Frequently Asked Questions

You may receive one or more forms that provide information about your health coverage. These forms (similar to a W2) are 1095-A, 1095-B and 1095-C. They contain information that is required for completing your taxes. You are likely to get more than one form if:

• You had coverage from more than one provider
• You changed coverage or employers during the year
• If different members of your family received coverage from different providers

At Community Health Options, our purpose is simple: We provide Members with benefits they can actually use. 

From the state’s broadest healthcare provider network to our Maine-based Member Services team that answers your questions instead of sending your employees down a robot rabbit hole, we focus on helping our Members get access to the care they need while working to lower out-of-pocket costs. 

View our Small Group or Large Group plans

The cost of a Small Group health plan varies based on factors like your location, employee demographics, and selected coverage options. Here at Community Health Options, we offer tailored plans designed to fit small business budgets while ensuring employees receive quality care. 

Want to find a plan for your small business? We're here to help. 

Employers typically must contribute a minimum percentage of the premium to qualify for a Small Group plan. Requirements vary by state and plan type, but many small businesses choose to contribute at least 50% of employee premiums to ensure affordability.

Our Small Group health plans include comprehensive medical, prescription drug, preventive care, and wellness benefits. Employers can choose from a range of deductible and copay options to find the right balance between coverage and cost.

We also partner with Northeast Delta Dental to offer dental coverage on select plans. 

We are Maine's exclusive carrier of Small Business Health Options Plans (SHOP) via CoverME.gov. Small businesses may qualify for tax credits under the Small Business Health Care Tax Credit if they meet certain eligibility criteria, such as contributing at least 50% of employees' premiums and having fewer than 25 full-time employees. 

Enrolling in a Small Group plan is simple with Community Health Options. Contact our team to get a quote, compare plan options, and find the best coverage for your business. We’ll guide you through the application process and ensure a smooth setup for your employees.

Yes! Many Small Group plans allow employees to choose from different coverage levels, deductible amounts, and provider networks. This flexibility ensures they can select a plan that fits their healthcare needs.

Employers can select and offer multiple fully insured health plans to their employees.

• Businesses with 1 – 10 employees can offer 2 plan options, with no more than a $3500 spread in deductible.
• Businesses with 11 – 19 enrolled employees can offer 2 plan options, with no deductible spread limitation.
• Businesses with 20 or more enrolled employees can offer 3 plan options, with no deductible spread limitation.

With a self-funded health plan, employers have more transparency and control over healthcare expenses, including customized plan designs, wellness initiatives, and access to claims data for better cost management. Businesses only pay for actual claims, and any unused funds remain with the company instead of an insurer.

Contact us to learn more

When selecting a large group health plan, consider factors such as total cost of coverage, network access, plan flexibility, wellness incentives, and administrative support. Community Health Options offers tailored solutions, ensuring your health plan aligns with your workforce’s needs while optimizing savings.

To receive a personalized health insurance quote, contact Community Health Options. Our team will assess your workforce demographics and business goals to provide competitive pricing and plan options that fit your company’s healthcare needs.

The cost of group health insurance in Maine varies based on factors like plan type, employer contribution, and the number of employees covered. Small businesses in Maine can have cost fluctuate based on deductibles, copays, and provider networks.

Our business development team is available to help find a cost-effective solution: Get started

Yes. Small businesses with 25 or fewer full-time equivalent employees may also be eligible for the Small Business Health Options Program (SHOP) covering up to 50% of premium costs. We are Maine's exclusive SHOP plan carrier with CoverME.gov. 

Learn more about SHOP plans

For all Members across every plan, we offer a variety of virtual care and telehealth services, including a partnership with Firefly Health for virtual primary care and Amwell for telehealth services on behavioral health and urgent care. What's even better is that urgent care with Amwell is $0 on all 2026 plans.

Virtual care reduces barriers to timely medical attention, helping employees address health concerns quickly without taking time off work. Telehealth options for urgent care and mental health support can lead to lower absenteeism, increased productivity, and overall employee well-being.

By offering telemedicine and virtual health visits, your company can improve employee productivity and the associated costs when that is lost. Virtual care provides an affordable, convenient way for employees to seek medical attention, helping manage healthcare expenses more effectively for all.

Most Community Health Options employer health plans include virtual care benefits with low or no copays, making it an affordable telehealth solution for your workforce. Coverage details vary, so we recommend reviewing your plan options with our benefits team for more information.

Community Health Options’ advanced administrative systems are fully integrated and built with the satisfaction of our Members, groups and brokers in mind. Our systems are managed by our Maine-based professionals who understand the local healthcare market. Our dedicated Account Management team ensures a seamless onboarding process.

Form 1095-A is a tax statement sent to consumers who purchase health insurance directly from the state-based marketplace CoverME.gov. This form is mailed by CoverME.gov to households where any household member was enrolled in a Marketplace plan. This form is issued by the Marketplace no later than mid-February.

Please note: On-Exchange Members on a Catastrophic plan will not receive a 1095-A form from CoverME.gov. Community Health Options will send a 1095-B form in mid-February.

Important: You must have your 1095-A before you file your taxes. You will use information from Form 1095-A to fill out IRS Tax Form 8962, when completing your tax filing. This is how you will find out if there’s any difference between the premium tax credit you used and the amount you qualify for. Be sure to carefully read the instructions on Form 1095-A.

If you have questions or concerns about this form, contact the CoverME.gov at 1-866-636-0355.

