Texas health plan · 2025

University Community Care Plan by Community First - Silver Plan · 63251TX0020001

Community First Insurance Plans offers this marketplace health insurance plan (Plan ID 63251TX0020001) 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: EPO CSR: 87% AV Level Silver Plan Issuer: Community First Insurance Plans
Telehealth Data pending HSA eligible No Dental Not listed Vision Child
Pay / Manage Plan View issuer site

CMS AV Calculator output: 87.87% (12.13% 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

$332 – $1300

Before subsidies

Estimate after subsidies

Deductible

$0

$0 per group

See deductible details

Max out-of-pocket

$2,700

$5400 per group

Review MOOP rules

Office visits

Primary care $20.00
Specialist $40.00
HSA Not eligible

Drug tiers

Generic $10.00
Preferred brand $20.00

View formulary tiers

$454 / mo before subsidies

≈ $5451 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.

$1439 / mo before subsidies

≈ $17272 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.

$1743 / mo before subsidies

≈ $20918 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.

$1108 / mo before subsidies

≈ $13293 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

$0.00

Emergency Room Services

$150.00

Durable Medical Equipment

$40.00

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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

$0.00

Emergency Room Services

$150.00

Durable Medical Equipment

$40.00

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 63251TX0020001
Coverage year 2025
State Texas
Issuer Community First Insurance Plans
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 63251TX0020001-05
Available variants

Standard Off Exchange Plan · 63251TX0020001-00

Standard On Exchange Plan · 63251TX0020001-01

Open to Indians below 300% FPL · 63251TX0020001-02

Open to Indians above 300% FPL · 63251TX0020001-03

73% AV Silver Plan · 63251TX0020001-04

87% AV Silver Plan · 63251TX0020001-05

94% AV Silver Plan · 63251TX0020001-06
Last plan update Tue, 14 Jan 2025 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 N/A
PCPs in Texas N/A
Telehealth support Data pending
Nationwide providers N/A

Provider network(s)

Providers Texas All US states
All N/A N/A
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A

Drug coverage overview

6,060 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 2,605
NON-PREFERRED-BRAND 2,186
SPECIALTY-DRUGS 788
MEDICAL-SERVICE-DRUGS 481
Prior authorization Drugs
Required 1,118
Not Required 4,942
Step therapy Drugs
Required 132
Not Required 5,928
Quantity limits Drugs
Has Limit 1,265
No Limit 4,795

Customer highlights

What stands out for members

  • Issuer: Community First Insurance Plans · Plan ID 63251TX0020001 · 2025 filing.
  • Disease management programs available: Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 63251TX0020001-05 (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

$40.00
Tier 1 in-network $40.00
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

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

nan

Exclusions: nan

Home Health Care Services

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

Limit: 60.0 Visit(s) per Year

Preauthorization is required.

Exclusions: nan

Laboratory Outpatient and Professional Services

$80.00
Tier 1 in-network $80.00
Out-of-network 100.00%

Preauthorization is required for all Genetic testing.

Exclusions: nan

Other Practitioner Office Visit (Nurse, Physician Assistant)

$20.00
Tier 1 in-network $20.00
Out-of-network 100.00%

nan

Exclusions: nan

Preventive Care/Screening/Immunization

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

nan

Exclusions: nan

Primary Care Visit to Treat an Injury or Illness

$20.00
Tier 1 in-network $20.00
Out-of-network 100.00%

nan

Exclusions: nan

Rehabilitative Occupational and Rehabilitative Physical Therapy

$80.00
Tier 1 in-network $80.00
Out-of-network 100.00%

Preauthorization is required.

Exclusions: nan

Rehabilitative Speech Therapy

$80.00
Tier 1 in-network $80.00
Out-of-network 100.00%

Preauthorization is required.

Exclusions: nan

Specialist Visit

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

nan

Exclusions: nan

Urgent Care Centers or Facilities

$20.00
Tier 1 in-network $20.00
Out-of-network 100.00%

nan

Exclusions: nan

X-rays and Diagnostic Imaging

$80.00
Tier 1 in-network $80.00
Out-of-network 100.00%

Preauthorization is required for Sleep Studies and Video EEG Monitoring.

Exclusions: nan

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

$250.00
Tier 1 in-network $250.00
Out-of-network 100.00%

Cancer Chemotherapy: requires preauthorization for any medication greater than $500 per dose.

