SMALL BUSINESS Health Insurance Plans

Transcription

1 SMALL BUSINESS Health Insurance Plans For more information, call or visit us online!

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3 LAND OF LINCOLN HEALTH Health Insurance Plans CONTENTS About Health PPO Plans Traditional Health Plans Health Plan Highlights About Health At Health, we know how complicated and impersonal health insurance can feel. That s why we re here to help you every step of the way. We make it easy to understand, easy to make good decisions and easy to use your insurance when you need to. We provide two plan types that offer low out-of-pocket expenses, allow you to choose your doctors and provide the security of knowing you have nationwide coverage. 41 AFFORDABLE Small Business Plan Options How to Enroll Call your broker directly to find the right plan and see if you qualify for a small business tax credit. Once you re ready to enroll, call your broker for a quote. If you don t have a broker, call us at or visit us at. Our PPO Plans offer innovative partnerships with major Illinois health systems, making it even easier and more affordable for you and your employees to receive care from your chosen doctors and hospitals. Our Traditional PPO Plans provide rich benefits with one of the strongest and widest networks of healthcare providers across the nation. That s the way health insurance should be we re changing health insurance for the better for you and your employees. Our strong benefits and network of trusted doctors and hospitals have made our 50,000 members think differently about health insurance. 1

4 PREFRED PARTN PPO 3-TI PLANS PREFRED PARTN PPO Our 3-Tier Plans PREFRED PARTN PPO 3-Tier Plans OUR PREFRED PARTNS These plans were created for you and your employees to visit the doctors and hospitals you trust most. Each plan is backed by a prominent health system, providing the best benefits and most savings when you seek care within a health system. If you want to see other doctors, you and your employees can still utilize Land of Lincoln Health s nationwide network of doctors and hospitals Includes the reputable doctors and hospitals. Save the most money by receiving care from an provider. Health Extensive network of world-class doctors and hospitals across the nation. Does not include doctors and hospitals. No out-of-pocket maximum. 2

5 PREFRED PARTN PPO 3-TI PLANS Adventist Health PPO Adventist Midwest Health s nonprofit hospitals and healthcare facilities operate in Chicago s western suburbs. Adventist takes a holistic, whole person approach to wellness, partnering with patients, families and healers to achieve optimal health for their patients and the communities they serve. New for 2016: Adventist Midwest Health and Alexian Brothers Health System have merged, forming a new health system, AMITA Heath. While this merger includes both hospital systems, our Adventist Health Plans DO NOT include Alexian Brothers doctors and hospitals. If you seek care with any Alexian Brothers doctors or hospitals, unless the coverage of such care is legally required to be paid at the rate (e.g. emergency care), the visit or service will be considered. Please make sure to confirm that your chosen doctor or hospital is for your Adventist Health Plan. This can be done by utilizing our Find a Doctor tool located on our website or by contacting our Member Services team at Centegra Health PPO Centegra Health System is committed to meeting the healthcare needs of the residents of greater McHenry County and to making services available in multiple convenient locations, including hospitals in McHenry and Woodstock, Immediate and Care Centers, Centegra Sage Cancer Center and Health Bridge Fitness Centers. As the region s leading healthcare system, Centegra s Health & Wellness Network offers access to more than 350 healthcare providers, the latest treatments and technology. The skills of nearly 4,000 associates help meet the needs of the growing McHenry County community. See page: 7 See page: 8 Champion Health PPO If Advocate is your preferred healthcare system, choose the Champion Plan. Advocate is one of the nation s top healthcare systems. We have more than 200 sites of care, including hospitals, medical groups, home health services and a network of outpatient centers. Our Partners integrated approach has achieved nationally-ranked outcomes for their chronic disease management programs. Advocate provides progressive and innovative healthcare services to its members, believing the best way to treat the whole person is through an integrated system of care. Chicago Health System Health PPO Chicago Health System s nationally-recognized doctors and hospitals are all uniquely qualified and united in their goals of providing superior personalized care and individual patient relationships that last a lifetime. Chicago Health System partners with four quality-driven hospitals including MacNeal in Berwyn, Weiss Memorial in Chicago, Westlake in Melrose Park and West Suburban in Oak Park, to place the patient at the center of their care to support them in living their best life. Through a network of community-based doctors and hospitals, Chicago Health System patients have access to care in their communities to meet their needs. See page: 9 See page: 10 3

