CO

MM

UN

ITY

H

EALT

H C

HO

ICE

2020

BRO

KER

TRA

ININ

G

Hea

lth In

sura

nce

Mar

ketp

lace

Hou

seke

epin

g

• B

e re

spec

tful o

f you

r pee

rs: P

leas

e m

ake

sure

to m

ute

your

pho

ne a

nd h

old

ques

tions

to th

e en

d of

the

pres

enta

tion

• P

rese

ntat

ion

will

be

sent

to a

ll ag

ents

via

em

ail a

nd w

ill

also

be

post

ed o

n th

e ag

ent p

orta

l

• 20

20 a

genc

y/ag

ent p

aper

wor

k is

ava

ilabl

e fo

r non

-ap

poin

ted

agen

ts/a

genc

ies,

but

sho

uld

be c

ompl

eted

and

su

bmitt

ed im

med

iate

ly to

ens

ure

timel

y ap

poin

tmen

t (yo

u w

ill n

ot b

e pa

id o

n an

y bu

sine

ss s

old

prio

r to

appo

intm

ent

conf

irmat

ion)

• P

leas

e be

sur

e to

pro

vide

any

upd

ates

to y

our

W9/

Add

ress

es/C

onta

ct In

form

atio

n, i.

e. p

hone

, em

ail,

etc.

2

Agen

da

• B

roke

r App

oint

men

t & A

gree

men

t Rem

inde

rs

• S

ofth

eon

Bill

ing

and

Enr

ollm

ent S

yste

m

• 20

20 P

lans

, Ben

efits

& R

ates

•

Ser

vice

Are

a an

d N

etw

ork

• En

rollm

ent &

SEP

’s

• N

ext S

teps

•

Q&

A

3

Bro

ker A

ppoi

ntm

ent &

Agr

eem

ent

Rem

inde

rs

4

Bro

ker A

ppoi

ntm

ent

• M

ust c

ompl

ete

annu

al C

MS

cer

tific

atio

n fo

r Ind

ivid

ual

Mar

ketp

lace

• M

ust c

ompl

ete

annu

al C

omm

unity

trai

ning

and

com

plet

e a

quiz

with

a s

core

of 8

0% o

r hig

her

• A

ll ag

ents

mus

t com

plet

e an

d re

turn

a tr

aini

ng a

ttest

atio

n

• M

ust h

ave

an a

ctiv

e TD

I lic

ense

• M

ust h

old

an a

ctiv

e E

rror

s &

Om

issi

ons

Pol

icy.

• M

ust s

uppl

y a

W9

that

cor

resp

onds

to ta

x fil

ing

addr

ess

5

Bro

ker A

gree

men

t Rem

inde

rs

• Ag

ent/A

genc

y m

ust k

eep

reco

rds

for a

per

iod

of 1

0 ye

ars

as re

quire

d by

CM

S

• Ag

ent/A

genc

y m

ust c

ompl

y w

ith a

ll ap

plic

able

sta

te a

nd fe

dera

l law

s re

gard

ing

solic

itatio

n of

bus

ines

s in

clud

ing

all

stat

e an

d fe

dera

l con

fiden

tialit

y co

nflic

t of i

nter

est

law

s, ru

les

and

regu

latio

ns

• M

ust c

ompl

y w

ith a

ll St

ate

and

Fede

ral r

egul

ator

y re

quire

men

ts in

clud

ing

all

disc

laim

ers

on e

nrol

lmen

t mat

eria

ls a

nd w

ebsi

tes:

•

Sam

ple

Lang

uage

: “A

ttent

ion:

Thi

s w

ebsi

te is

ope

rate

d by

[Nam

e of

Com

pany

] and

is n

ot th

e H

ealth

In

sura

nce

Mar

ketp

lace

web

site

. In

offe

ring

this

web

site

, [N

ame

of C

ompa

ny] i

s re

quire

d to

co

mpl

y w

ith a

ll ap

plic

able

fede

ral l

aw, i

nclu

ding

the

stan

dard

s es

tabl

ishe

d un

der 4

5 C

.F.R

. 15

5.22

0(c)

and

(d) a

nd s

tand

ards

est

ablis

hed

unde

r 45

C.F

.R. 1

55.2

60 to

pro

tect

the

priv

acy

and

secu

rity

of p

erso

nally

iden

tifia

ble

info

rmat

ion.

Thi

s w

ebsi

te m

ay n

ot d

ispl

ay a

ll da

ta o

n Q

ualif

ied

Hea

lth P

lans

bei

ng o

ffere

d in

you

r sta

te th

roug

h th

e H

ealth

Insu

ranc

e M

arke

tpla

ce w

ebsi

te. T

o se

e al

l ava

ilabl

e da

ta o

n Q

ualif

ied

Hea

lth P

lan

optio

ns I

in y

our

stat

e, g

o to

Hea

lth In

sura

nce

Mar

ketp

lace

web

site

at H

ealth

Car

e.go

v.”

• Li

nk: h

ttps:

//ww

w.cm

s.go

v/C

CIIO

/Pro

gram

s-an

d-In

itiat

ives

/Hea

lth-In

sura

nce-

Mar

ketp

lace

s/D

ownl

oads

/Gui

danc

e-W

eb-b

roke

rs-D

ispl

ayin

g-D

iscl

aim

ers.

pdf

6

Bro

ker A

gree

men

t and

C

ompe

nsat

ion

for 2

020

• P

ost T

rain

ing,

all

agen

ts w

ill c

ompl

ete

the

2020

Ben

efit

quiz

and

sig

n an

d da

te th

e 20

20

Trai

ning

Com

plet

ion

Atte

stat

ion.

You

mus

t sub

mit

both

the

quiz

AN

D a

ttest

atio

n ba

ck to

C

omm

unity

Hea

lth C

hoic

e @

Age

nt.C

rede

ntia

ling@

Com

mun

ityC

ares

.com

• 20

20 C

ompe

nsat

ion

– C

omm

unity

has

app

rove

d a

20%

INC

RE

AS

E in

Bro

ker

com

mis

sion

s be

ginn

ing

Janu

ary

1, 2

020.

Bro

ker

will

now

ear

n $1

8 pe

r m

embe

r pe

r m

onth

for

new

or

rene

win

g bu

sine

ss o

n al

l pla

ns

• C

omm

issi

on s

tate

men

ts a

re g

ener

ated

on

the

3rd F

riday

of t

he m

onth

• C

omm

issi

ons

are

paya

ble

on th

e 4th

Frid

ay o

f the

mon

th

• C

omm

issi

on D

irect

Dep

osit

is d

one

thro

ugh

EFT.

Thi

s re

quire

s se

t up

thro

ugh

our

third

-par

ty v

endo

r, FI

S In

tegr

ated

Pay

able

s an

d co

mes

in th

e fo

rm o

f an

emai

led

notif

icat

ion

dire

ct fr

om F

IS In

tegr

ated

Pay

able

s (n

ot C

omm

unity

). Fo

r mor

e in

form

atio

n pl

ease

con

tact

Age

nt.C

omm

issi

ons@

Com

mun

ityC

ares

.com

• Ag

ent o

f Rec

ord

(AO

R )

chan

ges

are

effe

ctiv

e th

e fir

st o

f the

follo

win

g m

onth

or a

t the

di

scre

tion

of C

omm

unity

Hea

lth C

hoic

e, In

c.

