EOBs for plan members are temporarily unavailable to view online. If you have questions about plan benefits, please contact the CommunityCare customer service team for assistance.

Plan Details

CommunityCare PPO Silver A20 Standard

Plan Year:

Silver Metal plans cover an estimated 70% of your medical and prescription drug costs. They limit your annual out-of-pocket expenses.

Individual Deductible:$7,000
Individual Out of Pocket Maximum:$9,000
Office Visit Copay:$35
Out of Network Coinsurance:30%*
Preferred Generics:$15
Preferred Brand Name:$45
Non-Preferred Brand Name:$120
Individual Rx Deductible:None
Preferred Specialty:$350
Non-Preferred Specialty:$400
OON Individual Deductible:$14,000
OON Family Deductible:$42,000
OON OOP Individual Deductible:Unlimited
OON OOP Family Deductible:Unlimited
OON Office Visit Copay:30%*
Specialist Copay:$65
OON Specialist Copay:30%*
*Subject to the deductible.

Essential Benefits

All health plans in the exchanges are required to provide a minimum set of benefits which are termed essential benefits. These benefits include:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health services
  • Substance use disorder services
  • Prescription drug coverage
  • Rehabilitative and habilitative services and devices
  • Preventative and wellness services
  • Pediatric Services