2016 INDIVIDUAL AND FAMILY HEALTH INSURANCE

8446351322 bull networkhealthcomindividualWE SPEAK YOUR LANGUAGE

We understand you have a lot of choices when it comes to health insurance for you and your family And you probably have a lot of questions too

Network Health can help with that

Network Health is a different kind of insurance company We call Wisconsin home and wersquore accountable to customers not shareholders We donrsquot use confusing health insurance jargon and can make sure you find the right coverage at the right price

Let Us Be Your Guide

In this kit you will findmdash

1 Why You Need Health Insurance See how Network Health can help protect you and your family

3 Health Care Reform Basics Find out how the government can help pay for your health care costswhen you can enroll and what the Marketplace is

7 Available Plans Compare plans offered by Network Health

12 Why Network Health Discover the personal local service yoursquoll receive and see what our members are saying

13 Doctors and Hospitals You Can Use Learn about the high-quality doctors and hospitals that are part of our network

15 How to Enroll When yoursquore ready to get a quote and enroll follow these simple steps

Southeast Wisconsinn Milwaukeen Ozaukeen Racinen Washingtonn Waukesha

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CE It was always a good idea to have health insurance but now itrsquos a federal law The individual mandate is the part of health care reform that

requires most Americans (and their dependents) to have insurance or pay a penalty

Signing up for a Network Health plan can help ensure your tax refund isnrsquot penalized plus yoursquoll have peace of mind knowing yoursquore protecting your health and your wallet Check out the scenario on the next page to see how Network Health could have you covered

Meet the Connors

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CE It was always a good idea to have health insurance but now itrsquos a federal law The individual mandate is the part of health care reform that

requires most Americans (and their dependents) to have insurance or pay a penalty

Signing up for a Network Health plan can help ensure your tax refund isnrsquot penalized plus yoursquoll have peace of mind knowing yoursquore protecting your health and your wallet Check out the scenario on the next page to see how Network Health could have you covered

Meet the Connors

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Note ndash This scenario is provided for educational purposes only It is not a guarantee of coverage or costs

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Too bad the Connors donrsquot realize they and many Americans may qualify

for financial assistance from the government to help cover the cost

One day Jim is on his way to work He feels a pain in his stomach He goes to the emergency room Unfortunately itrsquos his appendix and it needs to be removed Because Jim doesnrsquot have health insurance he has to pay for his three-day hospital stay This results in a $30000 bill This is almost as painful as his appendectomy

If Jim had been covered by Network Health he wouldnrsquot have had to worry about paying

for all the unexpected medical costs himself Network Health offers affordable coverage that

protects you in these situations Our health insurance coverage lets you focus on life and

avoid financial stress

Jim and Lisa Connor know health insurance is important but they donrsquot think their family can afford it Since they are pretty healthy anyway they decide not to enroll

First of all what is the Affordable Care Act and how does it affect me n The Patient Protection and Affordable Care Act (often called ACA) was signed into law on March 23 2010 The goal of the law was to make health care more accessible and affordable n One thing the law does is provide financial help to those with lower income These monies are called subsidies and the government provides these dollars to help people afford health insurance n The Affordable Care Actrsquos individual mandate went into effect on January 1 2014 This is a rule that requires most Americans to get health insurance or pay a tax penalty n For every full month you (or a family member) do not have the required health insurance coverage you may be charged a fee which must be paid on your federal income tax return The fee will vary based on your income and family size

When can I enrollOPEN ENROLLMENT PERIODFor individuals and families open enrollment is November 1 2015 ndash January 31 2016 This is generally the only time during the year when you can enroll or change your plan The first date your coverage can start is January 1 2016

SPECIAL ENROLLMENT PERIODThere are special circumstances (called qualifying events) which allow you to enroll in a health insurance plan outside of open enrollment A Special Enrollment Period may be available to you if one or more of the following applies

n You had a baby or adopted a child n You got married n You moved n You lost coverage under a previous planFor a complete list of qualifying events you can find them at HealthCaregov

t Network Health we know insurance and health care reform can be confusing But wersquore here to translate things into easy-to-understand terms We can make sure you understand the available options and find the plan that fits you best Plus wersquoll help you avoid a tax penalty

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BENEFITS OF THE AFFORDABLE CARE ACT

Free Preventive Care

Health Insurance Marketplace

FinancialAssistance

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Coverage for Preexisting Conditions

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Also known as the health insurance exchange the Marketplace is an organized website where you

can purchase health insurance The site is operated by the government to help families and individuals more easily compare their coverage options

For a Network Health plan you can start shopping at networkhealthcomindividual Our plans are available on the Marketplace at HealthCaregov as well