Exclusions: nan

Delivery and All Inpatient Services for Maternity Care

$300.00
Tier 1 in-network $300.00
Out-of-network 100.00%

Will cover 48-hour hospital stay for uncomplicated vaginal delivery and 96-hour hospital stay for uncomplicated caesarean section. Stays longer than the "global stay" requires preauthorization.

Exclusions: nan

Dialysis

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

nan

Exclusions: nan

Durable Medical Equipment

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

Preauthorization is required.

Exclusions: nan

Emergency Room Services

$150.00
Tier 1 in-network $150.00
Out-of-network $150.00

nan

Exclusions: nan

Emergency Transportation/Ambulance

$150.00
Tier 1 in-network $150.00
Out-of-network $150.00

nan

Exclusions: nan

Hospice Services

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

Preauthorization may be required.

Exclusions: nan

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

$300.00 Copay per Stay
Tier 1 in-network $300.00 Copay per Stay
Out-of-network 100.00%

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

Exclusions: nan

Inpatient Physician and Surgical Services

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Preauthorization is required.

Exclusions: nan

Mental/Behavioral Health Inpatient Services

$300.00 Copay per Stay
Tier 1 in-network $300.00 Copay per Stay
Out-of-network 100.00%

Preauthorization is required.

Exclusions: nan

Mental/Behavioral Health Outpatient Services

$20.00
Tier 1 in-network $20.00
Out-of-network 100.00%

Preauthorization may be required.

Exclusions: nan

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

$80.00
Tier 1 in-network $80.00
Out-of-network 100.00%

Preauthorization may be required.

Exclusions: nan

Outpatient Rehabilitation Services

$80.00
Tier 1 in-network $80.00
Out-of-network 100.00%

Limit: 35.0 Visit(s) per Year

Preauthorization is required. Limited to combined 35 visits per year, including Chiropractic.

Exclusions: nan

Outpatient Surgery Physician/Surgical Services

$250.00
Tier 1 in-network $250.00
Out-of-network 100.00%

Preauthorization may be required. Any procedure that could be deemed as cosmetic requires authorization.

Exclusions: nan

Radiation

$250.00
Tier 1 in-network $250.00
Out-of-network 100.00%

nan

Exclusions: nan

Skilled Nursing Facility

$150.00 Copay per Day
Tier 1 in-network $150.00 Copay per Day
Out-of-network 100.00%

Limit: 25.0 Visit(s) per Year

Preauthorization is required.

Exclusions: nan

Substance Abuse Disorder Inpatient Services

$300.00 Copay per Stay
Tier 1 in-network $300.00 Copay per Stay
Out-of-network 100.00%

Preauthorization is required.

Exclusions: nan

Substance Abuse Disorder Outpatient Services

$20.00
Tier 1 in-network $20.00
Out-of-network 100.00%

Preauthorization may be required. Certain services require preauthorization.

Exclusions: nan

Transplant

$300.00
Tier 1 in-network $300.00
Out-of-network 100.00%

Preauthorization is required.

Exclusions: nan

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

Coverage details pending

nan

Exclusions: nan

Hearing Aids

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

Preauthorization is required. To restore or correction of impaired speech or hearing loss.

Exclusions: nan

Major Dental Care - Child

Coverage details pending

nan

Exclusions: nan

Prenatal and Postnatal Care

$20.00
Tier 1 in-network $20.00
Out-of-network 100.00%

nan

Exclusions: nan

Routine Eye Exam for Children

$20.00
Tier 1 in-network $20.00
Out-of-network 100.00%

nan

Exclusions: nan

Well Baby Visits and Care

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

nan

Exclusions: nan

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

nan

Exclusions: nan

Non-Preferred Brand Drugs

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

nan

Exclusions: nan

Preferred Brand Drugs

$20.00
Tier 1 in-network $20.00
Out-of-network 100.00%

nan

Exclusions: nan

Specialty Drugs

40.00%
Tier 1 in-network 40.00%
Out-of-network 100.00%

Prior authorization may apply to select specialty medications.

Exclusions: nan

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

$300.00
Tier 1 in-network $300.00
Out-of-network 100.00%

nan

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

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

Preauthorization is required. Any injectable medication, including chemotherapy, greater than $500 per dose. Based on billed charges. NDC, HCPCS and billable units are required on the claim.