6 PREFRED PARTN PPO 3-TI PLANS Family Health Network Health PPO Family Health Network (FHN) is a health insurer with 20 years of experience in the Chicago community. FHN s main focus is providing affordable, high-quality care for its members. With a robust network of doctors and hospitals, including psychiatric and children s hospitals, FHN encourages members to routinely and conveniently access healthcare. For a better health plan and high quality healthcare you and your employees deserve, join the family! Illinois Health Partners Health PPO Illinois Health Partners (IHP) includes a network of more than 1,200 primary and specialty care physicians who are affiliated with DuPage Medical Group, Edward-Elmhurst Healthcare and Northwest Community Healthcare. IHP serves nearly 250,000 patients in the west, southwest and northwest suburbs of Chicago with a mission of improving the quality of healthcare and delivering value through access and efficiency. You ll find convenient locations, same-day appointments in many offices and many other patient conveniences. See page: 11 See page:12 Presence Health Health PPO Presence Health is a large health system of more than 150 locations in communities large and small, making access to healthcare convenient. In addition to delivering excellent care and service, Presence Health wants to inspire people to see their health in a new way. More than doctor visits and medical tests, it s a lifelong journey of small, manageable steps. The goal of Presence Health is to empower those they serve to take a few of those steps every day to achieve their best health. And there s no better time to start than today. Riverside Health PPO Riverside HealthCare is a fully integrated healthcare system serving the needs of patients throughout Kankakee, Iroquois, Will and Grundy counties. Our network of the region s premier physicians includes over 75 primary care doctors and specialists. Riverside HealthCare is comprised of Riverside Medical Center, Riverside Senior Life Communities, Riverside HealthCare Foundation and Oakside Corporation. Swedish Covenant Hospital Health PPO Swedish Covenant Hospital and their Network has been serving the Chicago area for more than 125 years. Swedish Covenant Hospital excels in safety, outcomes and the patient experience by providing expert care and outstanding health and wellness services in state-of-the-art facilities. Swedish Covenant Hospital is committed to providing a safe, quality hospital experience and is consistently recognized, including most recently in 2015 when they were awarded the Leadership in Safety Award from CNA Healthcare. See page: 13 See page: 14 See page: 15 4

7 TRADITIONAL PPO 2-TI PLANS Health is proud to continue offering our Traditional PPO Plans. These plans provide access to Health s extensive network, which includes most of the doctors and hospitals across the nation. CO-OPtions SM National Elite Multi-State Plan Health PPO This traditional health insurance plan offers one great level of benefits with all of Health s doctors and hospitals nationwide. CO-OPtions SM National Elite works just like the health insurance plans most people are familiar with. Most services received under this plan are paid for with copays and not subject to the deductible, helping members know exactly how much they can expect their healthcare to cost. See page: 16 Copay Plan Health PPO This traditional health insurance plan offers one great level of benefits with all of Health s doctors and hospitals nationwide. The Copay Plan works just like the health insurance plans most people are familiar with. Most services received under this plan are paid for with copays and not subject to the deductible, helping members know exactly how much they can expect their healthcare to cost. See page: TRADITIONAL PPO Our 2-Tier Plans Health Extensive network of world-class doctors and hospitals across the nation. Does not include doctors and hospitals. No out-of-pocket maximum. 5

8 TRADITIONAL PPO 2-TI PLANS HSA-Compatible Plan Health PPO The HSA-Compatible Plan offers great benefits and access to our Traditional PPO network, one of the larger networks of doctors and hospitals in the state. You will find this plan simple to use and highly effective if you prefer an HSA compatible plan. SBAC HSA-Compatible Plan Health PPO The Small Business Advocacy Council (SBAC) and Land of Lincoln Health have teamed up to help small business owners lower out-of-pocket medical expenses. This Traditional PPO plan provides comprehensive coverage with a simple implementation process. Choose from some of the best doctors and hospitals in Illinois, including some of the best-known and well-respected health systems nationwide. You ll find affordable benefits in a plan that is compatible with a Health Savings Account. The nonprofit SBAC empowers the small business community through advocacy, cost-savings programs, educational resources and collaboration. See page: See page: 21 3-Tier Plan Health PPO The 3-Tier Plan allows you the best benefits when accessing Health s own network of well-known and respected doctors and hospitals. If you want to see other healthcare providers, you can still utilize Health s nationwide network of doctors and hospitals. See page: 20 Health is proud to continue offering our Traditional PPO Plans. These plans all offer access to Health s nationwide network, which includes many of the doctors and hospitals in Illinois. You and your employees will find HSA-compatible options with our Traditional PPO plans. 6

9 ADVENTIST LAND OF LINCOLN HEALTH PPO ADVENTIST LLH 3-TI PLATINUM PPO ADVENTIST LLH 3-TI GOLD PPO ADVENTIST LLH 3-TI SILV PPO ADVENTIST LLH 3-TI BRONZE PPO Adventist Adventist Adventist Adventist 0 / $5,000 / $10,000 / $1,000 $6,000 / $12,000 $3,400 / $6,800 $10,000 / $20,000 $6,000 / $12,000 $15,000 / $30,000 45% $2,000 /,000 Unlimited / Unlimited $5,500 / $11,000 Unlimited / Unlimited $6,850 / $13,700 Unlimited / Unlimited $6,850 / $13,700 Unlimited / Unlimited $5 $15 5 $30 $70 (first 2 visits); then subject to deductible/coinsurance $20 $160 $100 $100 $100 copay/day for first 3 days $550 copay/day for first 3 days 0 copay/day for first 3 days $900 copay/day for first 3 days $850 copay/day for first 3 days $1,800 copay/day for first 3 days 45% $80 $10 $105 $65 $130 45% 1. Copays are not. Coinsurances are. The deductible for the and Health Tier 2 Providers is integrated, meaning qualified payments made within either of those networks apply to that single deductible. 2. Coinsurance is the percentage paid by member after meeting the deductible. Percentages shown within this table represent coinsurance amounts and are always subject to the deductible. Health is responsible for the remainder of the covered services. 3. Out-of-pocket maximum is the most you will ever have to pay in the plan year for covered services under a specific plan. Deductibles, coinsurance and copays in either the or with Health Providers all apply to your out-of-pocket maximum. 4. Includes room and board and some other additional charges. After the first three days of copays, Health pays 100% of covered services for that hospital stay. Includes services provided for mental/ 5. May include an outpatient clinic or same-day surgery center. Also includes services provided for mental/ 6. All Prescription Drug Benefits listed are for a 34-day supply. Copay for 90-day mail order prescriptions is 2½ times the 34-day retail copay. Coinsurance for mail order is the same as retail. Mutual Health Insurance Company ( Health ) is offering small business health insurance plans described herein. This brochure is distributed for marketing purposes and is not your certificate of coverage. Some health care services will require precertification. If there is any difference between this brochure and the certificate of coverage, the provisions of the certificate of coverage will control. For more information on Health, call or visit. All Small Business Plans sold through the Marketplace are considered QHPs (Qualified Health Plans) or MSPs (Multi-State Plans) as determined by the Affordable Care Act. 7 Adventist Midwest Health and Alexian Brothers Health System have merged, forming a new health system, AMITA. While this merger includes both hospital systems, our Adventist Health Plan DOES NOT include Alexian Brothers doctors and hospitals. If you seek care with any Alexian Brothers doctors or hospitals, unless the coverage of such care is legally required to be paid at the in-network rate (e.g. emergency care), the visit or service will be considered out-of-network. Please make sure to confirm that your chosen doctor or hospital is in-network for your Adventist Health Plan. This can be done by utilizing our Find-a- Doctor tool located on our website or by contacting our Member Services team at

