Molina Marketplace. We have a plan to keep you healthy.
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- Sybil Perry
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1 Molina Marketplace We have a plan to keep you healthy.
2 Access. Quality. Commitment. With the new Health Insurance Marketplace, you have a choice. Molina Healthcare is the answer. Here is why you should join our extended family. ExpErIEnCE you CAn trust We have more than 30 years of experience caring for individuals and their families. This includes providing health insurance in 10 states for more than 1.8 million members. flexibility you WAnt Because we offer care through Medicare, Medicaid and the Health Insurance Marketplace, we can cover each member in your family. This makes it convenient and easy for you and your family. About Molina Healthcare. Our company was created more than 30 years ago by Dr. C. David Molina. Dr. Molina was an emergency room doctor who believed that everyone should have access to high-quality care. Today, we provide medical services through Medicaid, Medicare and the Health Insurance Marketplace. Because we treat our members like family, we make sure they get the care they need, close to home. About the Health Insurance Marketplace. The Marketplace offers access to health care for everyone. Whether you have had health insurance before or not. Whether you are an individual or have a large family. Whether you are sick or healthy. No matter what, you now have access to affordable Molina Healthcare insurance through the Marketplace. A CoMMItMEnt to your CoMMunIty We provide health education, programs and services to create a healthier community. Call us for more information: (888)
3 Molina Marketplace Molina offers a variety of plans to fit your needs. Molina Healthcare plans are designed to meet your family s unique needs and budget. Talk to family members and friends you trust before you make a decision. VAluE MontHly premiums Co-pAyMEnts MAy be IdEAl for: silver Best Lower Lower Gold Better Higher Moderate bronze Good Lowest Highest Members who want low monthly premiums and co-payment costs. Higher income members who can afford moderate monthly premiums and co-payments. Members who want to pay less per month, but more per doctor visit. This is a plan overview. For complete details, see our 2014 Benefits At-A-Glance insert in this brochure. All of our plans meet the standards of the Affordable Care Act. Each plan includes these essential health benefits: Regular office visits Lab and radiology testing Mental health and drug abuse services Emergency services Prescription drug coverage Hospital care Maternity and newborn care Help recovering from injury Free preventive and wellness services Pediatric services, including vision care Coverage that goes beyond the doctor s office. We know every member has different needs. That s why we offer more than just access to doctors. We offer a wide range of services for our members, such as: 24-Hour nurse AdVICE line Call the line, anytime. Our nurses are ready to answer your medical questions. personal CArE MAnAGEMEnt Our skilled health care staff is here to help you with your chronic medical issues like asthma, diabetes and high blood pressure so you can live a healthier life. rides to your MEdICAl AppoIntMEnts We make it easier for you to get to your appointment. We offer our Silver plan members up to 4 low-cost rides per month. online MEMbEr services Change your address, phone number, even your primary care doctor. You can also sign up to receive alerts and appointment reminders. It s all at MyMolina.com, 24 hours a day. pregnancy program You have a friend at every stage of pregnancy. With our Motherhood Matters program, we re here to support you and your baby s health. dedicated CustoMEr support Our friendly staff speaks several different languages. We re here to answer your questions from 8:00 a.m. to 5:00 p.m., Monday through Friday. QuAlIty HEAltH And WEllnEss programs Have an important health screening coming up? We ll remind you. Need help scheduling an appointment or getting there? We can help. We ll also let you know about health events in your area and put you in touch with the right people for social services like counseling and housing assistance. Call us for more information: (888)
4 2014 Benefits At-A-Glance Molina Marketplace Bronze MBO-001 Silver MSO- 100 Silver MSO-150 Silver MSO-200 Silver MSO- 250 Gold MGO-001 FeAtureS 6 Annual Deductible (individual/family) Prescription Drug Deductible (individual/family) Annual Out-of-Pocket Maximum (individual/family) $4,000/$8,000 9 $300/$600 2 $2,250/$4,500 $2,250/$4,500 $1,500/$3,000 1 $5,200/$10,400 $1,700/$3,400 1 $200/$400 3 $250/$500 1 BeneFitS Office Visits4 Preventive Care Prenatal Visits Well-child Visits Family Planning Primary Care $45 co-pay copy $15 copy $30 co-pay $40 co-pay $20 co-pay Specialty Care $75 co-pay $10 co-pay $40 co-pay $60 co-pay $65 co-pay $50 co-pay Other Practitioner Care $75 co-pay $10 co-pay $40 co-pay $60 co-pay $65 co-pay $50 co-pay Habilitative Care Rehabilitative Care 40% 40% 20% 20% Mental Health Services $75 co-pay $10 co-pay $40 co-pay $60 co-pay $65 co-pay $50 co-pay Substance Abuse Services $75 co-pay $10 co-pay $40 co-pay $60 co-pay $65 co-pay $50 co-pay emergency and urgent Care Emergency Room 6 $300 co-pay $100 co-pay $150 co-pay $250 co-pay $250 co-pay $250 co-pay Urgent Care $100 co-pay $15 co-pay $30 co-pay $60 co-pay $75 co-pay $60 co-pay Pediatric Vision Services 8 Vision Exam Glasses Contacts Prescription Drugs Formulary Generic Drugs $25 co-pay $3 co-pay $10 co-pay $20 co-pay $20 co-pay $20 co-pay Formulary Preferred Brand