7

Boo

k of

Bus

ines

s Tr

ansf

ers

• P

urch

asin

g/Tr

ansf

errin

g bo

oks

of b

usin

ess

due

to d

eath

, ret

irem

ent,

etc.

•

On-

Exc

hang

e bu

sine

ss

• B

ulk

trans

fer p

roce

ss n

ot c

urre

ntly

in p

lace

per

CM

S

• C

onse

nt re

quire

d by

eac

h co

nsum

er (A

OR

form

) bef

ore

you

can

proc

eed

to

1) c

ondu

ct a

n on

line

pers

on s

earc

h 2)

ass

ist w

ith c

ompl

etin

g a

Mar

ketp

lace

app

licat

ion

3) a

ssis

t with

pla

n se

lect

ion

and

enro

llmen

t 4)

ass

ist w

ith o

ngoi

ng a

ccou

nt/e

nrol

lmen

t mai

nten

ance

usi

ng

the

Dire

ct E

nrol

lmen

t Pat

hway

.

For m

ore

info

rmat

ion

on th

e co

nsum

er c

onse

nt re

quire

men

t, se

e th

is

reso

urce

: http

s://w

ww.

cms.

gov/

CC

IIO/P

rogr

ams-

and-

Initi

ativ

es/H

ealth

-In

sura

nce-

Mar

ketp

lace

s/D

ownl

oads

/AB

-Sum

mit-

Mas

terin

g-A

gent

-Bro

ker-

Com

plia

nce.

pdf

8

Sof

theo

n B

illin

g an

d E

nrol

lmen

t S

yste

m

9

Sof

theo

n B

illin

g an

d En

rollm

ent S

yste

m

• S

ofth

eon

is a

clo

ud-b

ased

ser

vice

that

is re

spon

sibl

e fo

r ha

ndlin

g C

omm

unity

’s e

nrol

lmen

ts a

nd in

voic

ing

need

s,

incl

udin

g th

e br

oker

enr

ollm

ent p

orta

l

• C

omm

unity

onl

y re

ceiv

es th

e ef

fect

uate

d fil

es (m

embe

rs

who

hav

e pa

id th

eir f

irst p

rem

ium

) w

ho a

re th

en lo

aded

in

to th

e el

igib

ility

and

cla

ims

paym

ent s

yste

ms

• M

embe

rs w

ill n

ot re

ceiv

e m

ater

ials

incl

udin

g M

embe

r W

elco

me

Pac

kets

, or I

D c

ards

unt

il th

e m

embe

r ha

s ef

fect

uate

d co

vera

ge a

nd s

elec

ted

a P

rimar

y C

are

Phy

sici

an

• If

a P

CP

is n

ot s

elec

ted,

one

will

be

assi

gned

10

Pay

men

ts

• O

nce

a m

embe

r enr

olls

in a

Com

mun

ity p

lan

they

will

be

able

to m

ake

thei

r ini

tial

paym

ent a

nd a

ny o

ngoi

ng p

aym

ents

: –

Onl

ine

via

our w

ebsi

te

– Pa

y-by

-pho

ne b

y ca

lling

Com

mun

ity d

irect

ly

• op

tion

to s

peak

to a

repr

esen

tativ

e •

optio

n to

pay

by

IVR

pay

men

t pro

mpt

s w

ithou

t spe

akin

g to

an

indi

vidu

al

– M

aile

d m

oney

ord

er o

r che

ck to

add

ress

on

billi

ng s

tate

men

t (m

ust

incl

ude

subs

crib

er ID

or

mon

ies

cann

ot b

e ap

plie

d)

• Fo

rms

of P

aym

ent A

ccep

ted:

–

Che

ck

– C

redi

t car

d (V

isa/

Mas

terc

ard/

Dis

cove

r)

– D

ebit

card

–

Mon

ey O

rder

• A

fter

mem

bers

hav

e m

ade

thei

r ini

tial b

inde

r pay

men

t, th

ey c

an s

et u

p re

curr

ing

paym

ents

onl

ine.

Pay

men

ts w

ill b

e de

duct

ed th

e 15

th o

r the

25th

of e

ach

mon

th fr

om

the

esta

blis

hed

acco

unt.

This

can

als

o be

com

plet

ed a

fter m

akin

g th

e in

itial

pay

men

t at

the

time

of e

nrol

lmen

t.

• M

embe

rs w

ho a

re s

et u

p on

recu

rrin

g pa

ymen

ts fo

r 201

9 th

at re

new

for 2

020

will

onl

y be

re

quir

ed to

re-e

stab

lish

recu

rring

pay

men

ts if

they

sel

ecte

d th

e “o

ther

am

ount

” pay

men

t op

tion

whe

n cr

eatin

g th

eir a

ccou

nt

11

• BIi

ngH

nma

f "

pp

ea,

Of1

')IO

I.JI'

(OTIH

h c;

ard)

Ml

Con

p,m

v N

rn

e

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rlg

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s

Str

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ddr

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l 77

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c::>-

ll

.,,, P

lea

se s

en

d m

e a

p.t

)'m

en

l con

finn.

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n e

ma

il

c,_

Cllr

d -r

ypo

Cra

lll

Car

d H

i.an

ber

E>

pn

llo

n

Cre

di! C

ard

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ber

Mon

lh,

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m

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cv

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et T

h,,-

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ou

r hr

.;;t p

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ill b

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Setti

ng u

p re

curri

ng p

aym

ents

• If

you

are

setti

ng u

p re

curr

ing

paym

ents

for t

he fi

rst t

ime

and

also

nee

d to

mak

e a

paym

ent:

You

can

acco

mpl

ish

this

by

mak

ing

your

initi

al

paym

ent (

popu

latin

g th

e pa

ymen

t inf

orm

atio

n) th

en s

elec

ting

“Set

Thi

s Ac

coun

t for

Aut

opay

”. By

doi

ng s

o yo

u w

ill se

e th

e sc

reen

on

the

right

ha

nd s

ide

that

will

allo

w th

e au

topa

y in

form

atio

n to

be

popu

late

d an

d pa

ymen

t sel

ectio

n da

te. T

his

will

als

o in

clud

e th

e fir

st d

ate

of a

utop

ay.

You

will

als

o ha

ve th

e op

tion

to re

ceiv

e an

em

ail c

onfir

mat

ion.

12

HEAL

TH C

HO

ICE

Wha

t wou

ld y

ou li

ke to

do

? Ret

urn

Hom

e

Con

tact

Info

rmat

ion

Mak

e a

Qui

ck P

aym

ent

lndi

v

Aut

omat

ic P

aym

ents

W

hy G

ive U

s Yo

ur E

mai

l Add

ress

? By

pro

vidi

ng y

our e

mai

l add

ress

, you

giv

e C

omm

unity

1

time.

