Frequently Asked Questions
Once a month, 4th Friday of the month
Statements are sent out via secure email every 3rd Friday of the month. If you do not receive this statement, contact AgentRelations@CommunityCares.com
First, make sure you are entering your username, NPN and, password given on you confirmation email.
If you are still unable to login you can request this information from AgentRelations@CommunityCares.com
You and any other non-covered member on your income tax return will be subject to tax penalties. The penalty for 2017 will be the greater of 2.5% of your total household income or $695 per adult and $347.50 per child.
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 deductible 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, for 2017 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 anytime by calling Member Services.
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 had a PCP referral before they will agree to schedule an appointment. Yes, if you are a Kelsey Care member, Kelsey will require referrals but manages all their specialist referrals themselves.
Yes, after you have made your 2017 January premium payment (due by December 31, 2016), you will receive a welcome packet, and a new member ID card. A temporary card will also be available in your member portal after December 31st if you should ever lose it and need to print one before you receive a new one in the mail.
Payments can be made online through the one-time payment option, online through your member portal, you can mail in a check or money order, you can pay by phone through our automated payment line or with a member of our team, and you can also pay onsite at our Community Cares Center Monday through Friday 8:00 a.m. to 5:00 p.m.
Yes, you can set up automatic payments for 2017 however, you must first make your January 2017 premium payment and allow that payment to post to your account before setting up re-occurring payments.
Payments can be made by check, money order, credit card, or checking/savings accounts.
If the member is enrolled on-exchange through the Health Insurance Marketplace, they need to call HC.gov @ 1.800.318.2596 to cancel coverage. If the member is enrolled off-exchange (direct with Community) then we can have them complete an enrollment/change form and mark "cancellation" then send back for the termination to be processed.
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 and covered for children 18 and under
During the annual open enrollment period you can change plans but outside of annual open enrollment you can only make a plan change if you have a qualifying event (e.g. birth of child, loss of other coverage, etc.)
In order to access KelseySeybold in 2017 you must be enrolled in one of our KelseyCare plans. The KelseyCare plans are the Silver 007 or the Gold 006.
You can determine tax credit qualification by completing an account through HC.gov or by calling HC.gov at 1.800.318.2596.
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)
Community only offers HMO policies in Harris, Brazoria, Chambers, Fort Bend, Galveston, Jefferson, Liberty, Montgomery, Orange, and Waller Counties).