NMHIX Healthcare Guide Training Roswell: Thursday, November 14, 2013

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Presbyterian was founded in 1908 to servetuberculosis patients and has grown to become the state’s largest healthcareprovider.

Because it is community owned, Presbyterian is dedicated to being a good steward of local healthcare resources.

Who we areImproving health for over 105 years

Our hospitals, physicians, caregivers and insurance plans work together as an integrated delivery system to serve more than 660,000 New Mexicans.

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Working Together

As the most preferred healthcare organization in New Mexico, Presbyterian offers you the value that comes with our integrated system of physicians, hospitals, and health plan – all working together to keep you healthy and provide new and innovative services.

DeliverySystemDeliverySystem

MedicalGroup

MedicalGroup

Health Plan

Health Plan

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Presbyterian Hospitals Our hospitals, physicians, caregivers and insurance

plans serve more than 700,000 New Mexicans.

HospitalsAlbuquerque  

Presbyterian and Presbyterian Kaseman Hospitals

ClovisPlains Regional Medical Center

EspañolaPresbyterian Española Hospital

Rio RanchoPresbyterian Rust Medical Center

RuidosoLincoln County Medical Center

SocorroSocorro General Hospital

TucumcariDan C. Trigg Memorial Hospital

DeliverySystemDeliverySystem

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Offers care at more than 30 different locations throughout the state.

16 clinic locations in the Albuquerque metro area

Our clinics handle more than 1,100,000 patient visits.

Fastest growing physician group, employing nearly 500 practitioners

Presbyterian Medical Group MedicalGroup

MedicalGroup

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Presbyterian has the state’s largest health plan, with approximately 400,000 members.

We offer a full spectrum of health insurance choices to meet the diverse needs of all New Mexicans.

Medicare Advantage Plans Medicaid (Centennial Care) Individual Plans Group Products (fully insured and self-funded (ASO)

Our Health Plan Health Plan

Health Plan

Presbyterian Health Plan, Inc.Presbyterian Insurance Company, Inc.

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Best Health Plan Presbyterian

Source: Research & Polling, Inc.

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Presbyterian Individual & Family Plans in the MarketplacePlans to choose from:•Gold A, B, C•Silver A, B, C, D •Bronze A, B, C•Catastrophic•Native American (on exchange)•Members within 138%-250% of FPL may qualify for benefit subsidies available in Silver plans. (12 benefit subsidy plans)

All Individual & Family Plans offer: •A fitness center membership at no charge•The only Individual & Family Plans in NM that provide access to Presbyterian’s network•High-deductible health plans include a health savings account at no additional charge, administered by HealthEquity®

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Gold Plans Plans Gold A Gold B Gold C

Benefits with copayments ($) are not subject to deductible

Deductible $0 $250 $1,000

Primary Care Provider & Behavioral Health Visit $15 20% $0

Specialist Visit $50 20% $25

Diagnostic Services (Lab & X-Ray) $0 20% $0

Hospital Inpatient 30% 20% 20%

Rx – Generic (preferred) $10 20% $5

Rx- Brand Name (preferred) $50 20% $25

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Silver PlansPlans Silver A Silver B* Silver C Silver D

Benefits with copayments ($) are not subject to deductible

Deductible $250 $1,300 $2,500 $5,000

Primary Care Provider & Behavioral Health Visit 50% 25% $10 $5

Specialist Visit 50% 25% $60 $50

Diagnostic Services (Lab & X-Ray) 50% 25% $0 $0

Hospital Inpatient 50% 25% 20% 20%

Rx – Generic (preferred) 50% 25% $10 $5

Rx- Brand Name (preferred) 50% 25% $75 $50

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* HDHP – Qualified High Deductible Health Plan. See HealthEquity flyer for details.

