Plan Choices for 2019

Traditional Plan

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.

Emerald Care

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.

Diamond Care

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.

Plan Details

Detail
Traditional Plan
Emerald Care Plan
Diamond Care Plan
Share Pricing Varies from $61 to $266 per person per month based on member’s age $45 per unit per month with a maximum of 3 units or $135 per household $162 per unit per month with a maximum of 3 units or $486 per household
Member Responsibility Annual Member Responsibility (AMR) of $1,000 per person with maximum of $2,000 per household per year Incident Member Responsibility (IMR) of $5,000 per incident Annual Member Responsibility (AMR) of $1000 per person
Incident threshold to qualify for sharing All approved bills are applied to AMR or shared as per CHA Guidelines Incident must exceed $5,000 to be eligible for sharing Incident must exceed $1,000 to be eligible for sharing even if AMR has already been satisfied
Submission of Medical Bills Bills may be submitted to CHA directly by the provider, or may be sent to the member to submit to CHA with documentation All bills are sent to the member, who will assemble bills for the incident & submit to CHA with proper documents All bills are sent to the member, who will assemble bills for the incident & submit to CHA with proper documents
Handling of discounts Discounts are taken off total amount billed before anything is applied to AMR or shared by CHA Discounts are taken off total amount billed before anything is applied to IMR or shared by CHA Discounts are taken off total amount billed before anything is applied to AMR or shared by CHA
Sharing percentage 80% after AMR is satisfied when primary; 100% of remaining bill when secondary to other coverage 100% after IMR is satisfied 100% after AMR is satisfied
Annual sharing limit $35,000 per person $100,000 per person (unless enrolled in ExtenCare) $200,000 per person (unless enrolled in ExtenCare)
Illness sharing limit No lifetime limit or illness limit Lifetime limit of $125,000 per illness (unless enrolled in ExtenCare) Lifetime limit of $125,000 per illness (unless enrolled in ExtenCare)
Help beyond the plan limits Bills that exceed the $35,000 limit are eligible for board review and further donations An additional $100,000 per person per year is available by participating in the ExtenCare companion program at an additional cost of $20 per unit per month. To receive help from ExtenCare, you must be enrolled before the incident begins.
Pre-existing clauses No pre-existing clauses or waiting periods Incidents for which you are receiving treatment (other than routine medication) when you join Emerald Care or Diamond Care (whether or not you have been a member of a different plan with CHA) will not be shareable. New incidents which begin after becoming a member will be shareable.
Member Responsibility for Maternity Cases OB bills are paid by case year based on the year in which the pregnancy begins with only one AMR and Annual Limit per pregnancy Each pregnancy is considered one incident so member will pay one $5,000 Incident Member Responsibility per pregnancy. (Only inpatient bills are eligible for sharing.) OB bills will have a new Annual Member Responsibility each year, even when one pregnancy spans portions of two years.
Secondary to Other Assistance & Other Provisions This plan is secondary to all other insurance or medical aid with the exception of state aid who is always the payer of last resort. These plans are secondary to all other types of coverage or financial assistance with the exception of state aid who is always the payer of last resort. If funds that are shared by CHA for the payment of medical bills are not used for this purpose, membership in the plan will be terminated.

Overview of Shareable and Non-Shareable Items

Traditional CHA Plan
All shareable items are applied to AMR and/or shared.
Emerald Care Plan
All shareable items are subject to being part of a qualifying incident.
Diamond Care Plan
All shareable items are subject to being part of a qualifying incident.
Ambulance Shareable Not Shareable Shareable up to $5,000
Anesthesia Shareable Shareable Shareable
Assistant Surgeon Shareable Shareable Shareable
Breast & Eye Prostheses Shareable Not Shareable Shareable
Cataract Surgery Shareable Shareable Shareable
Chemotherapy & Radiation Shareable Not Shareable Shareable
Chiropractic Care Up to 12 manipulative treatments per year are shareable as well as procedures that would be shareable if performed by medical personnel Not Shareable Not Shareable
Consultations Shareable Shareable Shareable
Critical Care Unit Shareable Shareable Shareable
Delivery Room Shareable Shareable Shareable
Dental Accidents Shareable with limitations Shareable with limitations Shareable with limitations
Diabetic Supplies Up to $150/mo for non- insulin dependent, $300/mo for insulin dependent, not subject to AMR or 80% limit Not shareable Not shareable
Diagnostic Testing Shareable Shareable Shareable
Disc Decompression Therapy Shareable Not Shareable Not Shareable
Durable Medical Equipment Limited to apnea monitor, bili blanket, home infusion pump, insulin pump, CGM, nebulizer, orthotics Not shareable Limited to essential equipment with limit of $5,000 per incident
Emergency Room Shareable Shareable Shareable
Home Health Up to 24 licensed personnel visits per year shareable Not Shareable Up to 24 licensed personnel visits per year shareable
Hospice Shareable Not Shareable Shareable
Hospital Room & Board Shareable Shareable Shareable
Intensive Care Unit Shareable Shareable Shareable
Maternity Care & Delivery Shareable except for take-home meds (includes pre-existing pregnancy) Inpatient charges only are shareable - (pre-existing pregnancies excluded) Shareable - (pre-existing pregnancies excluded)
Mental Health Treatment Shareable with exclusions Shareable with exclusions Shareable with exclusions
Nursery & Neo-natal Nursery Shareable Shareable Shareable
Office & Out-patient Surgery Shareable Shareable Shareable
Office Visits Shareable Shareable Shareable
Operating Room Shareable Shareable Shareable
Out-patient IV Shareable Not Shareable Shareable
Physician Charges for Inpatient Care Shareable Shareable Shareable
Plastic Surgery for Reconstruction Limited Sharing Not Shareable Limited Sharing
Prescriptions & Injections Limited to meds used in hospital or surgery, chemo drugs, RhoGam or Progesterone for OB use Shareable during in-patient hospital stay or emergency room treatment only Shareable as part of incident; excludes immunizations and maintenance medications
Pulmonary Procedures Shareable Shareable Shareable
Radiation Shareable Not Shareable Shareable
Recovery Room Shareable Shareable Shareable
Skilled Nursing Shareable Shareable Shareable
Supplies for Outpatient Burn, Accident, and Respiratory Needs Shareable Shareable Shareable
Surgeons' Fees Shareable Shareable Shareable
Surgical Implants, including prosthetic Shareable Shareable Shareable
Therapy, including but not limited to Eye, Occupational, Physical, & Speech Shareable Not Shareable Shareable up to 45 sessions if ordered by MD, ARNP, or PA and performed by licensed therapist