Indiana Health Insurance Marketplace Enrollment & Benefits Guide

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1 Indiana Health Insurance Marketplace Enrollment & Benefits Guide

2 Health insurance coverage from a name you trust. Indiana University Health has been taking care of Indiana residents with the care of highly skilled physicians for more than a century. Now, that expertise is available to more Hoosiers through Plans on the Indiana Health Insurance Marketplace When you choose healthcare coverage from Plans, you get: Top ranked care from highly skilled physicians in your community, partners focused on your health and wellness Access to hospitals, including Riley Hospital for Children at, one of the nation s top children s hospitals A variety of plan options to meet your needs and fit your budget Free yearly check-ups, screenings and vaccines Generic prescriptions at low costs to you Affordable doctor office visit copays Give us a call or visit our website to sign up or have an expert help you determine which plan is right for you: ComparePlansIndiana.org 2

3 Having the right plan makes all the difference. Plans is a new individual health insurance option for Hoosiers. It s coverage driven by the highly skilled physicians of, who are experts at keeping you well. When you partner with plans, you get: ACCESS TO THE IU HEALTH NETWORK You are connected to highly skilled physicians in your community and s highly ranked hospitals, including Riley Hospital for Children at, which is among the top children s hospitals in the United States. From primary care doctors to nationally-renown specialists, you will receive expert, coordinated care to keep you and your family well. OPTIONS TO FIT YOUR BUDGET It s important to have health insurance coverage, and with Plans, you can select from a variety of options to fit your budget. Based on your medical needs, you can balance the monthly premium, and out-of-pocket costs so that you have the peace of mind. And you may qualify for financial discounts that could reduce your medical costs even more. AFFORDABLE DOCTOR OFFICE VISITS Your primary care physician (PCP) is more than just a doctor to see when you re sick. Your PCP is your partner in keeping you and your family well. PCP office visit copays are affordable, too. If you or your family gets sick, you won t have to worry about large medical bills. PRESCRIPTION DRUGS AT LOW COSTS All Plans choices have prescription drug coverage. And generic prescription drugs are available at low costs to you. FREE PREVENTIVE CARE Preventive care services like annual check-ups, vaccines and screenings are covered at no cost to you. We want to keep you and your family healthy so you can avoid emergencies and costly medical procedures. COVERED HEALTH BENEFITS Your Plan covers all of your essential healthcare needs, such as vaccines, screenings and other preventive services, as well as mental health services and prescription drugs, just to name a few. COVERAGE IS GUARANTEED Past or present health conditions will not prevent you from getting coverage. 3

4 Your plan choices All Plans are grouped into three different categories -- Bronze, Silver and Gold. The different categories do not reflect the quality or amount of care you can expect to receive. Each category has a different level of cost sharing, or what you and your plan will pay as a certain percentage of costs of medical care, including, coinsurance and copayments. In general terms, monthly premiums will go up as the insurer pays more of your health costs. In general, this is how the costs of the plans break down: GOLD SILVER BRONZE Your health plan pays 80% Your health plan pays 70% Your health plan pays 60% You pay 20% You pay 30% You pay 40% Keep in mind that you may qualify for financial discounts to help pay for your coverage. How do you decide whether to go with Gold, Silver or Bronze? It s difficult to predict all of your healthcare needs for the upcoming year. You should try to pick a plan that fits your budget and meets your family s expected needs. If you expect a lot of doctor visits or need regular prescriptions, you may want a Gold plan. The monthly premiums will be higher but the plan will pay more of the costs when you need care. If you expect to occasionally use medical services and take prescriptions, you may want a Silver plan. These plans balance the monthly premium with the other costs of care that you may need. If you don t expect to use regular medical services and don t take regular prescriptions, you may want a Bronze plan. These plans have a lower monthly premium but pay less of your costs when you need care. 4

5 Here is a breakdown of some of what each Plans option offers: See the key health insurance and medical definitions section of this guide for helpful explanations of some of this chart s words and terms. Keep in mind that you may qualify for financial discounts to help pay for your coverage. Plan Name BRONZE HSA BRONZE Enhanced BRONZE Value SILVER HSA SILVER Enhanced SILVER Value GOLD Value Network Annual Deductible $4,500 $9,000 $5,000 $10,000 $6,000 $12,000 $2,750 $5,500 $2,000 $4,000 $2,500 $5,000 $750 $1,500 Annual Max Out-of-Pocket Costs $6,350 $12,700 $6,350 $12,700 $6,350 $12,700 $3,600 $7,200 $5,750 $11,500 $6,350 $12,700 $6,000 $12,000 Primary Care Office Visit 20% after $50 copay before and 40% coinsurance after $40 copay 10% after $30 copay $40 copay $20 copay Preventive Care FREE FREE FREE FREE FREE FREE FREE Essential Health Benefits COVERED COVERED COVERED COVERED COVERED COVERED COVERED Retail Prescription Drug Coverage Generic & Preventive (Preferred) $10 copay after $10 copay $10 copay $5 copay after $5 copay $5 copay $8 copay Generic (Non-preferred) $25 copay after $25 copay $25 copay $15 copay after $15 copay $15 copay $20 copay Brand (Preferred) 30% after 30% after 30% after 25% after 25% after 25% after 20% after Brand (Non-preferred) 40% after 40% after 40% after 35% after 35% after 35% after 30% after Go to ComparePlansIndiana.org or call for full plan details. 5