10 CENTEGRA LAND OF LINCOLN HEALTH PPO CENTEGRA LLH 3-TI PLATINUM PPO CENTEGRA LLH 3-TI GOLD COPAY PPO CENTEGRA LLH 3-TI GOLD HSA-COMPATIBLE PPO CENTEGRA LLH 3-TI SILV PPO Centegra Centegra Centegra Centegra 0 / $5,000 / $10,000 0 / $1,500 $6,000 / $12,000 $1,350 / $2,700 $6,000 / $12,000 $3,100 / $6,200 $10,000 / $20,000 30% 15% 45% $3,000 / $6,000 Unlimited / Unlimited $6,850 / $13,700 Unlimited / Unlimited $3,000 / $6,000 Unlimited / Unlimited $6,850 / $13,700 Unlimited / Unlimited $5 $30 $10 $30 $ $85 $80 $160 $100 copay/day for first 3 days $550 copay/day for first 3 days 0 copay/day for first 3 days $900 copay/day for first 3 days $950 copay/day for first 3 days $1,600 copay/day for first 3 days 30% 15% 45% $15 $80 $10 $105 $65 $130 30% 15% 45% $20 $20 15% 15% 1. Copays are not. Coinsurances are. The deductible for the and Health Providers is integrated, meaning qualified payments made within either of those networks apply to that single deductible. 2. Coinsurance is the percentage paid by member after meeting the deductible. Percentages shown within this table represent coinsurance amounts and are always subject to the deductible. Health is responsible for the remainder of the covered services. 3. Out-of-pocket maximum is the most you will ever have to pay in the plan year for covered services under a specific plan. Deductibles, coinsurance and copays in either the or with Health Providers all apply to your out-of-pocket maximum. 4. Includes room and board and some other additional charges. After the first three days of copays, Health pays 100% of covered services for that hospital stay. Includes services provided for mental/ 5. May include an outpatient clinic or same-day surgery center. Also includes services provided for mental/ 6. All Prescription Drug Benefits listed are for a 34-day supply. Copay for 90-day mail order prescriptions is 2½ times the 34-day retail copay. Coinsurance for mail order is the same as retail. Mutual Health Insurance Company ( Health ) is offering small business health insurance plans described herein. This brochure is distributed for marketing purposes and is not your certificate of coverage. Some health care services will require precertification. If there is any difference between this brochure and the certificate of coverage, the provisions of the certificate of coverage will control. For more information on Health, call or visit. All Small Business Plans sold through the Marketplace are considered QHPs (Qualified Health Plans) or MSPs (Multi-State Plans) as determined by the Affordable Care Act. 8

11 CHAMPION LAND OF LINCOLN HEALTH PPO CHAMPION LLH 3-TI PLATINUM PPO Champion CHAMPION LLH 3-TI GOLD PPO Champion CHAMPION LLH 3-TI SILV PPO Champion / $5,000 / $10,000 / $1,000 $6,000 / $12,000 $3,100 / $6,200 $10,000 / $20,000 45% $5,000 / $10,000 Unlimited / Unlimited $5,800 / $11,600 Unlimited / Unlimited $6,850 / $13,700 Unlimited / Unlimited $5 $15 5 $30 $125 0 $80 $900 $950 $145 $1,600 45% $80 $10 $105 $65 $130 45% 1. Copays are not. Coinsurances are. The deductible for the and Health Providers is integrated, meaning qualified payments made within either of those networks apply to that single deductible. 2. Coinsurance is the percentage paid by member after meeting the deductible. Percentages shown within this table represent coinsurance amounts and are always subject to the deductible. Health is responsible for the remainder of the covered services. 3. Out-of-pocket maximum is the most you will ever have to pay in the plan year for covered services under a specific plan. Deductibles, coinsurance and copays in either the or with Health Providers all apply to your out-of-pocket maximum. 4. Includes room and board and some other additional charges. After the first three days of copays, Health pays 100% of covered services for that hospital stay. Includes services provided for mental/ 5. May include an outpatient clinic or same-day surgery center. Also includes services provided for mental/ 6. All Prescription Drug Benefits listed are for a 34-day supply. Copay for 90-day mail order prescriptions is 2½ times the 34-day retail copay. Coinsurance for mail order is the same as retail. Mutual Health Insurance Company ( Health ) is offering small business health insurance plans described herein. This brochure is distributed for marketing purposes and is not your certificate of coverage. Some health care services will require precertification. If there is any difference between this brochure and the certificate of coverage, the provisions of the certificate of coverage will control. For more information on Health, call or visit. All Small Business Plans sold through the Marketplace are considered QHPs (Qualified Health Plans) or MSPs (Multi-State Plans) as determined by the Affordable Care Act. 9

