Individual. insurance options. Capital BlueCross is an Independent Licensee of the BlueCross BlueShield Association

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1 Individual insurance options Capital BlueCross is an Independent Licensee of the BlueCross BlueShield Association

2 Why Do I Need Health Insurance? No one plans to get sick or hurt, but most people need medical care at some point. Health insurance covers these costs and protects you from very high expenses. And with coverage for preventive care, like screenings and check-ups, you can work with your health care practitioner to spot major health issues before they become a serious problem. Product Options Capital BlueCross offers you a choice of health plans to best fit the way you like to use health care services. Types of Plans HMO With an HMO, you will need to receive your health care from a network provider and select a primary care physician (PCP). Your PCP is responsible for managing and coordinating all of your health care. Your PCP will serve as your personal doctor to provide all of your basic health care services and coordinate your care. If you need care from a specialist in the network or a diagnostic service such as a lab test or x ray, your primary care physician (PCP) will provide you with a referral.

3 Why Capital BlueCross? When deciding on an individual plan for you or your family living here in Central Pennsylvania or the Lehigh Valley, you can depend on Capital BlueCross. We re part of the core BlueCross BlueShield brand, and that gives us access to 90 percent of doctors and hospitals in the country. Our 75 years experience and a national network of doctors and hospitals give you the product options to help you choose the health plan that best fits your needs. And we ll provide the resources, personal service, and wellness programs to help you to live a healthier life. If you think about it, it makes sense that Capital BlueCross is part of this new era of change. We re also part of the core BlueCross BlueShield brand a brand that got its start during the Great Depression, another time of big change and a lot of questions. About jobs. The economy. Our home towns. Those big concerns didn t change the fact that people still had doctor and hospital bills to pay. We helped people back then by offering health insurance plans that worked for them and fit their budgets. And we ve never stopped. PPO A preferred provider organization (PPO) is a health plan that has contracts with a network of preferred providers from which you can choose. You do not need to select a PCP and you do not need referrals to see other providers in the network. If you receive your care from a doctor in the preferred network, you will only be responsible for your annual deductible (a feature of some PPOs) and a copayment for your visit. If you get health services from a doctor or hospital that is not in the preferred network (known as going out-of-network), you will pay a higher amount. And, you will need to pay the doctor directly and file a claim with the PPO to get reimbursed.

4 Metal Levels Health plans are available at different tiers, or metal levels. The difference between the metal levels is based on how much of the medical costs your health plan is responsible for, and for how much you pay through copayments and coinsurance. Beginning in 2014, qualified health plans (QHPs) within the health insurance exchanges will be classified according to metal levels: bronze, silver, gold, and platinum. The purpose is to create a level playing field a health insurance marketplace where individuals and small business owners can compare plans with similar levels of coverage and make informed decisions. Plan Pays You Pay Bronze 60 percent 40 percent Silver 70 percent 30 percent Gold 80 percent 20 percent Catastrophic If you meet certain requirements, you may also qualify for a catastrophic health plan. A catastrophic plan provides coverage for preventive care without any cost share. In addition, the first three primary care physician visits that are not preventive in nature are covered at a copayment and not subject to the deductible. The deductible matches the out of pocket cost threshold of $6,350 for self-only coverage and $12,700 for family coverage. Who is Eligible for Catastrophic Plans? Catastrophic plans may only be offered to individuals who are under age 30 before the plan year begins, OR have received a certification from an Exchange that they are exempt from the individual mandate because they do not have an affordable coverage option or because they qualify for a hardship exemption.

5 Supplemental Dental Plans BlueCross Dental SM, issued by Capital Advantage Assurance Company, offers you a wide range of benefit plan options. We offer pediatric only dental plans* and plans that cover adults and pediatrics. From preventive care to orthodontic treatment, BlueCross Dental provides you with your choice of plan options all at competitive rates. With BlueCross Dental, you will save money whether you choose one of our PPO or HMO plans. Our PPO plans offer access to one of the largest nationwide dental networks, and our participating providers accept our allowance as payment in full. In addition, many PPO participating providers offer discounts on noncovered services and services received after program maximums are met. Our HMO plans offer access to one of the largest regional HMO networks. Participating HMO providers accept predetermined fees as payment in full for covered services which helps to eliminate surprises and save you money. Choose BlueCross Dental and you ll have something to smile about. For more information, visit capbluecross.com. * Only available for eligible individuals under the age of 19.

6 Where Can I Buy My Insurance? You can purchase a plan two ways: The Marketplace Through the Federal Marketplace, sometimes referred to as the Exchange. The Marketplace offers you a choice of qualified health plans and will provide you with a subsidy for your premium, if you are eligible. You can view the products Capital BlueCross offers on the Marketplace at choosecapitalblue.com. Catastrophic Bronze Silver Gold HMO HMO HMO HMO PPO PPO Off the Marketplace You have access to additional choices off the Marketplace. If you are not eligible for a subsidy, you may wish to consider these plan choices. Catastrophic Bronze Silver Gold HMO PPO PPO PPO Will I Qualify for Lower Costs on Monthly Premiums? When you get health insurance coverage in the Marketplace, you may be able to get lower costs on monthly premiums. This depends on your income and family size. Pay Lower Costs for Premiums Each Month In the Health Insurance Marketplace, you may be able to lower the costs of your health insurance coverage by paying lower monthly premiums. You ll see the amount of savings you re eligible for when you fill out your Marketplace application beginning October 1, Prices shown for insurance plans will reflect the lower costs. These lower costs are handled with a tax credit that can be applied directly to your monthly premiums, so you get the lower costs immediately. You can estimate your subsidy by using the subsidy calculator on our website at capbluecross.com /healthcarereform. You may also be able to get lower out-of-pocket costs, and your deductibles, coinsurance, and copayments depending on your income and family size.

7 Enroll in a Plan Today! Call us. If you would like to discuss your options with a sales representative, please contact us at Go online. You can explore your plan choices and enroll online. To get started, go to choosecapitalblue.com. Visit Us. You can meet with us face to face at our retail location at The Promenade Shops at Saucon Valley, or our headquarters at 2500 Elmerton Avenue, Harrisburg, PA. One of our representatives can answer your questions and explain your options. Questions About the New Health Care Law If you aren t ready to enroll, but have questions about the new health care law and how it affects you, Capital BlueCross is here to help. You can start learning more by visiting our website capbluecross.com /healthcarereform. You can also call us at

8 Do you have a smart phone? Scan this barcode to automatically visit our website: capbluecross.com. facebook.com/capbluecross twitter.com/capbluecross pinterest.com/capbluecross capitalbluestore.com/blog Health care benefit programs issued or administered by Capital BlueCross and/or its subsidiaries, Capital Advantage Insurance Company, Capital Advantage Assurance Company and Keystone Health Plan Central. Independent licensees of the BlueCross BlueShield Association. Communications issued by Capital BlueCross in its capacity as administrator of programs and provider relations for all companies. M (9/13)