Community Health Options is not able to assist you with your 1095-A form. If anyone in your household was covered by a Marketplace plan, you’ll get Form 1095-A, the Health Insurance Marketplace Statement, from CoverME.gov. The 1095-A is sent by CoverME.gov, not the IRS or Community Health Options. The 1095-A includes information for all Marketplace plans held by people in your household, including:

• Premiums paid
• Premium tax credits used
• A figure called ‘second lowest cost silver plan’ or SLCSP

More information on Form 1095-A is available here: https://www.healthcare.gov/tax-form-1095/

If you have questions, do not agree with the information on your 1095-A, or did not receive a 1095-A and you think you should have, please contact CoverME.gov at 1-866-636-0355.

The 1095-B form is sent to consumers who purchase health insurance directly from a health insurance issuer (like Community Health Options) or who were covered through their employer who purchased insurance directly from a health insurance issuer or CoverME.gov. This form is sent by the health insurance issuer and contains information about your health care coverage.

More information on Form 1095-B is available here: https://www.irs.gov/forms-pubs/about-form-1095-b

Call Member Services if:

• You have received your 1095-B and you believe there is an error
• If you haven’t received your 1095-B by the end of February

Note that Community Health Options will not have the ability to print copies of the 1095-B forms until we receive the file from our vendor, which we expect will occur in late February at the earliest

Form 1095-C is sent to consumers directly from their employer. Most consumers in a group plan will receive this form depending on the type of insurance provided by their employer.

Questions related to form 1095-C should be directed to your employer.

We’ve collaborated with Cigna Healthcare to give Members on National plans access to more doctors and hospitals when they are outside Community Health Options’ service area. Cigna Healthcare PPO network* will replace First Health for national providers in care.

The Community Health Option’s network has not changed. Our network continues to include providers in Maine, New Hampshire, and in select locations in Massachusetts. When a plan Member is outside of Maine and New Hampshire, they can use any provider in the Cigna Healthcare PPO network. If they are within Maine and New Hampshire and looking for a provider in the area, they should continue to use the healthoptions.org provider search tool. Massachusetts is the only state where Members have access to both the Cigna and Community Health Options networks. For Massachusetts providers, Members should check the Community Health Options directory before visiting Cigna.com.

The bottom line? Members can choose from a broader network and get care wherever they are, making their coverage more flexible and convenient than ever.

The Cigna Healthcare PPO national network offers access to nearly1.6 million in-network providers across the country, including 6,400 hospitals and health system**. This means Members can easily find dependable, in-network care wherever they are—and wherever they work—providing confidence and convenience for their health needs.

Members on New England plans continue to have access to the full Community Health Options network.

July 1, 2026 — Self-funded (ASO) plan Members can start using the Cigna Healthcare PPO national network. These Members will receive their new ID card approximately three weeks in advance.

Sept. 1, 2026 — Fully funded plan Members with a national plan make the switch. These Members will receive their new ID card approximately three weeks before and can start using the new network on this date.

No, Community Health Options continues to serve as the health plan insurer and plan administrator. We're working with Cigna Healthcare to expand Members’ access to providers nationwide on national plans, giving them a broader network without any changes to their benefits.

Members should check the Cigna Healthcare PPO network to confirm whether their doctors remain in-network. In-network national providers can be found at Cigna.com.

If a Member is in Maine or New Hampshire, they must use the Community Health Options provider network to find care, which can be found at healthoptions.org. If they are in Massachusetts, they should first check the healthoptions.org search tool: If the Massachusetts provider is not in our network, then check the Cigna.com website.

If a provider is not in the Community Health Options or the Cigna Healthcare PPO network, Members can call Member Services at (855) 624-6463, from  8 a.m. to 5 p.m. Monday through Friday. We'll help to find a great in-network provider. 

Community Health Options is already working hard to minimize disruption of care. Members with a Prior Authorization for surgery scheduled after the transition to Cigna Healthcare PPO from First Health should contact Member Services at (855) 624-6463, between 8 a.m. and 5 p.m., Monday through Friday. Our team will review their authorization and ensure continuity of coverage with no interruption to their scheduled care.

Prior Authorizations approved for First Health providers for visits or procedures scheduled on or after July 1 for self-funded health plans or September 1 for our fully-funded health plans will be reviewed to confirm coverage continuity under the Cigna Healthcare PPO network. Employers with questions about a specific Member's authorization should contact Member Services at (855) 624-6463, from 8 a.m. to 5 p.m., Monday through Friday.

If a Member receives services through the Cigna Healthcare PPO network, they may see the Cigna Healthcare name listed in the remarks section of the Explanation of Benefits (EOB). This is normal and expected.

New Member ID cards will reflect the updated Cigna Healthcare PPO network information, giving providers what they need to manage Prior Authorizations and claims. Members do not need to take any additional steps. If a provider has questions regarding authorizations or claims, they should contact Member Services at (855)-624-6463, from 8 a.m. to 5 p.m., Monday through Friday.

Members should continue to use your Member portal to find a Community Health Options network provider. To search for a national provider:

1.       Go to Cigna.com and click "Find a Doctor" at the top of the page.

2.       On the next screen, select "Employer or School”.

3.       Enter the Member’s zip code, choose any other search options you'd like, then click "Search".

4.       When prompted, select "Continue as guest", then "Continue”.

5.       Select the PPO plan. You will now see national providers that are in-network.