12 CHICAGO HEALTH SYSTEMS LAND OF LINCOLN HEALTH PPO CHICAGO HEALTH SYSTEM LLH 3-TI GOLD PPO CHS 0 / $1,500 $6,000 / $12,000 $ $5,100 / $10,200 Unlimited / Unlimited $900 $20 $105 CHICAGO HEALTH SYSTEM LLH 3-TI SILV PPO CHS $3,100 / $6,200 $10,000 / $20,000 45% $30 $80 $950 $6,850 / $13,700 Unlimited / Unlimited $160 $1,600 45% $65 $80 $130 45% 1. Copays are not. Coinsurances are. The deductible for the Preferred Partner and Health Providers is integrated, meaning qualified payments made within either of those networks apply to that single deductible. 2. Coinsurance is the percentage paid by member after meeting the deductible. Percentages shown within this table represent coinsurance amounts and are always subject to the deductible. Health is responsible for the remainder of the covered services. 3. Out-of-pocket maximum is the most you will ever have to pay in the plan year for covered services under a specific plan. Deductibles, coinsurance and copays in either the or with Health Providers all apply to your out-of-pocket maximum. 4. Includes room and board and some other additional charges. After the first three days of copays, Land of Lincoln Health pays 100% of covered services for that hospital stay. Includes services provided for mental/ 5. May include an outpatient clinic or same-day surgery center. Also includes services provided for mental/ 6. All Prescription Drug Benefits listed are for a 34-day supply. Copay for 90-day mail order prescriptions is 2½ times the 34-day retail copay. Coinsurance for mail order is the same as retail. Mutual Health Insurance Company ( Health ) is offering small business health insurance plans described herein. This brochure is distributed for marketing purposes and is not your certificate of coverage. Some health care services will require precertification. If there is any difference between this brochure and the certificate of coverage, the provisions of the certificate of coverage will control. For more information on Health, call or visit. All Small Business Plans sold through the Marketplace are considered QHPs (Qualified Health Plans) or MSPs (Multi-State Plans) as determined by the Affordable Care Act. 10

13 FAMILY HEALTH NETWORK LAND OF LINCOLN HEALTH PPO FAMILY HEALTH NETWORK LLH 3-TI SILV PPO FHN FAMILY HEALTH NETWORK LLH 3-TI BRONZE PPO FHN $2,300 /,600 $10,000 / $20,000 $5,000 / $10,000 $15,000 / $30,000 35% 45% $30 $850 $6,850 / $13,700 Unlimited / Unlimited $6,500 / $13,000 Unlimited / Unlimited $150 $1,800 35% 45% $65 $80 $130 35% 45% 35% 35% 35% 35% 1. Copays are not. Coinsurances are. The deductible for the Preferred Partner and Health Providers is integrated, meaning qualified payments made within either of those networks apply to that single deductible. 2. Coinsurance is the percentage paid by member after meeting the deductible. Percentages shown within this table represent coinsurance amounts and are always subject to the deductible. Health is responsible for the remainder of the covered services. 3. Out-of-pocket maximum is the most you will ever have to pay in the plan year for covered services under a specific plan. Deductibles, coinsurance and copays in either the or with Health Providers all apply to your out-of-pocket maximum. 4. Includes room and board and some other additional charges. After the first three days of copays, Land of Lincoln Health pays 100% of covered services for that hospital stay. Includes services provided for mental/ 5. May include an outpatient clinic or same-day surgery center. Also includes services provided for mental/ 6. All Prescription Drug Benefits listed are for a 34-day supply. Copay for 90-day mail order prescriptions is 2½ times the 34-day retail copay. Coinsurance for mail order is the same as retail. Mutual Health Insurance Company ( Health ) is offering small business health insurance plans described herein. This brochure is distributed for marketing purposes and is not your certificate of coverage. Some health care services will require precertification. If there is any difference between this brochure and the certificate of coverage, the provisions of the certificate of coverage will control. For more information on Health, call or visit. All Small Business Plans sold through the Marketplace are considered QHPs (Qualified Health Plans) or MSPs (Multi-State Plans) as determined by the Affordable Care Act. 11

