Texas health plan · 2025

Community Premier Silver 012 (No deductible for PCP, Urgent Care & Generics, $0 PCP 24/7 Virtual Care Options) · 27248TX0010012

Community Health Choice offers this marketplace health insurance plan (Plan ID 27248TX0010012) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Silver Plan type: HMO CSR: 87% AV Level Silver Plan Issuer: Community Health Choice
Telehealth Data pending HSA eligible No Dental Not listed Vision Child
Pay / Manage Plan View issuer site

CMS AV Calculator output: 87.54% (12.46% member share on average). Learn about AV methodology.

2025 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$347 – $1536

Before subsidies

Estimate after subsidies

Deductible

$500

$1000 per group

See deductible details

Max out-of-pocket

$2,500

$5000 per group

Review MOOP rules

Office visits

Primary care $25.00
Specialist $50.00 Copay after deductible
HSA Not eligible

Drug tiers

Generic $5.00
Preferred brand $70.00 Copay after deductible

View formulary tiers

$476 / mo before subsidies

≈ $5711 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$1621 / mo before subsidies

≈ $19458 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$1982 / mo before subsidies

≈ $23789 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$1230 / mo before subsidies

≈ $14757 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

40.00% Coinsurance after deductible

Durable Medical Equipment

15.00% Coinsurance after deductible

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Enrollment guidance

Stay on top of 2025 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2025 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Texas). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • 87% AV Level Silver Plan plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

40.00% Coinsurance after deductible

Durable Medical Equipment

15.00% Coinsurance after deductible

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 27248TX0010012
Coverage year 2025
State Texas
Issuer Community Health Choice
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 27248TX0010012-05
Available variants

Standard Off Exchange Plan · 27248TX0010012-00

Standard On Exchange Plan · 27248TX0010012-01

Open to Indians below 300% FPL · 27248TX0010012-02

Open to Indians above 300% FPL · 27248TX0010012-03

73% AV Silver Plan · 27248TX0010012-04

87% AV Silver Plan · 27248TX0010012-05

94% AV Silver Plan · 27248TX0010012-06
Last plan update Thu, 10 Oct 2024 00:00 GMT
Last HealthPorta import Tue, 02 Dec 2025 06:13 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in Texas 394
PCPs in Texas 44
Telehealth support Data pending
Nationwide providers 459
394 doctors statewide 44 PCPs 1 OB/GYN

Provider network(s)

Providers Texas All US states
All 394 459
PCP 44 53
Allergy N/A N/A
OB/GYN 1 1
Dentists 1 1

Drug coverage overview

4,723 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
NON-PREFERRED-GENERIC 2,533
NON-PREFERRED-BRAND 997
SPECIALTY-DRUGS 692
MEDICAL-SERVICE-DRUGS 501
Prior authorization Drugs
Required 834
Not Required 3,889
Step therapy Drugs
Required 86
Not Required 4,637
Quantity limits Drugs
Has Limit 969
No Limit 3,754

Customer highlights

What stands out for members

  • Issuer: Community Health Choice · Plan ID 27248TX0010012 · 2025 filing.
  • Disease management programs available: Asthma, Diabetes, Heart Disease, Pregnancy.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 27248TX0010012-05 (87% AV Silver Plan) currently displayed.
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Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

$50.00 Copay after deductible
Tier 1 in-network $50.00 Copay after deductible
Out-of-network 100.00%

Limit: 35.0 Visit(s) per Year

Limited to combined 35 visits per year, including Chiropractic.

Exclusions: nan

Diabetes Education

$25.00 Copay after deductible
Tier 1 in-network $25.00 Copay after deductible
Out-of-network 100.00%

Cost sharing depends on type and site of service.

Exclusions: nan

Home Health Care Services

$50.00 Copay after deductible
Tier 1 in-network $50.00 Copay after deductible
Out-of-network 100.00%

Limit: 60.0 Visit(s) per Year

Prior Authorization is required.

Exclusions: nan

Laboratory Outpatient and Professional Services

$25.00 Copay after deductible
Tier 1 in-network $25.00 Copay after deductible
Out-of-network 100.00%

Some services require preauthorization.

