Plan Choices for 2019
As the name suggests, this is the plan that has been around for quite some time. In answer to the input through the years for help with all-around small to medium sized healthcare costs, this plan has the most extensive list of sharable items of any of CHA’s plans. Among other things, it includes help with well-patient checkups, diagnostic work, surgery, ambulance, emergency room, hospital stays, diabetic supplies, optional dental and vision assistance, etc. See Overview of shareable and non-shareable items for more details. Monthly share contributions vary by age, but are charged for each person in the family (except where there are 6 or more children). There is an Annual Member Responsibility (AMR) of $1,000 per person with a maximum of $2,000 per family. After this is satisfied, CHA shares bills at 80%, with the remaining 20% being the member’s responsibility. This plan has a maximum shareable amount of $35,000 per year, and the board of directors will continue to consider each case that exceeds this maximum and offer additional assistance where needed through the Brother-to-Brother Fund. Diabetic supply assistance as well as the optional Vision and Dental sharing plans are available exclusively with the Traditional Plan.
This plan is for those who prefer to handle their own health care costs for the most part, but would like to have some help in place for major health care expenses. The monthly sharing amount is $45 per unit with a maximum of 3 units per household regardless of the number of family members enrolled. Members of this plan will have an Incident Member Responsibility (IMR) of $5,000 per incident, meaning they are personally responsible for the first $5,000 of each incident before it is eligible for sharing. Because all sharing under this plan is on a "per incident" basis, all bills are handled as self-pay. This means the provider will bill the member, who will assemble all bills pertaining to the incident and submit them to CHA along with the appropriate documentation as per CHA Guidelines. Once the bill has been determined to be shareable by CHA staff, CHA’s repricing team will negotiate an appropriate settlement with the provider. CHA will share 100% of the approved, negotiated charges after the member’s IMR has been satisfied. Payment is usually issued to the member who may then negotiate their portion of the bill if desired and issue payment to the provider. This plan shares up to an annual limit of $100,000 per person. There is a lifetime sharing limit of $125,000 per illness. Because of the lower cost of this plan, there is a limited list of shareable items. See Overview of shareable and non-shareable items.
This plan is for those who are willing to contribute a bit more than with Emerald Care on a monthly basis and consequently are able to submit more items for sharing from the plan. Shares for this plan are $162 per unit per month, with a maximum of 3 units per household. This plan choice has an Annual Member Responsibility (AMR) of $1,000 per person. Incidents must exceed $1,000 to be eligible for sharing, even after the AMR has been satisfied. As with the Emerald plan, all bills are handled as self-pay and the member is responsible to submit the bills to the office for sharing along with the appropriate documentation, where a settlement will be negotiated by our repricing team. Bills are shared at 100% on this plan after the member’s AMR has been satisfied. Payment is usually issued to the member who may then negotiate their portion of the bill and pay the provider. There is an annual limit of $200,000 per person and a lifetime limit of $125,000 per illness. See Overview of shareable and non-shareable items for more details about what is eligible for sharing.
Both the Emerald Care and Diamond Care plans are offered with an optional companion plan called ExtenCare, which offers an additional $100,000 sharing per year. The cost of this plan is $20 per unit per month in addition to the normal shares mentioned above.