14 ILLINOIS HEALTH PARTNS LAND OF LINCOLN HEALTH PPO ILLINOIS HEALTH PARTNS LLH 3-TI PLATINUM PPO IHP ILLINOIS HEALTH PARTNS LLH 3-TI GOLD PPO IHP ILLINOIS HEALTH PARTNS LLH 3-TI SILV PPO IHP / $5,000 / $10,000 / $1,000 $6,000 / $12,000 $3,100 / $6,200 $10,000 / $20,000 45% $5,000 / $10,000 Unlimited / Unlimited $6,800 / $13,600 Unlimited / Unlimited $6,850 / $13,700 Unlimited / Unlimited $5 $30 $10 5 $30 $70 $125 v $550 0 $80 $900 $850 $160 $1,800 45% $15 $80 $10 $105 $65 $130 45% 1. Copays are not. Coinsurances are. The deductible for the and Health Providers is integrated, meaning qualified payments made within either of those networks apply to that single deductible. 2. Coinsurance is the percentage paid by member after meeting the deductible. Percentages shown within this table represent coinsurance amounts and are always subject to the deductible. Health is responsible for the remainder of the covered services. 3. Out-of-pocket maximum is the most you will ever have to pay in the plan year for covered services under a specific plan. Deductibles, coinsurance and copays in either the or with Health Providers all apply to your out-of-pocket maximum. 4. Includes room and board and some other additional charges. After the first three days of copays, Health pays 100% of covered services for that hospital stay. Includes services provided for mental/ 5. May include an outpatient clinic or same-day surgery center. Also includes services provided for mental/ 6. All Prescription Drug Benefits listed are for a 34-day supply. Copay for 90-day mail order prescriptions is 2½ times the 34-day retail copay. Coinsurance for mail order is the same as retail. Mutual Health Insurance Company ( Health ) is offering small business health insurance plans described herein. This brochure is distributed for marketing purposes and is not your certificate of coverage. Some health care services will require precertification. If there is any difference between this brochure and the certificate of coverage, the provisions of the certificate of coverage will control. For more information on Health, call or visit. All Small Business Plans sold through the Marketplace are considered QHPs (Qualified Health Plans) or MSPs (Multi-State Plans) as determined by the Affordable Care Act. 12

15 PRESENCE HEALTH LAND OF LINCOLN HEALTH PPO PRESENCE HEALTH LLH 3-TI PLATINUM PPO Presence PRESENCE HEALTH LLH 3-TI GOLD PPO Presence PRESENCE HEALTH LLH 3-TI SILV PPO Presence / $5,000 / $10,000 / $1,000 $6,000 / $12,000 $3,400 / $6,800 $10,000 / $20,000 45% $5 $125 $5,000 / $10,000 Unlimited / Unlimited $6,800 / $13,600 Unlimited / Unlimited $6,850 / $13,700 Unlimited / Unlimited $10 $550 0 $30 $900 $850 $145 $1,800 45% $10 $15 $105 $65 $80 $130 45% 1. Copays are not. Coinsurances are. The deductible for the and Health Providers is integrated, meaning qualified payments made within either of those networks apply to that single deductible. 2. Coinsurance is the percentage paid by member after meeting the deductible. Percentages shown within this table represent coinsurance amounts and are always subject to the deductible. Health is responsible for the remainder of the covered services. 3. Out-of-pocket maximum is the most you will ever have to pay in the plan year for covered services under a specific plan. Deductibles, coinsurance and copays in either the or with Health Providers all apply to your out-of-pocket maximum. 4. Includes room and board and some other additional charges. After the first three days of copays, Health pays 100% of covered services for that hospital stay. Includes services provided for mental/ 5. May include an outpatient clinic or same-day surgery center. Also includes services provided for mental/ 6. All Prescription Drug Benefits listed are for a 34-day supply. Copay for 90-day mail order prescriptions is 2½ times the 34-day retail copay. Coinsurance for mail order is the same as retail. Mutual Health Insurance Company ( Health ) is offering small business health insurance plans described herein. This brochure is distributed for marketing purposes and is not your certificate of coverage. Some health care services will require precertification. If there is any difference between this brochure and the certificate of coverage, the provisions of the certificate of coverage will control. For more information on Health, call or visit. All Small Business Plans sold through the Marketplace are considered QHPs (Qualified Health Plans) or MSPs (Multi-State Plans) as determined by the Affordable Care Act. 13

16 RIVSIDE LAND OF LINCOLN HEALTH PPO RIVSIDE LLH 3-TI SILV PPO Riverside $3,100 / $6,200 $10,000 / $20,000 45% $30 $80 $950 $6,850 / $13,700 Unlimited / Unlimited $160 $1,600 45% $65 $80 $130 45% 1. Copays are not. Coinsurances are. The deductible for the Preferred Partner and Health Providers is integrated, meaning qualified payments made within either of those networks apply to that single deductible. 2. Coinsurance is the percentage paid by member after meeting the deductible. Percentages shown within this table represent coinsurance amounts and are always subject to the deductible. Health is responsible for the remainder of the covered services. 3. Out-of-pocket maximum is the most you will ever have to pay in the plan year for covered services under a specific plan. Deductibles, coinsurance and copays in either the or with Health Providers all apply to your out-of-pocket maximum. 4. Includes room and board and some other additional charges. After the first three days of copays, Land of Lincoln Health pays 100% of covered services for that hospital stay. Includes services provided for mental/ 5. May include an outpatient clinic or same-day surgery center. Also includes services provided for mental/ 6. All Prescription Drug Benefits listed are for a 34-day supply. Copay for 90-day mail order prescriptions is 2½ times the 34-day retail copay. Coinsurance for mail order is the same as retail. Mutual Health Insurance Company ( Health ) is offering small business health insurance plans described herein. This brochure is distributed for marketing purposes and is not your certificate of coverage. Some health care services will require precertification. If there is any difference between this brochure and the certificate of coverage, the provisions of the certificate of coverage will control. For more information on Health, call or visit. All Small Business Plans sold through the Marketplace are considered QHPs (Qualified Health Plans) or MSPs (Multi-State Plans) as determined by the Affordable Care Act. 14