Exclusions: nan

Major Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Nutritional Counseling

Coverage details pending

nan

Exclusions: nan

Orthodontia - Adult

Coverage details pending

nan

Exclusions: nan

Orthodontia - Child

Coverage details pending

nan

Exclusions: nan

Prosthetic Devices

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

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

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

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

Preauthorization is required when not provided by an Allergist or Immunologist.

Exclusions: nan

Bariatric Surgery

Coverage details pending

nan

Exclusions: nan

Cosmetic Surgery

Coverage details pending

nan

Exclusions: nan

Eye Glasses for Children

$20.00
Tier 1 in-network $20.00
Out-of-network 100.00%

nan

Exclusions: nan

Gender Affirming Care

Coverage details pending

nan

Exclusions: nan

Habilitation Services

$80.00
Tier 1 in-network $80.00
Out-of-network 100.00%

Limit: 35.0 Visit(s) per Year

Preauthorization is required. Habilitative and rehabilitative limits cannot be combined for plans issued or renewed on or after January 1, 2017. Habilitation services includes autism services, and the benchmark plan does not impose age or maximums on autism coverage.

Exclusions: nan

Imaging (CT/PET Scans, MRIs)

$80.00
Tier 1 in-network $80.00
Out-of-network 100.00%

Preauthorization is required for an MRI/MRA if not ordered by a Neurosurgeon or Orthopedic Surgeon. Preauthorization is required for an SPECT/3D imaging/CTA if not ordered by a cardiologist or cardiothoracic surgeon.

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

Coverage details pending

nan

Exclusions: nan

Reconstructive Surgery

$300.00
Tier 1 in-network $300.00
Out-of-network 100.00%

Preauthorization is required. Examples of covered services include: Treatment provided for reconstructive surgery following cancer surgery; Reconstruction of the breast on which mastectomy has been performed.

Exclusions: nan

Routine Eye Exam (Adult)

Coverage details pending

nan

Exclusions: nan

Routine Foot Care

Coverage details pending

nan

Exclusions: nan

Treatment for Temporomandibular Joint Disorders

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

Preauthorization is required. Though state law only mandates coverage for temporomandibular joint (TMJ) disorders for large group plans and HMOs, the benchmark plan covers TMJ. Therefore, it is considered part of the EHB package for Texas.

Exclusions: nan

Variant attributes

University Community Care Plan by Community First - Silver Plan · Variant 63251TX0020001-05

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

87% AV Level Silver Plan

HIOS Product ID

63251TX002

Metal Level

Silver

Plan ID (Standard Component ID with Variant)

63251TX0020001-05

Plan Marketing Name

University Community Care Plan by Community First - Silver Plan

Plan Variant Marketing Name

University Community Care Plan by Community First - Silver Plan

Issuer & service area

Issuer-provided metadata for this variant.

Issuer ID

63251

Issuer Marketplace Marketing Name

Community First

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

0.878749043134293

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

$0

SBC Scenario, Having a Baby, Copayment

$1,200

SBC Scenario, Having a Baby, Deductible

$0

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$1,200

SBC Scenario, Having Diabetes, Deductible

$0

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$0

SBC Scenario, Treatment of a Simple Fracture, Copayment

$1,200

SBC Scenario, Treatment of a Simple Fracture, Deductible

$0

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

per group not applicable

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

per person not applicable

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

Not Applicable

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

40.00%

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

$5400 per group

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

$2700 per person

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

$2,700

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

TXF001

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, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy

EHB Percent of Total Premium

1.0

First Tier Utilization

100%

Import Date

2025-01-14 00:02:24

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

EPO

QHP/Non QHP

Both

Source Name

HIOS

Plan ID

63251TX0020001

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

per group not applicable

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

per person not applicable

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

Not Applicable

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

$0 per group

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

$0 per person

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

$0

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?

University Community Care Plan by Community First - Silver Plan (63251TX0020001) is a Silver EPO from Community First Insurance Plans 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 University Community Care Plan by Community First - Silver Plan 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 University Community Care Plan by Community First - Silver Plan 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 University Community Care Plan by Community First - Silver Plan 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 University Community Care Plan by Community First - Silver Plan?

The issuer lists disease management resources for: Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy.

Is there out-of-country coverage for University Community Care Plan by Community First - Silver Plan?

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

Does University Community Care Plan by Community First - Silver Plan 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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