network.
  • Out-of-Country Plan includes access to care for emergent conditions outside the U.S.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $40 copay; no deductible required; copays accumulate to the deductible
Specialty Care Office Visit
$60 copay; no deductible required
Urgent Care Center
$40 copay; no deductible required
Amwell® Urgent Telehealth
$0 copay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $40 copay; no deductible required; copays accumulate to the deductible
Emergency Room Visit
40% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 copay; no deductible required
Tier 2 – Generics
$20 copay; no deductible required
Tier 3 – Preferred Brands
$50 copay; no deductible required
Tier 4 – Non-Preferred Brands
$100 copay after deductible
Tier 5 – Specialty (30 day supply only)
$250 copay after deductible

Health Options Clear Choice Silver $3500 HSA PLUS PPO National Dental Off MP
$4,000 $8,000
Deductible
$7,000 $14,000
Out-of-pocket Maximum
20% 20%
Coinsurance
  • Includes out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
array(8) { [0]=> string(12) “adult_vision” [1]=> string(6) “dental” [2]=> string(12) “chiropractic” [3]=> string(4) “cisp” [4]=> string(8) “wellness” [5]=> string(10) “telehealth” [6]=> string(8) “national” [7]=> string(12) “outofcountry” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Pediatric Dental Plan includes pediatric dental coverage through Northeast Delta Dental® with a separate, low deductible.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • CISP The Chronic Illness Support Program makes it easier for Members to manage and pay for the treatment of select chronic conditions including asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes 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.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
  • National Coverage Plan includes in-network access to providers throughout the U.S. via the First Health Network.
  • Out-of-Country Plan includes access to care for emergent conditions outside the U.S.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
20% coinsurance after deductible
Specialty Care Office Visit
20% coinsurance after deductible
Urgent Care Center
20% coinsurance after deductible
Amwell® Urgent Telehealth
$0 copay after deductible
Mental Health/Substance Use Disorder (Outpatient)
20% coinsurance after deductible
Emergency Room Visit
20% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 copay after deductible
Tier 2 – Generics
$25 copay after deductible
Tier 3 – Preferred Brands
$50 copay after deductible
Tier 4 – Non-Preferred Brands
$100 copay after deductible
Tier 5 – Specialty (30 day supply only)
$250 copay after deductible
Includes expanded, pre-deductible drug list

Health Options Clear Choice Silver $3500 HSA PPO NE Dental Off MP
$3,500 $6,000
Deductible
$7,000 $14,000
Out-of-pocket Maximum
20% 20%
Coinsurance
  • Includes out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
array(6) { [0]=> string(12) “adult_vision” [1]=> string(6) “dental” [2]=> string(12) “chiropractic” [3]=> string(11) “acupuncture” [4]=> string(8) “wellness” [5]=> string(10) “telehealth” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Pediatric Dental Plan includes pediatric dental coverage through Northeast Delta Dental® with a separate, low deductible.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • Acupuncture Acupuncture benefit with a copay for in-network providers on select plans and up to $50 reimbursement for out-of-network providers.
  • 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.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
20% coinsurance after deductible
Specialty Care Office Visit
20% coinsurance after deductible
Urgent Care Center
20% coinsurance after deductible
Amwell® Urgent Telehealth
$0 copay after deductible
Mental Health/Substance Use Disorder (Outpatient)
20% coinsurance after deductible
Emergency Room Visit
20% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 copay after deductible
Tier 2 – Generics
$25 copay after deductible
Tier 3 – Preferred Brands
$50 copay after deductible
Tier 4 – Non-Preferred Brands
$100 copay after deductible
Tier 5 – Specialty (30 day supply only)
$250 copay 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%
Coinsurance
  • Includes out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions not available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
array(4) { [0]=> string(12) “adult_vision” [1]=> string(12) “chiropractic” [2]=> string(4) “cisp” [3]=> string(10) “telehealth” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • CISP The Chronic Illness Support Program makes it easier for Members to manage and pay for the treatment of select chronic conditions including asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and hypertension.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $20 copay; no deductible required; copays accumulate to the deductible
Specialty Care Office Visit
$50 copay; no deductible required
Urgent Care Center
$40 copay; no deductible required
Amwell® Urgent Telehealth
$0 copay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $20 copay; no deductible required; copays accumulate to the deductible
Emergency Room Visit
30% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 copay; no deductible required
Tier 2 – Generics
$25 copay; no deductible required
Tier 3 – Preferred Brands
$50 copay; no deductible required
Tier 4 – Non-Preferred Brands
30% coinsurance, up to max of $300/script; no deductible required
Tier 5 – Specialty (30 day supply only)
50% coinsurance. 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%
Coinsurance
  • Includes out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions not available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