When you use the Marketplace to purchase your health insurance coverage you can also find out if you qualify for coverage through Medicaid or the Childrenrsquos Health Insurance Program (CHIP) Find out more about these programs at HealthCaregov

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What is theMarketplace

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Want to learn more Check out the Reform 101 sectionof our blog at CoPilotcom for helpful educational tools and articles

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1 Premium Tax Credit This is an amount of money provided by the government that you can put toward your health insurance premium It can help make your monthly payment lower You can choose to apply the entire amount toward your premium each month (often called Advanced Premium Tax Credit or APTC) or wait until the end of the year and get the money back at tax time You may qualify for this credit if you purchase a plan on the Marketplace and have an income below a certain level The government pays a portion of your health insurance directly to your insurance company every month

2 Cost Sharing Reduction (CSR) This lowers the amount you pay for health insurance deductibles coinsurance and copayments when you receive health care You may qualify for lower costs if you purchase a silver plan on the Marketplace and have an income below a certain level

What is a subsidyA subsidy is financial help provided by the government to help people afford health insurance There are two types of subsides tax credits and cost sharing reduction

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You must purchase health insurance through the Marketplace to be eligible for lower costs

Silver

Purchase a Network Health silver plan on the Marketplace

Qualify for a cost sharing

reductionYou pay less for deductibles coinsurance and copayments

Qualify to receive money from the government for

your premiumPurchase a Network Health

plan on the MarketplaceGet lump sum with tax return

or

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Use the money toward your monthly premium(called APTC)

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Depending on your household income and size you may qualify for financial assistance from the government (known as subsidies) to help pay for your health insurance premiums and out-of-pocket costs If your financial situation changes your subsidy level may change

View the chart below to see at a quick glance if you might qualify To verify that yoursquore eligible and get your savings estimate start your quote at networkhealthcomindividual

This process can take up to 30 minutes You will need a recent pay stub your W2 and income information

SAVINGS ESTIMATE Number of people in your household

You may qualify for lower premiums on a Marketplace insurance plan if your annual income is between

$11770 -$47080

$15930 -$63720

$20090 -$80360

$24250 -$97000

$28410 -$113640

$32570 -$130280

You may qualify for lower premiums and lower out-of-pocket costs on a Marketplace insurance plan if your annual income is between

$11770 -$29425

$15930 -$39825

$20090 -$50225

$24250 -$60625

$28410 -$71025

$32570 -$81425

Wisconsin did not adopt the Medicaid expansion You may qualify for Marketplace savings programs if your annual income is below

$11770 $15930 $20090 $24250 $28410 $32570

See if you qualify for lower costs

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LOWCOST

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Everyonersquos insurance needs are different Thatrsquos why we offer a variety of options to make sure you have the coverage you need at an affordable cost

Prestige Bronze 20If yoursquore looking for a low monthly premium and quality coverage when the unexpected happens this plan offers 20 percent coinsurance and yoursquoll pay $0 for preventive services

Prestige Silver 20If yoursquore looking for a plan with a reasonable deductible an affordable monthly premium and low copayments for common medical services this could be a good fit Plus just like all of our plans yoursquoll pay $0 for preventive care

Prestige Silver 0This plan offers broad coveragemdashyou pay $0 for most services once you meet your deductible If you know you and your family will be using medical services often Prestige Silver 0 provides the quality coverage you need

Prestige Gold 10This plan offers our lowest deductible With Prestige Gold 10 yoursquoll also get affordable coinsurance and comprehensive coverage including six $0 doctor visits

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Typically as plans go up in metal level (bronze silver gold) yoursquoll pay more for your monthly premium and get more coverage Your exact monthly premium will depend on the financial assistance you may be eligible for To find out what your premium will be get a quote at networkhealthcomindividual

PLAN COMPARISONPrestige Bronze 20

Prestige Silver 20

Prestige Silver 0

Prestige Gold 10

Monthly PremiumCoinsurance 20 20 0 10

DEDUCTIBLE

Individual $4500 $2750 $3500 $1000

Family $9000 $5500 $7000 $2000

OUT-OF-POCKET

LIMIT

Individual $6850 $6850 $6850 $6850

Family $13700 $13700 $13700 $13700

BENEFITS

Preventive Care $0 $0 $0 $0Primary Care Doctor Visit 20 after deductible $25 per visit 0 after deductible Six $0 visits then 10

after deductibleSpecialist Visit 20 after deductible $50 per visit 0 after deductible 10 after deductibleHospital Stay 20 after deductible 20 after deductible 0 after deductible 10 after deductibleMaternity Care 20 after deductible 20 after deductible 0 after deductible 10 after deductibleEmergency Room 20 after deductible 20 after deductible 0 after deductible 10 after deductibleX-ray Lab and Pathology 20 after deductible 20 after deductible 0 after deductible 10 after deductibleAmbulance 20 after deductible 20 after deductible 0 after deductible 10 after deductible