The

se e

mai

ls w

ill be

sen

t to:

(1) h

elp

you

gel t

he m

ost o

ut o

f you

r hea

lth p

lan,

(2) k

e,

info

rmat

ion,

(3) h

elp

you

stay

as

heal

thy

as p

ossi

ble,

and

, (4)

occ

asio

nally

, req

uest

you

r le

•Ent

er y

our a

ccou

nt in

form

atio

n be

low

exa

ctly

as

it ap

pear

s on

you

r sta

tem

ent R

efer

to y

our m

ost r

ecen

t sla

fem

enl a

nd th

£

Cho

ose

a pa

ymen

t met

hod

• C

redi

t Car

d Pa

ymen

t C

heck

Pay

men

t <

:G,n

age

Recu

rring

Pay

me~

Ac

coun

t Nic

knam

e Pa

perle

ss P

refe

renc

es

Cha

nge

My

Addr

ess

Cha

nge

Alte

rnat

e Ad

dres

s

View

Dep

ende

nts

Add

a D

epen

dent

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ove

a D

epen

dent

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nge

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Prov

ider

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Bene

fits

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unt

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tory

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ice R

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st H

isto

ry

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erag

e

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nge

Effe

ctiv

e D

ate

Polic

y H

isto

ry

Gen

erat

e In

voic

e

Sign

Out

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Acc

ount

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g Na

me

(as

it ap

pear

s on

you

r cre

dit c

ard)

Firs

t Nam

e

Billin

g Ad

dres

s

Stre

et A

ddre

ss 1

Stre

et A

ddre

ss 2

City

E-M

ail

Cred

it Ca

rd T

ype

Cred

it Ca

rd N

umbe

r

Cre

dit C

ard

Num

ber

El Zi

p

Ml

Expi

ratio

n

Mon

th

e a

date

for p

aym

ents

to b

e m

ade La

st N

ame

CV

Cor

CW

El Y

earE

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e

each

mon

th

Your

firs

t pay

men

t will

be m

ade

on 1

1115

1201

7 ¢

the

amou

nt to

pay

Mem

ber r

ecur

ring

paym

ent o

ptio

ns

• M

embe

rs c

an s

et u

p or

man

age

recu

rrin

g pa

ymen

ts o

nlin

e •

Aut

omat

ic P

aym

ents

ca

n be

mad

e by

ch

ecki

ng/s

avin

gs

acco

unt o

r cre

dit

card

•

Pay

men

t opt

ions

in

clud

e th

e 15

th o

r 25

th o

f the

mon

th

(ple

ase

note

pay

men

ts a

re

due

prio

r to

the

cove

rage

m

onth

)

13

HEAL

TH C

HOIC

E

End

My

Cove

rage

Chan

ge E

ffecti

ve D

ate

Polic

y Hi

story

Gen

erat

e In

voice

Sign

Out

Indi

vidu

al &

Fam

ily

Cred

tt Ca

rd N

umbe

r Ex

pirat

ion

CV

Cor

CW

Cred

it Ca

rd N

umbe

r M

onth

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Yea

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cw e

Ch

oose

a da

te fo

r pay

men

ts to

be m

ade

15th

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of e

ach

mon

th

Your

first

paym

ent w

ill be

mad

e on

11/

15/2

017

Choo

se th

e am

ount

to p

ay

• To

tal A

mou

nt D

ue

0.00

Mon

thly

Prem

ium

120.

39

Oth

er A

mou

nt

O 00

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ired

field

s ar

e de

note

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a co

lore

d ba

r.

0 0

Plea

se n

ote th

at by

sele

cting

''Tota

l Am

ount

Due"

, this

amou

nt is

subje

ct to

chan

ge b

ased

on

your

late

st ou

tstan

ding

balan

ce o

n the

recu

rring

pa

ymen

t dat

e.

Back

Brok

ers -

Rec

urrin

g Pa

ymen

t Opt

ions

Opt

ion

1: T

otal

Am

ount

Due

By

sele

ctin

g to

tal a

mou

nt d

ue th

e m

embe

r is

agre

eing

to p

ay th

e fu

ll am

ount

ow

ed, i

nclu

ding

any

out

stan

ding

pay

men

ts

14

HE

ALT

H C

HO

ICE

End

My

Cov

erag

e

Cha

nge

Effe

ctiv

e D

ate

Pol

icy

His

tory

Gen

erat

e In

voic

e

Sig

n O

ut

Indi

vidu

al &

Fam

ily

Cre

dit C

ard

Num

ber

Expi

ratio

n C

VC

orC

W

Cre

dit

Car

d N

umbe

r M

onth

El

Y

ea

rE]

cw

e C

hoos

e a

date

for p

aym

ents

to b

e m

ade

15th

E]

of e

ach

mon

th

You

r firs

t pay

men

t will

be

mad

e on

11/

15/2

017

Cho

ose

the

amou

nt to

pay

• To

tal A

mou

nt D

ue

000

Mon

thly

Pre

miu

m

120.

39

Oth

er A

mou

nt

0 00

I Req

uire

d fie

lds

are

deno

ted

by a

col

ored

bar

.

0 0

Plea

se n

ote

that

by

sele

ctin

g "M

onth

ly

Prem

ium

", th

is a

mou

nt is

sub

ject

to

chan

ge b

ased

on

your

mon

thly

pr

emiu

m a

ssoc

iate

d w

ith y

our l

ates

t po

licy

on th

e re

curri

ng p

aym

ent d

ate.

Bac

k

Bro

kers

-

Rec

urrin

g Pa

ymen

t Opt

ions

• O

ptio

n 2:

Mon

thly

Pre

miu

m

• B

y se

lect

ing

mon

thly

pre

miu

m th

e m

embe

r is

agre

eing

to p

ay

only

the

mon

thly

pre

miu

m a

mou

nt (n

ot a

ny o

utst

andi

ng

paym

ents

ow

ed)

15

HE.A

CTH

CH

OIC

B

End

My

Cov

erag

e

Cha

nge

Effe

ctiv

e D

ate

Polic

y H

isto

ry

Gen

erat

e In

voic

e

Sign

Out

Cre

dit C

ard

Num

ber

Expi

ratio

n C

VC

orC

W

Cre

dit C

ard

Num

ber

Mon

th

El

Yea

rE]

cw e

Ch

oose

a d

ate

for p

aym

ents

to b

e m

ade

15th

E]

of e

ach

mon

th

Your

firs

t pay

men

t will

be m

ade

on 1

1/15

/201

7

Choo

se th

e am

ount

to p

ay

• To

tal A

mou

nt D

ue

0.00

0

Mon

thly

Pre

miu

m

120.

39

0

Oth

er A

mou

nt

O 00

I Req

uire

d fie

lds

are

deno

ted

by a

col

ored

bar

.

Indi

vidu

al &

Fam

ily

Bro

kers

Back

-

Rec

urrin

g Pa

ymen

t Opt

ions

Opt

ion

3: O

ther

Am

ount

B

y se

lect

ing

othe

r am

ount

the

mem

ber i

s ag

reei

ng to

pay

onl

y th

e am

ount

en

tere

d (o

r an

amou

nt th

ey h

ave

deci

ded

at th

e tim

e au

to p

aym

ents

wer

e se

t up)

. Ple

ase

note

, if t

his

amou

nt is

less

than

wha

t is

due

they

will

go in

to

Gra

ce P

erio

d.