Exclusions: nan

Other Practitioner Office Visit (Nurse, Physician Assistant)

$25.00
Tier 1 in-network $25.00
Out-of-network 100.00%

Cost sharing and limitations depend on type and site of service.

Exclusions: nan

Preventive Care/Screening/Immunization

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

nan

Exclusions: nan

Primary Care Visit to Treat an Injury or Illness

$25.00
Tier 1 in-network $25.00
Out-of-network 100.00%

$0 24/7 Virtual Care Options available under select plans for care received from a virtual provider for primary care services. Cost sharing for primary care services received from an in-person provider may cost more. Please see the Plan Brochure associated with this plan for more information on this benefit.

Exclusions: nan

Rehabilitative Occupational and Rehabilitative Physical Therapy

$50.00 Copay after deductible
Tier 1 in-network $50.00 Copay after deductible
Out-of-network 100.00%

Prior Authorization is required. Limited to medical necessity.

Exclusions: nan

Rehabilitative Speech Therapy

$50.00 Copay after deductible
Tier 1 in-network $50.00 Copay after deductible
Out-of-network 100.00%

Prior Authorization is required. Limited to medical necessity.

Exclusions: nan

Specialist Visit

$50.00 Copay after deductible
Tier 1 in-network $50.00 Copay after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Urgent Care Centers or Facilities

$50.00
Tier 1 in-network $50.00
Out-of-network 100.00%

$0 24/7 Virtual Care Options available under select plans for care received from a virtual provider for primary care services. Cost sharing for primary care services received from an in-person provider may cost more. Please see the Plan Brochure associated with this plan for more information on this benefit.

Exclusions: nan

X-rays and Diagnostic Imaging

$25.00 Copay after deductible
Tier 1 in-network $25.00 Copay after deductible
Out-of-network 100.00%

Prior authorization is required.

Exclusions: nan

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

$50.00 Copay after deductible
Tier 1 in-network $50.00 Copay after deductible
Out-of-network 100.00%

Cost sharing and limitation depend on type and site of service. Injectable chemotherapeutic agents require preauthorization.

Exclusions: nan

Delivery and All Inpatient Services for Maternity Care

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

Will cover 48-hour hospital stay for uncomplicated vaginal delivery and 96-hour hospital stay for uncomplicated caesarean section.

Exclusions: nan

Dialysis

$50.00 Copay after deductible
Tier 1 in-network $50.00 Copay after deductible
Out-of-network 100.00%

Cost sharing depends on type and site of service.

Exclusions: nan

Durable Medical Equipment

15.00% Coinsurance after deductible
Tier 1 in-network 15.00% Coinsurance after deductible
Out-of-network 100.00%

Certain services require preauthorization (DME over $500).

Exclusions: nan

Emergency Room Services

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 40.00% Coinsurance after deductible

nan

Exclusions: nan

Emergency Transportation/Ambulance

$50.00 Copay after deductible
Tier 1 in-network $50.00 Copay after deductible
Out-of-network $50.00 Copay after deductible

Prior authorization required for out of network ambulance services, out of area transfers, non-emergency ground transportation, air transportation, and facility to facility transfers.

Exclusions: Travel or ambulance services for convenience

Hospice Services

$50.00 Copay after deductible
Tier 1 in-network $50.00 Copay after deductible
Out-of-network 100.00%

Cost sharing and limitations depend on type and site of service.

Exclusions: nan

Inpatient Hospital Services (e.g., Hospital Stay)

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

All usual Hospital services and supplies, including semiprivate room, intensive care, and coronary care units; Preauthorization is required.

Exclusions: nan

Inpatient Physician and Surgical Services

No Charge after deductible
Tier 1 in-network No Charge after deductible
Out-of-network 100.00%

Prior Authorization is required for inpatient surgical services.

Exclusions: nan

Mental/Behavioral Health Inpatient Services

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

Preauthorization is required.

Exclusions: nan

Mental/Behavioral Health Outpatient Services

$25.00
Tier 1 in-network $25.00
Out-of-network 100.00%

Certain services require preauthorization.Cost sharing depends on type and site of service. This benefit (Mental/Behavioral Health Outpatient Services, Substance Abuse Disorder Outpatient Services, and Habilitation Services) is subject to different cost-sharing depending on whether the service is an office visit or other outpatient service. Office visits are subject to copays, while facility-based services are subject to coinsurance.