array(5) { [0]=> string(12) “adult_vision” [1]=> string(6) “dental” [2]=> string(12) “chiropractic” [3]=> string(4) “cisp” [4]=> string(10) “telehealth” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Pediatric Dental Plan includes pediatric dental coverage through Northeast Delta Dental® with a separate, low deductible.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • CISP The Chronic Illness Support Program makes it easier for Members to manage and pay for the treatment of select chronic conditions including asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and hypertension.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $20 copay; no deductible required; copays accumulate to the deductible
Specialty Care Office Visit
$50 copay; no deductible required
Urgent Care Center
$40 copay; no deductible required
Amwell® Urgent Telehealth
$0 copay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $20 copay; no deductible required; copays accumulate to the deductible
Emergency Room Visit
30% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 copay; no deductible required
Tier 2 – Generics
$25 copay; no deductible required
Tier 3 – Preferred Brands
$50 copay; no deductible required
Tier 4 – Non-Preferred Brands
30% coinsurance, up to max of $300/script; no deductible required
Tier 5 – Specialty (30 day supply only)
50% coinsurance. 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%
Coinsurance
  • Includes out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions not available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
array(8) { [0]=> string(12) “adult_vision” [1]=> string(6) “dental” [2]=> string(12) “chiropractic” [3]=> string(4) “cisp” [4]=> string(11) “acupuncture” [5]=> string(10) “telehealth” [6]=> string(8) “national” [7]=> string(12) “outofcountry” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Pediatric Dental Plan includes pediatric dental coverage through Northeast Delta Dental® with a separate, low deductible.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • CISP The Chronic Illness Support Program makes it easier for Members to manage and pay for the treatment of select chronic conditions including asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and hypertension.
  • Acupuncture Acupuncture benefit with a copay for in-network providers on select plans and up to $50 reimbursement for out-of-network providers.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
  • National Coverage Plan includes in-network access to providers throughout the U.S. via the First Health Network.
  • Out-of-Country Plan includes access to care for emergent conditions outside the U.S.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $20 copay; no deductible required; copays accumulate to the deductible
Specialty Care Office Visit
$50 copay; no deductible required
Urgent Care Center
$40 copay; no deductible required
Amwell® Urgent Telehealth
$0 copay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $20 copay; no deductible required; copays accumulate to the deductible
Emergency Room Visit
30% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 copay; no deductible required
Tier 2 – Generics
$25 copay; no deductible required
Tier 3 – Preferred Brands
$50 copay; no deductible required
Tier 4 – Non-Preferred Brands
30% coinsurance, up to max of $300/script; no deductible required
Tier 5 – Specialty (30 day supply only)
50% coinsurance. 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%
Coinsurance
  • Includes out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions not available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
array(6) { [0]=> string(12) “adult_vision” [1]=> string(12) “chiropractic” [2]=> string(4) “cisp” [3]=> string(11) “acupuncture” [4]=> string(8) “wellness” [5]=> string(10) “telehealth” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • CISP The Chronic Illness Support Program makes it easier for Members to manage and pay for the treatment of select chronic conditions including asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and hypertension.
  • Acupuncture Acupuncture benefit with a copay for in-network providers on select plans and up to $50 reimbursement for out-of-network providers.
  • 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.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $25 copay; no deductible required; copays accumulate to the deductible
Specialty Care Office Visit
$50 copay; no deductible required
Urgent Care Center
$40 copay; no deductible required
Amwell® Urgent Telehealth
$0 copay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $25 copay; no deductible required; copays accumulate to the deductible
Emergency Room Visit
30% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 copay; no deductible required
Tier 2 – Generics
$25 copay; no deductible required
Tier 3 – Preferred Brands
$50 copay; no deductible required
Tier 4 – Non-Preferred Brands
$100 copay after deductible
Tier 5 – Specialty (30 day supply only)
$250 copay 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%
Coinsurance
  • Includes out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions not available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
array(8) { [0]=> string(12) “adult_vision” [1]=> string(12) “chiropractic” [2]=> string(4) “cisp” [3]=> string(11) “acupuncture” [4]=> string(8) “wellness” [5]=> string(10) “telehealth” [6]=> string(8) “national” [7]=> string(12) “outofcountry” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • CISP The Chronic Illness Support Program makes it easier for Members to manage and pay for the treatment of select chronic conditions including asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and hypertension.
  • Acupuncture Acupuncture benefit with a copay for in-network providers on select plans and up to $50 reimbursement for out-of-network providers.
  • 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.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
  • National Coverage Plan includes in-network access to providers throughout the U.S. via the First Health Network.