16

Bill

ing

Cyc

le a

nd G

race

Per

iod

• M

embe

rs p

rem

ium

s ar

e du

e by

the

first

day

of t

he c

over

age

mon

th

– e.

g. F

ebru

ary’

s pr

emiu

m is

due

no

late

r tha

n Fe

brua

ry 1

st

• P

aym

ents

not

rece

ived

by

the

first

day

of t

he c

over

age

mon

th a

re c

onsi

dere

d la

te

• Te

rmin

atio

ns a

re p

roce

ssed

on

the

5th

of e

ach

mon

th

• M

embe

rs w

ho h

ave

AP

TC re

ceiv

e a

90 d

ay g

race

per

iod

only

aft

er th

e bi

nder

pa

ymen

t has

bee

n m

ade

in fu

ll to

effe

ctua

te c

over

age

• M

embe

rs w

ho d

o no

t hav

e A

PTC

rece

ive

a 30

day

gra

ce p

erio

d on

ly a

fter

the

bind

er p

aym

ent h

as b

een

mad

e in

full

to e

ffect

uate

cov

erag

e

• M

embe

rs w

ho e

nter

gra

ce w

ill o

nly

com

e ou

t of g

race

per

iod

if al

l cur

rent

and

pa

st d

ue p

rem

ium

s ar

e pa

id b

efor

e th

e en

d of

the

grac

e pe

riod

cycl

e

• In

201

8, C

MS

pas

sed

new

regu

latio

ns re

late

d to

mem

bers

who

term

inat

e fo

r no

n-pa

ymen

t tha

t pre

vent

s m

embe

rs fr

om re

-enr

ollin

g w

ithou

t pay

ing

back

pas

t du

e pr

emiu

ms.

Thi

s w

ill c

ontin

ue to

be

enfo

rced

by

Com

mun

ity H

ealth

Cho

ice

in

2020

17

Bill

ing

and

Enro

llmen

t Ter

min

olog

y

• P

assi

ve E

nrol

lmen

t – A

n en

rollm

ent w

here

the

mem

ber r

emai

ns w

ith th

e sa

me

Qua

lifie

d H

ealth

P

lan

unde

r the

sam

e pl

an

• G

race

Per

iod

– A

tim

efra

me

give

n to

mem

bers

to a

llow

the

mem

ber t

o pa

y al

l pas

t due

am

ount

s to

avo

id b

eing

term

inat

ed fo

r non

pay

men

t. N

ote:

Gra

ce p

erio

d on

ly a

pplie

s to

effe

ctua

ted

polic

ies

• B

inde

r P

aym

ent

– Th

e in

itial

pay

men

t req

uire

d to

effe

ctua

te c

over

age

for t

he fi

rst m

onth

of t

he

polic

y

• E

ffec

tuat

e –

A p

olic

y is

con

side

red

effe

ctua

ted

whe

n th

e bi

nder

pay

men

t is

mad

e in

full

to a

ctiv

ate

polic

y

• P

olic

y R

ate

Am

ount

– T

he s

tand

ard

rate

for a

ll m

embe

rs. T

he p

olic

y ra

te a

mou

nt is

bas

ed o

n ag

e, to

bacc

o us

er, p

lan

sele

cted

and

ratin

g ar

ea

• A

PTC

(A

dvan

ced

Pre

miu

m T

ax C

redi

t) –

Fin

anci

al a

ssis

tanc

e (s

ubsi

dies

) pro

vide

d by

the

Fede

ral G

over

nmen

t giv

en to

indi

vidu

als

who

app

ly fo

r cov

erag

e th

roug

h H

C.g

ov a

nd m

eet

all q

ualif

icat

ions

. The

am

ount

var

ies

from

fam

ily to

fam

ily

�Fa

mili

es a

pply

ing

for A

PTC

sho

uld

list h

ead

of h

ouse

hold

as

the

subs

crib

er

�In

divi

dual

s re

ceiv

ing

AP

TC m

ust f

ile in

com

e ta

x re

turn

�

Indi

vidu

als

who

pro

vide

inac

cura

te o

r inc

ompl

ete

info

rmat

ion

are

subj

ect t

o pe

nalti

es a

nd

may

ow

e ba

ck a

ll su

bsid

y re

ceiv

ed

18

Bill

ing

and

Enro

llmen

t Ter

min

olog

y C

ontin

ued

• C

SR

(Cos

t Sha

re R

educ

tion)

– A

redu

ctio

n of

cos

t for

hea

lth b

enef

its fo

r in

divi

dual

s w

ho a

re e

nrol

led

in a

qua

lifie

d S

ilver

pla

n. H

ealth

ben

efits

in

clud

e de

duct

ible

s, c

oins

uran

ce, c

opay

s, o

r oth

er s

imila

r cha

rges

(doe

s no

t ap

ply

to p

rem

ium

). M

embe

rs q

ualif

y fo

r CS

R b

ased

on

inco

me

repo

rted.

• P

ast D

ue A

mou

nt –

The

am

ount

the

mem

ber o

wes

for m

onth

s th

at w

ere

not p

aid

by th

e du

e da

te.

• P

aid

Thro

ugh

Dat

e –

The

date

in w

hich

the

mem

ber h

as m

ade

timel

y pa

ymen

ts. N

ote:

The

Pai

d th

roug

h da

te d

oes

not r

oll o

ver i

f a p

artia

l pa

ymen

t is

mad

e.

• C

laim

s P

aid

Thro

ugh

Dat

e –

The

date

cal

cula

ted

for A

PTC

mem

bers

, the

ca

lcul

ated

dat

e is

the

Pai

d th

roug

h da

te +

1 m

onth

. The

Cla

ims

Pai

d Th

roug

h D

ate

will

not b

e gr

eate

r tha

n th

e te

rmin

atio

n da

te.

• Fi

nanc

e P

aid

Thro

ugh

Dat

e –

The

date

cal

cula

ted

for m

embe

rs s

olel

y ba

sed

on p

rem

ium

s an

d pa

ymen

ts. T

he F

inan

ce P

aid

Thro

ugh

Dat

e do

es

not l

ook

at w

heth

er th

e pa

ymen

t was

mad

e on

tim

e.

19

HEAL

TH IN

SURA

NCE

MARK

ETPL

ACE

QUICK

, MAK

E YOU

R LIFE

EASIE

R.

Creat

e an o

nline

accou

nt so

you ca

n:

Q• Pri

nt a t

empo

rary I

D card

• Find

a do

ctor o

r phar

macy

• Chec

k you

r Mem

ber ha

ndbo

ok

Q • Se

nd se

cure

messa

ges

• Make

a qu

ick pa

ymen

t

• Mana

ge au

tomati

c paym

ents

• Sign

up fo

r pap

erless

billin

g

• Upd

ate yo

ur ad

dress

• View

your

depe

nden

ts

Q• Ch

ange a

Prov

ider

• View

your

bene

fits

[QUIC

K PAY

MENT

] Ma

ke a p

ayme

nt wi

thout

creati

ng an

acco

unt o

r log

ging i

nto yo

ur acc

ount.

NOTE

: Com

munit

y Heal

th Ch

oice i

s not

affilia

ted w

ith Co

mmun

ityOu

ickCa

re. Pl

ease m

ake A

ll Com

munit

y He

alth C

hoice

Mark

etplac

e paym

ents b

y sign

ing in

to

your o

nline

accou

nt or

using

our O

ulck P

ay op

tion.