PET scans MRIs MRAs CT scans and stress tests

20 after deductible $100 plus 20 coinsurance

0 after deductible 10 after deductible

Chiropractic 20 after deductible $25 per visit 0 after deductible 10 after deductibleUrgent Care 20 after deductible $75 per visit 0 after deductible 10 after deductible

Preventive Drugs 30-Day Supply

$0 per prescription or refill

$0 per prescription or refill

$0 per prescription or refill

$0 per prescription or refill

$ $ $ $ $ $ $ $

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PHARMACY BENEFIT COMPARISONPrestige Bronze 20

Prestige Silver 20

Prestige Silver 0

Prestige Gold 10

RETAIL30-DAY SUPPLY

Preventive Drugs $0 per prescription or refill

$0 per prescription or refill

$0 per prescription or refill

$0 per prescription or refill

Adherence Generics (limited only to categories of antidiabetics statins and RAS antagonists)

$2 per prescription or refill

$2 per prescription or refill

$2 per prescription or refill

$2 per prescription or refill

Generics 20 coinsurance after deductible

$15 $15 $15

Preferred Brand Drugs 20 coinsurance after deductible

$40 $40 $40

Non-Preferred Brand Drugs

35 coinsurance after deductible

35 coinsurance after deductible

35 coinsurance after deductible

35 coinsurance after deductible

Preferred Specialty Drugs 30 coinsurance after deductible

30 coinsurance after deductible

30 coinsurance after deductible

30 coinsurance after deductible

Non-Preferred Specialty Drugs

40 coinsurance after deductible

40 coinsurance after deductible

40 coinsurance after deductible

40 coinsurance after deductible

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Prescription drug coverageWith our Network Health Prestige plans yoursquoll enjoy built-in drug coverage Check out the chart below to see how prescriptions are covered

Save More Using Mail OrderYou may also save additional money on your prescriptions by ordering a 90-day supply through the mail Plus then yoursquoll have the convenience of your medications delivered right to your home

Preventive drugs Like preventive care or services preventive drugs can help you avoid many illnesses and conditions

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Network Health Prestige Plans Cover Preventive Drugs at $0Just make sure you have a prescription and you can even receive many over-the-counter drugs at no cost Here are some common examples

n Baby aspirinn Nicotine patches and gumn Contraceptive products for womenn Vitamin D (based on age)

Yoursquoll also save money by using drugs on our formulary (or drug list) Make sure to check your drug is on the formulary before getting your prescriptions filled You can view the formulary at networkhealthcombenefitsindividualdruglistphp

Take advantage of $0 prescriptions

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Not sure what all the health insurance jargon means Let us translate

Monthly PremiumWhat you pay (per month usually) to keep your insurance active

CoinsuranceSome services are covered 100 percent by your plan Some may be 80 percent covered The remaining 20 percent is the coinsurance the amount you pay

DeductibleThe amount of money you must pay before the insurance company begins paying for most services Itrsquos different and separate from a copayment which is a fee paid at office visits or the pharmacy

Out-of-Pocket LimitThe maximum amount you pay during a certain period (usually one year)for essential health benefits covered by your plan Once the limit is reached you pay nothing for essential health benefits for the rest of the period

Preventive CareServices that prevent illness or detect illness at an early stage such as flu shots blood pressure screenings and screening mammograms Find a full list of services at HealthCaregovpreventive-care-benefits

All copayments and coinsurance (medical and pharmacy) are applied to the out-of-pocket maximum These summaries are only intended to highlight and give a general description of some of the benefits available For a complete description of benefits limitations and exclusions view plans at networkhealthcomindividual and refer to the policy at networkhealthcombenefitssbcindividualpolicypdf This policy does not include pediatric dental services as required under the federal Patient Protection and Affordable Care Act This coverage is available in the insurance market and can be purchased as a stand-alone product Please contact your insurance carrier agent or the Federally-Facilitated Exchange if you wish to purchase pediatric dental coverage or a stand-alone dental services product Network Health does not discriminate on the basis of race color national origin disability age sex gender identity sexual orientation or health status in the administration of the plan including enrollment and benefit determinations

EVERY PLAN INCLUDESnComplete coverage for preventive care You pay $0nPrescription drug coveragenLocal personal customer service