Exclusions: nan

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Cost sharing and limitations depend on the type and site of service. Preauthorization is required for outpatient surgeries.

Exclusions: nan

Outpatient Rehabilitation Services

$50.00 Copay after deductible
Tier 1 in-network $50.00 Copay after deductible
Out-of-network 100.00%

Limited to Medically Necessary outpatient Rehabilitative Therapy visits to or by a Participating Provider other than a Primary Care Physician. Prior authorization is required.

Exclusions: nan

Outpatient Surgery Physician/Surgical Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Outpatient services and Habilitation Services are subject to different cost-sharing depending on whether the service is an office visit or other outpatient service. Office visits are subject to copays, while facility-based services are subject to coinsurance. Preauthorization is required for outpatient surgeries.

Exclusions: nan

Radiation

$50.00 Copay after deductible
Tier 1 in-network $50.00 Copay after deductible
Out-of-network 100.00%

Cost sharing and limitation depend on type and site of service. Proton beam radiation requires preauthorization.

Exclusions: nan

Skilled Nursing Facility

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 25.0 Days per Year

Cost sharing and limitation depend on type and site of service. Prior authorization is required.

Exclusions: nan

Substance Abuse Disorder Inpatient Services

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

Preauthorization is required.

Exclusions: nan

Substance Abuse Disorder Outpatient Services

$25.00
Tier 1 in-network $25.00
Out-of-network 100.00%

Certain services require preauthorization. Cost sharing depends on type and site of service. This benefit (Mental/Behavioral Health Outpatient Services, Substance Abuse Disorder Outpatient Services, and Habilitation Services) is subject to different cost-sharing depending on whether the service is an office visit or other outpatient service. Office visits are subject to copays, while facility-based services are subject to coinsurance.

Exclusions: nan

Transplant

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

Preauthorization is required. Cost sharing and limitation depend on type and site of service.

Exclusions: Subject to the conditions described below, benefits for covered services and supplies provided to a Participant by a Hospital, Physician, or Other Provider related to an organ or tissue transplant will be determined as follows, but only if all the following conditions are met: The transplant procedure is not Experimental/Investigational in nature; and Donated human organs or tissue or an FDA-approved artificial device are used; and The recipient is a Participant under the Plan; and The transplant procedure is preauthorized as required under the Plan; and The Participant meets all of the criteria established by CHC in pertinent written medical policies; and The Participant meets all of the protocols established by the Hospital in which the transplant is performed. Donor expenses for a Participant in connection with an organ or tissue transplant is not a covered benefit if the recipient is not covered under this Plan. No benefits are available for any organ or tissue transplant procedure, or services performed in preparation for, or in conjunction with, such procedure, which CHC considers to be Experimental/Investigational.

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

Coverage details pending

nan

Exclusions: nan

Hearing Aids

15.00% Coinsurance after deductible
Tier 1 in-network 15.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 1.0 Item(s) per 3 Years

To restore or correction of impaired speech or hearing loss. Each ear, every three years. Prior authorization is required.

Exclusions: nan

Major Dental Care - Child

Coverage details pending

nan

Exclusions: nan

Prenatal and Postnatal Care

$50.00 Copay after deductible
Tier 1 in-network $50.00 Copay after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Routine Eye Exam for Children

$50.00 Copay after deductible
Tier 1 in-network $50.00 Copay after deductible
Out-of-network 100.00%

Limit: 1.0 Visit(s) per Year

Covered services for children 18 and under.

Exclusions: nan

Well Baby Visits and Care

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

nan

Exclusions: nan

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$5.00
Tier 1 in-network $5.00
Out-of-network 100.00%

Subject to formulary requirements and preauthorization may be required (when generic is not the preferred agent).

Exclusions: nan

Non-Preferred Brand Drugs

$100.00 Copay after deductible
Tier 1 in-network $100.00 Copay after deductible
Out-of-network 100.00%

Subject to formulary requirements and preauthorization may be required.

Exclusions: nan

Preferred Brand Drugs

$70.00 Copay after deductible
Tier 1 in-network $70.00 Copay after deductible
Out-of-network 100.00%

Subject to formulary requirements and preauthorization may be required.