MEMB

ER LO

G IN

Usern

ame

Passw

ord

Reme

mber

Me

-

Mem

ber P

orta

l Acc

ess •

Mem

bers

who

crea

te a

n on

line

acco

unt a

re a

ble

to u

se se

lf-se

rve

func

tiona

lity

inclu

ding

: •

Send

secu

re e

mai

l to

Mem

ber

Serv

ices

• Pr

int t

empo

rary

ID ca

rds

• Su

bmit

a re

ques

t to

add

or

chan

ge a

Prim

ary

Care

Phy

sicia

n (P

CP)

• M

ake

one-

time

paym

ents

“Q

uick

Pay

men

t”

• Se

t-up

or m

anag

e re

curr

ing

paym

ents

•

Part

icipa

te in

the

2020

Wel

lnes

s Pr

ogra

m a

nd e

arn

gift

card

s

20

· H

EALT

H C

HO

ICE

Wha

t wou

ld y

ou li

ke to

do

? Ret

urn

Hom

e

Con

tact

Info

rmat

ion

Mak

e a

Qui

ck P

aym

ent

Man

age

Rec

urrin

g Pa

ymen

ts

Pape

rless

Pre

fere

nces

Cha

nge

My

Addr

ess

Cha

nge

Alte

rnat

e Ad

dres

s

View

Dep

ende

nts

Add

a D

epen

d ent

Rem

ove

a D

epen

dent

Cha

nge

My

Prov

ider

View

My

Bene

fits

Acc

ount

His

tory

Invo

ice

Hist

ory

Hom

e Sh

owin

g de

tails

for 1

/1/2

017

-12/

31/2

017

Paym

ent S

tatu

s

Unp

aid

Mon

thly

Pre

miu

m

$180

.04

$426

.56

Prem

ium

-$2

46.5

2 A

PTC

Last

Pay

men

t

$180

.04

on 8

/27/

2017

11

1\.

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a ra

11

11

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t Pay

men

t Due

$360

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Due

In

13 D

ays

by 1

0/31

/201

7

Paid

Thr

ough

Dat

e

9/30

/201

7 A

grac

e pe

riod

is wh

en y

ou a

re s

till

cove

red,

but

hav

e a

late

pay

men

t You

m

ust e

xn th

e gr

ace

perio

d in

a ce

rtain

am

ount

of t

ime

to a

void

losin

g yo

ur

heal

th c

over

age.

Mem

ber P

orta

l Acc

ess

• G

race

Per

iod

info

rmat

ion

can

be v

iew

ed o

n th

e M

embe

r Por

tal

21

Rec

ap

• A

PTC

Mem

bers

rece

ive

a 90

day

gra

ce p

erio

d

• N

on-A

PTC

Mem

bers

rece

ive

a 30

day

gra

ce p

erio

d

• G

race

Per

iod

does

NO

T ro

ll ov

er, t

he m

embe

r mus

t pay

all

past

du

e pr

emiu

m a

mou

nts

to e

xit t

he G

race

Per

iod

befo

re th

e en

d of

th

e G

race

Per

iod

cycl

e

• B

egin

ning

in 2

018,

CM

S p

asse

d a

new

regu

latio

n al

low

ing

Hea

lth

Pla

ns to

cha

rge

all p

ast d

ue p

rem

ium

s ca

rrie

d ov

er in

ord

er to

ef

fect

uate

cov

erag

e. C

omm

unity

will

con

tinue

to e

nfor

ce th

is

regu

latio

n in

202

0 an

d co

llect

pas

t due

am

ount

s.

22

Plan

s, B

enef

its &

Rat

es

23

Adv

ance

d Pr

emiu

m T

ax C

redi

ts (A

PTC

)

• Ta

x cr

edit

subs

idie

s av

aila

ble

thro

ugh

the

exch

ange

are

ca

lled

Adv

ance

d P

rem

ium

Tax

Cre

dits

(AP

TC)

• AP

TC’s

ass

ist m

embe

rs w

ith th

eir m

onth

ly p

rem

ium

• W

ho is

elig

ible

for A

PTC

? 9

Indi

vidu

al e

arns

bet

wee

n 10

0%-4

00%

Fed

eral

Pov

erty

Lev

el (F

PL)

9

Indi

vidu

al is

not

elig

ible

for c

over

age

thro

ugh

thei

r em

ploy

er,

Med

icai

d, o

r Med

icar

e*

�O

r em

ploy

er s

pons

ored

cov

erag

e is

mor

e th

an 9

.5%

of t

heir

inco

me

�O

r em

ploy

er s

pons

ored

cov

erag

e do

esn’

t mee

t min

imum

ess

entia

l co

vera

ge re

quire

men

ts

�Th

e on

ly w

ay to

get

APT

C is

to e

nrol

l “O

n Ex

chan

ge”

24

Cos

t Sha

ring

Red

uctio

n Pl

ans

• C

SR’s

will

still

exis

t in

2020

• E

nrol

lees

<25

0% F

eder

al P

over

ty L

evel

(FP

L) a

re e

ligib

le

for C

ost S

harin

g R

educ

tion

(CS

R) p

lans

• O

nly

Silv

er le

vel p

lans

hav

e C

SR b

enef

its

• C

ost S

harin

g R

educ

tions

mea

n re

duce

d co

pays

, co

insu

ranc

es, a

nd lo

wer

out

-of-p

ocke

t max

imum

s

• Th

ere

are

3 S

ilver

CS

R p

lans

: •

Silv

er 7

3 =

201-

250%

FP

L •

Silv

er 8

7 =

151-

200%

FP

L •

Silv

er 9

4 =

100-

150%

FP

L •

If a

pote

ntia

l enr

olle

e ea

rns

<100

% F

PL,

they

are

not

elig

ible

for C

SR

pl

ans

unle

ss th

ey m

eet s

peci

fic c

riter

ia

25

Lim

ited

and

Zero

Cos

t Sha

ring

Plan

s

If a

cons

umer

is a

mem

ber o

f the

fede

rally

reco

gnize

d tr

ibe

or a

n Al

aska

Nat

ive

Clai

ms S

ettle

men

t Act

Cor

pora

tion

shar

ehol

der,

they

may

qua

lify

for a

dditi

onal

co

st-s

harin

g re

duct

ions

.

To le

arn

mor

e: h

ttps:

//ww

w.he

alth

care

.gov

/am

eric

an-in

dian

s-al

aska

-nat

ives

/

Zero

Cos

t Sha

ring

Pla

ns

Lim

ited

Cos

t Sha

ring

Pla

ns

• P

ay $

0 co

pays

or 0

%•

Nat

ive

Am

eric

ans,

100-

300%

co

insu

ranc

e at

Indi

an H

ealth

FP

L an

d qu

alify

for A

PTC

S

ervi

ce P

rovi

ders

* on

ly

• P

ay $

0 co

pays

or 0

%

– G

old

Lim

ited

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001

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unity

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mun

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igh

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ual/f

amily

) $6

,750

/ $1

3,50

0 $6

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/ $1

3,50

0 O

ut-o

f-Po

cket

Max

(ind

ivid

ual/f

amily

) $6

,750

/ $1

3,50

0 $6

,750

/ $1

3,50

0 M

EDIC

AL B

ENEF

ITS

PCP

Off

ice

Visi

t N

o Ch

arge

aft

er d

educ

tible

N

o,Ch

arge

, afte

r ded

uctib

le

Spec

ia I i

st O

ffice

Vis

it

No

Char

ge a

fter d

educ

tible

N

o Ch

arge

.afte

r ded

uctib

le

Out

patie

nt F

acili

ty

No

Char

ge a

fter d

educ

tible

N

o Ch

arge

,afte

r ded

uctib

le

Out

patie

nt S

urge

ry

No

Char

ge a

fter

ded

uctib

le

No

Char

ge .a

fter d

educ

tible

U

rgen

t Car

,e Se

rvic

es

No

Char

ge a

fter

ded

uctib

le

No

Char

ge ,a

fter d

educ

tible

A

mbu

lanc

e Se

rvic

es

No

Char

ge a

fter

ded

uctib

le

No

Char

ge .a

fter

ded

uctib

le

Emer

genc

y Ro

om S

ervi

ces

No

Char

ge a

fter d

educ

tible

N

o Ch

arge

,afte

r ded

uctib

le

Inpa

tient

Hos

pita

l car

e N

o Ch

arge

aft

er d

educ

tible

N

o Ch

arge

.afte

r ded

uctib

le

Inpa

tient

Ski

lled

Nur

sing

Fac

ility

N

o Ch

arge

aft

er d

educ

tible

N

o Ch

arge

,aft

er d

educ

tible

O

utpa

tient

Men

tal/

Beh

avio

ral/S

ubst

ance

Abu

se

No

Char

ge a

fter

ded

uctib

le

No

Char

ge .a

fter

ded

uctib

le

Inpa

tient

Men

tal/

Beh

avio

ral/

Subs

tanc

e· A

buse

N

o Ch

arge

aft

er d

educ

tible

N

o Ch

arge

,afte

r ded

uctib

le

Out

patie

nt R

ehab

ilita

tion

No

Char

ge a

fter

ded

uctib

le

No

Char

ge .a

fter d

educ

tible

M

edic

al Im

agin

g (C

T/PE

T Sc

ans/

MR

l's)

No

Char

ge a

fter

ded

uctib

le

No

Char

ge .a

fter

ded

uctib

le

Rout

ine

Lab/

X-R

ay/D

iagn

ostic

Imag

ing

No

Char

ge a

fter

ded

uctib

le

No

Char

ge ,a

fter d

educ

tible

PR

ESCR

IPTI

ON

DRUG

S Pr

escr

iptio

n Dr

ug D

educ

tible

(ind

ivid

ual/f

amily

) Co

mbi

ned

with

Co

mbi

ned

with

00

day

mai

l ord

e,r s

uppl

y av

aila

ble

at 2

.5 x

copa

y)

Med

i,cal

Ded

uctib

le

Med

ical

Ded

uctib

le

Gen

eric

N

o Ch

arge

afte

r ded

uctib

le

No

Char

ge ,a

fter d

educ

tible

Pr

efer

red

No

Char

ge a

fter

ded

uctib

le

No

Char

ge a

fter d

educ

tible

N

on~P

refe

rred

Bra

nd

No

Char

ge a

fter

ded

uctib

le

No,

Char

ge ,a

fter

ded

uctib

le

Spec

ialty

Hig

h Co

st D

rugs

N

o Ch

arge

aft

er d

educ

tible

N

o Ch

arge

.aft

er d

educ

tible

£or D

educ

tible

Pla

ns: A

ll ,co

insu

ranc

e/co

pays

app

ly a

fter

ann

ual d

educ

tible

has

bee

n m

et. U

nle•s

s ot

herw

ise•

indi

cate

d +

2020

Cha

nges

-Hig

h D

educ

tible

H

ealth

Pla

n (H

DH

P) 0

08

35

2020

20

19

2020

20

19

2020

20

19

2020

Sil

ver D

educ

tible

Si

lver D

educ

tible

Si

lver D

educ

tible

Silv

er D

educ

tible

Si

lver

MEMB

ER

Silve

r Ded

uctib

le S

ilver

Ded

uctib

le

Silve

r Ded

uctib

le

009

(73)

009(

73)

009

(87)

009 (

87)

Dedu

ctibl

e 009

CO

ST SH

ARE

009

250%

FPL a

nd 0

09 25

0% FP

L and

00

9 (94

) ab

ove

abov

e 20

0-249

%

200-

249%

15

0-199

% FP

L and

150

-199%

FPL a

nd

100-1

49%

FPL

(94)

FPL a

nd ab

ove

FPL a

nd ab

ove

abov

e ab

ove

100-1

49%

FPL

Med

ical D

educ

tible

(indi

vidu

al/fa

mily

) $5

,ooo I

$10,

000

$5,o

oo I $

10,0

00

$2,5

00 /

$5,00

0 $2

,soo

/ $5

,ooo

N/A

N/

A

N/A

N/

A

Out-o

f-Poc

ket M

ax (i

ndivi

dual

/fam

ily)

$1,00

0 I $1

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o $7

,000 /

$14

,000

$6

,000

/ $1

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$6

,000

/ $1

2,000

$2

,600

/ $5

,200

$2

, 700

/ $5

,400

$2,5

00 /

$5,00

0 $2

,500

/ $5

,000

MEDI

CAL

BENE

FITS

PCP

Offic

e Vi

sit

*$30

*$

30

*$30

*$

30

$20

$25

$10

$10

Spec

ialis

t Offic

e Visi

t $6

0 $6

0 $6

0 $6

0 $5

0 $5

0 $2

0 $2

0 Ou

tpat

ient

Facil

ity

30%

30%

30%

30%

20%

20%

10%

10%

Outp

atie

nt S

urge

ry 30

% 30

% 30

% 30

% 20

% 20

% 10

% 10

% Ur

gent

Care

Servi

ces

*$60

*$

60

*$60

*$

60

$50

$50

$20

$20

Ambu

lance

Ser

vice

s $6

0 $6

0 $6

0 $6

0 $5

0 $5

0 $2

0 $2

0 Em

erge

ncy R

oom

Serv

ices

30%

30%

30%

30%

20%

20%

10%

10%

Inpa

tient

Hos

pita

l Car

e 30

% 30

% 30

% 30

% 20

% 20

% 10

% 10

% In

patie

nt Sk

illed

Nur

sing F

acili

ty

30%

30%

30%

30%

20%

20%

10%

10%

Outp

atie

nt M

enta

l/Beh

avior

al/S

ubsta

nce A

buse

*$

30

*$30

*$

30

*$30

$2

0 $2

0 $1

0 $1

0 In

patie

nt M

enta

l/Beh

avior

al/S

ubsta

nce

Abus

e 30

% 30

% 30

% 30

% 20

% 20

% 10

% 10

% Ou

tpat

ient

Reh

abilit

ation

$6

0 $6

0 $6

0 $6

0 $5

0 $5

0 $1

0 $1

0 M

edica

l Imag

ing

(CT/P

ET Sc

ans/M

Rl's)

30

% 30

% 30

% 30

% 20

% 20

% 10

% 10

% Ro

utine

Lab/X

-Ray

/Diag

nost

ic Im

aging

$3

0 $3

0 $3

0 $3

0 $2

0 $2

0 $1

0 $1

0 PR

ESCR

IPTIO

N DR

UGS

Com

bined

Co

mbi

ned w

ith

Com

bined

with

Co

mbin

ed w

ith

Com

bine

d with

Co

mbin

ed w

ith

Com

bined

with

Co

mbin

ed w

ith

with

* P

resc

riptio

n Dr

ug D

educ

tible

(indi

vidu

al/fa

mily

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edica

l M

edica

l M

edica

l M

edica

l M

edica

l M

edica

l M

edica

l M

edica

l 90

day m

ail o

rder

supp

ly av

aila

ble a

t 2.5

x cop

ay)