17 SWEDISH COVENANT LAND OF LINCOLN HEALTH PPO SWEDISH COVENANT LLH 3-TI PLATINUM PPO SCH SWEDISH COVENANT LLH 3-TI GOLD PPO SCH SWEDISH COVENANT LLH 3-TI SILV PPO SCH / $5,000 / $10,000 / $1,000 $6,000 / $12,000 $3,100 / $6,200 $10,000 / $20,000 45% $5,000 / $10,000 Unlimited / Unlimited $5,500 / $11,000 Unlimited / Unlimited $6,850 / $13,700 Unlimited / Unlimited $5 $15 $55 $30 $125 0 $80 $900 $850 $145 $1,800 45% $10 $105 $65 $80 $130 45% 1. Copays are not. Coinsurances are. The deductible for the and Health Providers is integrated, meaning qualified payments made within either of those networks apply to that single deductible. 2. Coinsurance is the percentage paid by member after meeting the deductible. Percentages shown within this table represent coinsurance amounts and are always subject to the deductible. Health is responsible for the remainder of the covered services. 3. Out-of-pocket maximum is the most you will ever have to pay in the plan year for covered services under a specific plan. Deductibles, coinsurance and copays in either the or with Health Providers all apply to your out-of-pocket maximum. 4. Includes room and board and some other additional charges. After the first three days of copays, Health pays 100% of covered services for that hospital stay. Includes services provided for mental/ 5. May include an outpatient clinic or same-day surgery center. Also includes services provided for mental/ 6. All Prescription Drug Benefits listed are for a 34-day supply. Copay for 90-day mail order prescriptions is 2½ times the 34-day retail copay. Coinsurance for mail order is the same as retail. Mutual Health Insurance Company ( Health ) is offering small business health insurance plans described herein. This brochure is distributed for marketing purposes and is not your certificate of coverage. Some health care services will require precertification. If there is any difference between this brochure and the certificate of coverage, the provisions of the certificate of coverage will control. For more information on Health, call or visit. All Small Business Plans sold through the Marketplace are considered QHPs (Qualified Health Plans) or MSPs (Multi-State Plans) as determined by the Affordable Care Act. 15

18 CO-OPTIONS SM NATIONAL ELITE MULTI-STATE PLAN LAND OF LINCOLN HEALTH PPO CO-OPTIONS SM LLH NATIONAL ELITE PLATINUM PPO, A MULTI-STATE PLAN CO-OPTIONS SM LLH NATIONAL ELITE GOLD PPO, A MULTI-STATE PLAN CO-OPTIONS SM LLH NATIONAL ELITE SILV PPO, A MULTI-STATE PLAN / $5,000 / $10,000 / $1,000 $5,000 / $10,000 $3,500 / $7,000 $8,000 / $16,000 30% $2,000 /,000 Unlimited / Unlimited $3,750 / $7,500 Unlimited / Unlimited $6,850 / $13,700 Unlimited / Unlimited $10 $ $900 30% $20 $30 $65 $100 30% 30% 30% 1. Copays are not. Coinsurances are. The deductible for the Preferred Partner and Health Providers is integrated, meaning qualified payments made within either of those networks apply to that single deductible. 2. Coinsurance is the percentage paid by member after meeting the deductible. Percentages shown within this table represent coinsurance amounts and are always subject to the deductible. Health is responsible for the remainder of the covered services. 3. Out-of-pocket maximum is the most you will ever have to pay in the plan year for covered services under a specific plan. Deductibles, coinsurance and copays in either the or with Health Providers all apply to your out-of-pocket maximum. 4. Includes room and board and some other additional charges. After the first three days of copays, Land of Lincoln Health pays 100% of covered services for that hospital stay. Includes services provided for mental/ 5. May include an outpatient clinic or same-day surgery center. Also includes services provided for mental/ 6. All Prescription Drug Benefits listed are for a 34-day supply. Copay for 90-day mail order prescriptions is 2½ times the 34-day retail copay. Coinsurance for mail order is the same as retail. Mutual Health Insurance Company ( Health ) is offering small business health insurance plans described herein. This brochure is distributed for marketing purposes and is not your certificate of coverage. Some health care services will require precertification. If there is any difference between this brochure and the certificate of coverage, the provisions of the certificate of coverage will control. For more information on Health, call or visit. All Small Business Plans sold through the Marketplace are considered QHPs (Qualified Health Plans) or MSPs (Multi-State Plans) as determined by the Affordable Care Act. 16

