Healthcare Program

Community Care Missouri (CCM) – Overview of Healthcare Plan & Provider Search

The healthcare plan has been constructed as a Preferred Provider Organization (PPO) that includes a local network with enhanced benefits and a national network that provides PPO benefits outside of the local network service area.  The healthcare plan is segmented into three (3) specific tiers of benefits:

  • Tier 1 – Benefit schedule based on the utilization of specific services from the local network (Evolutions Healthcare Systems – PRIME Network) with zero cost to the member
  • Tier 1 with Copay – Benefit schedule based on the utilization of the local network (Evolutions Healthcare Systems – PRIME Network)
  • Tier 2 – Benefit schedule based on the utilization of PHCS Network outside of the PRIME Network service area
  • Tier 3 – Benefit schedule based on utilization of Non-Network providers

 

Highlights of Tier 1 Benefits

  • $0 Copayment and 100% coverage for specific services provided by specific healthcare providers within the Tier 1 network
  • Annual Deductibles and Coinsurance Maximums reduced to 50% of the Annual Deductibles and Coinsurance Maximums listed in Tier 2 of your benefit schedule when specific providers are utilized in the Tier 1 Network such as
    • Black River Medical Center
    • Saint Francis Hospital
    • Healthcare Providers designated as Tier 1 with Copayments
  • $0 Copayment for generic drugs when dispensed at specific pharmacies within the Tier 1 service area

 

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