Dedu

ctibl

e De

ducti

ble

Dedu

ctib

le

Dedu

ctibl

e De

ducti

ble

Dedu

ctib

le

Dedu

ctibl

e De

duct

ible

Ge

neric

*$

15

*$15

*$

10

*$10

$1

0 $1

0 $5

$5

Pr

efer

red

$70

$70

$50

$50

$45

$50

$20

$20

Non-

Pref

erre

d Br

and

$120

$1

20

$100

$1

00

$85

$85

$40

$40

Spec

ialty

High

Cos

t Drug

s 45

% 45

% 45

% 45

% 30

% 30

% 20

% 20

%

- * Ser

vices

are

exem

pt fr

om de

duct

ible

whe

re in

dica

ted (P

CP/S

pecia

list/U

rgen

t Car

e/Ge

neric

RX/

Men

tal-B

ehav

ioral

Hea

lth O

ffice

Visit

s)

r Fo

r Ded

uctib

le Pl

ans:

All c

oinsu

ranc

e/cop

ays a

pply

afte

r ann

ual d

educ

tible

has b

een m

et. U

nles

s oth

erw

ise in

dica

ted

2020

-Silv

er D

educ

tible

009

36

2020

: Ded

uctib

le U

pdat

es

• Im

port

ant:

• A

ll of

Com

mun

ity d

educ

tible

pla

ns h

ave

a co

mbi

ned

(Rx

+ M

edic

al) d

educ

tible

.

• P

CP

vis

its a

re n

ot s

ubje

ct to

ded

uctib

le fo

r all

plan

s ex

cept

Bro

nze

008

HD

HP

• S

peci

alis

t vis

its a

re n

ot s

ubje

ct to

ded

uctib

le fo

r all

plan

s ex

cept

Bro

nze

008

HD

HP

and

Silv

er 0

09

• U

rgen

t Car

e vi

sits

are

not

sub

ject

to d

educ

tible

for a

ll pl

ans

exce

pt B

ronz

e 00

8 H

DH

P

• G

ener

ic D

rugs

are

not

sub

ject

to d

educ

tible

for a

ll pl

ans

exce

pt B

ronz

e 00

8 H

DH

P

• B

ronz

e H

igh

Ded

uctib

le H

ealth

Pla

n is

HS

A c

ompa

tible

but

doe

s no

t hav

e an

inte

grat

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HS

A. C

onsu

mer

wou

ld n

eed

to e

nrol

l in

a se

para

te H

SA

pla

n (o

r use

an

exis

ting

HS

A

acco

unt)

37

2020

: Ded

uctib

le U

pdat

es

Plan

Nam

e M

edic

al

and

Rx

Dedu

ctib

le

Com

bine

d

Unl

imite

d PC

P vi

sits

be

fore

de

duct

ible

Unl

imite

d Sp

ecia

list

visi

ts

befo

re

dedu

ctib

le

Unl

imite

d M

enta

l He

alth

and

Su

bsta

nce

Abus

e O

ffic

e vi

sits

bef

ore

dedu

ctib

le

Gen

eric

s av

aila

ble

befo

re

dedu

ctib

le

Unl

imite

d U

rgen

t car

e vi

sits

bef

ore

dedu

ctib

le

001

(Gol

d Co

pay)

Go

ld 0

01 d

oes n

ot h

ave

a m

edic

al o

r Rx

dedu

ctib

le

003

(Bro

nze

Dedu

ctib

le)

004

(Silv

er

Dedu

ctib

le)

005

(Gol

d De

duct

ible

)

008

(Bro

nze

All s

ervi

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ubje

ct to

ded

uctib

le

HSA)

009

(New

Silv

er

Dedu

ctib

le)

*Pre

vent

ive

serv

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re n

ot su

bjec

t to

dedu

ctib

le o

r cos

t-sh

arin

g (F

or A

ll Pl

ans)

38

Cop

ay P

lan

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old

Cop

ay 0

01 is

the

only

rem

aini

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opay

pla

n

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opay

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ply

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ny c

over

ed s

ervi

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om d

ay o

ne

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patie

nt c

opay

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ply

for t

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rst f

ive

days

of

inpa

tient

sta

y

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peci

alty

hig

h co

st d

rugs

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e a

coin

sura

nce

39

2020

Pla

n Ch

ange

Sum

mar

y

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inim

al c

hang

es to

the

plan

des

ign/

mem

ber c

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shar

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ll of

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cost

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chan

ges

wer

e m

ade

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ensu

re p

lans

rem

ain

with

in th

e al

low

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MS

met

al

desi

gnat

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OO

PS

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uctib

les

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ted

per C

MS

regu

latio

ns

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ost-s

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r PC

P, S

peci

alis

t, La

bs, X

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rgen

t Car

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st-s

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mai

ns th

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me

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2019

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ll bu

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40

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k

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Pla

ns

2020

Pla

ns

Gold

001

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ay)

Gold

001

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ay)

Silv

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opay

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lver

004

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uctib

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03 (D

educ

tible

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onze

003

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tible

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Gold

005

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MA

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PLACE

A v

ariety o

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insura

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Health

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earc

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Step

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evie

w o

r cha

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sear

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Plan

Pr

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Loca

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Mile

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On

Exch

ange

-

• O

n E

xcha

nge

enro

llmen

t can

be

com

plet

ed th

roug

h yo

ur b

roke

r por

tal,

via

ww

w.H

ealth

care

.gov

dire

ct o

r by

phon

e at

1.8

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18.2

596

• E

nrol

ling

On

Exc

hang

e is

the

only

way

a p

erso

n ca

n ge

t tax

cre

dits

to h

elp

pay

for t

heir

prem

ium

s

• In

divi

dual

s re

ceiv

ing

tax

cred

its M

UST

file

an

inco

me

tax

retu

rn

• O

n E

xcha

nge

plan

s in

clud

e th

e C

ost S

harin

g R

educ

tion

plan

s (C

SR

pla

ns)

– S

ilver

73%

, Silv

er 8

7%, a

nd S

ilver

94%

(can

not g

et O

ff Ex

chan

ge)

• O

n E

xcha

nge

plan

s al

so in

clud

e Ze

ro a

nd L

imite

d C

ost S

harin

g pl

ans

avai

labl

e to

mem

bers

of f

eder

ally

reco

gniz

ed tr

ibes

or A

lask

a N

ativ

e S

ettle

men

t Act

Cor

pora

tion

shar

ehol

ders

(can

not g

et O

ff Ex

chan

ge)

55

Off

Exch

ange

• O

ff E

xcha

nge

plan

s ar

e th

e sa

me

as th

e O

n E

xcha

nge

stan

dard

B

ronz

e, S

ilver

, and

Gol

d pl

ans

• N

o C

SR

(73/

87/9

4) o

r Lim

ited/

Zero

Cos

t Sha

ring

plan

s ar

e av

aila

ble

Off

Exch

ange

• A

pply

thro

ugh

fax

in a

pap

er a

pplic

atio

n th

at is

ava

ilabl

e on

line

• O

pen

Enro

llmen

t dat

es a

re th

e sa

me

as O

n Ex

chan

ge a

nd

Spe

cial

Enr

ollm

ent P

erio

d cr

iteria

is th

e sa

me

as O

n E

xcha

nge

• A

ccou

nt s

ervi

cing

(inc

ludi

ng c

hang

e of

info

rmat

ion,

add

ing

depe

nden

ts, e

tc.)

will

go

thro

ugh

Com

mun

ity, n

ot C

MS

56

Ren

ewal

s N

otic

e

• C

omm

unity

mem

bers

cur

rent

ly e

nrol

led

in a

201

9 pl

an w

ill

rece

ive

two

notic

es re

gard

ing

2020

cov

erag

e:

1.