Exclusions: nan

Specialty Drugs

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

Subject to formulary requirements and preauthorization may be required.

Exclusions: nan

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

$50.00 Copay after deductible
Tier 1 in-network $50.00 Copay after deductible
Out-of-network 100.00%

Cost sharing and limitation depend on type and site of service. Limited to treatment for a Dental Injury to a Sound Natural Tooth.

Exclusions: nan

Basic Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Dental Check-Up for Children

Coverage details pending

nan

Exclusions: nan

Infusion Therapy

$50.00 Copay after deductible
Tier 1 in-network $50.00 Copay after deductible
Out-of-network 100.00%

Cost sharing and limitation depend on type and site of service. Preauthorization is required.

Exclusions: nan

Major Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Nutritional Counseling

$25.00 Copay after deductible
Tier 1 in-network $25.00 Copay after deductible
Out-of-network 100.00%

Preauthorization is required. Cost sharing depends on type and site of service.

Exclusions: nan

Orthodontia - Adult

Coverage details pending

nan

Exclusions: nan

Orthodontia - Child

Coverage details pending

nan

Exclusions: nan

Prosthetic Devices

15.00% Coinsurance after deductible
Tier 1 in-network 15.00% Coinsurance after deductible
Out-of-network 100.00%

Medically necessary foot orthotics are not subject to a calendar year maximum. Preauthorization is required.

Exclusions: nan

Routine Dental Services (Adult)

Coverage details pending

nan

Exclusions: nan

Weight Loss Programs

Coverage details pending

nan

Exclusions: nan

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

nan

Exclusions: nan

Acupuncture

Coverage details pending

nan

Exclusions: nan

Allergy Testing

$25.00 Copay after deductible
Tier 1 in-network $25.00 Copay after deductible
Out-of-network 100.00%

Cost sharing depends on type and site of service

Exclusions: nan

Bariatric Surgery

Coverage details pending

nan

Exclusions: nan

Cosmetic Surgery

Coverage details pending

nan

Exclusions: nan

Eye Glasses for Children

$50.00 Copay after deductible
Tier 1 in-network $50.00 Copay after deductible
Out-of-network 100.00%

Limit: 1.0 Item(s) per Year

For select frames, standard lenses, and contact lenses only.

Exclusions: nan

Gender Affirming Care

Coverage details pending

nan

Exclusions: nan

Habilitation Services

$50.00 Copay after deductible
Tier 1 in-network $50.00 Copay after deductible
Out-of-network 100.00%

Cost sharing depends on type and site of service. Limited to medical necessity. Prior authorization is required.

Exclusions: nan

Imaging (CT/PET Scans, MRIs)

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

Preauthorization is required.

Exclusions: nan

Infertility Treatment

Coverage details pending

nan

Exclusions: nan

Long-Term/Custodial Nursing Home Care

Coverage details pending

nan

Exclusions: nan

Private-Duty Nursing

$50.00 Copay after deductible
Tier 1 in-network $50.00 Copay after deductible
Out-of-network 100.00%

Inpatient private duty nursing

Exclusions: nan

Reconstructive Surgery

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

Examples of covered services include: Treatment provided for reconstructive surgery following cancer surgery; Reconstruction of the breast on which mastectomy has been performed. Preauthorization is required. Cost sharing depends on type and site of service.

Exclusions: nan

Routine Eye Exam (Adult)

Coverage details pending

nan

Exclusions: nan

Routine Foot Care

$50.00 Copay after deductible
Tier 1 in-network $50.00 Copay after deductible
Out-of-network 100.00%

Coverage for foot care is limited to members with diabetes, circulatory disorders of the lower extremities, peripheral vascular disease, peripheral neuropathy, or chronic arterial or venous insufficiency is covered. Any services or supplies in connection with routine foot care, including the removal of warts, corns, or calluses, or the cutting and trimming of toenails in the absence of diabetes, circulatory disorders of the lower extremities, peripheral vascular disease, peripheral neuropathy, or chronic arterial or venous insufficiency are excluded. Cost sharing and limitations depend on site of service.

Exclusions: nan

Treatment for Temporomandibular Joint Disorders

$50.00 Copay after deductible
Tier 1 in-network $50.00 Copay after deductible
Out-of-network 100.00%

Prior authorization required for temporomandibular joint surgery.