Drugs $75 co-pay $8 co-pay $20 co-pay $40 co-pay $55 co-pay $50 co-pay Formulary Non Preferred Brand Drugs Specialty Drugs 40% 40% 20% 20% Outpatient Hospital / Facility Services Laboratory Services $45 co-pay co-pay $15 co-pay $30 co-pay $40 co-pay $20 co-pay Radiology Services $75 co-pay $10 co-pay $40 co-pay $60 co-pay $65 co-pay $50 co-pay Specialized Scanning Services (CT, MRI, PET Scans) Medical/Surgical Services inpatient Hospital Services Medical/Surgical, Maternity Care, Mental Health, Substance Abuse, Skilled Nursing Facility Hospice Care transportation Assistance Emergency Transportation - Ambulance Non-Emergency Medical Transportation to & from Medical Appointments 5 SuPPleMentAl BeneFitS 24-Hour Nurse Advice Line Weight control program Motherhood Matters, mothers-to-be program Tobacco counseling, smoking cessation program 40% 40% 40% $100 co-pay Not Covered $100 co-pay $5 co-pay per 0% $150 co-pay per trip $250 co-pay $250 co-pay 20% 20% 20% $250 co-pay per trip Not Covered 1. Applies Only to Outpatient Hospital / Facility and Inpatient Hospital / Facility Services 2. Prescription Drug Deductible waived for Generic drugs 3. Prescription Drug Deductible Applies only to Non-Preferred Brand Name drugs and Specialty drugs 4. Some Outpatient Professional Services not listed, are not Co-payment based and require a Coinsurance Cost Share 5. Non-Emergency Medical Transportation services are limited to four (4) s per month 6. Certain benefits require Prior Authorization prior to obtaining services 7. This cost does not apply, if admitted directly to the hospital for inpatient services (refer to Inpatient Hospital Services, for applicable Cost sharing for you) 8. Applicable to Dependent Children through age Medical Deductible waived for Preventive Care and first three (3) Office Visits This 2014 Benefits At-A-Glance is intended to be a summary of coverage benefits that lists some features of our plan, and does not list or describe all benefits covered under a specific product or every limitation or exclusion. Please consult the Molina Healthcare of Ohio, Inc. Agreement and Individual Policy for a detailed description of benefits, exclusions and limitations HIM0813OH
5 For more than 30 years, we ve been a part of your community. Now we invite you to join our extended family. Call us toll free at (888) HIM0813OH Product offered by Molina Healthcare of Ohio, Inc., a wholly owned subsidiary of Molina Healthcare, Inc. This is a solicitation for insurance and an agent may contact you.
Molina Marketplace. We have a plan to keep you healthy.
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What is the overall deductible?
Regence BlueCross BlueShield of Oregon: HSA 2.0 Coverage Period: 07/01/2013-06/30/2014 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual & Eligible Family
Group Health Cooperative: Seattle University Summary of Benefits and Coverage: What this Plan Covers & What it Costs
Group Health Cooperative: Seattle University Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 1/1/2016 to 1/1/2017 Coverage for: Group Plan Type: HMO This is only
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This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.studentplanscenter.com or by calling 1-800-756-3702.
You can see the specialist you choose without permission from this plan.
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.[insert] or by calling 1-800-[insert]. Important Questions
Group Health Cooperative: Core Silver HSA
Group Health Cooperative: Core Silver HSA Coverage Period: 1/1/2016 to 1/1/2017 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual & Family Plan Type: HDHP
Annual Notice of Changes for 2014
Advocare Spirit Rx (HMO-POS) offered by Security Health Plan of Wisconsin, Inc. Annual Notice of Changes for 2014 You are currently enrolled as a member of Advocare Spirit Rx (HMO-POS). Next year there
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This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at PacificSource.com or by calling 1-888-977-9299 Important
Highmark Delaware: Blue EPO $40 - $2,400/$4,800 Coverage Period: Beginning on or after 01/01/2013
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.highmarkbcbsde.com or by calling 1-800-633-2563. Important
Primary Select Platinum Plan: Health Republic Insurance of New York Coverage Period: 01/01/2015 12/31/2015
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document by calling 1-888-990-5702. Important Questions Answers Why this
Coverage for: Group Plan Type: HMO. Important Questions Answers Why this Matters: What is the overall deductible?
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at sutterhealthplus.org or by calling 1-855-315-5800. Important
TotalIndependence Silver Plan: Health Republic Insurance of New York Coverage Period: 01/01/2015 12/31/2015 Summary of Benefits and Coverage:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document by calling 1-888-990-5702. Important Questions Answers Why this
National Guardian Life Insurance Company: Kenyon College Student Health Insurance Plan Coverage Period: 08/15/2015-08/15/2016
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.studentplanscenter.com or by calling 1-800-756-3702.
Companion Life Insurance Company: Saint Xavier University Student Health Insurance Plan Coverage Period: 08/11/2015-08/10/2016
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.studentplanscenter.com or by calling 1-800-756-3702.
Important Questions Answers Why this Matters: What is the overall deductible?
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at austintexas.gov/benefits or by calling 512-974-3284. Important