One

from

Com

mun

ity o

utlin

ing

2020

pre

miu

ms

and

bene

fit

chan

ges

– M

aile

d on

Oct

ober

4, 2

019

2.

One

from

CM

S e

xpla

inin

g th

e op

en e

nrol

lmen

t pro

cess

• If

a cu

rren

t mem

ber t

akes

no

actio

n, th

e m

embe

r will

“p

assi

vely

rene

w” i

nto

a 20

20 C

omm

unity

pla

n

• M

embe

rs in

the

Silv

er C

opay

002

and

Lim

ited

Net

wor

k P

lans

00

6 &

007

will

be

cros

s w

alke

d in

to a

noth

er C

omm

unity

pla

n

• If

a cu

rren

t mem

ber t

akes

act

ion

and

upda

tes

thei

r ap

plic

atio

n on

Hea

lthca

re.g

ov th

en th

ey w

ill n

eed

to s

elec

t a

2020

pla

n

57

Pol

icy

Upd

ates

Whe

n a

polic

y up

date

is n

eede

d, p

leas

e ed

it th

e ex

istin

g ap

plic

atio

n ve

rsus

sub

mitt

ing

a ne

w

appl

icat

ion

Exa

mpl

es:

• A

ddin

g de

pend

ents

•

Rem

ovin

g de

pend

ents

•

Upd

atin

g in

com

e •

Upd

atin

g de

mog

raph

ics

58

Who

is e

ligib

le to

enr

oll?

• An

y in

divi

dual

resi

ding

in o

ne o

f Com

mun

ity’s

20

coun

ty s

ervi

ce a

rea

and

thei

r el

igib

le

depe

nden

ts

• E

ligib

le d

epen

dent

s in

clud

e:

– S

pous

e –

Bio

logi

cal c

hild

ren

unde

r th

e ag

e of

26

– S

tepc

hild

ren

unde

r th

e ag

e of

26

– A

dopt

ed c

hild

ren

unde

r th

e ag

e of

26

– Fo

ster

chi

ldre

n un

der

the

age

of 2

6 –

Bro

ther

or

Sis

ter (

child

onl

y po

licie

s)

– Li

fe p

artn

er

(chi

ldre

n up

to a

ge 2

6 ar

e co

vere

d th

roug

h th

e en

d of

the

year

)

• Fa

mili

es w

ith m

ore

than

3 c

hild

ren

enro

lled

on th

e sa

me

polic

y un

der

the

age

of 2

1 ar

e ch

arge

d fo

r th

e fir

st th

ree

child

ren

only

. Chi

ldre

n ag

e ba

nds

incl

ude:

0-1

4, 1

5, 1

6, 1

7, 1

8, 1

9, 2

0 –

e.g.

Fam

ily e

nrol

lmen

t rec

eive

d:

• Fa

ther

– c

harg

ed a

pplic

able

rat

e fo

r age

ban

d •

Mot

her

– ch

arge

d ap

plic

able

rat

e fo

r age

ban

d •

Chi

ld a

ge 1

0 –

char

ged

0-14

rat

e •

Chi

ld a

ge 6

– c

harg

ed 0

-14

rate

•

Chi

ld a

ge 4

– c

harg

ed 0

-14

rate

•

Chi

ld a

ge 2

– n

o ch

arge

59

Wel

lnes

s D

isco

unt

• 10

% p

rem

ium

redu

ctio

n w

ill c

ontin

ue to

be

offe

red

in 2

020

• P

rogr

am d

etai

ls w

ill fo

llow

via

em

ail

com

mun

icat

ion

60

FAQ

’s

• N

ewbo

rns

mus

t be

adde

d to

a p

olic

y to

hav

e ac

tive

cove

rage

–

If on

-exc

hang

e ne

wbo

rn s

houl

d be

add

ed w

ith H

C.g

ov

– If

off-e

xcha

nge

new

born

sho

uld

be a

dded

with

Com

mun

ity

• C

ance

llatio

ns/te

rmin

atio

ns re

quire

writ

ten

docu

men

tatio

n si

gned

by

the

mem

ber (

pref

erab

ly a

n ap

plic

atio

n ch

ange

/term

form

)

• PC

P c

hang

es a

re e

ffect

ive

first

of t

he fo

llow

ing

mon

th

• In

ord

er to

pro

vide

spe

cific

cla

ims

info

rmat

ion,

you

r clie

nt m

ust

com

plet

e a

HIP

AA

aut

horiz

atio

n fo

rm a

llow

ing

you

acce

ss

• C

hild

onl

y po

licie

s or

pol

icie

s w

here

an

indi

vidu

al o

ther

than

the

subs

crib

er w

ants

to b

e au

thor

ized

for p

olic

y in

quiri

es m

ust h

ave

an

HIP

AA

auth

oriz

atio

n fo

rm o

n fil

e

61

Key

Date

s Re

min

der

Nove

mbe

r 1, 2

019

Open

Enr

ollm

ent B

egin

s

Dece

mbe

r 15,

201

9 La

st o

fficia

l day

of o

pen

enro

llmen

t

Janu

ary

1, 2

020

2020

Hea

lth C

over

age

Begi

ns

62

Nex

t Ste

ps

• C

ompl

ete

CM

S tr

aini

ng

• Ta

ke C

omm

unity

Qui

z &

Sub

mit

to

Age

nt.C

rede

ntia

ling@

Com

mun

ityC

ares

.com

•

Com

plet

e th

e Tr

aini

ng A

ttest

atio

n an

d su

bmit

to

Age

nt.C

rede

ntia

ling@

Com

mun

ityC

ares

.com

•

Sub

mit

any

mis

sing

pap

erw

ork

– N

ew A

gent

s: A

gree

men

t, BA

A, W

9 –

Ret

urni

ng A

gent

s: U

pdat

ed D

emog

raph

ic/C

onta

ct

info

rmat

ion

incl

udin

g E

mai

l, U

pdat

ed W

9 (if

ne

cess

ary)

, Upd

ated

E&O

Cer

tific

ate

(if e

xpire

d),

Qui

z &

Atte

stat

ion

63

Que

stio

ns

Plea

se se

nd a

ll qu

estio

ns in

an

emai

l to

Agen

t.Cre

dent

ialin

g@Co

mm

unity

Care

s.c

om

Plea

se b

e su

re to

list

the

Subj

ect o

f the

Em

ail a

s: Su

bjec

t: W

ebin

ar Q

&A

In th

e bo

dy o

f you

r em

ail b

e su

re to

in

clude

any

que

stio

ns y

ou h

ave.

64