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 Multi-Choice MC22D Tier 1

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:$4,500
Individual Out of Pocket Maximum:$8,500
Office Visit Copay:$35
Out of Network Coinsurance:70%*
Preferred Generics:$15
Preferred Brand Name:$45
Individual Rx Deductible:Integrated
Preferred Specialty:50%*
Non-Preferred Specialty:50%*
OON Individual Deductible:$8,000
OON Family Deductible:$18,100
OON OOP Individual Deductible:Unlimited
OON OOP Family Deductible:Unlimited
OON Office Visit Copay:70%*
Specialist Copay:$55
OON Specialist Copay:70%*
*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