2023 Summary of Benefits & Coverage

Click the links below to access the Summary of Benefits & Coverage (SBC) for the On-Exchange 2023 base plans:

Gold Plans

• Gold $1800 Deductible
• HSA Gold $3000 Deductible
• Gold $3000 Deductible
• Gold Standard

Silver Plans

• Silver $4000 Deductible
• Silver $5000 Deductible
• Silver $5650 Deductible
• HSA Silver $3000 Deductible
• Silver Standard

Bronze Plans

• Bronze $6000 Deductible
• HSA Bronze $7500 Deductible
• Bronze $8150 Deductible
• Bronze $9100 Deductible $35 PCP
• Bronze Standard

$0 Deductible Plans

• Copay Gold $0 Deductible
• Copay Silver $0 Deductible / $1000 Rx Deductible
• Copay Bronze $0 Deductible / $2250 Rx Deductible

All On-Exchange plans offer variants with Adult Vision/Allergy Testing and Preventive Dental add-on options. Click here to learn more. 

Prescription Drug List   |   Certificate of Coverage

Click the links below to access the Summary of Benefits and Coverage (SBC) for these 2023 CSR plans:

73% CSR Plans

• Copay Silver $0 Deductible 73% CSR 
• Silver $2625 Deductible 73% CSR
• Silver $3400 Deductible 73% CSR
• Silver $3450 Deductible 73% CSR
• Silver $3600 Deductible 73% CSR
• Silver Standard 73% CSR

87% CSR Plans

• Copay Silver $0 Deductible 87% CSR
• Silver $600 Deductible 87% CSR
• Silver $600 Deductible $30 PCP 87% CSR
• Silver $700 Deductible 87% CSR
• Silver $800 Deductible 87% CSR
• Silver Standard 87% CSR

94% CSR Plans

• Copay Silver $0 Deductible 94% CSR
• Silver $0 Deductible 94% CSR
• Silver $0 Deductible $5 PCP 94% CSR
• Silver $150 Deductible 94% CSR
• Silver $250 Deductible 94% CSR
• Silver Standard 94% CSR

$0 Deductible CSR Plans

• Copay Silver $0 Deductible / $500 Rx Deductible  73% CSR 
• Copay Silver $0 Deductible 87% CSR
• Copay Silver $0 Deductible 94% CSR
• Silver $0 Deductible 94% CSR
• Silver $0 Deductible $5 PCP 94% CSR

All On-Exchange plans offer variants with Adult Vision/Allergy Testing and Preventive Dental add-on options. Click here to learn more. 

Prescription Drug List   |   Certificate of Coverage

Click the links below to access the Summary of Benefits and Coverage (SBC) for these Off-Exchange 2023 base plans:

Gold/Platinum Plans

• Platinum $500 Deductible Vision Exam + Allergy Testing
• Platinum $1000 Deductible Vision Exam + Allergy Testing
• Gold $1800 Deductible Vision Exam + Allergy Testing
• Gold $2000 Deductible Vision Exam + Allergy Testing
• CGHC HSA Gold $3000 Deductible Vision Exam + Allergy Testing
• Gold $3000 Deductible Vision Exam + Allergy Testing

Silver Plans

• Silver $4000 Deductible Vision Exam + Allergy Testing
• Silver $5000 Deductible Vision Exam + Allergy Testing
• Silver $5650 Deductible Vision Exam + Allergy Testing
• CGHC HSA Silver $3000 Deductible Vision Exam + Allergy Testing
• Silver $5000 Deductible Dental + Vision Exam + Allergy Testing
• Silver $5650 Deductible Dental + Vision Exam+ Allergy Testing

Bronze/Catastrophic Plans

• Bronze $6000 Deductible Vision Exam + Allergy Testing
• CGHC HSA Bronze $7500 Deductible Vision Exam + Allergy Testing
• Bronze $8150 Deductible Vision Exam + Allergy Testing
• Catastrophic $9100 Deductible Vision Exam + Allergy Testing
• Bronze $9100 Deductible Vision Exam + Allergy Testing
• Bronze $9100 Deductible $35 PCP Vision Exam + Allergy Testing

$0 Deductible Plans

• Copay Gold $0 Deductible Vision Exam + Allergy Testing
• Copay Silver $0 Deductible / $1000 Rx Deductible  Vision Exam + Allergy Testing
• Copay Bronze $0 Deductible / $2250 Rx Deductible Vision Exam + Allergy Testing
• Copay Bronze 0$ Deductible / $2250 Rx Deductible  Dental + Vision Exam + Allergy Testing

All Off-Exchange plans offer variants with a Preventive Dental add-on option. Click here to learn more. 