  • Out-of-Country Plan includes access to care for emergent conditions outside the U.S.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $25 copay; no deductible required; copays accumulate to the deductible
Specialty Care Office Visit
$50 copay; no deductible required
Urgent Care Center
$40 copay; no deductible required
Amwell® Urgent Telehealth
$0 copay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $25 copay; no deductible required; copays accumulate to the deductible
Emergency Room Visit
30% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 copay; no deductible required
Tier 2 – Generics
$25 copay; no deductible required
Tier 3 – Preferred Brands
$50 copay; no deductible required
Tier 4 – Non-Preferred Brands
$100 copay after deductible
Tier 5 – Specialty (30 day supply only)
$250 copay 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 2025 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 $1500 PPO National Dental Off MP
$1,500 $3,000
Deductible
$5,000 $10,000
Out-of-pocket Maximum
30% 30%
Coinsurance
  • Includes out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions not available on this plan
  • Not available at CoverME.gov marketplace; purchase directly from Community Health Options
INCLUDES
array(9) { [0]=> string(12) “adult_vision” [1]=> string(6) “dental” [2]=> string(12) “chiropractic” [3]=> string(4) “cisp” [4]=> string(11) “acupuncture” [5]=> string(8) “wellness” [6]=> string(10) “telehealth” [7]=> string(8) “national” [8]=> string(12) “outofcountry” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Pediatric Dental Plan includes pediatric dental coverage through Northeast Delta Dental® with a separate, low deductible.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • CISP The Chronic Illness Support Program makes it easier for Members to manage and pay for the treatment of select chronic conditions including asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and hypertension.
  • Acupuncture Acupuncture benefit with a copay for in-network providers on select plans and up to $50 reimbursement for out-of-network providers.
  • 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.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
  • National Coverage Plan includes in-network access to providers throughout the U.S. via the First Health Network.
  • Out-of-Country Plan includes access to care for emergent conditions outside the U.S.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $25 copay; no deductible required; copays accumulate to the deductible
Specialty Care Office Visit
$50 copay; no deductible required
Urgent Care Center
$40 copay; no deductible required
Amwell® Urgent Telehealth
$0 copay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $25 copay; no deductible required; copays accumulate to the deductible
Emergency Room Visit
30% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$5 copay; no deductible required
Tier 2 – Generics
$25 copay; no deductible required
Tier 3 – Preferred Brands
$50 copay; no deductible required
Tier 4 – Non-Preferred Brands
$100 copay after deductible
Tier 5 – Specialty (30 day supply only)
$250 copay 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%
Coinsurance
  • Includes out-of-network benefits Out-of-network provider visits and services have a separate, higher deductible and out-of-pocket maximum. Copays and coinsurance are also higher than in-network providers and services.
  • Includes Site of Service reduced costs $25 copays for labs and $75 copays for X-rays at specified locations; no deductible required.
  • Cost-share reductions not available on this plan
  • Available on the CoverME.gov marketplace
INCLUDES
array(6) { [0]=> string(12) “adult_vision” [1]=> string(12) “chiropractic” [2]=> string(4) “cisp” [3]=> string(11) “acupuncture” [4]=> string(8) “wellness” [5]=> string(10) “telehealth” }
  • Vision Pediatric and adult vision coverage with one exam every 12 months. Pediatric eye exams on all non-HSA plans with coverage for frames or contacts every two years. Some plans include exams for adults with a copay.
  • Chiropractic/Osteopathic Care Plan includes in-network coverage for chiropractic and osteopathic manipulative therapy. Benefit is available with a copay on non-HSA plans.
  • CISP The Chronic Illness Support Program makes it easier for Members to manage and pay for the treatment of select chronic conditions including asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and hypertension.
  • Acupuncture Acupuncture benefit with a copay for in-network providers on select plans and up to $50 reimbursement for out-of-network providers.
  • 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.
  • Amwell® Telehealth Plan includes $0 copay for telehealth urgent care through Amwell® for non-HSA plans. HSA plans have a copay after deductible.
COST-SHARING BREAKDOWN
Common Services
Primary Care Office Visit
$0 first visit, then $20 copay; no deductible required; copays accumulate to the deductible
Specialty Care Office Visit
$40 copay; no deductible required
Urgent Care Center
$25 copay; no deductible required
Amwell® Urgent Telehealth
$0 copay; no deductible required
Mental Health/Substance Use Disorder (Outpatient)
$0 first visit, then $20 copay; no deductible required; copays accumulate to the deductible
Emergency Room Visit
20% coinsurance after deductible
Prescriptions
Tier 1 – Preferred Generics
$0 copay; no deductible required
Tier 2 – Generics
$0 copay; no deductible required
Tier 3 – Preferred Brands
$15 copay; no deductible required
Tier 4 – Non-Preferred Brands
$100 copay after deductible
Tier 5 – Specialty (30 day supply only)
$250 copay after deductible