2016 IFP Plans. Products available both ON and OFF the Health Insurance Marketplace

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1 ATTENTION: This document is an internal document provided as a convenience to you, our agents. This document is not to be used at the point of sale. For plan details, please refer your clients to the appropriate Summary of Benefits and Coverages (SBC) IFP Plans Products available both ON and OFF the Health Insurance Marketplace Alliant Health Plans is a Qualified Health Plan issuer in the Health Insurance Marketplace AHP 2016 SOLOCARE PLANS 1

2 2016 IFP PLANS 16 SoloCare plans will be offered in 2016 for Individual/Family Plans (IFP) members. All plans are available OFF The Health Insurance Marketplace (HealthCare.gov). 8 plans available for sale both ON/OFF The Health Insurance Marketplace o Alliant Network ONLY o EHB Formulary (generic-heavy) - NO MAIL ORDER o Only the series plans are offered ON The Health Insurance Marketplace 8 plans available for sale only OFF The Health Insurance Marketplace. These are in-addition-to the 8 plans listed above. o These plans are similar in design to the 8 above mentioned plans; but some have slight variations PLUS added features: o o Commercial formulary with MAIL ORDER Alliant network PLUS PHCS network wrap (this is a larger network than the PHCS Healthy Directions network) 6 co-pay plans that have the $10/$35/$60 co-pay Rx benefit design & PHCS network wrap 2 no-co-pay plans & PHCS network wrap The naming convention follows CMS guidelines of unique HIOS ID #s... Each plan has a suffix of either 00 or 01 (i.e or ). 00 means sold OFF The Health Insurance Marketplace and 01 means it was sold ON The Marketplace AHP 2016 SOLOCARE PLANS 2

3 All Product Lines AHP Marketing and Rating Areas As of Applicable to ON/ OFF the Health Insurance Marketplace & SHOP Rate areas are identified by large red numbers and correspond to the DOI Rate Area map (all counties in the rate area MUST have the same price. Only the shaded areas are where AHP markets products which may not represent all the counties in the DOI rare area AHP 2016 SOLOCARE PLANS 3

4 Alliant Marketing Counties for 2016 A subscriber s residence address must be within a listed county to be eligible for coverage. County Rate Area Banks 10 Barrow 2 Bartow 3 Carroll 4 Catoosa 7 Chattooga 13 Cherokee 3 Dade 7 Dawson 10 Fannin 9 Floyd 13 Forsyth 3 Franklin 10 Gilmer 13 Gordon 13 Habersham 10 Hall 10 Haralson 4 Hart 10 Heard 4 Jackson 2 Lumpkin 10 Murray 9 Pickens 13 Polk 13 Rabun 10 Stephens 10 Towns 10 Union 10 Walker 7 White 10 Whitfield AHP 2016 SOLOCARE PLANS 4

5 HIOS Number Marketing Name will have SoloCare in front of the number SoloCare Plans Available ON/OFF The Health Insurance Marketplace These plans have the EHB (generic-heavy) formulary/no Mail Order These plans have the Alliant network ONLY THERE IS NO OPTION FOR BUY-UP ON EITHER FORMULARY OR NETWORK SORTED BY ABBREVIATED HIOS ID # EHB A/V % Value Metal Level ER PCP Visit IN-NETWORK BENEFITS Co-Pays (if blank or not listed, then deductible/co-insurance apply) Specialist Visit Gold 100% $1,500/$3,000 $6,850/$13,700 $250 $20 $50 OP Mental Health/ Behavioral Health Gold 90% $1,000/$2,000 $6,000/$12,000 $300 $25 $50 $50 $50 $ Silver 55% $1,750/$3,500 $6,850/$13,700 $300 $20 $ Silver 80% $2,500/$5,000 $6,850/$13,700 $250 $30 $ Silver 80% $3,000/$6,000 $6,850/$13,700 $250 $25 $ Silver 100% $4,500/$9,000 $6,850/$13,700 $250 $20 $ Bronze 50% $6,200/$12,400 $6,850/$13,700 $500 $85 $125 OP Rehab Skilled Nursing Facility Rx Generic/Preferred Brand/NP Brand & Specialty OUT-OF-NETWORK BENEFITS after deductible a 60% $4,500/$9,000 $9,000/$18,000 after deductible 60% $3,000/$6,000 $9,000/$18,000 after deductible 30% $5,250/$10,500 $18,000/$36,000 after deductible 60% $6,000/$12,000 $18,000/$36,000 after deductible 60% $12,000/$24,000 $18,000/$36,000 after deductible 60% $15,000/$30,000 $18,000/$36,000 50% co-insurance after deductible 30% $15,000/$30,000 $18,000/$36, Bronze 100% $6,850/$13,700 $6,850/$13,700 $250 60% $18,000/$36,000 $39,000/$78,000 Plans are ranked by HIOS #; not by AV value. The higher the EHB A/V value %, the richer the benefit structure. See map of counties where these products are available. ALL PLANS have $75 Urgent Care co-payment. Chiro covered at primary care cost-share Preventive Care Rx paid 100% - no cost-share for member Plans are NOT HSA Compatible Blank cells indicate: subject to deductible and co-insurance Note: Red text indicates a change from AHP 2016 SOLOCARE PLANS 5