Exclusions: nan

Variant attributes

Community Premier Silver 012 (No deductible for PCP, Urgent Care & Generics, $0 PCP 24/7 Virtual Care Options) · Variant 27248TX0010012-05

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

87% AV Level Silver Plan

HIOS Product ID

27248TX001

Metal Level

Silver

Plan ID (Standard Component ID with Variant)

27248TX0010012-05

Plan Marketing Name

Community Premier Silver 012 (No deductible for PCP, Urgent Care & Generics, $0 PCP 24/7 Virtual Care Options)

Plan Variant Marketing Name

Community Premier Silver 012 (No deductible for PCP, Urgent Care & Generics, $0 PCP 24/7 Virtual Care Options)

Issuer & service area

Issuer-provided metadata for this variant.

Issuer ID

27248

Issuer Marketplace Marketing Name

Community Health Choice

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

TXN001

Out of Country Coverage

No

Out of Service Area Coverage

No

Service Area ID

TXS001

State Code

TX

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

0.875378515636637

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

Yes

Medical Drug Maximum Out of Pocket Integrated

Yes

SBC Scenario, Having a Baby, Coinsurance

$1,600

SBC Scenario, Having a Baby, Copayment

$400

SBC Scenario, Having a Baby, Deductible

$500

SBC Scenario, Having Diabetes, Coinsurance

$90

SBC Scenario, Having Diabetes, Copayment

$800

SBC Scenario, Having Diabetes, Deductible

$500

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$200

SBC Scenario, Treatment of a Simple Fracture, Copayment

$600

SBC Scenario, Treatment of a Simple Fracture, Deductible

$500

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group

$5000 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person

$2500 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual

$2,500

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

0.00%

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group

$5000 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person

$2500 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$2,500

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

Not Applicable

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

TXF003

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$0

SBC Scenario, Having Diabetes, Limit

$0

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

0

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Dental Only Plan

No

Design Type

Not Applicable

Disease Management Programs Offered

Asthma, Diabetes, Heart Disease, Pregnancy

EHB Percent of Total Premium

1.0

First Tier Utilization

100%

Import Date

2024-10-10 01:01:49

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

Existing

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

No

Plan Effective Date

2025-01-01

Plan Expiration Date

2025-12-31

Plan Type

HMO

QHP/Non QHP

Both

Source Name

HIOS

Plan ID

27248TX0010012

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group

$1000 per group

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person

$500 per person

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual

$500

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group

$1000 per group

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person

$500 per person

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual

$500

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group

per group not applicable

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person

per person not applicable

Combined Medical and Drug EHB Deductible, Out of Network, Individual

Not Applicable

Unique Plan Design

No

Wellness Program Offered

No

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in Texas?

Community Premier Silver 012 (No deductible for PCP, Urgent Care & Generics, $0 PCP 24/7 Virtual Care Options) (27248TX0010012) is a Silver HMO from Community Health Choice in Texas for the 2025 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does Community Premier Silver 012 (No deductible for PCP, Urgent Care & Generics, $0 PCP 24/7 Virtual Care Options) support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is Community Premier Silver 012 (No deductible for PCP, Urgent Care & Generics, $0 PCP 24/7 Virtual Care Options) HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental coverage is not listed for this plan.

Vision add-ons: Child.

Does Community Premier Silver 012 (No deductible for PCP, Urgent Care & Generics, $0 PCP 24/7 Virtual Care Options) support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with Community Premier Silver 012 (No deductible for PCP, Urgent Care & Generics, $0 PCP 24/7 Virtual Care Options)?

The issuer lists disease management resources for: Asthma, Diabetes, Heart Disease, Pregnancy.

Is there out-of-country coverage for Community Premier Silver 012 (No deductible for PCP, Urgent Care & Generics, $0 PCP 24/7 Virtual Care Options)?

No, out-of-country services are not covered for this plan.

Does Community Premier Silver 012 (No deductible for PCP, Urgent Care & Generics, $0 PCP 24/7 Virtual Care Options) cover care outside the service area?

No, the issuer indicates out-of-service-area care is not covered except for emergencies.

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
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