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L IFE HEALTH amp WELLNESS

S U M M E R 2 0 1 5

A P U B L I C A T I O N O F

How Network Health helped Vincent Malcheski conquer cancer

Hersquos a miracle looking at him now nobody would ever know he was sick

Wisconsin is HomeWhen you call Network Health yoursquore going to get someone right here in Wisconsinmdashsomeone who knows how to pronounce Waukesha and Kaukauna We live and work where you do and we care about the communities we serve and speak your language

Wersquore Wisconsin-based and locally owned by Ministry Health Care and Froedtert Health which means our focus is on making sure you have access to the care you need to get and stay healthy

Life Health and WellnessEvery quarter you will receive a newsletter called Balance This publication provides helpful information on the topics of life health and wellness and how to get the most out of your health insurance coverage

Focused on YouOur health plans give you access to nurse care managers and helpful programs to managehealth conditions We believe in partnering with you for better health

Local Personal ServiceOne of the best things about Network Health is the one-on-one support you get You can call us with any issue and wersquoll make sure your questions are answered

Herersquos what people are sayingmdash

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The experience has been outstanding Network Health has provided an outstanding insurance product at a very competitive cost and their service has been excellentmdashsecond to none -Greg W Shawano WI

Network Health surpassed any expectation I had-Terry T Appleton WI

ldquoAs a parent you want to do everything for your child Network Health has given us the ability to say we did everything we could Itrsquos not just a health insurance company it supports the life of my familyrdquo

-Julie B Appleton WI

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Our Southeast Wisconsin Service Area

Our individual and family plan service area in southeast Wisconsin includes the five counties shown on the right

If you live in one of these counties yoursquoll have access to abroad network of providers See the next page for more detail and make sure to visit networkhealthcomdoctors-prestige-se for a full list of locations and a large number and selection of specialists

Great Coverage Close to HomeWith a Network Health Prestige plan you have access to a quality network of doctors hospitals clinics and specialists We have partnered with over 1000 providers in southeast Wisconsin to offer you superior care at convenient locations

See the map and list for a glimpse of our network For the most up-to-date complete list or to find a specific doctor or facility visit networkhealthcomdoctors-prestige-se and use the helpful Find a Doctor and Find a Facility search tools These easy-to-use search features take the guesswork out of finding a doctor or facility in our network

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EFroedtert HealthFroedtert Memorial Lutheran Hospital Community Memorial Hospital St Josephrsquos Community Hospital of West BendFroedtert amp MCW Community PhysiciansFroedtert Surgery Center LLCWest Bend Surgery Center LLC

Medical College of Wisconsin

Columbia St Maryrsquos Columbia St Maryrsquos Hospital Milwaukee IncColumbia St Maryrsquos Hospital Ozaukee IncOrthopaedic Hospital of WisconsinSacred Heart Rehabilitation Institute IncMadison Medical Affiliates Inc

Wheaton Franciscan Healthcare Wheaton Franciscan Healthcare ndash Franklin IncWheaton Franciscan Healthcare ndash St Francis IncWheaton Franciscan Healthcare ndash All Saints IncMidwest Orthopedic Specialty Hospital LLCWheaton Franciscan ndash Home Health and HospiceWheaton Franciscan Healthcare ndash Franciscan Woods IncWheaton Franciscan Medical Group Inc Wheaton Franciscan Medical Group ndash Sussex Inc

Childrenrsquos Hospital and Health System Inc Childrenrsquos Hospital of Wisconsin ndash Milwaukee amp Fox ValleyChildrenrsquos Health SystemChildrenrsquos Urgent CareChildrenrsquos Medical GroupChildrenrsquos Service Society of WisconsinSurgicenter of Greater Milwaukee

Visit networkhealthcomdoctors-prestige-se for a complete listing

Follow the instructions that appear to complete your enrollment Once your application has been submitted yoursquoll receive a confirmation email

Need Help EnrollingIf yoursquod like to enroll with the help of agent but need help finding one call us at the number below We work with hundreds of agents in Wisconsin who are happy to help

Wersquore also available to answer your questions Call us at 844-635-1322 Monday through Friday 8 am to 8 pm

The first step is to get a quote for coverage specific to you You can get started at networkhealthcomindividual on your own or with the help of an agent

See If You Qualify for Lower Costs

When you start your quote yoursquoll have the option to enter income information to find out if you qualify for financial help Enter your income to get an estimated savings amount Our site will then take you to HealthCaregov to create an account and verify your savings

Get a Quote

ChooseYour Plan

View and compare all of our plans and select the one you want At this point yoursquoll be able to see what your total cost will be for the plan

Enroll

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1570 Midway PlMenasha WI 54952

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HMO plans underwritten by Network Health Plan POS plans underwritten by Network Health Insurance Corporation or Network Health Insurance Corporation and Network Health Plan