6 HIOS Number Marketing Name will have SoloCare in front of the number SoloCare Plans Available ONLY OFF The Health Insurance Marketplace These plans have the COMMERCIAL formulary with Mail Order These plans have the Alliant network PLUS PHCS network wrap SORTED BY HIOS ID # EHB A/V % Value Metal Level ER PCP Visit IN-NETWORK BENEFITS Co-Pays (if blank or not listed, then deductible/co-insurance apply) Specialist Visit OP Mental Health/ Behavioral Health OP Rehab Skilled Nursing Facility Rx Generic/Preferred Brand/NP Brand& Specialty OUT-OF-NETWORK BENEFITS Gold 100% $3,000/$6,000 $3,000/$6,000 $250 $20 $50 $10/$35/$60 60% $5,000/$10,000 $10,000/$20, Gold 90% $1,500/$3,000 $3,500/$7,000 $300 $25 $50 $10/$35/$60 60% $5,000/$10,000 $10,000/$20, Silver 55% $1,850/$3,700 $6,850/$13,700 $250 $20 $20 $10/$35/$60 30% $10,000/$20,000 $15,000/$30, Silver 80% $3,425/$6,850 $6,850/$13,700 $250 $30 $75 $10/$35/$60 60% $13,425/$26,850 $15,000/$30, Silver 80% $4,800/$9,600 $6,000/$12,000 $250 $25 $60 $10/$35/$60 60% $10,000/$20,000 $15,000/$30, Silver 100% $5,850/$11,700 $6,850/$13,700 $250 $20 $50 $10/$35/$60 60% $10,000/$20,000 $15,000/$30, Bronze 50% $6,000/$12,000 $6,850/$13,700 $250 $100 $150 Subject to deductible 30% $15,000/$30,000 $20,000/$40,000 except preventive, which Bronze 100% $6,850/$13,700 $6,850/$13,700 $250 remains 0% cost-share 60% $15,000/$30,000 $20,000/$40,000 Plans are ranked by HIOS #; not by AV value. The higher the EHB A/V value %, the richer the benefit structure. See map of counties where these products are available. ALL PLANS have $75 Urgent Care co-payment. Chiro covered at primary care cost-share Preventive Care Rx paid 100% - no cost-share for member Plans are NOT HSA Compatible Blank cells indicate: subject to deductible and co-insurance Note: Red text indicates a change from AHP 2016 SOLOCARE PLANS 6

7 NOTES All plans have the following limits: Home Health day limit; Skilled Nursing- 30-day limit and Chiropractic -20-visit limit. All plans have $75 in-network co-pays for Urgent Care. Open Enrollment for 2016 begins on November 1, 2015 and ends on January 31, This is true whether purchasing plans on or off The Health Insurance Marketplace. Outside of Open Enrollment, applicants must experience a qualifying event that entitles them to a Special Enrollment Period (SEP). If applications are received by the 15 th of the month, the effective date is the 1 st day of the following month. Applications received on the 16 th or later in a month, receive a 1 st day of the second following month as an effective date. Initial premium must be received no later than the day before the effective date. SEPs have their own effective date rules. Plans are guaranteed renewal, calendar year plans. The subscriber can renew each year without a requirement to reenroll or take action, except pay their premium. Calendar year out-of-pockets, co- pays, deductibles and Out-of-pocket maximums reset on January 1 of every year; regardless of the date/month the plan was originally purchased. Plans renew each January 1 st based on filed/approved rates by CMS and the Georgia Department of Insurance. In addition to changes in the premium occurring on January 1 st of each year, CMS also allows for adjustments to the plan benefits; out-of-pocket and/or deductible limits. Upon renewal, plans may have an increase, or in some cases a reduction, in plan benefits, OOP s and/or deductibles, but by rule, must remain in their metal category. Non-HDHP plans have a different index than HDHP plans to establish annual limits. Alliant does not offer HDHP plans in the IFP Marketplace. Individuals entitled to, or currently on Medicare, are not eligible for an individual/family policy; by Federal Law. The unique HIOS identifier, in the first column of this document, is actually abbreviated as shown on these grids. The full HIOS ID is much longer and is used internally to communicate to vendors and CMS. For example, take the 1 st plan on the grid above, shown on the grid as The actual HIOS ID would be 83761GA if sold OFF The Marketplace and 83761GA is sold ON The Marketplace. Keep this in mind when trying to locate the exact plan someone is enrolled. Where possible, plans are displayed to the public as: SoloCare For 2016, the display on HealthCare.gov will show the last 7 digits (those digits following GA ) of the 83761GA number as a display identifier. So the 83761GA plan would show as SoloCare Alliant s online quoting tool will also displace IFP plans in this manner. In addition, for SoloCare plans sold ON The Health Insurance Marketplace, each of the Silver metal plans has variations of the base 01 plan, required by the Affordable Care Act. All Silver SoloCare plans have the following 7 variations; variations # d 3 through 7 are available only on The Marketplace and eligibility is determined by CMS: 1. Standard Silver OFF MARKETPLACE suffix is Standard Silver ON MARKETPLACE suffix is Zero Cost Sharing Plan suffix is Limited Cost Sharing Plan suffix is % AV Level suffix is % AV Level suffix is % AV Level suffix is AHP 2016 SOLOCARE PLANS 7