Prescription Drug List   |   Certificate of Coverage

Click the links below to access the Summary of Benefits and Coverage (SBC) for these Small Group EPO plans:

Bronze Plans

• EPO Bronze $5500 Deductible/30%
• EPO HSA Bronze $7000 Deductible/0%
• EPO Bronze $8550 Deductible/0%

Silver Plans

• EPO Silver $4000 Deductible/20%
• EPO Silver HSA $4800 Deductible/0%
• EPO Silver HSA $3000 Deductible/20%
• EPO Silver $5000 Deductible /20%
• EPO Silver $5500 Deductible/20%
• EPO Silver $6000 Deductible/20%

Gold Plans

• EPO Gold $800 Deductible/20%
• EPO Gold $1500 Deductible/20%
• EPO Gold $2000 Deductible/20%
• EPO Gold $2200 Deductible/20%
• EPO Gold $2750 Deductible/15%
• EPO Gold $2750 Deductible/15% ER Copay
• EPO HSA Gold $3000 Deductible/0%

Platinum Plans

• EPO Platinum $500 Deductible/20% 
• EPO Platinum $500 Deductible/10%

Click the links below to access the Summary of Benefits and Coverage (SBC) for these Out-of-Area EPO Plus plans:

Bronze OOA Plans

• EPO Plus Bronze $8550 Deductible/0%
• EPO Plus HSA Bronze $7000 Deductible/0%
• EPO Plus Bronze $5500 Deductible/30%

Silver OOA Plans

• EPO Plus Silver $4000 Deductible/20%
• EPO Plus HSA Silver $4800 Deductible/0%
• EPO Plus Silver $5000 Deductible /20%

Gold Plans

• EPO Plus Gold $800 Deductible/20%
• EPO Plus Gold $1500 Deductible/20%
• EPO Plus Gold $2000 Deductible/20%
• EPO Plus HSA Gold $3000 Deductible/0%

Click the links below to access the Summary of Benefits & Coverage (SBC) for the On-Exchange 2022 base plans:

Gold Plans

• Value Premier Gold $1800 Deductible
• Value Plus Gold $2000 Deductible
• HSA Gold $2800 Deductible
• Value 2 Gold $3000 Deductible
• Value 1 Gold $3600 Deductible

Silver Plans

• Value Premier Silver $3000 Deductible
• Value Plus Silver $4000 Deductible
• HSA Silver $3000 Deductible
• Value 2 Silver $6500 Deductible
• Value 1 Silver $7500 Deductible

Bronze Plans

• Value Premier Bronze $8150 Deductible
• Value Plus Bronze $8700 Deductible $35 PCP
• HSA Bronze $7000 Deductible
• Value 2 Bronze $6000 Deductible
• Value 1 Bronze $8700 Deductible

$0 Deductible Plans

• Solutions Gold $0 Deductible
• Solutions Silver $0 Deductible
• Solutions Bronze $0 Deductible

All On-Exchange plans offer variants with Adult Vision/Allergy Testing and Preventive Dental add-on options. Click here to learn more. 

Prescription Drug List   |   Certificate of Coverage

Click the links below to access the Summary of Benefits and Coverage (SBC) for these 2022 CSR plans:

Value Premier Silver 

• Value Premier Silver $3000 Deductible 73% CSR 
• Value Premier Silver $700 Deductible 87% CSR 
• Value Premier Silver $100 Deductible 94% CSR 

Value Plus Silver 

• Value Plus Silver $3400 Deductible 73% CSR 
• Value Plus Silver $700 Deductible 87% CSR 
• Value Plus Silver $100 Deductible 94% CSR 

HSA Silver 

• Silver $2500 Deductible 73% CSR 
• Silver $800 Deductible 87% CSR 
• Silver $250Deductible 94% CSR 

Value 2 Silver 

• Value 2 Silver $2400 Deductible 73% CSR 
• Value 2 Silver $600 Deductible 87% CSR 
• Value 2 Silver $0 Deductible 94% CSR 

Value 1 Silver

• Value 1 Silver $3450 Deductible 73% CSR 
• Value 1 Silver $600 Deductible 87% CSR $35 PCP 
• Value 1 Silver $0 Deductible 94% CSR $5 PCP

$0 Deductible Silver 

• Solutions Silver $0 Deductible 73% CSR 
• Solutions Silver $0 Deductible 87% CSR
• Solutions Silver $0 Deductible 94% CSR

All On-Exchange plans offer variants with Adult Vision/Allergy Testing and Preventive Dental add-on options. Click here to learn more. 

