Coverage Details

All Common Ground Healthcare Cooperative (CGHC) plans for Individuals and Small Groups have the Envision network, prior authorization requirements, and the same preventive care benefits. Your plan will also have a corresponding Certificate of Coverage (COC). Members can find essential information about your coverage here.

Individual Certificates of Coverage (COC)

Small Employer Certificate of Coverage

View last year’s Small Group Certificate of Coverages, here.

Preventive Care Coverage

 

Preventive care coverage is coverage for medical services that focus on preventing disease and evaluating a person’s current state of health. Examples include annual well visits, most immunizations, and screening tests such as mammograms.

 

When it comes to out-of-pocket expenses for certain preventive services, there is a distinction between “no-cost-share preventive care” under the ACA and other services that may be considered preventive by you or your health care provider.

 

CGHC provides members with a list of no cost-share preventive services covered for every member. It is important to know the difference between preventive services and diagnostic services because that will also determine the billing process. Learn more about preventive vs. diagnostic services, here.

 

Doctor and clients
Home physical therapy

Understanding Prior Authorization

 

Prior Authorization is the practice of getting certain medical services approved by CGHC before receiving treatment. Prior Authorization exists in order to give health insurance companies advanced noticed of certain claims that will coming in. It also can serve as a type of checks and balances system so that CGHC is able to validate that any planned care is medically necessary.

 

There are certain medical services that require Prior Authorization by CGHC before they will apply to your benefits. These can include tests, procedures, medical equipment and medications. CGHC’s Medical Management team oversees the Prior Authorization process to ensure our members receive medically necessary care.

 

All in-network providers should be aware that Prior Authorization must be obtained before they provide these services to you. However, it is ultimately your responsibility to be certain prior authorization was obtained in order to be applied to your benefits.

 

Member Guides

 

All new CGHC members get a Member Guide upon enrollment. Your ID cards will also be attached to the member guide. The member guide is meant to explain all of the necessary details about your coverage in one convenient place.

 

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