19 COPAY PLAN LAND OF LINCOLN HEALTH PPO LAND OF LINCOLN HEALTH GOLD COPAY PPO LAND OF LINCOLN HEALTH SILV COPAY PPO $1,500 / $3,000 $5,000 / $10,000 $2,500 / $5,000 $8,000 / $16,000 $3,450 / $6,900 Unlimited / Unlimited $6,850 / $13,700 Unlimited / Unlimited $20 0 $900 $30 $65 $ Copays are not. Coinsurances are. The deductible for the Preferred Partner and Health Providers is integrated, meaning qualified payments made within either of those networks apply to that single deductible. 2. Coinsurance is the percentage paid by member after meeting the deductible. Percentages shown within this table represent coinsurance amounts and are always subject to the deductible. Health is responsible for the remainder of the covered services. 3. Out-of-pocket maximum is the most you will ever have to pay in the plan year for covered services under a specific plan. Deductibles, coinsurance and copays in either the or with Health Providers all apply to your out-of-pocket maximum. 4. Includes room and board and some other additional charges. After the first three days of copays, Land of Lincoln Health pays 100% of covered services for that hospital stay. Includes services provided for mental/ 5. May include an outpatient clinic or same-day surgery center. Also includes services provided for mental/ 6. All Prescription Drug Benefits listed are for a 34-day supply. Copay for 90-day mail order prescriptions is 2½ times the 34-day retail copay. Coinsurance for mail order is the same as retail. Mutual Health Insurance Company ( Health ) is offering small business health insurance plans described herein. This brochure is distributed for marketing purposes and is not your certificate of coverage. Some health care services will require precertification. If there is any difference between this brochure and the certificate of coverage, the provisions of the certificate of coverage will control. For more information on Health, call or visit. All Small Business Plans sold through the Marketplace are considered QHPs (Qualified Health Plans) or MSPs (Multi- State Plans) as determined by the Affordable Care Act. 17

20 HSA-COMPATIBLE PLAN LAND OF LINCOLN HEALTH PPO LAND OF LINCOLN HEALTH HSA-COMPATIBLE GOLD 80/1350 PPO LAND OF LINCOLN HEALTH HSA-COMPATIBLE SILV 80/1900 PPO LAND OF LINCOLN HEALTH HSA-COMPATIBLE BRONZE 80/5500 PPO $1,350 / $2,700 $5,000 / $10,000 $1,900 / $3,800 $8,000 / $16,000 $5,500 / $11,000 $12,000 / $24,000 30% $3,300 / $6,600 Unlimited / Unlimited $6,500 / $13,000 Unlimited / Unlimited $6,500 / $13,000 Unlimited / Unlimited 30% 30% 30% 30% 30% 30% 30% 30% 30% 30% 30% 30% 30% 1. Copays are not. Coinsurances are. The deductible for the Preferred Partner and Health Providers is integrated, meaning qualified payments made within either of those networks apply to that single deductible. 2. Coinsurance is the percentage paid by member after meeting the deductible. Percentages shown within this table represent coinsurance amounts and are always subject to the deductible. Health is responsible for the remainder of the covered services. 3. Out-of-pocket maximum is the most you will ever have to pay in the plan year for covered services under a specific plan. Deductibles, coinsurance and copays in either the or with Health Providers all apply to your out-of-pocket maximum. 4. Includes room and board and some other additional charges. After the first three days of copays, Land of Lincoln Health pays 100% of covered services for that hospital stay. Includes services provided for mental/ 5. May include an outpatient clinic or same-day surgery center. Also includes services provided for mental/ 6. All Prescription Drug Benefits listed are for a 34-day supply. Copay for 90-day mail order prescriptions is 2½ times the 34-day retail copay. Coinsurance for mail order is the same as retail. Mutual Health Insurance Company ( Health ) is offering small business health insurance plans described herein. This brochure is distributed for marketing purposes and is not your certificate of coverage. Some health care services will require precertification. If there is any difference between this brochure and the certificate of coverage, the provisions of the certificate of coverage will control. For more information on Health, call or visit. All Small Business Plans sold through the Marketplace are considered QHPs (Qualified Health Plans) or MSPs (Multi-State Plans) as determined by the Affordable Care Act. 18

21 HSA-COMPATIBLE PLAN LAND OF LINCOLN HEALTH PPO LAND OF LINCOLN HEALTH HSA-COMPATIBLE GOLD 100/2300 PPO LAND OF LINCOLN HEALTH HSA-COMPATIBLE SILV 100/4100 PPO LAND OF LINCOLN HEALTH HSA-COMPATIBLE BRONZE 100/6500 PPO $2,300 /,600 $5,000 / $10,000,100 / $8,200 $8,000 / $16,000 $6,500 / $13,000 $12,000 / $24,000 0% 0% 0% $2,300 /,600 Unlimited / Unlimited,100 / $8,200 Unlimited / Unlimited $6,500 / $13,000 Unlimited / Unlimited 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 1. Copays are not. Coinsurances are. The deductible for the Preferred Partner and Health Providers is integrated, meaning qualified payments made within either of those networks apply to that single deductible. 2. Coinsurance is the percentage paid by member after meeting the deductible. Percentages shown within this table represent coinsurance amounts and are always subject to the deductible. Health is responsible for the remainder of the covered services. 3. Out-of-pocket maximum is the most you will ever have to pay in the plan year for covered services under a specific plan. Deductibles, coinsurance and copays in either the or with Health Providers all apply to your out-of-pocket maximum. 4. Includes room and board and some other additional charges. After the first three days of copays, Land of Lincoln Health pays 100% of covered services for that hospital stay. Includes services provided for mental/ 5. May include an outpatient clinic or same-day surgery center. Also includes services provided for mental/ 6. All Prescription Drug Benefits listed are for a 34-day supply. Copay for 90-day mail order prescriptions is 2½ times the 34-day retail copay. Coinsurance for mail order is the same as retail. Mutual Health Insurance Company ( Health ) is offering small business health insurance plans described herein. This brochure is distributed for marketing purposes and is not your certificate of coverage. Some health care services will require precertification. If there is any difference between this brochure and the certificate of coverage, the provisions of the certificate of coverage will control. For more information on Health, call or visit. All Small Business Plans sold through the Marketplace are considered QHPs (Qualified Health Plans) or MSPs (Multi-State Plans) as determined by the Affordable Care Act. 19