6 Frequently-asked health insurance questions Can I choose my doctor? Yes. You will have your choice of a wide variety of highly skilled doctors located in your community. See our directory of physicians at ComparePlansIndiana.org. If I get sick, how much do I have to pay? When you team with Plans, you get access to care driven by leading physicians. Your primary care physician (PCP) is your partner in keeping you and your family well. If you or your family gets sick, you won t have to worry about large medical bills. PCP office copays are affordable, too. Please see the chart on Page 5 for more information on PCP office copays. What health benefits are covered? All Plans options cover the following Essential Health Benefits: Emergency services Ambulatory patient services Hospitalization Prescription drugs Maternity and newborn care Pediatric services including vision care Preventive and wellness services Mental health and substance abuse disorder services Rehabilitative services and devices Laboratory service Do I have to pay for yearly check-ups, vaccines or screenings? No, preventive and wellness services are free. Are all facilities covered under this plan? Yes. physicians and hospitals are conveniently located in your community. You can find the nearest ones at IUHealth.org/contact. What if I visit a physician or hospital that is not part of the Plans network? There is no coverage for out-of-network physicians or hospitals, with the exception of emergency services. Is there a plan to fit my budget? With Plans, you can select from several options to fit your budget and expected medical needs. Keep in mind that you may qualify for financial discounts that could reduce your costs for coverage. To see if you qualify for financial discounts, visit ComparePlansIndiana.org. What plan is best for me? Pick a plan that suits your budget and meets your family s expected medical needs. Please see the chart on Page 5 for a more detailed breakdown on each Plans marketplace option s coverage,, copays and out-of-pocket costs. Enroll now or get pricing information at ComparePlansIndiana.org or

7 Key health insurance and medical definitions Network: The facilities, providers and suppliers your health insurer or plan has contracted with to provide healthcare services. Deductible: The amount you owe for healthcare services your health insurance or plan covers before your health insurance or plan begins to pay. OOP (out-of-pocket) costs: Your expenses for medical care that aren't reimbursed by insurance. Out-of-pocket costs include s, coinsurance, and copayments for covered services plus all costs for services that aren't covered. Copayment: A fixed amount you pay for a covered healthcare service, usually at the time when you get the service. Amounts vary by plans and services. Coinsurance: Your share of the costs of a covered healthcare service, calculated as a percentage of the allowed amount by your plan. You pay coinsurance plus any s you owe. Essential Health Benefits: Comprehensive care that covers all your healthcare needs, including emergency services, mental health services and prescription drugs coverage. Preventive care: Preventive services that can help you avoid illness and improve your health, including yearly check-ups, vaccines and screenings. 7

8 Important enrollment information Who is eligible to enroll in an individual health insurance plan? You currently don t have healthcare insurance You re self-employed You don t have job-based coverage You re retiring early You re simply looking for a better individual insurance plan The law now requires everyone to have health coverage. If you do not get a health plan you may have to pay a penalty, unless you qualify for an exemption. If you are 65 or older, you are not eligible to use the marketplace to buy a health or dental plan. How do I enroll? You can enroll with Plans: or ComparePlansIndiana.org. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact us at What are the important dates to remember? December 15, 2014 Last day to sign up for coverage that begins January 1, 2015 January 1, 2015 New health insurance plans begin if you signed up before December 15, 2014 February 15, 2015 Last day to sign up for 2015 coverage before tax penalty Indiana University Health Plans is a qualified health plan issuer through the Health Insurance Marketplace IUHealth HY1164 IUHEXG_026

9 Will I qualify for a financial discount? You might be eligible for a financial discount if you: Are a single person earning $46,680 or less Are a couple with a combined income of $62,920 or less Are a family of three with a total income below $79,160 Are a family of four with a total income below $95,400 Are a family of five with a total income below $111,640 Are a family of six with a total income below $127,880 Incomes that qualify for lower costs plans are set forth by Healthcare.gov. These numbers reflect the latest guidelines as of September Where is Plans coverage available? Plans offer a variety of plan options on the Indiana Health Insurance Marketplace for those living in the following counties: Benton Blackford Brown Carroll Clinton Delaware Greene Henry Lawrence Monroe Morgan Orange Owen Tippecanoe Tipton White Jay Enroll now or get pricing information: ComparePlansIndiana.org. 9

10 Give us a call or visit our website to sign up or have an expert help you determine which plan is right for you: ComparePlansIndiana.org

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