Bronze Plans Plans Bronze A* Bronze B* Bronze C

Benefits with copayments ($) are not subject to deductible

Deductible $2,500 $4,000 $6,350

Primary Care Provider & Behavioral Health Visit 50% 20% $45

Specialist Visit 50% 20% 0%

Diagnostic Services (Lab & X-Ray)

50%20%

0%Lab - $0

Hospital Inpatient 50% 20% 0%

Rx – Generic (preferred) 50% 20% 0%

Rx- Brand Name (preferred) 50% 20% 0%

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* HDHP – Qualified High Deductible Health Plan. See HealthEquity flyer for details.

Catastrophic and Native American Plans Plans

Catastrophic< 30 years of age

Native AmericanOn Exchange Only

Benefits with copayments ($) are not subject to deductible

Deductible $6,350 $0

Primary Care Provider & Behavioral Health Visit

0% Plan pays 100%

Specialist Visit 0% Plan pays 100%

Diagnostic Services (Lab & X-Ray)

0% Plan pays 100%

Hospital Inpatient 0% Plan pays 100%

Rx – Generic (preferred)

0% Plan pays 100%

Rx- Brand Name (preferred)

0% Plan pays 100%

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Free Gym Membership• All Individual Plan members (18

and over) will be enrolled in a fitness center membership for no additional cost

• There are over 8,000 fitness center locations nationwide

• Locations near Roswell include Curves (Alamogordo) and Ruidoso Physical Therapy

• Additional locations can be found online at https://phcprime.healthways.com/

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Premium ComparisonRoswell Area

PlansGold A

$0Deductible

Silver C$2,500

Deductible

Bronze C$6,350

Deductible

Catastrophic< 30 years of

age

Age 0-20 $173.49 $140.29 $111.50 $79.91

Age 40 $349.16 $282.34 $224.40 n/a

Age 60 $741.49 $599.59 $476.54 n/a

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Same rate for smoker and non-smoker

Advance Premium Tax Credit Savings depends on income and family sizeThe amount you save depends on your family size and how much money your family earns. In general, if your income falls within the following ranges you'll qualify to save money on your premiums in 2014. The lower your income within these ranges, the more you'll save. (The amounts below are based on 2013 numbers and are likely to be slightly higher in 2014.)

•$11,490 to $45,960 for individuals•$15,510 to $62,040 for a family of 2•$19,530 to $78,120 for a family of 3•$23,550 to $94,200 for a family of 4•$27,570 to $110,280 for a family of 5•$31,590 to $126,360 for a family of 6•$35,610 to $142,440 for a family of 7•$39,630 to $158,520 for a family of 8

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Coverage ConnectorAn interactive tool that helps determine where to start looking for health insurance, either through a commercial insurance plan, Medicaid or Medicare programs, or on New Mexico's new health insurance exchange.

www.phs.org/coverageconnector

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How to apply?To apply for coverage directly with Presbyterian:Premium tax credits or benefit subsidies will not apply

•Online at www.phs.org – coming soon •With a paper application – download online at http://docs.phs.org/idc/groups/public/documents/communication/pel_00169987.pdf

To apply for Presbyterian coverage in the Marketplace:•Online at www.healthcare.gov •With a paper application – download online at http://marketplace.cms.gov/getofficialresources/publications-and-articles/marketplace-application-for-family.pdf•By phone or with an in-person assister by calling 1-800-318-2596, 24 hours a day, 7 days a week.

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Presbyterian Resources• Presbyterian Website – www.phs.org

• Online Provider Directory - https://presbyterianproviderfinder.ipf.vitals.com/search

• Coverage Connector (Our Health Insurance Decision Tool) - https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/Pages/default.aspx

• Individual & Family Plan Information - https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/default.aspx

• Formulary (Prescription Drug Coverage) - https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx

• Call for a Quote: 1-866-869-7737, Weekdays, 8:00 a.m. – 5:00 p.m.

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Questions?

505-Ask-Pres505-875-7737

1-866-869-7737iplan@phs.org

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