22 3-TI PLAN LAND OF LINCOLN HEALTH PPO LAND OF LINCOLN HEALTH 3-TI PLATINUM PPO LAND OF LINCOLN HEALTH 3-TI GOLD PPO LAND OF LINCOLN HEALTH 3-TI SILV PPO LAND OF LINCOLN HEALTH 3-TI BRONZE PPO 0 / $5,000 / $10,000 / $1,000 $6,000 / $12,000 $3,600 / $7,200 $10,000 / $20,000 $5,500 / $11,000 $15,000 / $30,000 30% 30% $15 $1,750 / $3,500 Unlimited / Unlimited $3,900 / $7,800 Unlimited / Unlimited $6,850 / $13,700 Unlimited / Unlimited $6,850 / $13,700 Unlimited / Unlimited $30 $15 $30 $30 (first 3 visits); then subject to deductible/coinsurance $20 $120 $55 $110 $100 copay/day for first 3 days $200 copay/day for first 3 days $650 copay/day for first 3 days $1,300 copay/day for first 3 days 0 copay/day for first 3 days $1,500 copay/day for first 3 days 30% 30% $10 $20 $80 $10 $20 $100 $150 30% 30% 0.5% 30% 30% 30% 30% 1. Copays are not. Coinsurances are. The deductible for the and Health Providers is integrated, meaning qualified payments made within either of those networks apply to that single deductible. 2. Coinsurance is the percentage paid by member after meeting the deductible. Percentages shown within this table represent coinsurance amounts and are always subject to the deductible. Health is responsible for the remainder of the covered services. 3. Out-of-pocket maximum is the most you will ever have to pay in the plan year for covered services under a specific plan. Deductibles, coinsurance and copays in either the or with Health Providers all apply to your out-of-pocket maximum. 4. Includes room and board and some other additional charges. After the first three days of copays, Health pays 100% of covered services for that hospital stay. Includes services provided for mental/ 5. May include an outpatient clinic or same-day surgery center. Also includes services provided for mental/ 6. All Prescription Drug Benefits listed are for a 34-day supply. Copay for 90-day mail order prescriptions is 2½ times the 34-day retail copay. Coinsurance for mail order is the same as retail. Mutual Health Insurance Company ( Health ) is offering small business health insurance plans described herein. This brochure is distributed for marketing purposes and is not your certificate of coverage. Some health care services will require precertification. If there is any difference between this brochure and the certificate of coverage, the provisions of the certificate of coverage will control. For more information on Health, call or visit. All Small Business Plans sold through the Marketplace are considered QHPs (Qualified Health Plans) or MSPs (Multi-State Plans) as determined by the Affordable Care Act. 20

23 SBAC HSA-COMPATIBLE PLAN LAND OF LINCOLN HEALTH PPO SBAC LAND OF LINCOLN HEALTH HSA-COMPATIBLE GOLD PPO $2,000 /,000 $6,000 / $12,000 $6,500 / $13,000 Unlimited / Unlimited 1. Copays are not. Coinsurances are. The deductible for the Preferred Partner and Health Providers is integrated, meaning qualified payments made within either of those networks apply to that single deductible. 2. Coinsurance is the percentage paid by member after meeting the deductible. Percentages shown within this table represent coinsurance amounts and are always subject to the deductible. Health is responsible for the remainder of the covered services. 3. Out-of-pocket maximum is the most you will ever have to pay in the plan year for covered services under a specific plan. Deductibles, coinsurance and copays in either the or with Health Providers all apply to your out-of-pocket maximum. 4. Includes room and board and some other additional charges. After the first three days of copays, Land of Lincoln Health pays 100% of covered services for that hospital stay. Includes services provided for mental/ 5. May include an outpatient clinic or same-day surgery center. Also includes services provided for mental/ 6. All Prescription Drug Benefits listed are for a 34-day supply. Copay for 90-day mail order prescriptions is 2½ times the 34-day retail copay. Coinsurance for mail order is the same as retail. Mutual Health Insurance Company ( Health ) is offering small business health insurance plans described herein. This brochure is distributed for marketing purposes and is not your certificate of coverage. Some health care services will require precertification. If there is any difference between this brochure and the certificate of coverage, the provisions of the certificate of coverage will control. For more information on Health, call or visit. All Small Business Plans sold through the Marketplace are considered QHPs (Qualified Health Plans) or MSPs (Multi-State Plans) as determined by the Affordable Care Act. 21

24 Plans Built Hand-in-Hand with Doctors and Hospitals You Trust Questions? Call one of our experts today: Visit our website for more information: Like our Facebook page and stay connected: Facebook.com/LandofLincolnHealth Join us on Twitter and get the latest updates: Twitter.com/LLHInsured