Community Health Choice only offers HMO plans that require you to see an in-network (contracted) provider for covered services. Covered Services provided by a non-participating provider would only be covered in the case of an emergency or with prior authorization.

No. If your children are currently enrolled in CHIP or Medicaid or become eligible for CHIP or Medicaid during the year, they are not required to be enrolled on your Marketplace plan. You will, however, have to enroll them in these programs when they become eligible and remove them from your Marketplace plan, or if they lose CHIP or Medicaid, you can enroll them on your Marketplace plan at that time.

Yes. Your out-of-pocket maximum includes copayments, coinsurance(s), and deductibles for all covered services. It does not include your monthly premium (you are always responsible for paying your monthly premium). If you reach your MOOP during the calendar year (01/01 – 12/31), you are covered at 100% for the remainder of that calendar year.

Yes, you will be required to select a PCP. If you do not select a PCP, we will select one for you. You can change your PCP at any time by calling Member Services. The change will take effect on the first day of the following month.

No, Community does not require you to have a referral to see a specialist. However, there are some specialists that will require you to have seen a PCP and have a PCP referral before they will agree to schedule an appointment. 

Yes, after you have made your January premium payment (due by December 31). A temporary card will also be available in your Member Portal after December 31st.

Premium payments are due no later than the last day of the month prior to the coverage month. For example, your January premium payment is due no later than December 31st.

Payments can be made online through the one-time payment option, online through your Member Portal, through mail by check or money order, and by phone through our automated payment line or a member of our team. You may also pay onsite at our Community Cares Center Monday through Friday 8:00 a.m. to 5:00 p.m.

Payments can be made by check, money order, credit card or checking/savings accounts.

Yes, you can set up automatic payments. However, you must first make your January premium payment and allow that payment to post to your account before setting up recurring payments.

If the Member is enrolled On-Exchange through the Health Insurance Marketplace, they need to call HC.gov at 1.800.318.2596 to cancel their coverage. If the Member is enrolled Off-Exchange (direct with Community), the Member can complete and return a Policy Termination Form for processing.

Newborns delivered by a person covered under a Community Policy are covered for the first 31 days of life for services related to the delivery. If you want full continuous coverage for the child, you will need to add them to your policy once the child is born

Routine eye exams and eyeglasses or contact lens are covered for children 18 and under.

During the annual open enrollment period, you can change plans. Outside of annual open enrollment, you can only make a plan change if you have a qualifying event (e.g. birth of a child, loss of other coverage, etc.)

Community has expanded its service area to offer HMO policies in Harris, Brazoria, Chambers, Fort Bend, Galveston, Jefferson, Liberty, Montgomery, Orange, Waller, Walker, San Jacinto, Polk, Tyler, Jasper, Newton, Hardin, Austin, Wharton, and Matagorda.

If you miss a payment or do not pay your premium on time, your account is considered delinquent and you will go into a grace period. If you receive APTC tax credits, you will have a 90-day grace period; if you do not receive tax credits, you will have a 31-day grace period. In order to prevent your account from terminating, your account must be paid in full prior to the end of your grace period.

You can determine tax credit qualification by completing an account through Healthcare.gov or by calling Healthcare.gov at 1.800.318.2596.

Cost share reductions are available to individuals who are between 100% and 250% of the Federal Poverty Level (FPL) who enroll on-exchange through the Health Insurance Marketplace in a Silver plan. They come in three forms depending on income:
Silver 73 = individuals between 201% and 250% FPL
Silver 87 = individuals between 151% and 200% FPL
Silver 94 = individuals between 100% and 150% FPL

If you have no income or your income is below 100% FPL as reported on your income tax return, you do not qualify for advanced premium tax credits through the Health Insurance Marketplace and you are not required to have health insurance or pay a penalty. You do, however, need to file for a hardship exemption with HC.gov (this may also apply to someone earning up to 138%FPL).

If a consumer is a member of the federally recognized tribe or an Alaska Native Claims Settlement Act Corporation shareholder, they may qualify for Limited or zero cost share plans that are only offered On-Exchange.

Telehealth services give you access to a board-certified doctor within minutes by phone at no cost to you. The doctor can treat routine medical concerns 24/7 from anywhere by phone, web or mobile app. You can even get a new prescription or a refill. Telehealth services are available on most Community Health Choice Marketplace plans. Please contact Member Services at 713.295.6704 to confirm if your plan offers telehealth services.

Examples of when you may utilize telehealth services are when your primary care doctor is not available, you are traveling or if you are thinking of visiting the ER or Urgent Care for routine medical concerns.
Please note that telehealth services are available on most Community Health Choice Marketplace plans. Please contact Member Services at 713.295.6704 to confirm if your plan offers telehealth services.

Telehealth services helps treat:

• Sinus problems
• Bronchitis
• Cold and flu symptoms
• Allergies
• Respiratory infections
• Ear infections
• And more

Please note that telehealth services are an available service on most Community Health Choice Marketplace plans. Please contact Member Services at 713.295.6704 to confirm if your plan offers telehealth services.