Prescription Drug List   |   Certificate of Coverage

Click the links below to access the Summary of Benefits and Coverage (SBC) for these Off-Exchange 2022 base plans:

Gold/Platinum Plans

• CGHC Value Premier Gold $1800 Deductible Vision Exam + Allergy Testing
• CGHC Value Plus Gold $2000 Deductible Vision Exam + Allergy Testing
• CGHC HSA Gold $2800 Deductible Vision Exam + Allergy Testing
• CGHC Value 2 Gold $3000 Deductible Vision Exam + Allergy Testing
• CGHC Value 1 Gold $3600 Deductible Vision Exam + Allergy Testing
• CGHC Value Max 1 Platinum $1000 Deductible Vision Exam + Allergy Testing
• CGHC Value Max 2 Platinum $500 Deductible Vision Exam + Allergy Testing

Silver Plans

• CGHC Value Premier Silver $3000 Deductible Vision Exam + Allergy Testing
• CGHC Value Plus Silver $4000 Deductible Vision Exam + Allergy Testing
• CGHC HSA Silver $3000 Deductible Vision Exam + Allergy Testing
• CGHC Value 2 Silver $6500 Deductible Vision Exam+ Allergy Testing
• CGHC Value 1 Silver $7500 Deductible Vision Exam+ Allergy Testing

Bronze/Catastrophic Plans

• CGHC Value Premier Bronze $8150 Deductible Vision Exam + Allergy Testing
• CGHC Value Plus Bronze $8700 Deductible $35 PCP Vision Exam + Allergy Testing
• CGHC HSA Bronze $7000 Deductible Vision Exam + Allergy Testing
• CGHC Value 2 Bronze $6000 Deductible Vision Exam + Allergy Testing
• CGHC Value 1 Bronze $8700 Deductible Vision Exam + Allergy Testing
• Catastrophic $8700 Deductible Vision Exam + Allergy Testing

$0 Deductible Plans

• CGHC Solutions Gold $0 Deductible Vision Exam + Allergy Testing
• CGHC Solutions Silver $0 Deductible Vision Exam + Allergy Testing
• CGHC Solutions Bronze $0 Deductible Vision Exam + Allergy Testing
• CGHC Solutions Platinum $0 Deductible Vision Exam + Allergy Testing

All Off-Exchange plans offer variants with a Preventive Dental add-on option. Click here to learn more. 

Prescription Drug List   |   Certificate of Coverage

Click the links below to access the Summary of Benefits and Coverage (SBC) for these Small Group EPO plans:

Bronze Plans

• EPO Bronze $8550 Deductible/0%
• EPO HSA Bronze $7000 Deductible/0%
• EPO Bronze $5500 Deductible/30%
• EPO Bronze $6500 Deductible/40%

Silver Plans

• EPO Silver $4000 Deductible/20%
• EPO Silver HSA $3000 Deductible/20%
• EPO Silver $5500 Deductible/20% Rx $250
• EPO HSA Silver $4500 Deductible/0%
• EPO Silver $5000 Deductible /20%
• EPO Silver $6000 Deductible/20%

Gold Plans

• EPO Gold $800 Deductible/20%
• EPO Gold $1500 Deductible/20%
• EPO Gold $2000 Deductible/20%
• EPO Gold $2750 Deductible/20%
• EPO Gold $2750 Deductible/20% ER Copay
• EPO Gold $2200 Deductible/20% Rx $250
• EPO HSA Gold $3000 Deductible/0%

Platinum Plans

• EPO Platinum $500 Deductible/20% 
• EPO Platinum $500 Deductible/10%

Click the links below to access the Summary of Benefits and Coverage (SBC) for these Out-of-Area EPO Plus plans:

Bronze OOA Plans

• EPO Plus Bronze $8550 Deductible/0%
• EPO Plus HSA Bronze $7000 Deductible/0%
• EPO Plus Bronze $6500 Deductible/40%

Silver OOA Plans

• EPO Plus Silver $4000 Deductible/20%
• EPO Plus Silver HSA $3000 Deductible/20%
• EPO Plus HSA Silver $4500 Deductible/0%
• EPO Plus Silver $5000 Deductible /20%

Gold Plans

• EPO Plus Gold $800 Deductible/20%
• EPO Plus Gold $1500 Deductible/20%
• EPO Plus HSA Gold $3000 Deductible/0%